Presentation Title - hrmx.org

Differential diagnosis in narrow QRS complex tachycardias Hosted by DR Adrian Baranchuk MD FACC and DR Kevin Michael MBCB MPhil MD Presentation Overview A simple and useful algorithm to differentiate narrow complex tachycardias Clinical applicability Easy to remember Real clinical cases Some less frequent presentations There is no algorithm that can cover ALL clinical scenarios 2 2/23/20 Differential diagnosis in narrow QRS complex tachycardias Presentation

Algorithm 3 Questions: 1. Narrow vs. Wide 2. Regular vs. Irregular 3. Where is the P-Wave 3 2/23/20 Differential diagnosis in narrow QRS complex tachycardias Presentation Tachycardias SUPRAVENTRICULAR VENTRICULAR

SINUS TACHYCARDIA ATRIAL FIBRILLATION ATRIAL FLUTTER ATRIAL TACHYCARDIA AVNRT AVRT MONOMORPHIC VT POLYMORPHIC VT TORSADES DES POINTES VENTRICULAR FIBRILLATION 90% Narrow Complex Tachycardia

4 2/23/20 Wide Complex Tachycardia Differential diagnosis in narrow QRS complex tachycardias Presentation Algorithm Narrow Complex Tachycardia Narrow Complex Tachycardia Regular P before QRS No P waves + - P after QRS AVNRT ST

Irregular Atrial Fibrillation RPPR Atypical AVNRT A Flutter 5

2/23/20 A. Flutter w/variab.con. Differential diagnosis in narrow QRS complex tachycardias Presentation Sinus tachycardia Electrical alternans Low qrs voltage CASE 1 Cardiac Tamponade 6 2/23/20

Differential diagnosis in narrow QRS complex tachycardias Presentation CASE 2 Low Atrial Tachycardia - P-wave inf. Leads - P-wave in lead I Activation caudocranial left to right Negative P-waves in inferior leads 7 2/23/20 Differential diagnosis in narrow QRS complex tachycardias Presentation Atrial Flutter

CASE 3 Saw tooth Think in AFL if HR 150 bpm @ rest!!! CSM: variable conduction 8 2/23/20 Differential diagnosis in narrow QRS complex tachycardias Workshop CASE 4 Sinus Tachycardia

9 2/23/20 VAGAL MANEUVERS SVT: all or none A Flutter: degree of block Sinus Tach: slow the rate Differential diagnosis in narrow QRS complex tachycardias Presentation Regular, narrow complex - retrograde P-waves RP < PR RP < 80 ms CASE 5 Typical AVNRT

10 2/23/20 Differential diagnosis in narrow QRS complex tachycardias Presentation CASE 6 Orthodromic AVRT 11 2/23/20

Regular, narrow complex - retrograde P-waves RP < PR RP < 80 ms Differential diagnosis in narrow QRS complex tachycardias Presentation 2:1 AVNRT P-wave in the middle of RR - retrograde P-waves Pseudo R-waves CASE 7 (Infrequent Presentations) 12

2/23/20 Differential diagnosis in narrow QRS complex tachycardias Presentation 2 x 1 Tachycardia Narrow complex Slightly irregular 1 P-wave, 2 QRS CASE 8 P QRS QRS

Fast pathway Slow pathway 13 2/23/20 Differential diagnosis in narrow QRS complex tachycardias Presentation Once Again Narrow Complex Tachycardia Regular P before QRS No P waves + - P after QRS AVNRT

ST Irregular Atrial Fibrillation RPPR Atypical AVNRT A Flutter

14 2/23/20 A. Flutter w/variab.con. Differential diagnosis in narrow QRS complex tachycardias Presentation www.HRMx.org www.doctorsfixinghearts.com 15 2/23/20 Differential diagnosis in narrow QRS complex tachycardias Presentation

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