Not All Wide Complex Tachycardias Are What They Seem

ECG Weekly Workout with Dr. Amal Mattu

HPI

A 40-year-old man presents with chest discomfort and shortness of breath. He’s ashen, diaphoretic, and hypotensive at 90/45. The ECG monitor shows a wide-complex regular tachycardia at 135 bpm concerning for ventricular tachycardia. Your team prepares for cardioversion, while you review the following ECG obtained on arrival:

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

    1. Would you cardiovert this or is there a single lead that might completely flip your diagnosis?
    2. Can massive ST elevation mimic ventricular tachycardia?
    3. Why do some STEMI patients become tachycardic, and what does that really mean?