Title Wide QRS complex : diagnostic approach and treatment Title (croatian) Trahikardija širokog QRS kompleksa Author Curt Tobias Stridbeck Mentor Matias Trbušić (mentor)Committee member Matias Trbušić (predsjednik povjerenstva)Committee member Nikola Bulj (član povjerenstva)Committee member Boško Skorić (član povjerenstva)Granter University of Zagreb Defense date and country 2019-07-12, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract .Patients with wide QRS complex tachycardias are a challenge for physicians when they are
presenting in the emergency department. Symptoms associated with tachycardia can vary, from
mild symptoms as lightheadedness, weakness, chest discomfort, excessive sweating and
palpitations, to more severe such as dizziness, angina, pulmonary edema, pre-syncope or syncope,
coming from hemodynamic instability.
It is important to differentiate between the aetiologies since some of the initial treatment for
tachyarrhythmia with SVT as etiology can be lethal for a patient with VT. If the patient is
hemodynamically unstable urgent synchronised electrical cardioversion, or defibrillation in the case
of pulseless VT, is the first line initial therapy. If the patient is hemodynamically stable the
physician should use clues to differentiate etiology of wide QRS complex tachycardia. This clues
are present in the medical history, physical examination and echocardiography in order to verify
structural heart disease if present.
Of crucial importance is high quality ECG interpretation including rate, rhythm, axis and
morphology of the QRS complex using provided ECG criteria that helps us to differentiate VT from
SVT. Until proven otherwise, any wide QRS complex tachycardia should be managed as a VT.
In the case of VT the drugs of choice are procainamide and amiodarone with some
advantage of procainamide. While ICD is used regularly for secondary prevention of SCD, there is
under investigation a new concept of wearable cardioverter defibrillator indicated for patients with
poor left ventricular function who are at risk for SCD but are not candidates for an ICD. Catheter
ablation is an effective treatment option for patients with repetitive VT and structural heart disease.
It can reduce the number of ICD shocks, but there is still not clear mortality benefit. VA-ECMO is a
new and interesting approach for patients with VT and electrical storm as a rescue bridge to other
treatment options.
Abstract (english) Bolesnici s tahikardijom širokog QRS kompleksa izazov su za liječnika u hitnoj službi. Simptomi
mogu varirati od blagih kao slabost, nelagoda u prsima, preznojavanje i palpitacije do ozbiljnijih
poput angine, plućnog edema, presinkope i sinkope u okviru hemodinamske nestabinosti.
Važno je razlikovati uzrok tahikardije širokog QRS kompleksa jer neki lijekovi koji se
koriste u liječenju supraventrikulske tahikardijen (SVT) mogu uzrokovati pogoršanje i smrt
bolesnika s ventrikulskom tahikardijom (VT). Ako je inicijalno bolesnik hemodinamski nestabilan
indicirana je elektrokardioverzija ili, u slučaju VT bez pulsa, defibrilacija. Ako je bolesnik
hemodinamski stabilan, tada je potrebno na temelju speficifičnih pokazatelja postaviti točnu
dijagnozu tahikardije širokog QRS kompleksa. Ti pokazatelji nalaze se u anamnezi, fizikalnom
pregledu i ehokardiografiji koja se izvodi s ciljem da se dokaže strukturna bolest srca ako je
prisutna.
Od ključne važnosti je kvalitetna interpretacija elektrokardiograma uključujući frekvenciju,
ritam, električnu os i morfologiju QRS kompleksa koristeći postojeće EKG kriterije za razlikovanje
VT od SVT. Dok se ne dokaže suprotno, na bilo koju tahikardiju širokog QRS kompleksa treba
gledati kao VT i tako ju i liječiti.
U slučaju VT lijek izbora su prokainamid i amiodaron s time da je prema nekim studijama
prokainamid u prednosti. ICD se redovito koristi za sekundarnu prevenciju iznenadne srčane smrti
(ISS), ali je sada u istraživanjima novi koncept vanjskog kardioverter defibrilatora indiciranog u
bolesnika sa reduciranom funkcijom lijeve klijetke koji su pod rizikom za iznenadnu srčanu smrt, a
nisu kandidati za ICD. Kateter ablacija je učinkovit oblik liječenja za ponavljajuće VT kod
bolesnika sa strukturnom bolešću srca koja može smanjiti broj ICD šokova, ali još uvijek nije jasno
da li smanjuje smrtnost. VA-ECMO nov je i zanimljiv pristup za bolesnike s VT i električnom
olujom kao spašavajući most do drugih mogućnosti liječenja.
Keywords
wide QRS complex tachycardia
ventricular tachycardia
supraventricular tachycardia
differential diagnosis
electrocardiogram
criteria
treatment
Keywords (croatian)
tahikardija širokog QRS kompleksa
ventrikulska tahikardija
supraventrikulska tahikardija
diferencijalne dijagnoze
elektrokardiogram
kriteriji
liječenje
Language english URN:NBN urn:nbn:hr:105:096765 Study programme Title: Medicine (in English language) Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2020-07-22 11:46:56
