Thus, it is very likely that the patient has uncorrectable hypoxemia due to shunt physiology. This is especially true if there is no evidence of pulmonary edema on chest X-ray or bedside ultrasound.

One might call this patient unstable because of the low saturations, but a patient with a known single ventricle is likely to have cyanotic heart disease and to have baseline O2 saturations that are very low, even on high flow O2. Thus she must be considered unstable, so use electricity! Her altered mental status may be due to hypoperfusion (shock), in spite of the normal blood pressure (non-invasive blood pressures are unreliable in sick patients). If the patient is unstable, just cardiovert with electricity. Is it Ventricular Tachycardia (VT) or SVT with aberrancy?įull interpretation is at the far bottom of the post There is a monomorphic Right Bundle Branch block pattern with QRS duration of between 140 - 160 ms (is it difficult to ascertain the exact beginning and end of the QRS)

There is a regular, wide complex tachycardia at a rate of 160, with no P-waves. They did notice 'clubbing' of the fingers.Ī relative was able to state in broken English 'single ventricle.' O2 sats were 70s and 80s on high flow O2, but there was no evidence of pulmonary edema. Her blood pressure was normal throughout the case. There were no records immediately available. She was cyanotic and minimally responsive on arrival here, and had a healed sternotomy scar. They attempted cardioversion with adenosine, unsuccessfully (dose was uncertain, thought to be 12 mg, but this would be an unusual initial dose). ICD-10-CM I45.9 is grouped within Diagnostic Related Group(s) (MS-DRG v39.This case was sent by a former HCMC resident:Ī 20-something non-English speaking woman with a history of some sort of congenital heart defect collapsed at home and EMS found her with a regular wide complex tachycardia around 200 bpm. Impairment of conduction in heart excitation often applied specifically to atrioventricular heart block.Reversibility depends on the degree of structural or functional defects. Heart blocks can be classified by the duration, frequency, or completeness of conduction block. Impaired conduction of cardiac impulse that can occur anywhere along the conduction pathway, such as between the sinoatrial node and the right atrium (sa block) or between atria and ventricles (av block).An impairment of transmission of the cardiac electrical impulse along the fibers normally responsible impulse propagation.Typically patients develop an initial pallor, followed by facial flush during recovery. It is caused by a sudden decrease of the cardiac output that results from a sudden cardiac dysrhythmia. An episode of sudden and transient loss of consciousness sometimes associated with seizures.Abnormality in rhythm of heartbeat, including rate, regularity, and/or sequence of activation abnormalities.A disorder characterized by pathological irregularities in the cardiac conduction system.A disorder affecting the conduction system that sends electrical signals in the myocardium.In some cases, the syncope attacks are transient and in others cases repetitive and persistent. When the cardiac output becomes too low, the patient faints (syncope). A condition of fainting spells caused by heart block, often an atrioventricular block, that leads to bradycardia and drop in cardiac output.Cardiac dysrhythmia (heart rhythm disorder).transient cerebral ischemic attacks and related syndromes ( G45.-).systemic connective tissue disorders ( M30-M36).symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified ( R00- R94).injury, poisoning and certain other consequences of external causes ( S00-T88).

endocrine, nutritional and metabolic diseases ( E00- E88).

congenital malformations, deformations, and chromosomal abnormalities ( Q00-Q99).

complications of pregnancy, childbirth and the puerperium ( O00-O9A).

certain infectious and parasitic diseases ( A00-B99).

certain conditions originating in the perinatal period ( P04- P96).

Supraventricular tachycardia with ivcd