telemetry questions

PAERRN20 · Mar 5, 2009

I believe you are right. Generally Vtach is over 160 beats per minute. Wide QRS or "slow v-tach" is generally around 110-150 beats per minute.

Magsulfate, BSN, RN · Mar 5, 2009

I found this .... Approach to the diagnosis of narrow QRS complex tachycardias

INTRODUCTION-Tachycardias are broadly categorized based upon the width of the QRS complex on the electrocardiogram (ECG) [1].

A narrow QRS complex (

A widened QRS (≥120 msec) occurs when ventricular activation is abnormally slow. The most common reason that a QRS is widened is that the arrhythmia originates outside of the normal conduction system (eg, ventricular tachycardia). Alternatively, a supraventricular arrhythmia can produce a widened QRS if there are either preexisting or rate-related abnormalities within the His-Purkinje system (eg, supraventricular tachycardia with aberrancy), or if conduction occurs over an accessory pathway. Thus, wide QRS complex tachycardias may be either supraventricular or ventricular in origin. (See "Approach to the diagnosis and treatment of wide QRS complex tachycardias").

nursej22, MSN, RN · Mar 5, 2009

VTach identifies the rate and origin of the rhythm while "wide QRS tachycardia" describes the rate and morphology. Any heart rate >100 bpm is tachycardia. Sometimes you just can't differentiate an SVT with an aberrant or BBB from VTach on a monitor strip, so you describe what you see. If the rhythm is sustained and the pt is tolerating it, you should get a 12 lead to identify the axis which along with other clues with help identify the origin.

Of course, you should always treat the patient, not the rhythm strip. Luckily, amiodorone can treat either.

Several years ago an ICU nurse who was precepting me assured the internist on-call that the pt was in Afib with a rate in the 120's, but for some reason his rate just didn't respond to the diltiazem gtt. I found out the next day that a consulting cardiologist identified the pt's VTach, started a Pronestyl gtt, and voile, NSR.