Electrocardiogram of a 52-year old man with a history of myocardial infarction at the age of 25, 2 previous episodes of tachyarrythmias 11 and 10 years earlier, who presented to the Emergency Department with palpitations of several hours duration.

Rate 240/min
QRS 0.14 s
QRS axis – 60º

Interpretation: Abnormal. Extreme tachycardia with bizarre, prolonged QRS complexes of uniform morphology, indicative of monomorphic ventricular tachycardia. Possible retrograde V-A conduction.

The patient was hemodynamically stable, but the tachycardia did not respond to pharmacological agents. It was terminated by electrical cardioversion. The subsequent cardiogram (below) showed changes suggestive of previous anterior wall myocardial infarction. Coronary angiogram documented chronic proximal occlusion of the left anterior descending coronary artery (LAD), calcified apical aneurysm and severe left ventricular systolic dysfunction. The patient underwent implantation of the cardioverter-defibrillator (ICD).

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