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She was awake, alert, well perfused, with normal mental status and overall unremarkable physical exam except for a regular tachycardia, possible rales at both bases, some mild RUQ abdominal tenderness. Thus, I believe it is a regular, monomorphic, wide complex tachycardia. There is mild-moderate tricuspid valve regurgitation.
An initial electrocardiogram (ECG) is provided below. While the initial impression might not immediately suggest ventricular tachycardia (VT), a closer examination raises suspicion. This physical exam sign is seen with AV dissociation — and results from right atrial contraction against a closed tricuspid valve.
Abstract Introduction Typical atrial flutter (AFL) is a macroreentrant tachycardia in which intracardiac conduction rotates counterclockwise around the tricuspid annulus. The 12-lead electrocardiogram (ECG) and three-dimensional (3D) electroanatomical maps were analyzed.
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Electrocardiogram 
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