This ECG is from a man in his 60's who is experiencing chest discomfort and palpitations. The onset of the rapid heart rate and the symptoms was sudden, while he was at rest. The rate did not slow when he was placed on oxygen, given IV fluids, and rested further
This wide-complex tachycardia is ventricular tachycardia. Along with the wide QRS and the fast rate, features which favor a diagnosis of VT over BBB include: backwards (extreme right) QRS axis, negative QRS in V6, and an apparently monophasic QRS in V1, as opposed to the rSR' pattern of right bundle branch block.
Remember, ALL wide-QRS t
This ECG was donated to the ECG Guru by Brent Dubois, and was originally published on the FaceBook page, Paramedic Tips & Tricks. We published it to this site three years ago, but believe it should be shown again, as it is somewhat rare to catch a good-quality 12-Lead ECG of an implanted cardioverter-defibrillator pacemaer using overdrive pacing to terminate a ventricular tachycardia. Most of our examples have been rhythm strips.
This ECG was taken from a patient who was complaining of palpitations and tachycardia, but who was hemodynamically stable, with no history of heart disease. It is an example of RIGHT VENTRICULAR OUTFLOW TRACT TACHYCARDIA, a type of idiopathic ventricular tachycardia. The ECG signs of RVOT are: wide QRS complex, left bundle branch block pattern (QRS negative in V1 and positive in Leads I and V6), heart rate over 100 bpm, rightward or inferior axis (LBBB usually has a normal to leftward axis), AV dissociation.
This ECG shows AV nodal reentrant tachycardia in an elderly man. Clinical information is not available. AVNRT is the rhythm most often associated with the term, "supraventricular tachycardia".
This two-lead rhythm strip clearly shows the transition from normal sinus rhythm to a paroxysmal supraventricular rhythm. In this case, the arrhythmia is AV nodal reentrant tachycardia, AVNRT. The rate of the first rhythm, NSR, is around 75 per minute. The fourth beat on the strip is a PAC which initiates the paroxysm of tachycardia lasting 12 beats. The arrhythmia terminates spontaneously at that point. The tachycardia rate is about 150/min.
This ECG provides an example of atrial flutter with variable conduction. There are two distinct R - R intervals, making this a somewhat regularly-irregular rhythm, as opposed to the irregular irregularity of atrial fibrillation. The flutter waves (P waves) are very easy to see in most leads, but not in all. If you are teaching students who are making the transition from reading monitors and rhythm strips to 12-lead ECGs, this is a great ECG to illustrate for them how the more leads you have, the more you will see.
Unfortunately, we have no clinical information on this patient, not even age or gender, as the ECG machine defaults to "Age 60". The rhythm is a supraventricular tachycardia at a rate of about 260/min. with 2:1 conduction, resulting in a heart rate of about 130 / minute. Some would call this atrial tachycardia, and some atrial flutter. Since the reentrant pathways involved in the two rhythms are different, it is probable that an electrophysiologist could determine the exact location of the pathway in the EP lab. Without benefit of this test, we use our best guess.
This ECG was donated to the ECG Guru by Dr. Arnel Carmona, one of our favorite Gurus. You will not often see such a great example of this. We are very grateful to Dr. Carmona for his contribution to learning. Dr. Carmona's new blog is EZG - ECG for beginners and enthusiasts.
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