Wide Complex Tachycardias
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Preexcitation Pitfalls (Part 4): Potpourri Cases & Final Teaching Points
A 49-year-old man arrives with palpitations and chest discomfort. The monitor shows an irregular, wide-complex tachycardia with varying morphology and rates nearing 250 to 300 bpm. The team debates polymorphic…
Preexcitation Pitfalls (Part 3): Wide, Irregular, Fast…Avoid AV Nodal Blockers
A 53-year-old man presents with palpitations and lightheadedness. The following ECG is obtained on arrival and appears very rapid and irregular with changing QRS morphologies. He starts showing signs of…
The Post-Arrest Wide Complex Rhythm That Was Not VT
A 35-year-old woman arrives at the emergency department after a witnessed seizure and brief cardiac arrest with ROSC. Her arrival ECG shows a very wide complex rhythm that the machine…
The Post-Thanksgiving Rhythm You Cannot Miss
A 48-year-old woman presents two days after Thanksgiving with severe weakness, palpitations, and mild chest discomfort. Her ECG appears to show a very wide complex regular tachycardia at 119 bpm.
Not Cerebral T Waves: The Beat-to-Beat Warning You Cannot Miss
A 71-year-old woman with baseline dementia presents with worsened confusion, nausea, and multiple episodes of vomiting over the past 24 hours. Her vital signs are reasonable and her exam is…
Recent ECG Case Highlights from the University of Maryland (Part I)
A 64-year-old man is brought to the ED by EMS just after achieving return of spontaneous circulation following cardiac arrest. He received chest compressions, epinephrine, and was defibrillated prior to…
The Wide Complex Rhythm That Fooled Everyone
A 30-year-old woman presents with one hour of chest discomfort and palpitations. On arrival she is borderline but not frankly unstable. The 12-lead shows a fast rhythm that appears wide…
Not All Wide Complex Tachycardias Are What They Seem
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…
Really Wide, Kind of Slow: VT vs. Toxicity
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…
When to Default to VT and When to Doubt It
A 64-year-old man presents to the emergency department with palpitations. He was recently found to have an acute MI and is one day s/p RCA stenting. The following ECG is…
Recent University of Maryland Medical Center Cases (Part IV)
A 73-year-old man is brought to the emergency department with palpitations. The following ECG is obtained on arrival:
Optical Illusions and 12-Lead ECGs: How First Impressions Can Mislead
A 42-year-old woman presents to the emergency department with chest pain, shortness of breath, and palpitations. Her blood pressure and mental status are noted to be normal. The following ECG…
Unrecognized Killers in Emergency Electrocardiography, Part II
A 46-year-old woman presents after two syncopal episodes associated with palpitations. She reports feeling a rapid heart rate before losing consciousness. She has a few witnessed episodes in the emergency…
Unrecognized Killers in Emergency Electrocardiography
A 42-year-old man presents with fever, cough, shortness of breath, and vomiting. He appears toxic and dehydrated on arrival with suspected severe sepsis from multilobar pneumonia. He is later intubated…
2025 EMS Cases Part III
A 69-year-old woman is being brought in by EMS for palpitations and dizziness. She is found to be markedly tachycardic, but is alert with a normal blood pressure. The following…
How the Lewis Lead Can Improve Tachyarrhythmia Diagnosis
A 68-year-old woman presents to the emergency department with palpitations and tachycardia. The following ECG is obtained:
2024 EMS Cases Part IV
A 60-year-old man is being transported by EMS to the emergency department for acute chest pain. The following ECG is transmitted prior to arrival as a “CODE STEMI” and brought…
Wolff-Parkinson-White (WPW) Syndrome with Atrial Fibrillation (Afib)
A 53-year-old man presents to the emergency department with palpitations and lightheadedness. On arrival, he is found to have a wide complex tachycardia and the following ECGs is obtained:
Wolff-Parkinson-White (WPW) Syndrome with Supraventricular Tachycardia (SVT)
A 24-year-old man with past medical history of WPW syndrome s/p ablation presents to the emergency department with palpitations. On arrival, he is found to have a wide complex tachycardia…
Runs of ventricular tachycardia vs. another phenomenon
A 33-year-old man with a past medical history of atrial fibrillation years ago presents with anxiety and shortness of breath. His blood pressure is normal on arrival but he is…
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