Multiform Ventricular Tachycardia

Report:

Sinus tachycardia 180/min

VEBs, some in bigeminy

Multiform ventricular tachycardia 280-310/min

Comment:

The sinus tachycardia was confirmed on 12-lead ECGs. It is very fast, reflecting both continued pain and hæmodynamic instability.

The VEBs are small, with preceding sinus P waves giving them a spurious RSR’S’ pattern. A wise and distinguished old Cardiologist once told me that such miniature VEBs (in V1 or MCL1) are most likely to cause mischief; he regretted never having made a study of them. I’ve come to agree, but the notion requires firmer footing.

The multiform (polymorphous) VT has the morphology, but not the other defining characteristics of torsade de pointes; it is a different arrhythmia altogether. Some call this, perhaps misleadingly, ischæmic torsade. It is a tachycardie préfibrillatoire as seen before in this Volume (Case 47, 50).

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