Ventricular tachycardia is a fast rhythm that starts in the ventricles, seen on the ECG as wide QRS complexes at a rate over 100. It usually occurs with structural heart disease such as an old heart attack scar or cardiomyopathy, and it can cause collapse or turn into ventricular fibrillation.
Key symptoms
- Palpitations or a racing heartbeat
- Lightheadedness or fainting
- Chest pain or shortness of breath
- Sudden collapse with no pulse
What you find on exam
- Check for a pulse first
- Blood pressure, mental status and signs of shock
- Signs of heart failure: crackles, raised jugular venous pressure
- History of heart attack, cardiomyopathy or heart surgery
Tests
- 12-lead ECG if stable: regular wide QRS of 120 ms or more, AV dissociation, capture or fusion beats
- Potassium and magnesium
- Troponin and echocardiogram to look for ischemia and pump function
- Electrophysiology study in selected patients
Treatment basics
- No pulse: CPR and defibrillation, as for ventricular fibrillation
- Pulse but unstable: synchronized cardioversion
- Stable: amiodarone 150 mg IV over 10 minutes or procainamide, with expert consultation
- Correct potassium and magnesium and treat ischemia
- Long term: ICD, beta blocker or catheter ablation
Red flags
- No pulse: start CPR and defibrillate
- Low blood pressure, chest pain, confusion or shock
- Treat any wide-complex tachycardia as VT until proven otherwise
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Sources: AHA Guidelines for CPR and ECC; NASEMSO National Model EMS Clinical Guidelines; NCCPA PANCE Content Blueprint. Written by Making Synapses. Making Synapses is not affiliated with these organizations.