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ventricular tachycardia ECG wide complex tachycardia
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Now I have a thorough basis for interpretation. Let me analyze the ECG in the image carefully.
ECG Analysis
Technical Settings (visible on the printout)
- Paper speed: 50 mm/s (top strip) and 25 mm/s (bottom strip — "MANUAL 10mm/mV")
- Gain: 10 mm/mV
- Date/time: 2026-04-20 11:07:29
- Filters: AC 50 Hz, EMG 25 Hz, DFT 1 Hz
What the ECG Shows
Top strip (50 mm/s — leads I, II, III, aVR, aVL, aVF)
At the faster paper speed (50 mm/s), the waveforms are spread out. Key observations:
- Rate: Approximately 150–180 bpm (fast, regular rhythm)
- QRS complexes: Broad/wide — significantly wider than normal (>120 ms, likely ≥160 ms)
- Morphology: Bizarre, slurred, notched QRS complexes consistent with ventricular origin
- P waves: Not clearly identifiable preceding QRS complexes — suggests AV dissociation
- Axis: Appears abnormal (left or superior axis deviation based on limb lead polarity)
- aVR: Shows predominantly upright (positive) deflection — a classic VT criterion
Bottom strip (25 mm/s — precordial leads V1–V6 area)
- Wide complex tachycardia with rapid, monomorphic, regular complexes
- Broad, bizarre QRS morphology persists across all visible leads
- No obvious P waves before beats
- Concordance pattern visible in the precordial leads — complexes appear to point in the same direction across V1–V6
Primary Diagnosis: Monomorphic Ventricular Tachycardia (VT)
This ECG has the classic hallmarks of VT:
| Feature | Finding |
|---|---|
| Rate | ~150–180 bpm |
| QRS width | Markedly wide (>120 ms) |
| P wave/QRS relationship | AV dissociation (no clear P waves preceding QRS) |
| QRS morphology | Monomorphic, bizarre |
| aVR polarity | Positive (favors VT over SVT with aberrancy) |
| Precordial concordance | Present |
Brugada Criteria for VT (all likely met here)
- Absence of RS complex in all precordial leads — concordance pattern
- AV dissociation
- QRS duration in VT morphology >160 ms
- Positive aVR
Differential Diagnosis to Consider
| Diagnosis | Why it's less likely here |
|---|---|
| SVT with aberrancy (LBBB/RBBB) | Would typically show P waves, narrower QRS at onset |
| Antidromic AVRT (WPW) | Would need delta waves on prior ECG |
| Hyperkalemia | Produces sine-wave pattern, usually slower |
| Sodium channel toxicity (e.g., TCA overdose) | Could mimic this — check drug history |
Clinical Urgency
⚠️ This is a hemodynamic emergency until proven otherwise.
Immediate management depends on hemodynamic status:
- Unstable (hypotension, altered consciousness, chest pain, pulmonary edema): → Immediate synchronized DC cardioversion (100 J biphasic, escalate if needed)
- Stable: → IV amiodarone 150–300 mg over 20 minutes (first-line); procainamide is an alternative; lidocaine is a third option
- Always: IV access, continuous monitoring, defibrillator at bedside, cardiology consultation
Key Takeaway
This ECG shows a wide-complex tachycardia at ~150–180 bpm with broad, monomorphic QRS complexes, no clear P waves, and positive aVR — a pattern consistent with monomorphic ventricular tachycardia. This is a potentially life-threatening arrhythmia requiring urgent assessment and treatment.
Disclaimer: ECG interpretation from a photo is limited by image quality, angle, and resolution. This analysis is for educational purposes. Clinical correlation and formal interpretation by a qualified clinician are essential.
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