✔Bidirectional VT
The tachycardia with an identity crisis.
What you'll see:
Beat-to-beat alternation in QRS axis (often ~180)
RBBB-like morphology, most visible in lead Il or aVF
Regular rhythm, but clearly not your standard VT
Why it most likely happens:
Triggered activity (delayed afterdepolarizations)
Classically: two competing ventricular foci or alternating fascicular exits
Top causes:
Digoxin toxicity (check that level!)
CPVT (stress-induced VT in the young)
Andersen-Tawil syndrome
Rare: aconite poisoning, myocarditis
Key point:
BiVT is rare - but when you see it, it narrows the differential dramatically.
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