Scientific studies can be fun .In our spare time we often Indulge in rapid fire sessions. We tested 30 wide qrs ECGs from our archives (All proven VTs) and asked our cardiology fellows to apply Brugada criteria . They could correctly diagnose VT in 18* patients.The same ECGs were shown to the staff nurses of coronary care unit . 24 VTs were correctly identified it.They did it by their clinical sense and Instinct. (*12 vs 6 VTs missed)
And now , four clinical data was provided. (Age , sex , Blood pressure , and past H/o MI were given ) The Nurses were able to predict it 28/30 VTs correctly.(97 % accuracy ) and the cardiologists were able to equal the score now. So obviously clinical sense was far superior .
Cardiology fellows were more likely to mistake VT as SVT. This is far more common than SVT mistaken as VT. It is a strange academic irony ,even the junior most nurses never missed a VT !
Summary
Simple sequence of history and clinical presentation is still far more powerful than ECG data in predicting wide qrs arrhythmias . Nurses guess work is far superior than cardiologists in predicting a wide QRS tachycardia as VT.
In fact , the cardiology fellows are preconditioned to get confused whenever they get a wide qrs tachycardia . Why not aberrancy ? In my experience I have seen this question keeps erupting inappropriately .Even shrewd fellows suffer from an oscillatory mind between VT and SVT .This is primarily because , every wide qrs ECG is likely to have at least two criteria that fulfill both VT and SVT.
The implications are genuine and far reaching . While nurses show a patient centric thinking cardiology fellows thought process revolves around ECG . Many modern-day cardiac physicians are disconnected from clinical reality and are obsessed with complex EP concepts and end up with a miserable face in the bed side !
This is not a new revelation in 2013 . Masood Akthar told this three decades ago.
Dr.S.Venkatesan MD 