Ventricular Tachycardia: Pre-Existent LBBB with Right Axis Deviation
Report:
Ventricular tachycardia 167/min
Comment:
The diagnosis is based on RV1 morphology and the Northwest axis. In addition, the patient was known to have a pre-existing LBBB with RAD (a marker of congestive cardiomyopathy) shown below (Fig 89a).
Lead 3 is interesting in that it looks at first like narrow-QRS tachycardia with retrograde P waves. Looking up to leads 1 and 2 it becomes obvious that both the narrow QRS and the retrograde P are, in fact, just one broad QRS complex. It sounds obvious, but it’s a good advice I heard, as a student: examine all the leads before you open your mouth.
There is no definite atrial activity present, except, perhaps, for a suspicious notching of the baseline in V1. It happens only once during the recording – it is best disregarded. Einmal ist keinmal!
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