Slide 1: You arrive at a rapid response. He’s confused! HR 170s! BP 70s/40s!

Slide 2: Someone hands you this strip: [EKG] what do we do?

Slide 3: Tachycardia with pulse -> Try to identify rhythm but DO NOT delay treatment -> Assess for hypotension, AMS, chest pain or hypoxia. STABLE? To be discussed on another #12leadthursday! UNSTABLE? (this patient) -> synced cardioversion.

Slide 4: Later, after the patient had been stabilized…let’s think more about that rhythm…wide complex, regular tachycardia…but how can I tell if it’s VT or SVT with aberrancy?

Slide 5: Tip: Check aVR! [diagram] Quick takeaway: suspect VT if you see anything in aVR other than a negative QRS with a sharp downstroke.

Slide 6: Tip: Check aVR! [EKG with aVR isolated] -> QRS complexes -> negative and slow downslope


  • Vereckei A, Duray G, Szénási G, Altemose GT, Miller JM. New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia. Heart Rhythm. 2008 Jan;5(1):89-98. Epub 2007 Sep 20. PMID 18180024

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