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Challenges in Clinical Electrocardiography
December 2016

An Unusually Wide QRS Complex Tachycardia in a Patient With Hemodynamic Instability

Author Affiliations
  • 1Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325 000, China
JAMA Intern Med. 2016;176(12):1857-1859. doi:10.1001/jamainternmed.2016.6668

A man in his 60s was admitted to the emergency department with severe persistent chest tightness associated with dyspnea. On admission, the patient was hemodynamically unstable, with a blood pressure of 86/59 mm Hg and a heart rate of 140 bpm. The patient could not lie in supine position owing to orthopnea. His heart and lung examinations were remarkable for the presence of rapid and regular heart sounds, with S3 gallop and bilateral basal crackles. The initial electrocardiogram (ECG) showed a regular, wide QRS complex tachycardia (WCT) with no clearly identifiable P waves and a ventricular rate of 140 bpm (Figure 1). The tachycardia QRS complex appeared very broad. The tachycardia had left-axis deviation (LAD) and no typical bundle branch block pattern (qR in leads V1-V3 and R in leads V5-V6).

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