[Music] hi there marius here with the resuscitation coach on this channel we do all things resuscitation so please consider subscribing in our fourth video of our ecg made easy series we'll be discussing ventricular tachycardia so let's jump straight in here we go [Music] ventricular rhythms originates in the ventricles below the bundle of his the usual conduction pathway from the sa node through the av node into the ventricles is not used resulting in a widened qrs complex the intrinsic rate of the ventricles are 20 to 40 beats per minute so let's look at an idioventricular rhythm the rate is 20 to 40 per minute the rhythm is regular p waves are absent as asterism originates inside the ventricles and there is also no pr interval and the qrs complexes as it's originating with inside the ventricles is white the accelerated idio ventricular rhythm looks exactly like an idioventricular rhythm except for the rate which is 40 to 100 beats per minute the rhythm is still regular the p waves are absent as the rhythm originates inside the ventricles we do not have a pr interval and the qrs complex is wide what would you call this ecg it's a normal sinus rhythm with one premature ventricular contraction or pvc a pvc is a single ectopic impulse originating in the ventricles it's caused by electrical irritability in the ventricular conduction system or muscle tissues pvcs can be unifocal meaning they arise from the same irritable focus inside the ventricle or multifocal which means they are rising from multiple irritable focuses inside the ventricles they can also occur either singly or in clusters of two or more you get bygeminy trigeminy and quadrigemini here we see one normal sinus beat and then a pvc one normal sinus beat and another pvc and this pattern continues throughout the strip what do we call this repeating pattern that's correct it's called by gemini here we see two normal sinus beads and then a pvc two normal sinus beads and another pvc and this pattern continues throughout the strip what do we call this repeating pattern that's correct it's called trigeminy here we see three normal sinus speeds then a pvc three normal sinus beats then a pvc and again this pattern continues throughout the strip what do we call this repeating pattern that's correct it's called quadri germany what would you call this ecg look at the pvcs they look different meaning they come from different areas inside the ventricle this ecg is called a normal sinus rhythm with multifocal pvcs what would you call this ecg look at the pvcs with the green arrows before the normal sinus beat here we see a normal sinus rhythm with two pvcs these are called normal zionist rhythm with couplets i remember couplets by two people that are together is called a couple what would you call this ecg here we see three pvcs in a row yes it's a ventricular tachycardia ventricular tachycardia is a tachycardia that originates inside the ventricles it is defined as three or more consecutive pvcs in a row occurring at a rate of 150 to 250 beats per minute this is called a run of vt this slide illustrates monomortic ventricular tachycardia vt can be sustained and usually degenerates into vf or non-sustained treatment is initiated based on the clinical presentation if you see this rhythm what should be the first thing you do that's correct check for a pulse as this can be a pulseless ventricular tachycardia which requires high quality cpr and defibrillation or a vt with a pulse that could either be stable or unstable here our rate is 100 to about 250 the rhythm is regular p waves are usually not seen the pr interval is not applicable and the qrs complex is wide here we see the difference between an svt on top and a vt you will notice that the svt has a narrow qrs complex versus the vt which has a white complex don't get confused between them as they have different treatment protocols what does this slide illustrate this slide shows a polymorphic ventricular tachycardia the rate is 150 to 250 per minute the rhythm is irregular p waves is absent there is no pr interval and the qrs complex is wide let's review another type of polymorphic ventricular tachycardia called torsades the point the qrs complex appears to twist in a spiral pattern around the baseline in french it means twisting at the points the rate is variable at about 250 to 350 and the outline of those looks like a twisted ribbon so again our rate photo sides is 250 to 350 the rhythm is irregular p waves is absent we do not have a pr interval and the qrs complexes is white ventricular fibrillation or vf is the result of chaotic electrical activity in the ventricles from either a repetitive re-entry circuit or a series of rapid discharges from the various irritable foci within the ventricles the fibrillating ventricles do not have effective contraction meaning no blood is circulating and the only treatment that will help is immediate high quality cpr and defibrillation the top rhythm strip is a sample of a coarse vf a vf in the initial stages of cardiac arrest versus fine vf meaning the rhythm has been in vf for a while let's see what vf looks like in real life see how the heart muscle is quivering again be reminded that there's no cardiac output and immediate cpr anti-fibrillation is needed here we see the difference between vf which is on top which is an ecg full of chaos versus torsades which is a rhythm with a pattern let's have a look at a meaning there is no electrical activity and this is typically a rhythm that we will see at the end of cardiac arrest management if you benefited from this video kindly like subscribe and smash that notification bell and please leave a comment down below as he does help out our channel with the youtube algorithm have a fantastic day we'll see you in the next video