Chapter 13 Test — Wide QRS Rhythms — VT vs SVT with Aberrancy: The Critical Distinction

In a patient with wide-complex tachycardia, the presence of all of the following on the ECG indicates ventricular tachycardia EXCEPT:

All of the following features of a broad complex tachycardia favour a diagnosis of ventricular tachycardia EXCEPT:

All of the following features help differentiate ventricular tachycardia from supraventricular tachycardia EXCEPT:

The circled complex in the lower panel of the tracing shown — a hybrid QRS that is narrower than the tachycardia beats but wider than a normal sinus beat — is diagnostic of:

A patient presents with palpitations. The rhythm strip shown was recorded. What is the most probable diagnosis?

Identify the rhythm shown on this monitor strip:

A 65-year-old man with a previous anterior myocardial infarction presents with sudden palpitations and pre-syncope. BP is 94/60 mmHg but he is alert and perfusing. His 12-lead ECG is shown: a regular broad complex tachycardia at about 180/min. Which drug is the first choice for pharmacological cardioversion?

A 50-year-old man collapses during his morning walk. He had a myocardial infarction 5 years ago. BP is 80/60 mmHg, heart rate 160/min, and the ECG shows a wide-complex tachycardia with no identifiable P waves. He is confused and diaphoretic. What is the most appropriate immediate treatment?

Verapamil is used in all of the following EXCEPT:

Which of the following is the treatment of choice for atrial fibrillation in a patient with WPW syndrome who is haemodynamically unstable?

Which one of the following modalities is NOT used in the treatment of ventricular tachycardia?

A 74-year-old man with congestive heart failure presents with chest pain, breathlessness, dizziness and palpitations for 30 minutes. The ECG shows a wide complex tachycardia with a P-wave rate of 105/min, an R-wave rate of 130/min, and no relationship between the two. He is started on an intravenous antiarrhythmic that prolongs both the QRS and the QT interval. He was most likely treated with which drug?

A patient with a prolonged QT interval develops palpitations and near-syncope. The rhythm strip shows a polymorphic ventricular tachycardia in which the QRS complexes continuously change amplitude and polarity, appearing to twist around the isoelectric baseline in spindle-shaped clusters. Which rhythm is this?

You are applying the Brugada algorithm to a regular wide QRS tachycardia. On examining the precordial leads (V1–V6) you find NO RS complex in any of them — only monophasic R, QS and QR patterns. What does this mean?

A candidate is asked to distinguish the 'Brugada algorithm' from 'Brugada syndrome'. Which statement is correct?

As a rapid alternative to the full Brugada algorithm, the Vereckei (aVR) approach looks at a single lead. Which finding in lead aVR during a wide QRS tachycardia strongly favours ventricular tachycardia?

A registrar examines a 12-lead ECG during a regular wide QRS tachycardia and finds no AV dissociation, no capture beats and no fusion beats. He concludes the rhythm must be SVT with aberrancy. What is the flaw in this reasoning?

During a wide QRS tachycardia the QRS complexes are negative in every precordial lead from V1 to V6. This finding is called:

In a patient with a wide QRS tachycardia the QRS is negative in both lead I and lead aVF. Using the axis diagram shown, this places the axis in the shaded upper-left sector. What is the significance of this finding?

A 26-year-old man with no structural heart disease (normal echocardiogram) presents with palpitations. His ECG is shown: a tachycardia with a relatively narrow wide QRS (about 130 ms), RBBB morphology and left axis deviation. What is the most likely diagnosis?

In a wide QRS tachycardia with a dominant S wave in V1 (an 'LBBB-like' pattern), which of the following morphology features would indicate that this is VT rather than true LBBB aberrancy?

A 32-year-old man with no known cardiac history presents with a regular wide QRS tachycardia at 170/min. His BP is 118/76 mmHg and he is fully alert and comfortable. The rhythm diagnosis is not certain. What is the most appropriate management?

A 24-year-old woman is brought in unconscious after a deliberate overdose. Her ECG shows sinus tachycardia, a QRS duration of 130 ms, a rightward axis, and a prominent R wave in lead aVR measuring 5 mm. What is the immediate treatment?

A patient on telemetry has a run of 8 consecutive wide QRS beats at 140/min which stops spontaneously after about 6 seconds. He remains asymptomatic. How is this rhythm best classified and managed?