Podcast 804: Brugada Criteria for V Tach

<p><strong>Contributor: Peter Bakes, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Tachycardia describes a heart rate of >120 beats per minute</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Wide Complex describes a QRS duration of >120 ms or 3 small boxes on a standard EKG</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">The major differential for a wide complex tachycardia is Ventricular Tachycardia (VT), aka “V Tach”, or Supraventricular Tachycardia (SVT) with Aberrancy  </span></li> <ul> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">SVT alone is a narrow complex tachycardia, but as rate increases a right or left bundle branch block pattern may emerge, creating SVT with Aberrancy seen as a wide complex on EKG</span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">It is important to distinguish the rhythms as treatment for stable VT differs from treatment(s) for stable SVT </span></li> </ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Brugada Criteria is an algorithm for determining if wide complex tachycardia is VT with a high degree of sensitivity and specificity.</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Following is a simple ED approach based on brugada criteria to determine VT on EKG. If either condition is true, suspect and treat VT:  </span></li> <ul> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Concordance: All precordial leads have QRS complexes that are either all positive or all negative.</span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;"> R-S interval: >100 ms in any one precordial lead. </span></li> </ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Also note that VT is mo