ECG of the Week 22/10/22
ECG of the Week
Remember the 120 CRAM formula
- Faster than 120 bpm and wider than 120 ms
- Concordance
- T wave in aVR
- AV Dissociation
- Morphology
Remember that there are only a few causes of wide complex tachycardia.
- Ventricular Tachycardia (80% of cases)
- SVT with a BBB
- Sinus with a BBB
- Hyperkalaemia
- Na channel Blockade
- Paced rhythm
- Ishcaemia
CASE 1: 40 yo male presents with palpitations.
The ECG is shown below. Is this VT? What’s your diagnosis?
Answer
This is Atrial Fibrillation with a bundle branch block. It cannot be VT as it is irregular. VT will be very regular.
Case 2: A 58 yo male presents with pre-syncope
The ECG is shown below. Is this VT? What’s your diagnosis?
Answer
This is again atrial fibrillation with a BBB. It cannot be VT if it is irregular.
Case 3: An 86 yo male with hypotension
The ECG is shown below. Is this VT? What’s your diagnosis?
Answer
This is artefact. The patient had tremor that caused these changes. The give-away is lead I. You cannot have VT in all leads except one lead. The underlying rhythm marked in the red dots is shown below.
Case 4: A 19 yo with palpitations
The ECG is shown below. Is this VT? What’s your diagnosis?
Answer
This is Hyperkalemia. The complexes are too wide. Also the rate is 114. It is not considered VT unless the rate is above 120. Remember my 120CRAM formula.
