This post is an answer to the ECG Case 274
- Rate: 192 bpm
- Rhythm: Regular
- Axis: LAD
- Intervals: QRS – Prolonged (120ms)
- Segments: Discordant ST and T wave changes
- Additional: Typical LBBB morphology
Interpretation
- Wide complex tachycardia
- Differentials:
- VT
- SVT with aberrancy
- SVT with pre-exisiting BBB
Features favoring VT:
- Patient’s age
Features favoring SVT:
- Typical LBBB morphology
- No capture / fusion beats
- No concordance
- No extreme axis
In the stable patient it is not unreasonable to trial chemical cardioversion initially prior to DC cardioversion. The patient was treated with bolus IV adenosine with conversion to sinus rhythm.
Note persisting typical LBBB morphology, which proves that the rhythm in the first ECG was SVT with pre-exisiting LBBB.
The patient underwent coronary angiography with showed mild disease in the LAD, RCA and LCx.
READ MORE: Never Mistake Ventricular Tachycardia for Supraventricular Tachycardia with Aberrant Conduction
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