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ventricular tachycardia wide complex AV dissociation ECG
Based on careful analysis of the 12-lead ECG tracing:
Diagnosis: Monomorphic Ventricular Tachycardia (VT)
ECG Findings
| Feature | Finding |
|---|---|
| Rate | ~150–170 bpm (estimated from strip) |
| Rhythm | Regular |
| QRS width | Wide (>120 ms) — broad, bizarre complexes throughout all leads |
| P waves | Not clearly identifiable / dissociated from QRS (AV dissociation) |
| QRS morphology | Monomorphic — uniform shape beat-to-beat |
| Axis | Indeterminate / Northwest (extreme axis deviation) |
| Precordial concordance | Positive concordance pattern visible in V leads |
The notes on the paper also write "VT" and mention "vibration" (likely referring to the oscillating rhythm) — confirming the clinical impression.
Why VT and not SVT with aberrancy?
The key discriminators (Brugada criteria) favoring VT:
- Wide QRS throughout all 12 leads — no narrow-complex beats visible
- No RS complex in precordial leads (or RS interval >100 ms if present)
- AV dissociation — P waves march through independently (the hallmark finding per Braunwald's)
- Monomorphic — excludes torsades or polymorphic VT
- Clinical context: patient appears to be in a monitored setting with medications including Actrapid (insulin) and Earlioss — suggesting metabolic derangement (e.g., hyperkalemia or diabetic emergency) as possible precipitant
"The presence of fusion beats or AV dissociation during a wide-QRS complex tachycardia leads to the diagnosis of ventricular tachycardia." — Goldman-Cecil Medicine
Immediate Management Priorities
- Assess hemodynamic stability — if unstable (hypotension, altered consciousness, chest pain): synchronized DC cardioversion immediately
- If stable: IV amiodarone (150 mg over 10 min, then 1 mg/min infusion) or IV lidocaine
- Correct reversible causes: check K⁺, Mg²⁺, glucose, ischemia (the "Hs and Ts")
- The medication notes suggest concurrent insulin/glucose therapy — check for hypokalemia or hyperkalemia, both of which precipitate VT
- Continuous monitoring, IV access, crash cart at bedside
The handwritten notes confirm this is being managed in an ICU/monitored setting with IV medications. The diagnosis is sustained monomorphic VT until proven otherwise — treat as such.
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