QuestionSBA
QuestionChoice
Pulseless electrical activity presents as discernable P waves and QRS complexes in the absence of a pulse. There are no discernable P waves or QRS complexes, therefore they do not have pulseless electrical activity
33545
c
Pulseless electrical activity
QuestionChoice
Asystole appears as a 'flatline' on the ECG, where the heart has no electrical activity. It has a very poor mortality and is the most serious form of cardiac arrest. This ECG has electrical activity and is therefore not asystole
33546
d
Asystole
QuestionChoice
This patient has no discernible P waves or QRS complexes and they are unconscious and pulseless. They are in cardiac arrest
33544
b
Normal ECG
QuestionChoice
This patient has a typical ECG showing ventricular fibrillation. Their ECG shows chaotic, polymorphic, irregular deflections with no discernible QRS complexes. This is a medical emergency that should be managed with unsynchronised DC cardioversion
33543
a
Ventricular fibrillation
QuestionChoice
ECG signs of ventricular tachycardia include regular, wide QRS complexes of equal amplitude (monomorphic) with an absence of P waves. This is not the case with this ECG as the rhythm and amplitude are not regular
33547
e
Ventricular tachycardia
QuestionComment
Huh? This is VF? But it looks like normal sinus rhythm??
5752
User
subscriber
Migraine Body
QuestionComment
This looks nothing like VF. Even with PEA you wouldn't expect to see a normal looking ECG like this 
5775
User
subscriber
Dermis Fibrillation
QuestionComment
I think it looks like normal sinus rhythm. Has the correct rhythm strip been put in?
5827
User
subscriber
Endoscope Hematoma
QuestionComment
I think this looks sinus too! 

5868
User
subscriber
Endoscope Hematoma
Concept
Chapter
# Summary 

Broad complex tachycardia refers to dysrhythmias with a heart rate greater than 100 beats per minute and a QRS complex broader than 120 milliseconds. This term encompasses life-threatening rhythms such as ventricular tachycardia (VT) and ventricular fibrillation (VF). VT is a regular, broad complex tachycardia and may be with or without a pulse. In contrast, VF is irregular and is always pulseless. Pulseless VT and VF must be managed according to the ALS algorithm and require immediate defibrillation and administration of medications like adrenaline and amiodarone, whilst managing pulsed VT involves synchronised shocks and amiodarone. SVT with aberrancy, a condition where supraventricular tachycardia occurs in the presence of bundle-branch block, can mimic VT and should be treated cautiously.

# Definition 

Broad complex tachycardias are dysrhythmias that have a heart rate greater than 100bpm and a QRS complex that is greater than 120ms. The most common broad complex tachycardias are ventricular tachycardia or ventricular fibrillation. 

# Ventricular Tachycardia (VT)

A regular broad complex tachycardia. It can occur with a pulse or it may be pulseless. 

ECG features include: 

* Tachycardia (>100 beats per minute)
* Absent p waves
* Monomorphic regular broad QRS complexes (>120ms)

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# Management of VT 

## Pulseless VT 

If there is no pulse the patient should be managed according to the Advanced Life Support algorithm. 

* Pulseless VT is a shockable rhythm so a 200J bi-phasic **unsynchronised** shock should be administered. 
* IV adrenaline (1mg of 10ml 1:10,000 solution) and IV amiodarone (300mg) should be administered after delivery of the 3rd shock.
* Adrenaline should be administered every 3-5 minutes thereafter.  

## Pulsed VT with Adverse Features

If the patient has a pulse but is demonstrating adverse features (shock, syncope, myocardial ischaemia, or heart failure) the patient should be managed according to Resuscitation Council Tachyarrhythmia algorithm. 

* Administer synchronised DC shocks (up to 3 attempts). If the patient is conscious this will require sedation or anaesthesia. 
* Expert help should guide amiodarone administration (300mg IV over 10-20 minutes followed by 900mg infusion over 24 hours). 

## Pulsed VT with No Adverse Features 

If the patient has a pulse and is not demonstrating adverse features then the Resuscitation Council Tachyarrhythmia algorithm should be followed. 

* Amiodarone 300mg IV over 10-60 minutes. 
* If this is ineffective then administer synchronised DC shocks (up to 3 attempts). If the patient is conscious this will require sedation or anaesthesia. 
* *N.B. if there has been a previous certain diagnosis of SVT with aberrancy treat as for regular narrow complex tachycardias*

# Ventricular fibrillation (VF) 

An irregular broad complex tachycardia. This is always a pulseless rhythm.

ECG features include: 

* Tachycardia >100bpm 
* QRS complexes are polymorphic and irregular (>120ms)

[lightgallery1]

# Management of VF

The patient should be managed according to the Advanced Life Support algorithm. 

* VF is a shockable rhythm so a 200J bi-phasice **unsynchronised** shock should be administered. 
* IV adrenaline (1mg of 10ml 1:10,000 solution) and IV amiodarone (300mg) should be administered after delivery of the 3rd shock.
* Adrenaline should be administered every 3-5 minutes thereafter.

# Other Broad Complex Tachycardias 

Include: 

* Torsades des pointes: see section. 
* SVT with aberrancy: occurs when a patient with a bundle-branch block goes into SVT. It can be difficult to distinguish between VT and an SVT with aberrancy. The safest approach is to treat as VT. 

[lightgallery2]

# NICE Guidelines

[NICE CKS Guidelines for Cardiac Arrest and ALS](<https://cks.nice.org.uk/topics/cardiac-arrest-out-of-hospital-care/management/advanced-life-support-adult/>)

# References
[Resuscitation Council UK Adult Tachycardia Algorithm](<https://www.resus.org.uk/sites/default/files/2021-04/Tachycardia%20Algorithm%202021.pdf>)

[Resuscitation Council UK Adult ALS Algorithm](<https://www.resus.org.uk/sites/default/files/2021-04/Adult%20Advanced%20Life%20Support%20Algorithm%202021.pdf>)
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ventricularFibrillation.png
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ECG Interpretation
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Cardiology
Picture
Torsade de pointes on an ECG.
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Broad Complex Tachycardia
Topic
59
ECG Interpretation
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Topic
39
Emergency Medicine
A 70 year old patient who has been admitted on the cardiology ward has been found unconscious. They are not breathing and have no pulse on palpation. Their current ECG strip is shown below:

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What is the most likely diagnosis?
a