Large Rabbit Ears and Prominent A-V Dissociation with Positive Concordant Precordial Pattern

Report:

Sinus rhythm 82/min

Ventricular tachycardia 158/min

Complete A-V dissociation

Left atrial abnormality (LAA)

Comment:

This title contains three major features of ectopic ventricular tachycardia and is well suited to teaching beginners in electrocardiography.

One of those novices diagnosed “SVT with 2:1 block”, possibly on the strength of ventricular rate being approximately twice the atrial one. He proceeded to treat it with adenosine and then sotalol, producing electromechanical dissociation requiring intubation and adrenaline. She recovered to recordable blood pressure and was transferred to the Canberra Hospital still in VT, where she was shocked with 100 Joules into sinus rhythm (below, Fig 10a).

Her 12-lead ECG is shown in Fig 10b, with LAA and LVH with ST/T changes.

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