A young lady with wide complex tachycardia. My first time actually making this diagnosis de novo in real life in the ED!

 Written by Pendell MeyersA woman in her 30s with minimal past medical history presented simply stating she was " feeling unwell. " Her symptoms started suddenly about 48 hours ago, but had continued to worsen, including epigastric discomfort, nausea, cough, and dyspnea and lightheadedness on exertion. She denied chest pain and denied feeling any palpitations, even during her triage ECG:What do you think?Despite otherwise normal vital signs, she was appropriately triaged to the critical care area of the ED.She was awake, alert, well perfused, with normal mental status and overall unremarkable physical exam except for a regular tachycardia, possible rales at both bases, some mild RUQ abdominal tenderness. My bedside ultrasound was of insufficient quality, but showed somewhat reduced overall EF, distended IVC without respiratory variation, no pericardial effusion, and diffuse bilateral B lines.==========================What do you think of her ECG?There is clearly a wide complex tachcyardia (although the QRS duration is not far above 120msec). There is some movement artifact here and there, so the next determination of whether it is regular or irregularly irregular is slightly complicated, but I believe movement artifact is the only reason this rhythm is not regular. At beside, looking at the monitor during periods without movement artifact, this rhythm seemed perfectly regular and monomorphic. Thus, I believe it is a regular, monomorphic, wide complex tachycardia. Th...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs