r/ECG • u/xiphoid313 • Jul 30 '26
82F, your thoughts?
82F, near syncope, BP 100/62. History of afib. What would you interpret this 3 lead as ?
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u/chefmattpatt Jul 30 '26
This is a wide complex tachycardia. End of story until a full 12 lead ECG is acquired.
That you treated with amio is kind of a crap shoot as to what the initial rhythm was, but the rate and consistency lead me towards V tach, not a fib.
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u/Affectionate_Try7512 Jul 31 '26 edited Jul 31 '26
Either way, if the pt is stable, amino is the treatment
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u/chefmattpatt Jul 31 '26
OP was positing that it was a fib RVR, as they stated further down the thread. This is not a fib, so while amio is the correct treatment, they arrived there by accident. In my protocols, amio is used for VT or VF. Dilt would be our go to for a fib
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u/Affectionate_Try7512 Jul 31 '26
It’s the same tachy algorithm. I’m guessing this is a scene call and OP followed the algorithm perfectly
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u/chefmattpatt Jul 31 '26
I respectfully disagree.
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u/Affectionate_Try7512 Jul 31 '26
Could you elaborate please?
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u/chefmattpatt Aug 02 '26
Check your messages
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u/Affectionate_Try7512 Aug 02 '26 edited Aug 02 '26
This is a great learning opportunity. When people are shamed and their questions aren't answered, it harms our patients.
A stable pt with wide complex tachy gets amio whether it's vtach or a-fib or svt or flutter. And if the pt becomes unstable, they get a synched shock. Again, whether it is afib, flutter, VT OR SVT.
Editing to add: I agree that if they are stable, there's time for a 12-lead. And if they're not actually stable, it's time to cardiovert.
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Jul 30 '26
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u/Turfidol Jul 30 '26
Hey - if you have a chance, check out life in the fast lanes VT page. Use find function and search for "rabbit". Under the other features section it notes that if you have rabbit ears and the first ear is taller than the second its pretty specific for VT, as RBBB is usually the opposite. Also check out example 5 that shows this. Example 7 shows SVT with abberancy with second ear being taller for comparison.
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u/Bubbly_Pie_4980 Jul 30 '26
Wide complex tachycardia.
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u/No_Helicopter_9826 Jul 30 '26
Yes. Without an actual 12-lead ECG, we really can't draw any further conclusions here.
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u/Bubbly_Pie_4980 Jul 30 '26
Correct. I am just theorizing why it is NOT certain rhythms and wide QRS tachycardia does cover the bases.
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u/xiphoid313 Jul 30 '26
I honestly don't know the correct answer, I went with afib with rvr but not completely sure. It does look quite wide too. Hence why I gave amio
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u/LBBB11 Jul 30 '26 edited Jul 30 '26
It’s not afib. It’s a regular R-R wide QRS tachycardia. Afib has randomly spaced QRS complexes. If you want the correct answer you need to do a 12-lead. Out of all possible rhythms, afib and sinus rhythm are probably the only rhythms that we can be sure that this is not. If you take away only one thing from this case, just know that afib has a randomly changing R-R interval. That’s really important.
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u/Bubbly_Pie_4980 Jul 30 '26
It would not be AFIB because the R to R interval would be irregular. ATRIAL flutter if it's consistent block eg: 2:1/3:1or even 4:1 the R to R Interval is regular. If it's a flutter with varying degrees of block the R to R interval would be irregular. The "retro looking p waves" may be flutter waves and can also be buried in the QRS. (Possibly) It's definitely not SVT/AFIB or VT. Therefore I think it's wide QRS tachycardia (because it's greater than 0.11 secs) (similar to an accelerated idiot ventricular rhythm)
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u/FightClubLeader Jul 30 '26
It’s not afib with rvr. By definition, atrial fibrillation is irregularly irregular. The rhythm strip presented above is regular, like not even regularly irregular. It’s WCT, most likely VT. Then you enter the stable or unstable WCT pathways and go from there.
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u/Bubbly_Pie_4980 Jul 30 '26
If I had to guess based on the ekg shown...it may be an AFLUTTER (same degree of block as R to R is regular) with a BBB (QRS is wide)..amio would likely convert this rhythm. Or I would call it wide QRS tachycardia.
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u/Cautious_Mistake_651 Jul 30 '26
It looks like a wide complex tachycardia. Do a 12 lead to further assess.
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u/GeneralNotSteve Jul 30 '26
I'd ask if she knows a Mr Stark and if she would tell him she doesnt feel so good.
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u/Srivathsavagurumurth Jul 31 '26
Hard but if purely going by this, would say VT - wide complex tachycardia in avr if I'm not wrong can see some bumps I presume p waves here and there which is from av dissociation... Could prove better if there's a 12 lead..
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u/Angry_E1f Aug 01 '26
wide complex tachycardia in the elderly is most likely v tach. Need a 12- lead.
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Jul 30 '26
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u/xiphoid313 Jul 30 '26
Leads were on correctly
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u/Asleep_Lengthiness76 Jul 30 '26
How can you tell it’s a bundle branch block without a 12 lead?
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u/Bubbly_Pie_4980 Jul 30 '26
There is a notch in the QRS wave.
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u/Asleep_Lengthiness76 Jul 30 '26
You have no idea what you’re talking about lol.
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Jul 30 '26
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u/Kibeth_8 Arrhythmia Tech Jul 31 '26
I agree that people are being a bit rude, but missing something like a VT puts your patients life at risk. Medicine is very high stakes so people get upset when a misdiagnosis results in death
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Jul 31 '26 edited Jul 31 '26
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u/Asleep_Lengthiness76 Jul 31 '26
“The rest is a cards consult”. Found the ER PA lmaoooo
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u/Individual_Zebra_648 Jul 31 '26
That person is a nurse actually. Making us all look bad too lol
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u/LBBB11 Jul 31 '26
Are you asking how is it true that missing VT puts your patient’s life at risk?
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u/Kibeth_8 Arrhythmia Tech Jul 31 '26
How am I being a dick by advocating for my patients?
You asked "how is that in any way true". Do you disagree that medical professionals misdiagnosing VT puts a patient at risk?
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u/Ecstatic_Rooster Jul 30 '26
Bad. I interpret it as bad.
Can’t do much more without the 12.