Young Man with Very Fast Regular Wide Complex Tachycardia

EMS was dispatched for a 30-something male who feels his heart is racing.  Sudden onset.The patient had no previous medical history.Vitals were normal except for a heart rate of 226.A prehospital 12-lead was recorded:There is a regular wide complex tachycardia.  The computer diagnosed this as Ventricular Tachycardia.Is it definitely VT??The patient was given 6mg, then 12 mg, of adenosine, without a change in the rhythm.He arrived in the ED and had an immediate bedside cardiac ultrasound while this ECG was being recorded.The bedside ultrasound (video not available) reportedly showed only a slightly reduced LV function.Here is the ECG:What do you think?There is a wide complex regular tachycardia at a rate of 226.  The first part of the QRS is slow onset (see magnification below).  The differential is VT vs. AVRT.  Could it beRVOT (Right ventricular outflow tract VT). No, this requires inferior axis and LBBB morphology.  There is no inferior axis.RVOT VT:A 40-something without past history presents with wide complex tachycardia and crushing chest pain Regular Wide Complex Tachycardia. What is the Diagnosis?Toothache, incidental Wide Complex TachycardiaCould it befascicular VT or Bundle Branch VT (i.e., idiopathic VT)?  No, because the first part of the QRS is slow onset (see magnified V1-V6 below).Could it bestandard VT?  Yes, but this would be unusual in someone with no cardiac history and a reasonably good contractili...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs