V tach is identified by: wide QRS complexes (>.12 seconds), rate faster than 100 bpm. In MONOMORPHIC V tach, all QRS complexes look alike. There are other mechanisms of wide-complex tachycardia, but they can be difficult to differentiate from a single rhythm strip. All WCT should be treated as V tach until proven otherwise.
These two ECGs are from a 77-year-old woman who was complaining of palpitations and mild shortness of breath. She stated a history of atrial fibrillation. She was alert, with a systolic BP over 120. At the hospital, she was found to have cardiomyopathy, resulting in global hypokinesis. She also had significant coronary artery narrowing in her left main, left anterior descending, and circumflex, which were treated with coronary artery bypass graft surgery.
The first ECG was taken on arrival of the EMS crew at the patient’s home. It shows ventricular tachycardia, rate 226 bpm, All WCTs should be considered to be ventricular tachycardia until proven otherwise. While WCT can sometimes be difficult to definitively diagnose in the field, this ECG has many features which favor the diagnosis of VT, including:
· An extremely wide QRS (I measure .24 sec., the machine measures .368 sec.).
· An extreme left axis deviation (aVF is all negative).
· Absence of either RBBB or LBBB pattern, with a completely negative QRS in V6. This all negative V6 places the liklihood of the rhythm being VT to about 100%.
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