A 60 year old man with Ischaemic Heart Disease.

Polymorphous ventricular tachycardia (Torsade de pointes).

• This is a form of VT where there is usually no difficulty in recognising its ventricular origin.
• wide QRS complexes with multiple morphologies
• changing R - R intervals
• the axis seems to twist about the isoelectric line
• it is important to recognise this pattern as there are a number of reversible causes
  • heart block
  • hypokalaemia or hypomagnesaemia
  • drugs (e.g. tricyclic antidepressant overdose)
  • congenital long QT syndromes
  • other causes of long QT (e.g. IHD)