Rodrigues de Holanda-Miranda Wallace, Furtado Felipe Magalhães, Luciano Paula Menezes, Pazin-Filho Antonio
Clinical Hospital of the Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
J Emerg Med. 2012 Aug;43(2):e97-9. doi: 10.1016/j.jemermed.2009.08.057. Epub 2009 Dec 21.
The differential diagnosis of wide QRS tachycardia is a challenge for the emergency physician. The major tool is the electrocardiogram (ECG), even though the sensitivity and specificity may be variable, depending on presentation. Additional leads could be used to improve the diagnostic accuracy of the ECG.
To document the use of the Lewis lead in improving the diagnostic accuracy of the ECG in wide QRS tachycardia.
A 52-year-old woman with rheumatoid arthritis, in treatment with methotrexate, was admitted with progressive dyspnea that evolved to acute respiratory distress and shock at arrival. Pneumonia was diagnosed as the infection and she received antibiotics, and respiratory and inotropic support. She was also using amiodarone for more than 10 years, but she couldn't state the reason. On cardiac monitoring, wide QRS tachycardia was detected and ventricular tachycardia was considered on the differential diagnosis. The standard 12-lead ECG was complemented with the Lewis lead, obtained with higher speed and amplitude, demonstrating atrioventricular concordance and excluding ventricular tachycardia. The patient was treated for septic shock, and she died 2 days later.
The Lewis lead is a simple and easy strategy to enhance atrial activity detection in wide QRS tachycardia.
宽QRS波心动过速的鉴别诊断对急诊医生来说是一项挑战。主要工具是心电图（ECG），尽管其敏感性和特异性可能因表现而异。可使用附加导联来提高心电图的诊断准确性。
记录Lewis导联在提高宽QRS波心动过速心电图诊断准确性方面的应用。
一名52岁患类风湿关节炎且正在接受甲氨蝶呤治疗的女性因进行性呼吸困难入院，入院时发展为急性呼吸窘迫和休克。诊断为肺炎感染，给予抗生素治疗以及呼吸和强心支持。她还使用胺碘酮超过10年，但她说不出原因。心脏监测时检测到宽QRS波心动过速，鉴别诊断考虑为室性心动过速。标准12导联心电图辅以Lewis导联，以更高的速度和幅度记录，显示房室一致，排除了室性心动过速。该患者接受了感染性休克治疗，2天后死亡。
Lewis导联是一种简单易行的策略，可增强宽QRS波心动过速时心房活动的检测。
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