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Sinus tachycardia masquerading as ventricular tachycardia.
1Department of Internal Medicine, School of Medicine, Tokai University, Kanagawa, Japan.
The Tokai Journal of Experimental and Clinical Medicine
|March 1, 1990
Summary
This case study highlights a diagnosis of sinus tachycardia with a tachycardia-dependent left bundle branch block in an elderly patient presenting with chest pain and dyspnea. It emphasizes considering sinus tachycardia with bundle branch block in wide QRS tachycardia emergencies.
Area of Science:
- Cardiology
- Emergency Medicine
- Electrocardiography
Background:
- Wide QRS tachycardia is a common emergency presentation.
- Distinguishing between different causes of wide QRS tachycardia is critical for appropriate management.
- Left bundle branch block can complicate the interpretation of electrocardiograms during tachycardia.
Observation:
- An 87-year-old male presented with dyspnea and chest pain.
- Electrocardiogram revealed wide QRS tachycardia, left bundle branch block pattern, and low voltage in lateral leads.
- Analysis of P waves suggested sinus origin despite aberrant conduction.
Findings:
- The patient was diagnosed with sinus tachycardia with a tachycardia-dependent left bundle branch block.
- Low voltage in lateral leads was attributed to left-sided pneumothorax.
- Premature ventricular complexes were noted, with sinus beats showing consistent P wave morphology.
Implications:
- In emergency settings, sinus tachycardia with coexistent bundle branch block or aberrant conduction should be considered in wide QRS tachycardia.
- Pneumothorax can present with subtle electrocardiogram findings, including low voltage.
- This case emphasizes the importance of a comprehensive diagnostic approach in complex cardiac presentations.