Wide QRS tachycardia

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Normal sinus rhythm• Originate from sinus node• All same P wave• P followed by narrow QRS (<120ms)

RSR’ pattern in V1 Deep slurred S waves in V4-V6

Dominant S wave+ broad notched R in V1 waves Absent Q waves in V4-V6

RBBB LBBB

Aberrant conduction 1.Bundle branch block (RBBB or LBBB) 2.Hyperkalaemia 3.Poisoning with sodium-channel blocking agents (e.g. Tricyclic antidepressants) 4.Pre-excitation (i.e. Wolff-Parkinson-White syndrome) 5.Ventricular pacing 6.Hypothermia

EKG case

VAGAL MANEUVER TECHNIQUESto slow a person’s heart rate

• Valsalva maneuver: increase intrathoracic pressure and stimulate the vagus nerve

• Coughing • Cold Stimulus face• Gagging• Carotid Massage: Pressure is applied underneath the angle of the jaw in a gentle circular motion for ~10 secs