Ventricular Tachycardia
Report:
Ventricular tachycardia 190/min
Comment:
There is a monophasic R in V1, QS in V4-6 and nonsense axis in the frontal plane - the trace is virtually diagnostic of VT. One could think of atypical RBBB with anterolateral infarction or WPW with antegrade conduction down the bypass tract in SVT - but those remain remote possibilities. WPW should not, in fact, be even thought of without R waves in V4-6.
The patient did have an intraventricular conduction defect (IVCD) in atrial fibrillation (Fig 56a), and also an old anterolateral infarction; but the IVCD was, if anything, of LBBB type, with left axis deviation.
56a. Prominent thin R waves in right precordial leads (V2 here) may be seen in anterior infarction and cardiomyopathy.
56. 77 year old lady on sotalol for atrial tachyarrhythmias.
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