Wide QRS Complexes in the Setting of Acute Myocardial Infarction: Good News or Bad?

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Author(s) N.J.W. Verouden, R.J. de Winter, A.A.M. Wilde
NHJ edition: 2009:01,062
These Rhythm Puzzles have been published in the Netherlands Heart Journal and are reproduced here under the prevailing creative commons license with permission from the publisher, Bohn Stafleu Van Loghum.
The ECG can be enlarged twice by clicking on the image and it's first enlargement
Figure 1A
Figure 1B

A 57-year-old man collapsed after one hour of angina symptoms in the presence of the alarmed ambulance personnel. He had never had any complaints of chest pain before and his medical history did not contain any cardiac events. Current smoking and a positive family history were noted as risk factors for coronary artery disease. Ventricular fibrillation (VF) was recorded as the first rhythm and the patient was successfully defibrillated with external DC shock. The first ECG after defibrillation is shown in figure 1A, followed by a second ECG (figure 1B) 40 minutes later.

What would be your diagnosis and thoughts?

Answer