ECG case series for paramedics: November 2023

This 72-year-old man has been experiencing increasing shortness of breath recently. On occasion, he can also feel his heart racing and feels particularly unwell when these episodes occur.

He has a significant cardiac medical history. He had an anterior ST-segment elevation myocardial infarction (STEMI) 6 years ago, and a further non-STEMI (NSTEMI) last year. He had a tissue aortic valve replacement for aortic stenosis 15 years ago. A diagnosis of heart failure was made more recently. His echocardiogram shows significantly impaired left ventricular function and a low ejection fraction of 35%.

This morning, while getting washed, he felt extremely unwell and lowered himself to the ground. He was short of breath and distressed. He was also aware of his heart racing.

His daughter immediately called for an ambulance. Cardiac monitoring was commenced and his ECG rhythm is shown in Figure 1.

This is an example of a ‘broad complex tachycardia’ and, in this case, is sustained ventricular tachycardia (VT).