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Answer Rhythm Puzzle 2004 10 469: Difference between revisions
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Answer Rhythm Puzzle 2004 10 469 (view source)
Revision as of 16:38, 7 October 2007
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m (New page: {{NHJ| |mainauthor= '''I.C.D. Westendorp, G.S. de Ruiter, L.V.A. Boersma, E.F.D. Wever''' |edition= 2007:4,157 }} Figure|thumb A 27-year-old female was...) |
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==Answer== | ==Answer== | ||
Figure 1 shows a wide-QRS tachycardia (QRS duration 120 ms, rate 150 | Figure 1 shows a wide-QRS tachycardia (QRS duration 120 ms, rate 150 beats/min) with complete right bundle branch block (RBBB) morphology, and a (slight) leftaxis deviation. Lead V6 shows an RS configuration. P waves are not discernible. Signs suggestive of both ventricular and supraventricular origin are present. The tachycardia was terminated by adenosine. This is (usually) suggestive of a supraventricular origin. The ECG after conversion (figure 2) shows an incomplete RBBB and | ||
beats/min) with complete right bundle branch block (RBBB) morphology, and a (slight) leftaxis deviation. Lead V6 shows an RS configuration. P waves are not discernible. Signs suggestive of both ventricular and supraventricular origin are present. The tachycardia was terminated by adenosine. This is (usually) suggestive of a supraventricular origin. The ECG after conversion (figure 2) shows an incomplete RBBB and | |||
an intermediate electrical axis. If assuming a supraventricular origin, more pronounced RBBB aberrancy (due to phase-3 block) is postulated. Then,the differential diagnosis would be as follows: | an intermediate electrical axis. If assuming a supraventricular origin, more pronounced RBBB aberrancy (due to phase-3 block) is postulated. Then,the differential diagnosis would be as follows: | ||