When you hear hoof beat, think the horse not the zebra !

 again Sustained Monomorphic VT.!
From clinical stand point ,
1) patient has LV systolic heart failure . and CMP so this is VT favors otherwise.
2) These patients are in increased risk o

f ventricular arrhythmias and SCD. POOR prognosis.
3) there is AV dyssynchrony that itself is one of two methods that we can measure lower LVEF of patients BY ECG>
4) patients is old age and dyspenic , hemodynamically patient is unstable , because , old age , dyspnea and EF heart failure . ( hemdynamically unstable is not mean BP or other sign and symptom traditionally )
ECG analysis.
single -lead rhythm strip analysis for VT:
1) presence of unusually wide QRS complex in wider one . 160ms.
2) presence of comple AV dissociation ( lead ii.iii,v1)
3) presence of ventricular capture complexes and sinus fusion complex.(lead 1 , 2.V5, v3 etc)
4) presence of VA conduction .
12 leads ECG .Positive BRUGADA criteria for WCT
1) there is RS complexes in precordial leads ;the RS is very deciptive for differentiating RS or QS in as such conditions . but we can see obviously the QS in V1. v2. v3. so then VT is favors than others.
2) RS duration is more than 100 ms in prolonged QRS ones ( v1 . v5 .v6 ) .
3) Av dissociation is there .
4) Morphologic Criteria is also positive that patient has LBBB pattern .
when this criteria for Diagnosis of VT is confirmed sensitivity , specificity and positivity of predictive value is going more than 90% .
Rx: So this patient , is Sustained Monomorphic VT , hemndynamically unstable and . DC shock , then ICD for future is advised .
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If the diagnosis of VT cannot be confirmed , the ECG should be evaluated for wide Complex SVT . if the diagnosis remains uncertain after careful evaluation of the side complex tachycardia practice guidelines recommend that the tachycardia should be managed as VT.Written by : Dr.Nabil Paktin