Ventricular Tachycardia

Question 1

Define Ventricular Tachycardia?

Answer 1

A regular broad-complex tachycardia originating from a ventricular ectopic focus
The rate is usually > 120 bpm

Question 2

What is the aetiology of Ventricular Tachycardia?

Answer 2

Electrical impulses arise from a ventricular ectopic focus

Question 3

What are the risk factors of Ventricular Tachycardia?

Answer 3

Coronary Heart Disease
Structural Heart Disease
Electrolyte Deficiencies (e.g. hypokalaemia, hypocalcaemia, hypomagnesaemia)
Use of stimulant drugs (e.g. caffeine, cocaine)

Question 4

What is the epidemiology of Ventricular Tachycardia?

Answer 4

Fairly common
It is one of the shockable rhythms that is seen in cardiac arrest patients
VT incidence peaks in the middle decades of life

Question 5

What are the presenting symptoms of Ventricular Tachycardia?

Answer 5

Symptoms of ischaemic heart disease or haemodynamic compromise due to poor perfusion:
Chest Pain
Palpitations
Dyspnoea 
Syncope

Question 6

What are the signs of Ventricular Tachycardia dependent on?

Answer 6

Degree of haemodynamic instability

Question 7

What are the signs of Ventricular Tachycardia on physical examination?

Answer 7

Respiratory Distress
Bibasal crackles 
Raised JVP
Hypotension
Anxiety 
Agitation
Lethargy 
Coma

Question 8

What investigations do we do for Ventricular Tachycardia?

Answer 8

ECG
Electrolytes
Drug Levels (e.g. check for Digoxin toxicity)
Cardiac Enzymes (e.g. troponins to check for recent ischaemic event)

Question 9

What are the ECG features of Ventricular Tachycardia?

Answer 9

Rate> 100 bpm
Broad QRS complexes
AV dissociation

Question 10

What is sometimes the problem with diagnosing Ventricular Tachycardia?

Answer 10

It can sometimes be difficult to distinguish between VT and SVT with aberrant conduction
If in doubt, treat as a Ventricular Tachycardia

Question 11

Why do we measure Electrolyte levels for Ventricular Tachycardia?

Answer 11

Derangement can cause arrhythmias

Question 12

What is the management plan for Ventricular Tachycardia?

Answer 12

ABC approach

Check whether the patient has a pulse or not

Question 13

What do we do for Pulseless Ventricular Tachycardia?

Answer 13

Follow Advanced Life Support algorithm

Question 14

What do we do for Unstable Ventricular Tachycardia?

Answer 14

Reduced cardiac output
Correct electrolyte abnormalities
Amiodarone

Question 15

What do we do for the management of stable Ventricular Tachycardia?

Answer 15

These patients don’t experience symptoms of haemodynamic compromise
Correct Electrolyte abnormalities
Amiodarone
Synchronised DC shock (if steps above are unsuccessful)

Question 16

Which conditions require defibrillation?

Answer 16

VF and Pulseless VT require defibrillation (unsynchronised), but other Ventricular Tachycardia’s can be treated with synchronised cardioversion

Question 17

When are Implantable Cardioverter Defibrillator’s (ICD) considered?

Answer 17

If:
Sustained VT causing syncope
Sustained VT with ejection fraction < 35% 
Previous cardiac arrest due to VT or VF 
MI complicated by non-sustained VT

Question 18

What are the possible complications of Ventricular Tachycardia?

Answer 18

Congestive cardiac failure
Cardiogenic Shock
VT may deteriorate into VF