A weekly ECG / EKG review blog looking at some interesting ECG's from the world of Emergency Medicine.
Rate: ~150-160 bpmRegularity: Regular with one exception (3rd complex)P-waves: Potentially visible before the QRS in V5, likely retrograde in V1 and IPRi: either non-existent, associated WNL, or short-RPQRS: wide-wide ~180ms, V1-positive, IVCD appearance (I and V6 are inconsistent with RBBB)Most likely rhythm:- Ventricular tachycardia with fusion beatOthers to consider:- Supraventricular tachycardia with pre-existing IVCD- Atrial flutter with pre-existing IVCDGiven 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.
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