Megacode: Unstable Ventricular Tachycardia Part 1

A 45 year old male construction worker is brought to the ER by his foreman with complaints of intermittent chest pain, weakness, nausea, and difficulty breathing that began two hours ago on the construction site.  At first he thought it was just indigestion but the symptoms “just got worse.” His skin appears pale, cool and clammy.   He is alert and oriented.  He appears anxious and has difficulty answering some of questions.   He is immediately taken to an empty monitored room and placed on the cardiac monitor and his vital signs are obtained:  97.6-185-24.  BP 88/50.   SPO2 93%.  The monitor shows this initial rhythm.   

A 12 lead EKG is obtained to confirm the rhythm.

1.  Identify the above rhythm

a.   Ventricular tachycardia

b.   Wandering atrial pacemaker with RVR

c.   Supraventricular tachycardia

d.   Atrial tachycardia

2.  What are three examples of wide complex tachycardia?

a.       

b.      

c.       

3.   What is the difference between symptomatic tachycardia and unstable tachycardia?

a.       Symptomatic Tachycardia:

b.      Unstable Tachycardia: 

4.  Based upon the patient’s symptoms what is the recommended treatment for this patient?

a.  Immediate defibrillation at 200 J

b.  Adenosine 12mg IV given rapid push

c.  Diltiazim 0.35mg/kg IV push over 5 minutes

d.  Synchronized cardioversion

5.  What are the ECG characteristics of ventricular tachycardia?

a.       Rate:

b.      Rhythm: 

c.       P Wave:

d.      PRI: 

e.      QRS: 

f.        T Waves:

Answers
1. Identify the above rhythm
a. Ventricular tachycardia

2. What are three examples of wide complex tachycardia?

a. Monomorphic VT

b. Polymorphic VT

c. SVT with aberrancy

3. What is the difference between symptomatic tachycardia and unstable tachycardia?

a. Symptomatic Tachycardia: Symptomatic implies that an arrhythmia is causing symptoms, such as palpitations, lightheadedness, or dyspnea, but the patient is stable and not in imminent danger. In such cases more time is available to decide on the most appropriate intervention.

b. Unstable Tachycardia: refers to a condition in which vital organ function is acutely impaired or cardiac arrest is ongoing or imminent. When an arrhythmia causes a patient to be unstable, immediate intervention is indicated.

4. Based upon the patient’s symptoms what is the recommended treatment for this patient?

d. Synchronized cardioversion

5. What are the ECG characteristics of ventricular tachycardia?

a. Rate: The atrial rate can't be determined. The ventricular rate is 150 - 250. If the rate is below 150, it is called a slow VT.

b. Rhythm: The rhythm is usually regular.

c. P Wave: Not usually visible.

d. PRI: There is no PRI, as the focus is ventricular.

e. QRS: The QRS is wide and bizarre, usually 0.12 or greater. It is sometimes difficult to differentiate between QRS complexes and T waves. S-T Segment: Difficult, if not impossible to see.

f. T Waves: Difficult to differentiate T waves from QRS complexes