Overview

• A regular broad-complex tachycardia originating from a ventricular ectopic focus. The rate is usually >120 bpm.
• Risk Factors → coronary heart disease, structural heart disease, hypokalaemia, cocaine
• One of the shockable rhythms that may be seen in cardiac arrest patients

Making Diagnosis

Clinical Features:

• Chest Pain
• Palpitations
• Dyspnoea
• Syncope
• Depending on degree of haemodynamic instability → Respiratory Distress, Bibasal Crackles, Raised JVP, Hypotension

Investigations:

• ECG → rate >100bpm, broad QRS complexes, no P waves, AV dissociation
  • SVT = QRS <120ms (narrow-complex). VT = QRS >120ms (broad-complex).
  • VT ECG
  • Torsades de Pointes (Polymorphic VT - VT with varying amplitude) → associated with long QT interval. May deteriorate into VF and cause sudden death.
  • Causes of QT Prolongation ⇒ SSRI’s (citalopram), macrolides (clarithromycin), hypokalaemia, hypocalcaemia, hypomagnesemia, hypothermia

Management Plan

ABC approach, check whether patient has pulse or not (if in cardiac arrest may require defibrillation).