A 58-year-old man is admitted with unstable angina. Chest pain continued to occur despite maximal therapy. A few hours before his scheduled aorto-coronary bypass surgery, the patient developed palpitation, dyspnea and angina:

• Ventricular tachycardia, 126/min
• Capture and fusion complexes as noted below

Comment: There is a wide QRS tachycardia (QRS duration 135 msec) with right axis deviation and right bundle branch block pattern. The presence of capture and fusion complexes strongly supports the diagnosis of ventricular tachycardia.

The arrhythmia subsided spontaneously after 4 minutes

• Sinus rhythm, 70/min
• ST and T abnormality, consider antero-lateral ischemia
• Tall R wave in V2. The possibility of posterior infarction, age undetermined, should be considered.