This 68-year-old man with a longstanding history of coronary artery disease is brought to the Emergency Department complaining of palpitations, dyspnea and faintness:

• Ventricular tachycardia

The diagnosis of ventricular tachycardia is supported by:

• The clinical presentation: patient with known coronary artery disease, very symptomatic, with wide QRS tachycardia
• Very wide QRS (280 msec)
•  Unusual QRS pattern (right bundle branch block with single broad R wave in V1 and a QS pattern in I and V6) which suggests a ventricular arrhythmia rather than supraventricular tachycardia with aberrancy