A 45 years old male came to JIPMER hospital pondicherry, India with chief complaints of palpitation since last four days, which was acute in onset associated with one episode of vomiting, intermittent to continuous in nature, associated with atypical chest pain and breathlessness. Patient was a known case of diabetes mellitus. Patient also giving history of Old acute anterior wall myocardial infarction in february 2015, for which coronary angiography done at JIPMER hospital was suggestive of recanalized Left anterior descending coronary artery. Patient lost to followup and stopped all medication since last six months. During evaluation in the emergency department patient pulse was 200 beats per minute, BP-100/60 mmhg, CVS S1S2 were present, Respiratory system bilateral equal air entry and there were no crepitation. ECG of the patient done in the emergency department is shown below.
ECG of the patient during tachycardia
ECG Continued-----
ECG-Broad complex regular tachycardia with rate around 215 beats per minute, axis being left axis deviation, QRS duration in lead with maximum wide QRS in lead V1 is 240 msec, QRS being LBBB morphology, P wave are seen merged in QRS complex suggestive of AV dissociation, but there were no capture beat, fusion beat so the diagnosis of the ecg is most likely ventricular tachycardia with Supraventricular tachycardia with aberrancy being second differential diagnosis.Patient was started on injection amiodarone. Patient tachycardia reverted with injection amiodarone. ECG after injection amiodarone is shown below.
ECG after giving injection amiodarone
Baseline ECG after giving injection amiodarone is suggestive of normal sinus rhythm with rate around 83 beats per minute,left axis deviation,narrow QRS complex, no preexcitation seen, intermittent ventricular premature contraction seen
So the final diagnosis is Ventricular tachycardia. Lets us see how to approach in a patient with broad complex tachycardia
Thank you.
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