An 83 year old lady presents with palpitations and central chest pain.

Her GCS is 15 but her BP is unrecordable.

Her ECG is as below.

Interpretation:

• Rate: 192
• Rhythm: Wide complex regular tachycardia
• Summary: VT

Indication for DCCV:

• Chest pain
• Shock: hypotension, failure, altered GCS
• Don’t forget to check for a pulse (!) – although in this case its safe to assume that with a GCS of 15 she has a palpable pulse.

You decide to go ahead with DCCV and are successful in reverting her to normal sinus rhythm. Her ECG post DCCV is below:

Discussion:

Main abnormality post DCCV if STE in AVR 1mm

Differential for this is LMCA occlusion vs diffuse subendocardial ischaemia.

Management would be for ACS (ie morphine, aspirin, ticagrelor, heparin + Angio)

In terms of clinical closure this lady had recently had an angiogram which showed no LMCA disease.

Further Reading – Textbook:

Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.