This ECG was recorded in a coronary care unit from a patient admitted 2 h previously with an acute anterior myocardial infarction. The patient was cold, clammy and confused, and his blood pressure was unrecordable. What does the ECG show, and what would you do?
*Detailed Answer
The ECG shows:
• Broad complex tachycardia,rate about 215 bpm.Regular QRS complexes•QRS complex duration uncertain: probably about 280 ms
• Indeterminate axis and QRS complex configuration.
*Clinical interpretation
In the context of acute myocardial infarction, broad complex tachycardias should be considered to be ventricular in origin ,unless the patient is known to have bundle branch block when in sinus rhythm. Here, the regularity of the rhythm and the very broad complexes of bizarre configuration leave no room for doubt that this is ventricular tachycardia.
*What to do?
In cases of severe circulatory failure, immediate direct current (DC) cardioversion is needed.
