EKG of the Week


This EKG was done after patient on telemetry for syncope work up had a change in rate on monitor. He was not symptomatic at this time.

+ EKG Interpretation

Dr. Ohlbaum's Explanation

This clearly falls under heading of scary looking EKGs!

The rhythm is wide and fast (rate near 170). What is the differential for wide and fast and how can we differentiate? The differential is between a supraventricular fast rhythm (a reentry SVT or aflutter with 2:1 could be examples) with aberrant conduction (a RBBB or a LBBB) vs ventricular tachycardia.

Brugada criteria comes from an article in mid 90s that helps us make the decision quickly.

1) Is there a monomorphic QRS in all the V leads? If yes -> V. Tach and you are done, if no next step

  • In this patient there is an RS in V1 and tiny Q's in v4,5,6 -> no, next criteria...

2) Is the interval between the start of the R and the bottom of the S>100 msecs. If yes -> V. Tach, if no, next step

  • In this patient it is a bit tricky because there is an S and an S prime in V1 but I would argue that it is >100 to the deepest part of the S, so yes, it is Vtach. We don't need the third question, but for fun...

3) Is there AV dissociation (i.e. p-waves that march through unrelated to the QRS). If yes -> V.Tach, if no, look further

  • The quality on this tracing, the rate and the very wide QRS make that a hard, I get a sense there is something marching through separate from the QRS in V5 and V6, but it is hard to follow

This EKG is V.Tach

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