Name that ECG: 51 year old male – Findings

This is the conclusion to Name that ECG: 51 year old male.

51 year old male, palpitations.

Name that ECG: 51 year old male

 

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.

 

4 Comments

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Comments
Kevin
44 year old male CC: Palpitations
Why on earth would you risk VF, by giving Adenosine to rule out rhythms.. This is dangerous, and foolish. There might be a slight chance that this is WPW.. You might as well just give him Cardizem, they are both AV nodal blockers... I don't know why the AHA even added this stupid idea..
2014-10-22 13:31:06
Vince DiGiulio
The 360 Degree Heart – Part II
It is standard practice in electrocardiography to label the first 90 degrees counter-clockwise from "zero" that way. When you see a patient with "left axis deviation" you'll see that their measured QRS axis is somewhere between -30 and -90 degrees. Imagine if you saw someone with a mean QRS axis at 5 degrees. Now imagine…
2014-10-21 14:00:37
Bryan
The 360 Degree Heart – Part II
I don't understand why (-)III and aVL are be labeled -60 and -30 degrees instead of 300 and 330 degrees?
2014-10-21 13:43:29
The 360 Degree Heart – Part II | EMS 12 Lead
The 360 Degree Heart – Part I
[…] first post in our “360 Degree Heart” series attempted to visualize how the different frontal plane […]
2014-10-21 12:50:56
Eric Strong
Axis Determination – Part VI
This is a great discussion of axis determination. One minor suggestion: I think it's potentially misleading to refer to an axis between 0 and -30 as "physiologic left axis deviation", since "axis devitation" implies deviation from normal, and axes between 0 and -30 are perfectly normal, (depending on age and body habitus). It may be…
2014-10-05 17:09:00

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