hey everyone today I'm going to talk about ventricular tachycardia also known as v-tac what is ventricular tachycardia well it's an abnormal heart rhythm that originates from the ventricles hence why we call it ventricular tachycardia and the reason that this rhythm is occurring is because electrical conduction system is sending out an abnormal electrical signal that is causing those ventricles to just contract very rapidly and the problem with this rhythm is that these ventricles cannot pump Blood Out efficiently through the heart and if it can't do that cardiac output cannot be maintained so we really want to correct this as soon as we notice it now one thing you want to remember about this rhythm is that it can be short in duration and quip for example a patient can have a bunch of premature ventricular contractions also known as PVCs together like three or more in a row and we refer to this as v-tac or this Rhythm can be sustained where it's just continuing so what are some characteristics takes in criteria that tell you that you're dealing with ventricular tachycardia well the Hallmark finding in this Rhythm will be its QRS complex and the QRS complex is really the star of this Rhythm it's really easy to identify because the QRS complex is going to be really wide it's going to be greater than 0.12 seconds and it's going to look bizarre therefore because of this the ventricular rate is going to be very fast anywhere between 100 to 250 beats per minute and the rhythm is going to be regular because of this you really can't assess the T wave in addition you can't assess p waves either so you won't be able to determine the atrial Ray or its Rhythm or assess the PR interval and as you can see here in this Rhythm what really catches your eye is this bizarre looking QRS complex it's very wide it's regular and you can see that it's very fast you can't really see any p waves no PR intervals or T waves and here this is a classic example of ventricular tachycardia now a couple things you want to remember about vtac is that it can have various presentations vtac can appear monomorphic and refer to this as monomorphic v-tac and this is where its presentation is the same throughout or it can appear as polymorphic and we refer to this as polymorphic v-tac and this is where the Rhythm does not look the same throughout but it's different and one type of polymorphic v-tac is called torsods the plant and you want to be aware of these different presentations Because treatment is slightly different for each now what can cause v-tac well if a patient is having abnormal electrolyte levels especially abnormal potassium like hypokalemia it can lead to this or if a patient has had a myocardial infarction where there's a lot of damage to that heart tissue which will affect how the electrical conduction system can work plus medication toxicity can lead to this like ditch toxicity or if a patient has heart disease specifically like heart failure coronary artery disease or some type of valve disease but now let's say that your patient is in polymorphic v-tax such as torso as a plant what could cause this Rhythm well one of the most common causes is that the patient is taking a medication that prolongs that QT interval such as amioderone sodol or procainamide so you wouldn't want to give your patient these medications for treatment of this rhythm in addition a low calcium magnesium or potassium level can cause it now let's talk about the treatment for v-tac so with this Rhythm it requires immediate attention because it could easily progress to ventricular fibrillation which will lead to death now depending on where you're at how your patient is doing are they stable unstable they don't have a pulse you want to get help so some things you want to do is you want to activate the emergency response system you want to get supplies like Crash Cart defibrillator and you want to follow ACLS protocol so let's say that your patient is stable meaning they have no symptoms and they have a good pulse what can be ordered is like an antiarrhythmic medication such as amiodarone IV and if this doesn't convert them to normal sinus rhythm what could be considered as synchronized cardioversion which will help put that patient back into a normal Rhythm but let's say that your patient is unstable meaning they're having symptoms but they still have a pulse so their symptoms are revolving around decreased cardiac output because whenever that heart is pumping like this especially those ventricles it's not pumping very well so cardiac output will fall so you'll start to see hypotension mental status changes that pulse will be there but it'll be weak they'll be cool and clammy and they can have chest pain so what can be ordered for this is that synchronized cardioversion can be used where we can put them back into a normal Rhythm and then follow it up with like an antiarhythmic like amiodarone but now let's say we have worst case scenario our patient is in this Rhythm but they have no no pulse well what you want to do is you want to start CPR immediately so you'll be doing chest compressions defibrillation giving epinephrine and then other medications can be given throughout that time where you're doing chest compressions and defibrillating such as like amiodarone or lidocaine and then in addition you want to be securing that Airway now in regards to treatment for like let's say a polymorphic v-tac like torsods one thing that can be given is magnesium sulfate and then stopping any medications that prolong that QT interval so you would not want to give the patient amiodarone or propanamide because those increase that QT interval and of course if the patient is unstable has no pulse you'd want to treat it like the FIB with CPR and defibrillation and then once the patient is converted back to a normal Rhythm it may be necessary that they get an implanted ICD which is a cardioverter defibrillator to prevent any further episodes of this happening again okay so that wraps up this video on ventricular tachycardia and if you'd like to watch more ECG videos you can access the link in the YouTube description below