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Patient
64-year-old man with inferior myocardial infarction 8 years previously; ejection fraction of 45%; sensation of palpitations with lipothymia; ECG recorded upon entry to the emergency department;
Trace
Regular, monomorphic, broad QRS tachycardia of 180 bpm; right delay (positive QRS in V1, negative in V6), left axis (negative in inferior leads); atrial activity difficult to identify; possible atrial activity synchronized 1:1 in the ascending portion of the T wave (negative in lead III); probable retrograde atrial activity; probable diagnosis of ventricular tachycardia originating from the infarction sequela (inferior left ventricular wall);
Trace
Tracing recorded the day after the termination of the tachycardia; sinus rhythm, first degree atrioventricular block; sequela of inferior necrosis (q wave in leads II, III, aVF); parietal block with moderately widened QRS (122 ms);
Exergue
During an episode of ventricular tachycardia due to a myocardial infraction related scar, the morphology of the QRS complexes is dependent on the location of the scar. It is possible to document different morphologies in a patient for the same infarction scar, the point of emergence of the activation wave from the intra- or peri-lesional tissue having the ability to change.
Substantial progress in the prevention, diagnosis and treatment of coronary syndromes has led to a significant prolongation of survival after the occurrence of a myocardial infarction.