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:

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

Textbook

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

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