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ECG of the week #14: 65 year old with palpitations – SVT or VT?

Test yourself with this week’s ECG case. Then scroll down for a structured step-by-step interpretation and clinical pearl.

Clinical Scenario

A 65 year old with coronary artery disease presented with palpitations and normal blood pressure.

ECG

Question

Is this SVT or VT, and what’s the treatment?

ECG Analysis

H: regular wide complex tachy at 120, without P waves
E: LBBB morphology but slow rS V1-2
A: left axis, positive aVR
R: late transition in V6
T: normal
S: secondary

Answer

monomorphic VT

Clinical Pearl

1. pre-test: 65 year old with history of coronary artery disease = high pre-test likelihood VT >SVT
2. test: atypical features for normal LBBB: slow rS, positive aVR, late transition
3. post-test: both VT and SVT are primary arrhythmias – so just cardiovert!

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Clinical Scenario
ECG
Question
Analysis
Answer
Clinical Pearl

ECG of the week #14: 65 year old with palpitations – SVT or VT?

Clinical Scenario

ECG

Question

ECG Analysis

Answer

Clinical Pearl

Want to get better at ECG interpretation?

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