Ventricular Tachycardia in Acute Myocardial Infarction
A 67-year-old woman arrived via ambulance in ventricular tachycardia. She had been experiencing crushing substernal chest pain and shortness of breath that had worsened over the past several hours. She received oxygen (by mask) and lidocaine (100 mg intravenously) en route to the emergency department (ED), but there was no change in the rhythm.
Figure 1 – The
wide-complex tachycardia
seen on the ECG obtained at the patient’s arrival in the emergency department, with a rate of 180 beats per minute and a leftward axis, suggests ventricular tachycardia.
Figure 2 – This ECG, obtained after cardioversion with 150 J of biphasic energy, shows
normal sinus rhythm,
with a rate of 90 beats per minute and normal intervals. Note the ST-segment elevation in V
1
through V
4
, consistent with an acute anteroseptal wall infarct. The ST-segment depression in leads II, III, and aVF and laterally in leads V
5
and V
6
is consistent with ischemia.
A 67-year-old woman arrived via ambulance in ventricular tachycardia. She had been experiencing crushing substernal chest pain and shortness of breath that had worsened over the past several hours. She received oxygen (by mask) and lidocaine (100 mg intravenously) en route to the emergency department (ED), but there was no change in the rhythm.
The patient had several risk factors for coronary artery disease: hypertension, hyperlipidemia, a multiple pack-year smoking history, and a previous myocardial infarction (MI). Multiple medications had been prescribed, but she did not take them regularly.
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