Wide complex tachycardia: recognition and management in the emergency room

Cardiac arrhythmias often present as urgent medical conditions requiring immediate care. Patient presenting with a tachyarrhythmia is a common finding in the emergency room. They also occur commonly in patients undergoing non-cardiovascular procedures including surgeries. It is thus pertinent that the physician handling such cases must be appropriately trained to diagnose and provide emergency management till the case is referred to a specialist. Most cases present as a narrow or a wide complex tachycardia. The differential diagnosis is arrived at by deciding on the ECG morphology alongwith relevant history and physical examination where feasible. This article describes the bedside approach to diagnose and treat an arrhythmia presenting as a wide complex. Wide complex tachycardia can result from rhythms originating both from the atrium and the ventricle. Appropriate deduction of the source of the arrhythmia is essential to decide on drug therapy as wrong diagnosis with inappropriate therapy can result in fatalities.