ECG of the Week - 11th November 2013 - Interpretation

I'm busy updating my ECG collection so I'm using some of the older ECG's I've collected. Unfortunately many of these, including this week's ECG, don't have any associated clinical information. I will try and track down some information on this case and will update the post if I find any.
Even without any clinical information it's still a nice ECG :-)
Check out the comments on our original post here.

Click to enlarge

Rate:

• 150

Rhythm:

• Regular

Axis:

• Indeterminate

Intervals:

• QRS - Markedly Prolonged (320ms)

Additional:

• Notching lead II ? Atrial activity
• Lead aVF variable QRS morphology
• Absence of typical BBB morphology

Interpretation:

• Broad Complex Tachycardia

I think this ECG would benefit from having a real patient / clinical case attached to narrow down the differential list.

General DDx would be:

• VT
• Toxicological
• E.g. sodium channel blockade
• Metabolic
• Hyperkalaemia - in isolation or in conjunction with causes above
• SVT with aberrancy / pre-excitation
• Less likely given marked QRS prolongation & QRS morphology

References / Further Reading

Life in the Fast Lane

• Ventricular Tachycardia Overview here
• VT vs SVT with aberrancy here

Textbook

• Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.