Wide-complex tachycardia in a gentleman with a cardiac history including prior MI – think no further about the etiology of this rhythm…this is V tach.
What to do? Remember ACLS protocols (and common sense) – this gentleman is having chest pain. With his history, wouldn’t you like to see what is going on under all that wide-complex tachycardia? Besides, although his vital signs are currently stable, do we ever let people with active chest pain sit about with a heart rate of 180? Seriously, even though he seems very stable, this rhythm needs to be treated aggressively – electricity is the right answer.