Practice - Mayan (5-13.1-2025)

Hi Mayan.

Yes — Regular WCT ( = Wide-Complex Tachycardia) rhythm without clear sign of atrial activity:

• The QRS is very wide.
• Marked right axis alone is actually not discriminating unless there is “extreme” axis deviation. By that I mean that the QRS is ALL negative (no r wave at all) in EITHER lead I or lead aVF.
• So there IS an R wave here in lead I — which means that there is not “extreme” axis. That said — the initial R wave in lead I is WIDE! — and THAT is clearly abnormal (ie, slow initial conduction — which suggests that the impulse originate outside of the conduction system).
• But as you say — there is MUCH more that suggests VT = very wide and amorphous ( = formless) QRS in V1 that does not look at all like rbbb conduction — and even though it is full of artifact, it looks like the QRS is all negative in lead V6, which almost always by itself means VT.
• Bottom Line: The QRS is very wide — it has slow initial conduction in many lead — and it does not at all resemble any known form of conduction defect. Assuming there is no “toxicity” producing the marked QRS widening (ie, no hyperkalemia, no sodium-channel blocker toxicity) — this is 99% likely to be VT.

Hope that helps — :)