Friday 26 October 2012

ECG of the Week - 29th October 2012

This ECG is from an 83 year old male patient.
Presented with shortness of breath.




Click to enlarge

2 comments:

  1. Rate: ~150-160 bpm
    Regularity: Regular with one exception (3rd complex)
    P-waves: Potentially visible before the QRS in V5, likely retrograde in V1 and I
    PRi: either non-existent, associated WNL, or short-RP
    QRS: wide-wide ~180ms, V1-positive, IVCD appearance (I and V6 are inconsistent with RBBB)

    Most likely rhythm:
    - Ventricular tachycardia with fusion beat

    Others to consider:
    - Supraventricular tachycardia with pre-existing IVCD
    - Atrial flutter with pre-existing IVCD

    Given patient's age, chief complaint, and findings on the ECG my field diagnosis would be one of VT. Likely I would give a trial of adenosine if stable, followed by procainamide if unchanged. If unstable, conscious sedation and elective synchronized cardioversion.

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  2. broad complex regular tachycardia.
    1. VT with RBBB. LAH.
    2. Other option - possible also SVT with aberrancy and RBBB. LAH.

    always bit difficult to distinguish both.
    if IHD, wld be careful with adenosine. slow patient down first, otherwise, some synchronised electricity.
    Raf

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