Large Rabbit Ears and Prominent A-V Dissociation with Positive Concordant Precordial Pattern

Report:

Sinus rhythm 82/min

Ventricular tachycardia 158/min

Complete A-V dissociation

Left atrial abnormality (LAA)

Comment:

This title contains three major features of ectopic ventricular tachycardia and is well suited to teaching beginners in electrocardiography.

One of those novices diagnosed “SVT with 2:1 block”, possibly on the strength of ventricular rate being approximately twice the atrial one. He proceeded to treat it with adenosine and then sotalol, producing electromechanical dissociation requiring intubation and adrenaline. She recovered to recordable blood pressure and was transferred to the Canberra Hospital still in VT, where she was shocked with 100 Joules into sinus rhythm (below, Fig 10a).

Her 12-lead ECG is shown in Fig 10b, with LAA and LVH with ST/T changes. Fig 10a. This is one of the gladdest sights in electrocardiography. 10b. Sinus rhythm ECG, post-cardioversion. The early beat in V1 could be aberrantly conducted junctional one, with blocked sinus P wave closely following. The delay to the nadir of its S wave is in favour of ventricular ectopic origin. This cannot be taken any further. Fig 11. 81 year old man with sudden onset of weakness, palpitations and breathlessness.

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