Ventricular Rhythms

Question 1

Ventricular Rhythms include

Answer 1

■ Asystole
■ Ventricular Tachycardia (VT)
■ Ventricular Fibrillation (VF)
■ Torsade de Pointes

Question 2

Ventricular Arrhythmias

Answer 2

● Ventricular Rhythms originate in the ventricles, below the AV Bundle.
Thaler, M. S., MD. (2015). The Only EKG Book You’ll Ever Need (8th ed.). Lippincott Williams & Wilkins.
● Because impulses are generated from within the ventricles, atrial kick is lost
and cardiac output decreases by as much as 30-50%
● Even though Ventricular Rhythms may be benign, some are potentially lethal.

Question 3

Asystole

Answer 3

● Asystole is simply the lack of a rhythm.
● It’s not really Sinus, Atrial, Junctional, or
Ventricular.
● Asystole is a form of cardiac arrest that is
managed by ACLS Protocols.
○ Make sure leads are hooked up right

Question 4

Asystole EKG characteristics

Answer 4

○ Regularity = None
○ Rate = None
○ P Waves = None
○ PR Interval = None
○ QRS Complex = None

Question 5

Ventricular Tachycardia (VT) EKG characteristics

Answer 5

○ Regularity = Generally regular (although can be slightly irregular)
○ Rate = Usually between 120-200 BPM
○ P Waves = Usually none, but if present, no relationship to QRS
○ PR Interval = Not available
○ QRS Complex = Greater than 3 little boxes, may be difficult to differentiate T Wave

Question 6

What is this rhythm showing?

Answer 6

V-tach

Question 7

_____ may precede ventricular fibrillation and sudden cardiac death

Answer 7

V-Tach

Question 8

There are two different morphologies of V-Tach:

Answer 8

○ Monomorphic: Uniform appearance.
○ Polymorphic: Changing appearance. (Below is Torsade, a form of polymorphic V-Tach)

Question 9

What is this showing?

Answer 9

Ventricular Tachycardia (VT) that is Monomorphic

Question 10

What is this showing?

Answer 10

V-tach that is polymorphic (torsade in this one)

Question 11

Torsade de Pointes

Answer 11

● A form of VT where the amplitude of the wide QRS complexes goes up and down
due to the axis of the vector “spiralling” around baseline.

Question 12

Torsade de Pointes EKG Characteristics:

Answer 12

○ Regularity = Regular or irregular
○ Rate = Rapid and often chaotic
○ P Waves = None
○ PR Interval = None
○ QRS Complex = Chaotic, usually wide

Question 13

Torsade de pointes, which means “twisting of the points,” is a unique form of
ventricular tachycardia that is usually seen in patients with _____

Answer 13

prolonged QT intervals

Question 14

Cause of prolonged QT

Answer 14

Prolonged QT can be caused by several prescription medications, congenital reasons,
electrolyte disturbances, and myocardial infarction (more to come in future unit).

Question 15

For Torsade, the TOC is

Answer 15

the acute drug of choice is Magnesium IV

Question 16

Ventricular Fibrillation (VF) EKG characteristics

Answer 16

○ Regularity = Totally chaotic
○ Rate = Rapid and chaotic discharges, rate usually undeterminable
○ P Waves = None
○ PR Interval = None
○ QRS Complex = Not discernable, no true QRS complexes

Question 17

Ventricular Fibrillation (VF)

Answer 17

● Ventricular fibrillation is a preterminal event, seen almost solely in dying hearts. It is the
most commonly encountered arrhythmia in adults who experience sudden cardiac death
● There are no true QRS complexes, just fibrillatory waves. Because of this, the heart
generates no meaningful cardiac output. ACLS protocol must be performed at once.

Question 18

What is this showing?

Answer 18

V-Fib

Question 19

Besides deteriorating VT, other
causes of V-fib are:

Answer 19

MI, heart failure,
hypoxemia, hypercapnia, shock,
electrolyte disturbances,
stimulant overdose, etc.

Question 20

Points of difference between ventricular and supraventricular rhythms

Answer 20

Whether Atrial polarization is seen or not
Width of the QRS complexes