The Fusion is the Clue


A 30 yo with no known significant PMHx is c/o of SOB. This telemetry strip is:



Image 1 -  Fusion beat is marked with a red arrow which means the wide QRS complexes are ventricular ectopics (VT)

There are 3 QRS morphologies on this rhythm strip. QRS #4 is a sinus beat. QRS #5 is a fusion beat and the rest are VT in morphology. A fusion beat (aka "Dressler beat") is a QRS that has a morphology that is INTERMEDIATE between a sinus QRS and that of a ventricular complex. This intermediate QRS morphology is due to the simultaneous ventricular myocardial activation by a supraventricular impulse (sinus) and a ventricular ectopic.

Thus, this telemetry strip is SR with ventricular tachycardia (VT).

#709


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