Monomorphic Ventricular tachycardia ? What is your diagnosis.

A 50 year old female k/c/o  Diabetes mellitus, hypertension comes to JIPMER, Pondicherry, India with chief complaints of palpitation on and off since last one month. Patient was investigated outside at private hospital. Coronary angiography of the patient was suggestive of minimal coronary artery diseases. Her cardiac examination was unremarkable. Patient ECG done at outside hospital is shown below

ECG 1(Click on the image to enlarge it)

Description of the ECG

 Broad complex regular tachycardia with rate around 200 beats per minute, AV dissociation was present with intermittent visible P wave in lead I,II, V1. No capture beats, no fusion beat seen, Negative QRS concordance seen in lead V1-V5. QRS complex were of LBBB morphology, QRS axis being inferior (QRS complex are positive in lead II,III,avF) so the diagnosis of this ECG is Ventricular tachycardia with inferior axis.(Presence of AV dissociation and negative concordance favour the diagnosis of Ventricular tachycardia rather than supraventricular tachycardia with aberrancy)

ECG 2

Description of the ECG

 Broad complex regular tachycardia with rate around 200 beats per minute, AV dissociation was present with intermittent visible P wave in lead I,II, V1. No capture beats, no fusion beat seen, QRS complex were of LBBB morphology, QRS axis being inferior (QRS complex are positive in lead II,III,avF) so diagnosis is Ventricular tachycardia with probable origin from right ventricular outflow tract in view of Inferior axis and LBBB morphology of tachycardia.

ECG 3

Description of the ECG

 Broad complex regular tachycardia with rate around 200 beats per minute, AV dissociation was present with intermittent visible P wave in lead I,II, V1. No capture beats, no fusion beat seen, QRS complex were of LBBB morphology, QRS axis being inferior (QRS complex are positive in lead II,III,avF) 

Patient ECG during sinus rhythm is shown below

Description of the ECG Sinus rhythm at 75 beats per minute, normal axis, QRS complex in lead V1, V5,V6 is suggestive of RBBB morphology, ST segment flattening with Deep T wave inversion seen in lead  I, avL, V2-V6, PR interval 120 msec,QT interval 560 msec, QTc 626 msec

Another sinus rhythm ECG of the patient

 So the diagnosis of this patient is Ventricular tachycardia probably originating from right ventricular outflow tract with Long QT interval. Patient ECHO cardiography done which was suggestive of Dilated right ventricular outflow tract with right ventricular dysfunction with Left ventricular dysfunction. Patient is presently admitted in Cardiology CCCU at JIPMER hospital for further evaluation. Presently differential diagnosis kept is Arrhythmogenic right ventricular cardiomyopathy. Patient is planned for cardiac MRI and Electrophysiological study and further management. I will let you know soon the final diagnosis of patient after detail evaluation.