This is a good example of ventricular tachycardia with PRECORDIAL CONCORDANCE. The QRS complexes in the chest, or precordial, leads all point downward. When the precordial leads are all negative or all positive in a wide-complex tachycardia, there is virtually a 100% chance that the WCT is ventricular tachycardia. This ECG shows many characteristics of VT, including the extreme "backwards" axis: aVR is positive and II, III, and aVF are negative. Lead I is almost equiphasic. Also, the lack of a clear BBB pattern and a negative V6 are strongly suggestive of VT. REMEMBER: In the treatment of wide-complex tachycardia, the rhythm should be considered VT unless proven otherwise. This is especially true in unstable patients, patients over 50 years old, and patients with known heart disease.
INSTRUCTORS' NOTE: We purposely left the machine interpretation on this week's ECG of the Week. How many errors did the machine make? This might be a good teaching point for students of all levels.
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