Assess the RS interval (interval from start of the R-wave to the nadir of the S-wave). The ventricular rate is typically very high (100–250 beats per minute) and cardiac output is affected (i.e reduced) in virtually all cases. Hypokalemia and hypomagnesaemia should be corrected rapidly. EKG Criteria for Ventricular Tachycardia Wellens Morphology Criteria for VT. Therefore, the purpose of the discussion below is to present the reader with several types of ventricular tachycardia just for reference. Lidocaine is given as iv bolus of 0.75 mg/kg which can be repeated after 5–10 minutes. Ventricular tachycardia may be classified as idiopathic if no cause can be identified. The arrhythmia is mostly idiopathic but some patients may have ARVC (arrhythmogenic right ventricular cardiomyopathy). Extreme axis deviation / northwest axis is present, -150 degree; QRS positive in aVR, negative in I + aVF, There is a RBBB-like pattern in V1 with a, There is an RSR’ complex with a taller left rabbit ear, There is an rS complex in V6 (R/S ratio < 1), Although there is a broad complex tachycardia (HR > 100, QRS > 120), the appearance in V1 is more suggestive of SVT with aberrancy, given that the the complexes are not. It is a ventricular tachycardia if there is: If none of the previous statements are fulfilled: It is a supraventricular tachycardia. Atypical presentations of STEMI on the EKG, Concordant pattern: QRS complexes entirely upright or entirely inverted on precordial leads, from V1 to V6. Sotalol (may cause QT prolongation) and amiodarone may also be considered. Examples include Torsades and digitalis toxicity. In 1978, Wellens et al 1 proposed the so-called “classical criteria” to help in the differential diagnosis of supraventricular tachycardia with wide QRS complex and ventricular tachycardia. Accelerated abnormal impulse generation by a region of ventricular cells. If the tachyarrhythmia has a left bundle branch block pattern but the electrical axis is more positive than 90° it suggests ventricular tachycardia. In addition to these characteristics, researchers have developed several algorithms to differentiate ventricular tachycardia from SVTs. Discrete variability in R-R intervals actually suggest ventricular tachycardia. Features common to any broad complex tachycardia, Additional morphological criteria for VT can be found on ECGpedia. Develops due to abnormal myocardial scarring usually due to prior ischemia or infarction. Brugada’s sign is present: the time from the onset of the QRS complex to nadir of S wave is > 100 ms (best seen in V6). In most cases it alternates between two variants of the QRS complex. If there is atrioventricular dissociation. As you can imagine, the rapid and accurate diagnosis of an electrocardiogram with ventricular tachycardia is vital. Early repolarization and hypertrophic obstructive cardiomyopathy also causes polymorphic VT. Bidirectional ventricular tachycardia means that the QRS morphology alternates from one ebat to another. R to S interval greater than 100 ms in one precordial lead. ECG criteria for ventricular tachycardia ECG features of ventricular tachycardia ≥3 consecutive ventricular beats with rate 100–250 beats per minute (in most cases >120 beats per minute). This site uses Akismet to reduce spam. Before dwelling into these characteristics and algorithm it should be noted that 90% of all wide complex tachycardias are ventricular tachycardias! If the ECG does show long QT interval, the condition is classified as torsade de pointes; refer to this article for treatment recommendations. This indicates that the impulses originate in the same ectopic focus. If the individual has suffered a myocardial infarction, an ICD should be considered. Ventricular/atrial ratio >1 (more QRS complexes than P waves). If the R-R intervals during the start of the tachycardia were irregular, it suggests ventricular tachycardia. Ventricular tachycardia is mostly regular, although the R-R intervals may vary somewhat. Ventricular tachycardia with duration <30 seconds is classified as non-sustained ventricular tachycardia. The rapid ventricular rate, which may be accompanied by already impaired ventricular function, does not allow for adequate filling of the ventricles, which results in reduced stroke volume and reduced cardiac output. This might be useful in trying to decipher what the cause of the ventricular tachycardia may be. If the morphological criteria for ventricular tachycardia are present both in precordial leads V1-V2 or V6 (see above). 4. If adenosine do not have any effect or if it accelerates the tachycardia, it is likely to be ventricular tachycardia. This is called warp-up phenomenon and is characteristic of ventricular tachycardia. Monomorphic VT alternates with ventricular bigeminy. My EKG team recomends you the books that we used to create our website. Fascicular ventricular tachycardia is an idiopathic form of VT. Digoxin induced ventricular tachycardia may be treated as a hemodynamically stable patients above. The rhythm may be irregular. The ECG provides valuable information regarding the location of the ectopic foci causing the tachycardia. Supraventricular tachycardias may also be irregular; the most common being atrial fibrillation. R-wave duration ≥40 ms suggest ventricular tachycardia. Negative concordance (all QRS complexes being negative) strongly suggest ventricular tachycardia). hypotension, collapse, and acute cardiac failure. Background— ECG criteria identifying epicardial (EPI) origin for ventricular tachycardia (VT) in nonischemic cardiomyopathy have not been determined. Bradycardia induced ventricular tachycardia (sinus bradycardia, AV-block etc): Bradycardia may induce premature ventricular complexes and ventricular arrhythmias. Intermittent ventricular tachycardia with frequent capture beats should be treated pharmacologically. Long QT Syndrome (LQTS) & Torsade de Pointes (TdP), Management and diagnosis of tachycardias (narrow complex tachycardia and wide complex tachycardia), Premature ventricular beats (premature ventricular contractions / complex), Ventricular Rhythm, Accelerated Ventricular Rhythm (Idioventricular Rhythm), Ventricular Fibrillation (VF), Pulseless Electrical Activity (PEA) & Sudden Cardiac Arrest (SCA), STEMI – ST Elevation Myocardial Infarction, NSTEMI – Non-ST Elevation Myocardial Infarction & Unstable Angina. In monomorphic ventricular tachycardia all QRS complexes display the same morphology (minor differences are allowed). This prompted physicians to construct coronary care units, in which all patients with acute myocardial infarction were monitored with continuous ECG and ventricular tachyarrhythmias were handled by means of immediate resuscitation and defibrillation. It was believed that the mere presence of physicians and nurses caused harmful stress. The following ECG shows VT with AV dissociation (the arrows point at P-waves). Read more about the different types of VT by following these links: Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. If a ventricular impulse is discharged simultaneously as the atrial impulse enters the His-Purkinje system, the ventricles will be depolarized by both. If there is no QRS complex from lead V1 to lead V6 which is an RS complex (i.e consists of an R wave and an S wave), then ventricular tachycardia is very likely. If a wide QRS complex tachycardia presents one of these morphological criteria, it is more likely to be ventricular tachycardia. Interestingly, treatment of VT is considered one of the greatest advances in cardiology. Fortunately, there are several characteristics that separate ventricular tachycardia from supraventricular tachycardias (SVT). Coronary artery disease (ischemic heart disease) is by far the most common cause of ventricular tachycardia and the mechanism is mostly re-entry.
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