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ClearRounds Health · Cardiology · Quick Reference
Ventricular Tachycardia / Ventricular Fibrillation
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Arrhythmias & DevicesAdvancedIn progressOne-page PDF
Stable vs unstable VT, reversible causes, ischemic evaluation, amiodarone/lidocaine concepts, ICD considerations, and escalation.
Covers both VT and VF.
Last reviewed
Pending initial clinical review
Sources / guidelines to verify
- 2017 AHA/ACC/HRS Ventricular Arrhythmias & SCD Guideline
- Current ACLS algorithms
Disclaimer: Educational reference only. Not a substitute for clinician judgment, local protocols, or current guideline review.
One-page reference
Draft content pending the site owner’s clinical review. Verify against the sources above and local protocol before clinical use.
1
What it is / why it matters
- VT = ≥3 consecutive ventricular beats >100 bpm; "sustained" if ≥30 s or causing hemodynamic compromise.
- VF = disorganized ventricular activity with no effective output → cardiac arrest.
- A wide-complex tachycardia is VT until proven otherwise — especially with prior MI or reduced EF.
2
Key diagnostic clues
- QRS >120 ms, AV dissociation, capture or fusion beats, very wide/bizarre QRS.
- Known structural heart disease, prior MI, or low EF strongly favors VT.
- Pulseless and unresponsive with VT/VF morphology = cardiac arrest.
3
Initial workup / reversible causes
- 12-lead ECG; continuous monitoring; electrolytes (K⁺, Mg²⁺, Ca²⁺).
- Ischemia evaluation (troponin; consider urgent coronary angiography).
- Review QT-prolonging and proarrhythmic drugs; echo for EF/structure.
- Address the H’s and T’s (hypoxia, hypovolemia, H⁺, hypo/hyperkalemia, hypothermia; tension pneumothorax, tamponade, toxins, thrombosis).
4
Management framework
Unstable / pulseless
- Pulseless VT or VF → immediate defibrillation + ACLS (CPR, epinephrine, antiarrhythmic).
- VT WITH a pulse but unstable (hypotension, ischemia, shock, altered mentation) → synchronized cardioversion.
Stable monomorphic VT
- IV antiarrhythmic (procainamide is often preferred for stable monomorphic VT; amiodarone is an alternative) or elective cardioversion.
- Do NOT give AV-nodal blockers when the wide-complex rhythm could be VT.
Polymorphic VT
- With long QT (torsades): IV magnesium, correct K⁺/Mg²⁺, stop offending drugs, overdrive pacing or isoproterenol.
- With normal QT: treat ischemia — it is often ischemic in origin.
After the event
- Correct reversible causes; an ICD is indicated for secondary prevention when VT/VF is not due to a fully reversible cause.
5
Red flags / escalate now
- Pulselessness → call the code and defibrillate immediately.
- Sustained VT, recurrent shocks, or electrical storm (≥3 episodes/24 h) → emergent escalation (antiarrhythmic, sedation, ischemia work-up, EP).
6
Clinic pearls
- The dangerous error is calling a wide-complex tachycardia "SVT with aberrancy" and undertreating — assume VT.
- Magnesium is first-line for torsades; verapamil/diltiazem can be lethal in VT.
7
Sources to verify
- 2017 AHA/ACC/HRS Ventricular Arrhythmias & Sudden Cardiac Death Guideline
- Current AHA ACLS algorithms
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