To the Editor.—
Morady and colleagues1 make a solid contribution in dispelling the misconception that hypotension necessarily accompanies wide QRS tachycardias. Their term "wide-complex" was quite apropos, since the interpretation "ventricular tachycardia" is never quite certain except in an electrophysiological study. One can always have preexisting bundle-branch block or nodal (junctional) rhythm with an aberrant QRS complex.In the absence of ventriculoatrial conduction, a useful marker of ventricular tachycardia is atrioventricular dissociation. An often neglected clinical sign of this during ventricular tachycardia is the occurrence of intermittently intense Korotkoff's sounds while the blood pressure is being taken. Because atrioventricular dissociation produces occasional critical timing of atrial systole with improved ventricular function, there will be occasional intense first heart sounds and Korotkoff's sounds heard when the cuff is inflated above the systolic level.
Spodick DH. The Diagnosis of Ventricular Tachycardias. JAMA. 1986;255(13):1709. doi:10.1001/jama.1986.03370130065021