The value of electrocardiography for differential diagnosis in wide QRS complex tachycardia
Correct diagnosis in wide QRS complex tachycardia remains a challenge. Differential diagnosis between ventricular and supraventricular tachycardia has important therapeutic and prognostic implications, and although data from clinical history and physical examination may suggest a particular origin,...
Main Authors: | , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Elsevier
2014-03-01
|
Series: | Revista Portuguesa de Cardiologia (English Edition) |
Online Access: | http://www.sciencedirect.com/science/article/pii/S2174204914000749 |
id |
doaj-04265c06d2dd4dd98923cdb0b3c869f2 |
---|---|
record_format |
Article |
spelling |
doaj-04265c06d2dd4dd98923cdb0b3c869f22020-11-25T02:55:45ZengElsevierRevista Portuguesa de Cardiologia (English Edition)2174-20492014-03-01333165173The value of electrocardiography for differential diagnosis in wide QRS complex tachycardiaPedro A. Sousa0Salomé Pereira1Rui Candeias2Ilídio de Jesus3Corresponding author.; Serviço de Cardiologia, Hospital de Faro, E.P.E., Faro, PortugalServiço de Cardiologia, Hospital de Faro, E.P.E., Faro, PortugalServiço de Cardiologia, Hospital de Faro, E.P.E., Faro, PortugalServiço de Cardiologia, Hospital de Faro, E.P.E., Faro, PortugalCorrect diagnosis in wide QRS complex tachycardia remains a challenge. Differential diagnosis between ventricular and supraventricular tachycardia has important therapeutic and prognostic implications, and although data from clinical history and physical examination may suggest a particular origin, it is the 12-lead surface electrocardiogram that usually enables this differentiation.Since 1978, various electrocardiographic criteria have been proposed for the differential diagnosis of wide complex tachycardias, particularly the presence of atrioventricular dissociation, and the axis, duration and morphology of QRS complexes. Despite the wide variety of criteria, diagnosis is still often difficult, and errors can have serious consequences. To reduce such errors, several differential diagnosis algorithms have been proposed since 1991. However, in a small percentage of wide QRS tachycardias the diagnosis remains uncertain and in these the wisest decision is to treat them as ventricular tachycardias.The authors’ objective was to review the main electrocardiographic criteria and differential diagnosis algorithms of wide QRS tachycardia. Resumo: O diagnóstico correto de taquicardia de complexos largos permanece um desafio. A sua diferenciação entre taquicardia supraventricular e taquicardia ventricular tem grandes implicações terapêuticas e prognósticas e, embora alguns dados na história clínica e no exame físico nos possam sugerir uma determinada origem, é o eletrocardiograma de 12 derivações que permite habitualmente essa diferenciação.Desde 1978, diversos critérios eletrocardiográficos têm sido propostos para o diagnóstico diferencial das taquicardias de complexos largos, nomeadamente a presença de dissociação aurículo-ventricular e a duração, o eixo e a morfologia dos complexos QRS. Apesar da grande diversidade de critérios, o diagnóstico revela-se frequentemente difícil, originando erros com consequências gravosas. Para diminuir a probabilidade de erros foram introduzidos desde 1991 vários algoritmos de diagnóstico diferencial. Contudo, apesar de os vários critérios e algoritmos de diagnóstico, continua a existir uma pequena percentagem de taquicardias de QRS largos que mantêm um diagnóstico incerto e em que o mais sensato é tratar como se fossem taquicardias ventriculares.O objetivo dos autores foi rever os principais critérios e algoritmos eletrocardiográficos de diagnóstico diferencial de uma taquicardia de QRS largos. Keywords: Wide QRS tachycardia, Ventricular tachycardia, Supraventricular tachycardia, Algorithms, Criteria, Differential diagnosis, Electrocardiogram, Palavras-chave: Taquicardia de QRS largos, Taquicardia ventricular, Taquicardia supraventricular, Algoritmos, Critérios, Diagnóstico diferencial, Eletrocardiogramahttp://www.sciencedirect.com/science/article/pii/S2174204914000749 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Pedro A. Sousa Salomé Pereira Rui Candeias Ilídio de Jesus |
spellingShingle |
Pedro A. Sousa Salomé Pereira Rui Candeias Ilídio de Jesus The value of electrocardiography for differential diagnosis in wide QRS complex tachycardia Revista Portuguesa de Cardiologia (English Edition) |
author_facet |
Pedro A. Sousa Salomé Pereira Rui Candeias Ilídio de Jesus |
author_sort |
Pedro A. Sousa |
title |
The value of electrocardiography for differential diagnosis in wide QRS complex tachycardia |
title_short |
The value of electrocardiography for differential diagnosis in wide QRS complex tachycardia |
title_full |
The value of electrocardiography for differential diagnosis in wide QRS complex tachycardia |
title_fullStr |
The value of electrocardiography for differential diagnosis in wide QRS complex tachycardia |
title_full_unstemmed |
The value of electrocardiography for differential diagnosis in wide QRS complex tachycardia |
title_sort |
value of electrocardiography for differential diagnosis in wide qrs complex tachycardia |
publisher |
Elsevier |
series |
Revista Portuguesa de Cardiologia (English Edition) |
issn |
2174-2049 |
publishDate |
2014-03-01 |
description |
Correct diagnosis in wide QRS complex tachycardia remains a challenge. Differential diagnosis between ventricular and supraventricular tachycardia has important therapeutic and prognostic implications, and although data from clinical history and physical examination may suggest a particular origin, it is the 12-lead surface electrocardiogram that usually enables this differentiation.Since 1978, various electrocardiographic criteria have been proposed for the differential diagnosis of wide complex tachycardias, particularly the presence of atrioventricular dissociation, and the axis, duration and morphology of QRS complexes. Despite the wide variety of criteria, diagnosis is still often difficult, and errors can have serious consequences. To reduce such errors, several differential diagnosis algorithms have been proposed since 1991. However, in a small percentage of wide QRS tachycardias the diagnosis remains uncertain and in these the wisest decision is to treat them as ventricular tachycardias.The authors’ objective was to review the main electrocardiographic criteria and differential diagnosis algorithms of wide QRS tachycardia. Resumo: O diagnóstico correto de taquicardia de complexos largos permanece um desafio. A sua diferenciação entre taquicardia supraventricular e taquicardia ventricular tem grandes implicações terapêuticas e prognósticas e, embora alguns dados na história clínica e no exame físico nos possam sugerir uma determinada origem, é o eletrocardiograma de 12 derivações que permite habitualmente essa diferenciação.Desde 1978, diversos critérios eletrocardiográficos têm sido propostos para o diagnóstico diferencial das taquicardias de complexos largos, nomeadamente a presença de dissociação aurículo-ventricular e a duração, o eixo e a morfologia dos complexos QRS. Apesar da grande diversidade de critérios, o diagnóstico revela-se frequentemente difícil, originando erros com consequências gravosas. Para diminuir a probabilidade de erros foram introduzidos desde 1991 vários algoritmos de diagnóstico diferencial. Contudo, apesar de os vários critérios e algoritmos de diagnóstico, continua a existir uma pequena percentagem de taquicardias de QRS largos que mantêm um diagnóstico incerto e em que o mais sensato é tratar como se fossem taquicardias ventriculares.O objetivo dos autores foi rever os principais critérios e algoritmos eletrocardiográficos de diagnóstico diferencial de uma taquicardia de QRS largos. Keywords: Wide QRS tachycardia, Ventricular tachycardia, Supraventricular tachycardia, Algorithms, Criteria, Differential diagnosis, Electrocardiogram, Palavras-chave: Taquicardia de QRS largos, Taquicardia ventricular, Taquicardia supraventricular, Algoritmos, Critérios, Diagnóstico diferencial, Eletrocardiograma |
url |
http://www.sciencedirect.com/science/article/pii/S2174204914000749 |
work_keys_str_mv |
AT pedroasousa thevalueofelectrocardiographyfordifferentialdiagnosisinwideqrscomplextachycardia AT salomepereira thevalueofelectrocardiographyfordifferentialdiagnosisinwideqrscomplextachycardia AT ruicandeias thevalueofelectrocardiographyfordifferentialdiagnosisinwideqrscomplextachycardia AT ilidiodejesus thevalueofelectrocardiographyfordifferentialdiagnosisinwideqrscomplextachycardia AT pedroasousa valueofelectrocardiographyfordifferentialdiagnosisinwideqrscomplextachycardia AT salomepereira valueofelectrocardiographyfordifferentialdiagnosisinwideqrscomplextachycardia AT ruicandeias valueofelectrocardiographyfordifferentialdiagnosisinwideqrscomplextachycardia AT ilidiodejesus valueofelectrocardiographyfordifferentialdiagnosisinwideqrscomplextachycardia |
_version_ |
1724716448929021952 |