 |
| ECG on arrival |
- ~210 bpm
- Regular
- RAD
- QRS - Prolonged (120-160 ms)
- QRS Alternans - best seen in leads III & aVF
- ? Retrograde P waves buried in terminal QRS - best seen in V3
- Lack of concordance
- No fusion or capture beats
- Marked baseline artifact leads I, II, aVR
Interpretation:
- Wide complex tachycardia (WCT)
- General differentials for all WCT include:
- VT
- SVT with aberrancy (rate ralted BBB, pre-exisiting BBB)
- SVT with pre-excitation
- Paced rhythm
- Given the patient's age the likeliest diagnosis is one of SVT
 |
| Post intervention |
- 90 bpm
- Regular
- Sinus rhythm
- Inferior axis
- PR - Short (120ms)
- QRS - Prolonged (110-120 ms)
- QT - 320ms
- ST Elevation lead aVR and aVL
- ST Depression leads II, III, aVF, V1-6
- Delta waves - best seen leads II, III, aVF, V1-6
- Deep Q wave lead aVL - 'pseudo-infarction' pattern due to pre-excitation
- Artifact mimicking pacing spikes in leads V1-3
- WPW
- Left lateral / anterolateral accessory pathway (Arruda Algorithm)
- ST changes likely due to period of arrhythmia rather than acute infarction
 |
| 30 mins post ECG above |
Rate:
- 90 bpm
- Regular
- Sinus rhythm
- RAD
- As above: Short PR & QRS Prolongation
- Resolution of ST segment changes seen above
- Delta waves as described above
- Voltage criteria for right ventricular hypertrophy - 'pseudo-hypertrophy' due to pre-excitation
- Deep Q wave lead aVL - 'pseudo-infarction' pattern due to pre-excitation
- WPW with left accessory pathway and an episode of antidromic AVRT
Life in the Fast Lane
Textbook- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.
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