BMH Med. J.  2017;4(3):111-112.   ECG Challenge - Answer

Wide QRS Tachycardia

Syamkumar Divakara Menon

Associate  Professor of  Medicine, Faculty of health Sciences, McMaster University, Canada

Address for Correspondence: Dr. Syamkumar Divakara Menon, MBBS, MD, DM, MSc, Associate  Professor of  Medicine, McMaster University, Hamilton, ON, Canada. Email: mdsmenon@gmail.com

Abstract

56 years old male patient presenting with palpitation to emergency room. On examination: tachycardic, BP 96/70. What is the diagnosis?

Rhythm strip shows wide and narrow QRS tachycardias alternating.  It could either be a narrow QRS tachycardia with intermittent aberrant conduction or two simultaneous tachycardias. It is more likely one tachycardia since the rate and regularity is not changing.

Keywords: wide QRS tachycardia, narrow QRS tachycardia, ECG

56 years old male patient presenting with palpitation to emergency room. On examination: tachycardic, BP 96/70. What is the diagnosis?

Figure 1

ECG shows a regular tachycardia at a rate of 220 beats per minute. QRS complexes are alternating between wide and narrow complexes without change in the rate (noted well in the rhythm strip).

Question: Is it same tachycardia or two tachycardias occurring simultaneously?

Two possibilities are:

1) SVT which is conducted with wide / aberrant complexes intermittently.
2) Double tachycardia with an SVT and a VT at the same rate.

It is more likely one tachycardia since the rate and regularity is not changing.