A 40-something without past history presents with wide complex tachycardia and crushing chest pain

See Ken Grauer ' s important and detailed ECG analysis at the bottom.CaseA 40-something with no PMH presented with palpitations, tachycardia, and crushing chest pain.This was the prehospital ECG.Sustained wide complex tachycardia.  Is it VT or SVT with Aberrancy?Also: there is no concordant ST segments or clearly excessively discordant ST segments, so superimposed Occlusion MI (OMI) is unlikely.There is a regular wide complex tachycardia, without P-waves, and anLBBB configuration andinferior axis.  [LBBB "configuration" is different from LBBB: it means that there is a predominant S-wave in V1 and V2 and monophasic R-wave in V6.]Guide to VT vs. SVT with Aberrancy:  I like to simplify and aggregate the many rules for this determination with these 4 questions:1. Is there LBBB or RBBB (not just " configuration " )?       ---Then likely SVT2. Is it bizarre? Concordance makes it look bizarre, and concordance is 1) ABSENCE of any precordial RS complexes (i.e., monophasic) and especially if 2) all monophasic QRS are in the same direction.     ---Then likely VT3. Does the voltage of the onset of the QRS change quickly or slowly? (change in voltage per change in time)     ---If slow, then VT     ---If fast, then SVT4. Is there a Northwest axis (toward aVR)     ---More likely to originate from the SouthEast (LV,& therefore mo...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs