ECG Interpretation — Physician Level

Meet the patient

A 72-year-old man arrives breathless and hypotensive at 3am. The nurse hands you a tracing: a regular broad-complex tachycardia at 180 per minute. The registrar calls it SVT with aberrancy and reaches for verapamil. ^[1]

Stop. A regular broad-complex tachycardia in a patient with a cardiac history is ventricular tachycardia until proven otherwise — and an AV-nodal blocker given to VT can collapse the circulation. The five-step sequence tells you that in the time it takes to read the strip. Hold that sequence and every ECG below slots into place. ^[1]

References8ShowHide

1. [1]Kligfield P, Gettes LS, Bailey JJ, et al. Recommendations for the standardization and interpretation of the electrocardiogram: part I: The electrocardiogram and its technology: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: endorsed by the International Society for Computerized Electrocardiology Circulation, 2007.PMID 17322457
2. [2]de Zwaan C, Bär FW, Wellens HJJ Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction Am Heart J, 1982.PMID 6121481
3. [3]de Winter RJ, Verouden NJW, Wellens HJJ, Wilde AAM A new ECG sign of proximal LAD occlusion N Engl J Med, 2008.PMID 18987380
4. [4]Sgarbossa EB, Pinski SL, Barbagelata A, et al. Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) Investigators N Engl J Med, 1996.PMID 8559200
5. [5]Schwartz PJ, Moss AJ, Vincent GM, Crampton RS Diagnostic criteria for the long QT syndrome. An update Circulation, 1993.PMID 8339437
6. [6]Priori SG, Wilde AA, Horie M, et al. HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes: document endorsed by HRS, EHRA, and APHRS in May 2013 and by ACCF, AHA, PACES, and AEPC in June 2013 Heart Rhythm, 2013.PMID 24011539
7. [7]Thygesen K, Alpert JS, Jaffe AS, et al. Fourth Universal Definition of Myocardial Infarction (2018) Circulation, 2018.PMID 30571511
8. [8]Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay Circulation, 2019.PMID 30586771