ECG of the Week - 13th August 2018 - Interpretation

The following ECG is from a 72 yr old male who presented with chest pain and palpitations. He has a history of hypertension and hypercholesterolaemia.

Click to enlarge

Rate:

• 220 bpm

Rhythm:

• Regular

Axis:

• LAD

Intervals:

• QRS - Prolonged (210ms)

Additional:

• Typical LBBB Morphology
• Apparent atrial activity within QRS in leads V5-6
• Absent fusion or capture beats

Interpretation:

• Wide Complex Tachycardia
• DDx
• VT
• SVT with aberrancy
• SVT with pre-existing BBB
• SVT with pre-excitation

Differentiating SVT from VT can be difficult and not always possible, also it may not be clinically necessary.
VT would be favoured given the patients age and co-morbidites whereas the the typical LBBB morphology and visible regular atrial activity favors SVT.
You can check out more on differentiating VT from SVT in a number of other blogs and posts, selection below:

• Life in the Fast Lane - VT vs SVT
• ECGpedia - Approach to Wide Complex Tachycardia
• Dr Smith's ECG Blog - Wide Complex Tachycardia: Ventricular Tachycardia or Supraventricular Tachycardia with Aberrancy?

What happened ?

The patient underwent urgent DC cardioversion and was taken for angiogram which showed a mid LAD stenosis which was stented.

References / Further Reading

Life in the Fast Lane

• SVT vs VT
• VT 

Textbook

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