Wide Complex Tachycardia WPW

This case is courtesy of Dr. Kelly Huang.

Kelly is a 4th year EM resident at the University of British Columbia – Vancouver Site.

She has an interest in medical education and wilderness medicine and is always looking for ways to combine the two together!


Recognition of wide complex rhythms and their treatment options is an important skill, and often results in some anxiety in junior learners due to unfamiliarity and patient decompensation. This case will allow learners to recognize the rhythm, explore different treatment options, and deal with the side effects or progression of the disease. It is also a good case to practice communication with the team and effective decision making. 


37F with 3 hour history of palpitations. It started when she was driving her kids to school and has gotten worse. She denies any recreational drug use. She denies any cardiac history.


A 37F with no past medical history presents with wide complex tachycardia. She is initially stable, and after unsuccessful treatments, will decompensate either with hypotension or with polymorphic atrial fibrillation, and require synchronized cardioversion. After stabilizing the patient, she is revealed to have undiagnosed Wolfe-Parkinson-White.


Source: https://litfl.com/wp-content/uploads/2019/04/WCTfeb2012-1.jpg
Source: https://www.acc.org/education-and-meetings/patient-case-quizzes/2020/03/09/09/00/treatment-of-wide-complex-tachycardias#
Source: https://litfl.com/wp-content/uploads/2018/08/Orthodromic-AVRT-post-adenosine-1-2.jpg

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