ECG is from a 70yr old male who presented with chest pain and palpitations.
Vital signs: BP 85/64 RR 20 Sats 98% on 10L/min.
Describe and interpret this ECG
ECG ANSWER and INTERPRETATION
- LAD (~ 80deg)
- QRS – Prolonged (140ms)
- QT – 320ms
- RBBB Morphology
- Typical morphology
- Regular Wide Complex Tachycardia
- Clinical compromise evidence by chest pain and hypotension
General differential diagnosis include:
- Ventricular Tachycardia
- SVT with aberrancy
- SVT with pre-existing conduction delay
- SVT with pre-excitation
- Not applicable in this case but don’t forget paced rhythms
But what about this ECG? This ECG is most probably SVT (likely atrial flutter) with RBBB aberrancy as the principle diagnosis. The QRS activation pattern of rapid activation till QRS peak followed by slower activation is classic for RBBB aberrancy.
The combination of RBBB and LAD (left axis deviation) means the SVT exit is the left posterior fascicle (left mid to basal LV), if this was VT it would be a fascicular VT.
Check out the links below for more on VT vs SVT with aberrancy and also on fascicular VT:
- ECG Library – Ventricular Tachycardia
- ECG Library – VT vs SVT with aberrancy
- ECG Library – Fascicular VT
What happened next?
…the patient underwent DC cardioversion in the Emergency Department and his post cardioversion ECG can be interpreted as Top 100 ECG Case 106