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


  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.

  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.