A Different Kind of Wide Rhythm -- Pleomorphic Ventricular Tachycardia

===================================MY Comment by KEN GRAUER, MD (6/1/2020):===================================YOU are asked to interpret the ECG shown in Figure-1. Unfortunately, no history is available to assist.WHAT are the diagnostic possibilities for the rhythm?What are the prognostic implications of this rhythm?Figure-1: The initial ECG in the ED. Please note that the long lead II rhythm strip is not simultaneously obtained with the 12-lead tracing above it. (See text).MY THOUGHTS on ECG #1: My initial impression on looking at the ECG in Figure-1  — was that the rhythm was either rapid AFib in a patient with WPW — or  — PMVT (PolyMorphic VT). On looking closer — I realized that neither of these 2 possibilities was likely to be correct.QRS morphology varies in this tracing. Overall, the QRS complex looks wide — although in a number of leads, many of the beats look narrow. I suspect this is because part of the QRS complex in certain leads lies on the baseline. I thought the “theme” of this tracing was that the QRS is wide.I see no sign of atrial activity.The reason I initially thought the underlying rhythm was AFib — is that no atrial activity is seen in any lead and the rhythm “looks” irregular. However, on measuring R-R intervals with calipers — I was s...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs