A 63-year-old woman with a history of alcoholic cirrhosis and chronic obstructive lung disease is admitted to the ICU with severe pneumonia and sepsis with sudden onset of tachycardia and hypotension:

• Wide QRS tachycardia – Ventricular tachycardia
• Left bundle branch block pattern

The sudden onset of tachycardia with wide QRS (>140 ms) and left bundle branch block pattern, associated with hypotension strongly supports the diagnosis of ventricular tachycardia. The pattern in lead II may raise the question whether a P wave precedes the QRS complex. Comparing the V1, II and V5 10 sec. strips it is obvious that the small positive wave in II is the initial portion of the QRS and not a P wave.

DC cardioversion was carried out successfully:

• Sinus tachycardia, 106/min
• Otherwise normal ECG