Ventricular Tachycardia (VT/V-Tach)
Ventricular Tachycardia (VT/V-Tach)
David Ray Velez, MD
A Wide Complex Tachycardia Originating from the Ventricles
EKG Pattern
- Heart Rate > 100 bpm
- Wide QRS Complex (≥ 120 ms)
- No Fixed Relationship of P Wave and QRS Complex
Ventricular Tachycardia (VT/V-Tach)
Duration
- Non-Sustained Ventricular Tachycardia: Self-Terminates within 30 Seconds
- Generally Not an Immediate Threat to Life
- Sustained Ventricular Tachycardia: Lasts > 30 Seconds
- Can Cause Hemodynamic Instability and Collapse
Morphology
- Monomorphic Ventricular Tachycardia: All Beats Have the Same Appearance – Most Common
- Originates from a Single Ectopic Foci in the Ventricles
- Polymorphic Ventricular Tachycardia: There is Beat-to-Beat Variation
- Originates from a Multiple Ectopic Foci in the Ventricles
- Torsades de Pointes – Refers to Polymorphic Ventricular Tachycardia with a Prolonged QT
Causes
- Myocardial Ischemia – Most Common
- Hypokalemia, Hypomagnesemia, and Hypocalcemia
- Sepsis
- Metabolic Acidosis
- Dilated Cardiomyopathy
- Hypertrophic Cardiomyopathy
- Chaga’s Disease
Treatment
- Non-Sustained Ventricular Tachycardia Can Generally Be Managed by Close Monitoring with Treatment of Any Underlying Disorders
- Pulseless Ventricular Tachycardia (pVT): Start CPR and Follow ACLS Guidelines
- Unstable: Synchronized Cardioversion
- Stable: Amiodarone
- Initial IV Bolus: 150 mg Bolus and Repeat if Necessary
- Continuous Infusion: 1 mg/min for 6 Hours, then 0.5 mg/min
- *See Antiarrhythmic Pharmacology
Cardiac Arrest Management Algorithm:
Immediate CPR and Oxygen
Check Rhythm Every 2 Minutes:
- VF/pVT:
- Defibrillate
- Alternate Epinephrine and Amiodarone After Each Check
- PEA/Asystole:
- Epinephrine After Every Other Check
Adjuncts:
- Calcium Chloride
- Sodium Bicarbonate