A 70-Something Woman with a Very Wide Tachycardia

 ===================================MY Comment by KEN GRAUER, MD (10/4/2020):===================================Today ’s patient is a 70-something year old woman who presented to the ED for possible acute Covid-19 symptoms. She was conscious, but appeared acutely ill at the time the initial ECG was obtained in the ED (Figure-1). The computer interpretation read, “Extreme wide complex tachycardia”. How would YOU interpret the cardiac rhythm in ECG #1?Should you treat with Adenosine? Amiodarone? Immediate cardioversion? — or — Would you first do something else?Figure-1: The initial ECG in today ’s case (See text).MY Thoughts on ECG #1: At 1st glance — ECG #1 indeed appears to be an “extremely wide tachycardia” in this acutely ill, elderly patient. That said — there are 2 things that “don’t fit”. These are:My 1st Concern: The rate of the ventricular response is extremely rapid = about 260/minute. While clearly not impossible for VT to be this fast — it is not common for a patient to remain conscious at this fast of a ventricular rate.My 2nd Concern: There appear to be some narrow QRS complexes occurring at a fairly regular rate in at least some of the leads in ECG #1 (See BLUE arrows in Figure-2).Figure-2: I ’ve added BLUE arrows to ECG #1 in places where it look...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs