Case #9

dzeccola · November 1, 2013 at 9:33 am

So for realz, here’s a shot.

The basics

1) Assume its the right patient, right date and time of study
2) Assume its a standard 12 lead anterior ECG
3) Rate is > 150, read as 179 by machine, probably correct
4) Rhythm is well…not sinus, more to come
5) QRS is wide complex
6) Axis – Negative in AVR and positive in lead I has a normal axis

In my mind, the main diagnostic questions is VTach vs. SVT w/ abberrancy. The reason this is a dillema is that SVT will do well with adenosine or dilt, VTach will probably go into hemodynamic collapse – if they’re not already in it.

Fortunately, there’s a great “life in the fastlane” post on this (http://lifeinthefastlane.com/ecg-library/basics/vt_vs_svt/)

From what I learned in this post, I’m thinking this is SVT w/ aberrancy.

Some of the clues

1) Axis is normal
2) No AV disassociation
3) No capture beats
4) No RSR’ w/ high left bunny ear
5) Vectors in V1-V6 are not all the same, you have some negative some positive
6) No RSR’ with higher left bunny ear.

So push some Adenosine and say a hail mary.

Ian deSouza · December 7, 2013 at 7:11 pm

Ha, Bogoch. If “that guy” is ready to defibrillate as he should be before giving the adenosine, and then defibrillates prn, the patient will be saved!