Sympathetic Stimulation

Ischemia and sympathetic stimulation can enhance a ventricle’s automaticity, stimulating the ventricle to initiate an impulse before a sinus initiated wave reaches the ventricles. This solitary wave doesn’t ride the Autobahn. Rather, this one wave must traverse both ventricles. The efficient autobahn is not utilized; instead, slower routes cross the ventricular myocardium. As a result, the distance and time taken to depolarize the ventricles are longer. A wide QRS of 3mm or more is produced.

Rhythms that are initiated in the ventricles have wide QRS complexes. A second characteristic of these ventricular rhythms is that the T wave is usually (though not always) facing the opposite polarity as the R wave.

A wide QRS complex is produced most often from an impulse that originates from within the ventricles. In fact, a wide QRS has a ventricular origin about 85% of the time in the general population. With those with known coronary artery disease, tachycardias with wide QRS complexes are indeed ventricular tachycardia almost 95% of the time. As a general rule, if it looks like ventricular tachycardia, treat it like ventricular tachycardia.

1. Six Second ECG Guidebook (2012), T Barill, p. 109-110

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Dynamic ECG rhythm interpretation
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Acute Coronary Syndromes Overview
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ST Segment & T Wave Differential
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Electrical Axis
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Left Bundle Branch Blocks with ACS
Atypical Findings
Acute Non-Ischemic Disease Conditions
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