 Hi welcome to nursing school explain and this video in the ventricular dysrhythmia series about ventricular tachycardia. If you haven't already done so I highly recommend watching my other videos that are in the basic EKG interpretation list so you know how to apply the basic electrophysiology as well as the normal intervals and how to read EKG paper. The other video that might be helpful for you to watch before diving into this ventricular tachycardia is the one about premature ventricular contractions that can sometimes be the precursor to ventricular tachycardia. Ventricular tachycardia is also known as VTAC and usually means that there are three or more pvcs which are premature ventricular contractions in a row. The heart rate usually is greater than 100 and VTAC can be non-sustained meaning less than 30 seconds or sustained meaning greater than 30 seconds and the main difference here or the important thing to note is that the patient may have a pulse with VTAC which means that they are stable or somewhat stable but they also may be pulse less which means that they would certainly be unstable then and a patient who has a pulse with ventricular tachycardia many times will not stay stable for very long until they turn pulse less and we can't become unstable. So ventricular tachycardia just by looking at this rhythm strip you can already see it looks very different from any other rhythm strip you might have previously seen if you've been following my EKG playlists. The rate for ventricular tachycardia is usually 101 greater than 100 to 250 beats in this particular case it's 180 and just like we would always count the QRS complexes we do the same thing here although these QRS complexes certainly look a little bit different by being wide and bizarre which is a characteristic of an abnormal focus or an abnormal cardiac cell located in the ventricles. So if we would count those all the way we would count them to be 18 and hence the heart rate of 180 here. Rhythm and regularity essentially regular there's not a whole lot we can see that's abnormal and looks irregular here. The P wave in ventricular tachycardia may be visible but may also have no relationship to the QRS complex. So in this case we can't really determine if there is a P wave anywhere hidden in this very fast rhythm the chances are higher than that you will see a P wave if the rate is closer to the 101 so the slower the heart rate the more of a chance that you will see the P wave but really that's not what's important here because this is a ventricular dysrhythmia that can be lethal if we don't intervene very quickly and then looking at intervals so because we don't have a P wave visible we are not going to have a PRI and then again the QRS is greater than 0.12 it has this wide and bizarre looking shape and it's often difficult to differentiate between the QRS and the T wave so just like we can't really see the P wave it is very hard to picture that there's a T wave anywhere in this strange looking rhythm so ventricular tachycardia is is pretty easily identifiable although there's different morphologies or shapes that can happen with this rhythm as well and we'll look into that going forward so here we have monomorphic versus polymorphic ventricular tachycardia and monomorphic basically just means one shape where polymorphic means that there's more than one shape so in this upper example here you can see they're pretty much all have the same kind of height and the same negative deflection here too where in this polymorphic example on the bottom it's also known as torsades de puentes which is a French term and torsades basically just means it kind of is like a spindle so you can see kind of goes up and down here it almost looks like a DNA shape if you want to call it that so it's not very straightforward and monomorphic with the same height here it has this very strange looking shape and then if you look at these beats here they from a morphology from a shape here they look very similar to the monomorphic ones but these here so there could be a T wave somewhere in hidden in here that could maybe be argued that there's a P or a T wave in there but either way these complexes are wide and bizarre greater than the 0.12 which usually makes it pretty easily identifiable that this is a type of a ventricular tachycardia now looking a little bit deeper into this polymorphic ventricular tachycardia that is also known as torsades de puentes which basically means it is kind of an in between between ventricular tachycardia and ventricular fibrillation and it's French meaning twisting of the points and this is exactly what I was drawing out for you earlier here this DNA kind of shape that it has and that means that the QRS changes in shape and amplitude and the width with twisting around the isoelectric line so the isoelectric line in this case would be somewhere right in there so it has this strange shaping twisting around this isoelectric line and if you see this rhythm you better be on guard because it may quickly deteriorate to ventricular fibrillation it may sometimes be participated precipitated by a slow heart rate and it is associated with medications that prolong the QT interval or electrolyte imbalances that's why it's so important to know the medications and their possible side effects and if you have a medication that the patient is receiving for the first time where a side effect says may prolong QT interval then it's always best to place the patient on an EKG monitor to see what their heart rate and rhythm is doing while they are receiving this medication or shortly thereafter causes for ventricular tachycardia most common causes is coronary artery disease with a prime myocardial infarction so that ventricle or the heart has taken some sort of an insult before and now there can be an abnormal electrical pathway and irritable cardiac cell that causes the ventricular tachycardia certainly underlying heart disease anything that can cause ischemia can cause ventricular tachycardia as well as cardiomyopathy and tricyclic antidepressant overdose so that's also fairly commonly seen digitalis toxicity so remember you did joxin is a very has a very narrow therapeutic range and can cause all kinds of trouble with EKG rhythms valve disorders electrolyte imbalances acid based imbalances and then again anything that causes increasing catecholamine release now signs and symptoms if the patient has a pulse might be chest pain hypotension shortness of breath chf signs and symptoms any that would also qualify as acute mi signs and symptoms and then decreased level of consciousness because of the impaired perfusion to their brain now if the patient doesn't have a pulse they're probably not going to be complaining of any signs and symptoms there will be signs and symptoms that you need to be picking up and specifically looking at the cardiac rhythm and seeing that they are in a post less ventricular tachycardia intervention so now we have to distinguish is the patient stable do they have a pulse or are they unstable and do they not have a pulse but actually the patient can be stable and can be symptomatic so they might be complaining of again chest pain shortness of breath or any of these symptoms that we just looked at so if the patient is stable we can put them on oxygen just like that helps with anybody with premature ventricular contractions IV entire rythmics need to be initiated fairly quickly to stabilize the cardiac membrane and cells from being so irritable and causing this dysrhythmia treating the underlying cause again if it is due to electrolyte imbalances or acid based imbalances and then specifically if we're dealing with torsals the point this this multi or a polymorphic ventricular tachycardia the patient will respond well usually to IV magnesium IV phenytoin which is also dilantin which is a anti-seizure medication but it can be very effective in stabilizing a patient who has torsals the pointus or lidocaine which is also an anti-arhythmic that works well for ventricular tachycardia that is polymorphic and then if the patient is unstable so if they are now showing signs of hypertension altered level of consciousness if they have a pulse we will want to sedate them if there is time and then perform a synchronized cardioversion if the patient does not have a pulse then they will need defibrillation followed by immediate CPR and then follow ACLS protocol to determine the cause and underlying issues associated with this dysrhythmia so we can hopefully bring the patient back. Here are some credits and references for you to look at more practice strips specifically and then here are the other videos in my EKG interpretation playlist specifically ventricular dysrhythmias like I mentioned earlier premature ventricular complexes or contractions can a lot of times precede ventricular tachycardia and then ventricular fibrillation is another rhythm that can be lethal as well as PEA pulse less electrical activity and asystole. Thanks for watching Nursing Soul Explained I'll see you soon.