Semiventricular Tachycardia
Report:
Sinus tachycardia 100/min
VEBs in bigeminy
Possible ventricular fusion
Left axis deviation (LAD) – 40o
LVH with ST/T changes
Inferior infarction, probably old
Comment:
Semiventricular is one of my own neologisms. Foreigners often take greater liberties with the language than native speakers. Actually the tachycardia may be less than semiventricular, given the possible contribution of sinus rhythm to fusion beats. The VEBs are preceded by shorter (but not more than 0.06” shorter) PR intervals and look rather narrow: they are almost certainly fusion beats.
The bigeminy breaks at the end of the recording as the P wave following the last VEB is completely blocked.
The LAD is due to the inferior infarction rather than LAHB: the latter would have no terminal R waves in the inferior leads, but would have one in aVR; similarly, Rs rather than qRs in V6 would be expected with LAHB. The S wave in Lead 2 would be deeper than 5 mm in LAHB.
Below (Fig 190a) is another trace form this patient, one month previously, in flutter 280/min with 4:1 block. The flutter makes it difficult to see whether the inferior MI was present then.
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