Mon25October0844PM 14

A 75-year-old woman is admitted with a pre-syncopal episode.

She had felt as though she was going to 'black out' whilst out shopping and an ambulance was called. She denies any history of chest pain or shortness of breath. She has a past history of hypertension for which she has been taking a diuretic.

On examination she is conscious and has a BP of 85/50 mmHg. Her ECG is shown below.

Which of the following is the most likely diagnosis?

(Please select 1 option)

Torsades de pointes

Ventricular tachycardia Correct

Ventricular fibrillation

Atrial tachycardia with aberrant conduction

SVT with aberrant conduction

Explanation

The ECG shows a wide complex tachycardia with a rate of about 200 with marked left axis deviation.

On careful examination of the rhythm strip there is evidence of independent atrial activity; P waves can be seen 'marching through' the QRS complexes.

Even without demonstrating independent P waves, the QRS width, axis deviation and rate all suggest a ventricular origin rather than a supraventricular origin.

This is not torsades as there is no characteristic twisting about the isoelectric line, and it is not VF since there is a regular pattern to the QRS complexes.

Another possibility (not listed here) is ventricular flutter but this would normally have an even higher rate.

Answer Statistics

1

3%

2

58%

3

1%

4

9%

5

31%

Times answered: 276