This is the conclusion to Name that ECG: 51 year old male.
51 year old male, palpitations.
Rhythm:
- Rate: ventricular rate ~185 bpm, unknown atrial rate
- Regularity: regular
- P-waves: none appreciated
- PRi: N/A
- QRS duration: ~200 ms
Bonus points:
- Axis: inferior, +90 degrees
- Bundle Branches: V1-negative, wide-complex
- QTc: not appreciable
- ST/T-waves:
- T-waves: appropriate discordance in all leads
- ST-elevation: not readily interprettable
- ST-depression: not readily interprettable
Differentials:
- Ventricular tachycardia
Notes:
- Subtle dissociation of the atria may be visible in the ST/T-waves in II and III.
- It is unlikely that this rhythm is anything but ventricular tachycardia.
- The ST-segments in aVL are arguably excessive, potentially indicating an ACS cause of this tachycardia.
I read about RVOT VT yesterday. Could this be considered that since it's +90 degree axis?
It could be, although this doesn't quite "look" like RVOT-VT (which is a poor cop-out). The axis points in its favor and a V1-negative morphology is present, but the complexes in the inferior leads are fractionated which is atypical of RVOT-VT.
In a younger patient or if this patient was known to have numerous extrasystoles from the RVOT, I think that would be a very reasonable differential.
Hey Chris, given the superwide QRS, what keeps hyper k off the differential?
Thanks!
Calcium Crusade,
To be fair it probably does not keep it off the list! It would depend on the patient's history as hyperkalemia is rarely idiopathic.
Great question!