McGill Case 254

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This case report is kindly provided by Michael Rosengarten from McGill and is part of the McGill Cases. These cases come from the McGill EKG World Encyclopedia.

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Wide Complex Tachycardia This EKG shows a fast wide complex tachycardia in the range of 270/min., lead V4 is missing due to a poor electode contact. Considering the patient's age and history of previous infarctions and low ejection fraction the diagnosis is almost certainly ventricular tachycardia. The QRS morphology favors ventricular tachycardia as this is a RBBB morphology with the R to S ratio in V6 is less than 1 and a Monomorphic R in V1. The patient was shocked with 200 joules (less probably have worked too) and regained sinus rhythm A cardiac cath showed a 100% LAD stenosis and an 80-90% circumflex stenosis with patient grafts to the LAD and OM. The EF was 15%. The patient was implanted with a defibrillator and is doing well with no shocks received 3 months post implant.