Cardiac Arrest on 12-lead ECG

Report:

Sinus rhythm

Triplet of multiform ventricular tachycardia

Sustained multiform ventricular tachycardia/VF

Inferior infarction, age uncertain

Comment:

This may or may not be VF; if not, it is at least another tachycardie préfibrillatoire41.

The patient lost output during the recording; by the time a countershock was applied, the CCU rhythm strips (not shown) recorded obvious VF.

The preserved QRS amplitude in leads aVR, aVL and 3 after the onset of tachycardia may be against the diagnosis of VF at this stage51.

Complete 12-lead ECGs taken at times of catastrophes are often held against the critical care staff. This is usually complete rubbish: the last thing the staff should be doing is disconnecting the ECG or turning off the machine. And yet, as medicine becomes more “defensive” and formulaic, they may start doing just that!

Fig 50a is (a bad) reproduction of the patient’s ECG in (mostly) sinus rhythm. The VEBs do look rather similar to those of VT/FV in the corresponding leads; but they are larger in size.