Broad-Complex Tachycardia?

Report:

Atrial fibrillation with rapid response 186/min

Acute inferolateral infarction

Comment:

The computer and, regrettably, some of the staff pronounced this VT despite some (and by inference, all) complexes being quite thin and the obvious ST segment shifts and the irregular rate. Cardioversion in Casualty was justified anyway in view of the understandable distress felt by all (including the patient). It revealed a tombstone pattern in sinus rhythm (16a) and the patient was rushed to the Cath Lab where successful stenting ensured a happy ending.

The final ECG pattern was borderline evidence of posterolateral infarction (16b). The patient remained well and went home 5 days after admission.

16a. Tombstoning in sinus tachycardia 100/min.

16b. Posterolateral MI pattern (the Q in qR of V6 is more than the “septal” one. 17. 76 year old man with paroxysms of dyspnœa and weakness.

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