A 45 year old lady with palpitations and history of chronic renal failure
Ventricular tachycardia
A wide QRS tachycardia is VT until proven otherwise (1). Features suggesting VT include:-
- evidence of AV dissociation
- independent P waves (shown by arrows here)
- capture or fusion beats
- beat to beat variability of the QRS morphology
- very wide complexes (> 140 ms)
- the same morphology in tachycardia as in ventricular ectopics
- history of ischaemic heart disease
- absence of any rS, RS or Rs complexes in the chest leads (2)
- concordance (chest leads all positive or negative)
1) Griffith MJ, Garrat CJ, Mounsey P, Camm AJ. Ventricular tachycardia as the default diagnosis in broad complex tachycardia. Lancet. 1994;343:386-
2) Brugada P, Brugada J, Mont L, et al. A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex. Circulation. 1991;83:1649-1659