From the Guidelines
Ventricular tachycardia with a pulse is a life-threatening condition that requires immediate medical attention.
Definition and Diagnosis
According to the 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death 1, ventricular tachycardia (VT) is defined as a cardiac arrhythmia of ≥3 consecutive complexes originating in the ventricles at a rate >100 bpm. The diagnosis of VT with a pulse is typically made using a 12-lead ECG, which can help identify the characteristic wide-complex tachycardia pattern.
Management
The management of VT with a pulse depends on the patient's stability, as outlined in the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. If the patient is unstable, immediate cardioversion should be performed. If the patient is stable, the next step is to obtain a 12-lead ECG to evaluate the rhythm and consider the need for expert consultation.
- Stable VT: For stable patients with VT, the provider should consider the need for expert consultation and evaluate the patient's clinical status to identify potential reversible causes of the tachycardia 1.
- Unstable VT: For unstable patients with VT, immediate synchronized cardioversion or unsynchronized defibrillation should be performed if the arrhythmia deteriorates to VF or is due to a polymorphic VT 1. It is essential to note that the management of VT with a pulse requires a thorough evaluation of the patient's clinical status and identification of potential reversible causes of the tachycardia.
From the Research
Definition and Characteristics of Ventricular Tachycardia with a Pulse
- Ventricular tachycardia (VT) is an arrhythmia that originates from the ventricles of the heart, presenting as a wide and prolonged QRS complex on the electrocardiograph of greater than 120 milliseconds, with a heart rate of over 100 beats per minute 2.
- VT can occur as a pulsed or pulseless rhythm, with pulsed VT manifesting with the patient presenting asymptomatically, or with symptoms of reduced cardiac output resulting from poor ventricular filling 2.
- The symptom most suggestive of unstable ventricular tachycardia is a change in mental status or loss of consciousness 3.
Diagnosis and Management of Ventricular Tachycardia with a Pulse
- The diagnosis of VT is usually made based on electrocardiographic data, most commonly 12-lead echocardiography (ECG), as well as supportive cardiac telemetric monitoring 4.
- Accurate diagnosis of VT is important to allow prompt referral to specialist services for ongoing management 4.
- Stable ventricular tachycardia is managed with antiarrhythmic medications, while unstable ventricular tachycardia requires immediate cardioversion 3.
- Emergency treatment of VT follows the Advanced Cardiac Life Support (ACLS) algorithms for pulseless VT and stable and unstable VT with a pulse 5.
Key Considerations for Ventricular Tachycardia with a Pulse
- Understanding of the initial electrocardiographic pattern and subsequent changes can lead to early intervention and an improved outcome 6.
- VT can be caused by various conditions, including myocardial muscle deterioration and drug stimulation 3.
- There is the potential for the patient to quickly become haemodynamically unstable if not treated 2.