This wide-complex tachycardia is ventricular tachycardia. Along with the wide QRS and the fast rate, features which favor a diagnosis of VT over BBB include: backwards (extreme right) QRS axis, negative QRS in V6, and an apparently monophasic QRS in V1, as opposed to the rSR' pattern of right bundle branch block.
Remember, ALL wide-QRS tachycardias should be treated as V Tach until proven otherwise, as it is a life-threatening arrhythmia. Factors which lower cardiac output during V Tach include: Fast rate, wide QRS, and lack of P wave preceding the QRS. The sudden severe lowering of perfusion that usually accompanies V Tach can lead to rapid deterioraton and ventricular fibrillation.
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