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This sample section comes from Basic Arrhythmia Interpretation, Lesson 8, Ventricular Rhythms
Ventricular Tachycardia(V-Tach, VT)What is "Ventricular Tachycardia?"Ventricular tachycardia occurs when an irritable or "ectopic focus" in the ventricles overrides the higher pacemaker site and takes control of the heart. Ventricular tachycardia is defined as a series of three or more consecutive PVC's. The causes are the same as PVC's: electrolyte imbalance, overuse of caffeine or alcohol, acid-base imbalance, drug-initiated ventricular irritability. What are the Key Identifying Features of Ventricular Tachycardia?The key identifying EKG features of Ventricular Tachycardia are easy to learn! This rhythm is very unique and recognizable. The rate is rapid (around 150-150 beats per minute) However, nobody stops to actually calculate the rate when you see this rhythm march across your monitor!! The rhythm consists only of QRS complexes, which are wide and bizarre (They look just like the QRS' you see with PVC's.) Before I summarize the Key features of Ventricular Tachycardia below, let me tell you a TRUE story (names have been changed to protect the innocent) to help you remember how to recognize Ventricular Tachycardia:
My good friend, Ginny, was working in an area hospital's ICU during
graduate school. The ICU had an SICU (Surgical Intensive Care Unit) on one side and a CCU
(Coronary Care Unit) on the other side.
One shift, she was working on the SICU side of the unit, and there was another
nurse, Sally, working on the CCU side. Sally was orienting
a new nurse, Margaret, to the CCU. This is a true story that will help you remember what Ventricular Tachycardia looks like. However, let me warn you: if you see Ventricular Tachycardia in the clinical setting, and say "Hey that patient has ghosts holding hands" everyone and I mean EVERYONE will think you are crazy and will NOT KNOW WHAT YOU ARE TALKING ABOUT! (You may have to use your imagination a little to identify with this story :-)
Ghosts holding hands
Summary of Key Identifying EKG Features Of Ventricular Tachycardia
What are the Hemodynamic Considerations of Ventricular Tachycardia?Ventricular Tachycardia is ALWAYS considered a worrisome arrhythmia that requires immediate attention! You must go to the bedside IMMEDIATELY AND RAPIDLY ASSESS THE PATIENT! The patient can have no cardiac output or a significant drop in the cardiac output with this rhythm. You will not know until you go to the bedside and assess your patient. There is usually a significant drop in cardiac output with this rhythm because there is loss of atrial contraction and decreased diastolic filling time related to rapid ventricular rate.
SymptomsThe symptoms seen with V-Tach depends on how much this rhythm has dropped the cardiac output in an individual patient. To know how to treat this rhythm you must immediately go to the bedside and assess the patient!!! (Pulse, blood pressure first then other assessment parameters if these are present.) The three scenarios you might find are:
The bottom line with this rhythm is that YOU DON'T KNOW HOW YOUR PATIENT IS DOING BY LOOKING AT THE MONITOR. YOU HAVE TO GO TO THE BESIDE TO ASSESS THE PATIENT!!!
Treatment
If the patient is pulseless, then start CPR and call for help. For pulseless Ventricular Tachycardia, the FIRST-LINE treatment is to defibrillate the patient. You must again be familiar with the treatment protocols where you work. Drugs that will be given during the code will include Epinephrine and Lidocaine. Click below to see the ACLS algorithm for Pulseless Ventricular Tachycardia. If the patient has a pulse but has symptoms of decreased cardiac output (low BP, chest pain etc.) then the first-line treatment is to start oxygen and an IV then to cardiovert the patient (more about that below.) The patient may also receive Lidocaine I.V. to help convert the rhythm. Click below to view the ACLS algorithm for Unstable Ventricular Tachycardia (with a pulse.) If the patient has Ventricular Tachycardia on the monitor and you determine through your assessment that the patient is stable (their BP is stable and they are not having chest pain or other symptoms of decreased cardiac output), then first-line treatment will be to start oxygen and an I.V. and to give the patient Lidocaine I.V. Click on the algorithm below to view the ACLS treatment algorithm for Stable Ventricular Tachycardia.
Now, let's look at a strip of Ventricular Tachycardia
Here is an example of the R on T phenomena that throws the patient into VTACH!
A BRIEF WORD ABOUT THE DIFFERENCE IN CARDIOVERSION AND DEFIBRILLATIONCardioversion and defibrillation of the patient both refer to using electricity or electrical current to artificially massively depolarize the heart so the SA node will (hopefully) pick back up and start pacing the heart in a normal fashion. The difference in cardioversion is that this electricity is delivered in a synchronized manner (you actually have to push a button on the machine to tell it to go in synchronize mode)--that is, the electrical current is delivered on the R wave of the QRS. So you have to have a rhythm of some kind to synchronize from. The other difference is that sometimes, lower dosages of electricity are used to start off with in cardioversion.
Treatment Algorithms for Ventricular TachycardiaThese algorithms are included in the lesson...
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Joy D. Kimbrell, RN,
MSN
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Treatment
for Ventricular Tachycardia depends on your assessment findings.
