UMEM Cases, Part 4: When the Computer Misses the Rhythm and Flutter Fakes a STEMI

UMEM Potpourri ECG Cases with Dr. Amal Mattu

HPI

A 44-year-old man with severe cardiomyopathy, an LVAD, chronic amiodarone therapy, and an AICD presents with palpitations. His ECG shows a regular wide-complex tachycardia, but the rate is only 135. There also appears to be retrograde atrial activity after the QRS complexes, and the device is not firing. At first glance, those details may seem reassuring. They should not be.

Before watching this week’s workout, review the arrival ECG carefully and consider:

    1. Can ventricular tachycardia occur at a relatively modest rate, especially in a patient taking chronic antiarrhythmic therapy?
    2. Do retrograde P waves rule out VT and prove that the rhythm is supraventricular?
    3. How would you interpret and document this rhythm?