Shocking VT Cheating the Paddles

Report:

Ventricular tachycardia 210/min

Spontaneous termination

Sinus rhythm

Left atrial abnormality (LAA)

VEBs

Acute anterior infarction

Movement artefact

Leads V2-3 missing

Comment:

The tracing is rather chaotic, secured in a hurry on a sick patient in Casualty. The VT looks very bizarre and most of us would accept it as a VT without further analysis. Its appearance is, however, modified by two important factors: movement artefact and gross ST segment displacement from acute infarction. Even so, no sensible aberration pattern can be made out: it is a VT.

The acute MI pattern is seen in V4-5, with reciprocal ST depression in simultaneously recorded Lead 2 (rhythm strip) and V6. This is also where the LAA can be diagnosed, from 0.10” long, notched P waves.

Technically better ECG was obtained 2 minutes later (Fig 63a).

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