@S_Cook_EMTP contacted me on Twitter with regard to a 77 year old male with an interesting heart rhythm.
He subsequently took a picture of the ECG and emailed it to me with this description:
77 yo male with history of COPD, CHF. Initial 4-lead EKG reveals A-Flutter with variable response: 2:1, 3:1, 4:1, and 5:1 is what I saw. Patient would have runs of both bi and trigeminal PVCs then settle back to A-Flutter in the 80s/90s. Then patient developed 20-30 second runs of the attached that ran from ~100BPM to 225BPM.
Best I can think is this is a run of V-Tach. Patient does have an implanted pacer/defib, but relates he hasn’t felt it fire.
Up to about 130 to 140, electrical rate and radial rates were equal.
Otherwise, patient was hemodynamically stable, BPs in the 120s/70s, A&O X 4, with some difficulty breathing.
Patient was recieveing an A&A neb treatment. Initial SaO2 was 75, increasing to 98 during treatment. Heavy smoker. Denies any and all pain and relates he “just feels like $%^*”
Here’s the picture of the ECG in question.
What do you think this heart rhythm is showing?
After I gave my answer, @S_Cook_EMTP shared the following ECGs from the same case, indicating that the treating emergency physician did not agree with my assessment.
However, I still think I’m right!
Of course, I could be wrong (we’ll discuss that a little bit more later).
So, for the sake of Rhythm Challenge #5, to what do you attribute this wide complex tachycardia and why?
Previous “rhythm challenges” can be found here: