This ECG is from an 83 year old male patient.
Presented with shortness of breath.
|Click to enlarge|
- ? Flutter waves - best seen in precordial leads esp. V3 rate ~300bpm
- LAD (-66 deg)
- QRS - Prolonged (160-200ms)
- QT - 360ms (QTc Bazette ~ 270 ms)
- ST Depression V2-4, II
- T Inversion V1-3, I, aVL, aVR
- RBBB Morphology with discordant ST changes
- 3rd & 19th Complexes morpholoigcally different ? Fusion
- Nil Concordence
- Broad Complex Tachycardia
- Ventricular Tachycardia
- SVT with aberrant conduction (pre-existing or rate related)
- SVT in setting of pre-excitation
- Right Bundle Branch Block Morphology
- Left Axis Deviation
- Our diagnosis is:
- Atrial Flutter 2:1 Block with either pre-existing RBBB or rate-related RBBB
- Bifasicular block
Further links on differentiating broad complex tachydysrhythmias and types of broad complex tachydysrhythmias can be found below.
What happened ?
- Old notes revealed a Hx of Paroxysmal Atrial Fibrillation and a pre-existing RBBB (same morphology as this ECG)
- Pt reviewed by cardiology
- Initially Tx with adensosine with no response
- Underwent DC cardioversion
- Resultant rate controlled Atrial Fibrillation
- Tx oral amiodarone.
- Dilated LV
- Extensive akinese of infero-posterior and lateral walls
- Severe MR
- Mild Pulmonary Hypertension
- Hypokinetic Right Ventricle
- Mod - Severe systolic impairment.
References / Further Reading
Life in the Fast Lane
- Approach to Wide Complex Tachycardia here
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.