Ventricular tachycardia

A 43 year old male came to JIPMER Hospital with chief complaints of palpitation since last 3 days which was acute in onset, intermittent to continuous in nature, regular in nature, associated with chest pain and giddiness.Palpitation were associated with history of nausea and one episode of vomiting. Patient was a known case of hypertension since last 7 years and was on regular treatment. Patient was also giving history of acute anterior wall myocardial infaction in 2014, for which he was treated at private hospital. Coronary angiography done at that time was suggestive of single vessel diseases of Left anterior descending coronary artery for which PCI was tried but it got failed. Patient was on medical management since that time. But again in Nov 2016 patient develop acute onset chest pain with palpitation, sweating for which he was investigated at private hospital and diagnosed to have Acute coronary syndrome/unstable angina. Medical management was given. Coronary angiogram was suggestive of single vessel disease of LAD ( 100% stenosis)  with chronic total occlusion. ECHO was done , which was suggestive of severe left ventricular dysfunction (LVEF=35%) with moderate mitral regurgitation with left ventricular apical aneurysm and he was started on prophylactic amiodarone, antiplatelets, beta blocker and ACE inhibitor.Patient was asymptomatic but he develop recent episode of palpitation. Patient went to private hospital, ECG done, BP at that time was 70 mmhg, DC cardioversion was done follwing which patient was refeered to JIPMER Pondicherry Hospital for further management. ECG of the patient during the episode of tachycardia is given below.

ECG 1 (Click on the image to enlarge it)

ECG 2

ECG 3

Description of the ECG-Broad complex regular tachycardia at heart rate around 190 beats per minute, QRS of RBBB morphology, QRS duration 240 msec, normal axis, there were no capture beats, no fusion beats, no AV dissociation seen, no visible P wave seen, negative concordance seen from lead V1-V6, rS seen in lead V6, 

 ECG 4 (After giving DC cardioversion)

 

Description of the ECG-Noraml sinus rhythm at rate 86 beats per minute, LAD,LAHB, RBBB, QS wave seen in lead V1-V6

So from both the above ecg the diagnosis of this patient is Ventricular tachycardia. 

Lets discuss how to approach in a patient with Broad complex  tachycardia

Thank you.