Really Wide, Kind of Slow: VT vs. Toxicity

ECG Weekly Workout with Dr. Amal Mattu

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HPI

A 78-year-old woman with PMHx of atrial fibrillation presents to the emergency department with generalized weakness. She is noted to be tachycardic on arrival, is known to be on flecainide and also takes metoprolol as needed. The following ECG is obtained on arrival:

Before watching this week’s workout, closely examine the ECG and ask yourself:

1. 1. What’s your differential for wide complex tachyarrhythmias?
   2. What conditions can cause tall R waves in V1?
   3. How would you manage both stable and unstable patients with this rhythm?