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What’s up guys and welcome to the NRSNG podcast. My name is Kati Kleber, and I am your host. We’re gonna be talking about ventricular rhythms today. This is kind of part of the series of our arrhythmias, if you will. Couple resources, excuse me, that I have available that are free, check out nrsng.com, click on Cheat Sheets. We have got a wonderful cheat sheet of different arrhythmias. They give you great visual examples. I’m gonna be describing some things but it’s great to also see these things in action. If you Google how to interpret EKG strips like a boss, you’ll come up with a great long, wonderful blog post that breaks down all of them with a lot of great videos, and a great resource. I’m gonna go through just two ventricular rhythms, V-tach and V-fib. Okay guys, so let’s jump right in.
When the SA node and the VA node are not pacing the heart correctly, the Purkinje fibers, or Purkinje, jinkie, I don’t ever say that right. I’m sorry guys. The bundle of His, they take over, okay? They’re located in the ventricles. This is kinda the end-of-the-road for pacing the heart. The body cannot sustain this for very long, basically. This is a big friggin’ deal guys. This is a, “I’m calling a code,” kinda situation. It’s important that you are able to recognize these quickly on a EKG strip. If you are working on a normal cardiac floor and there’s telemetry monitor people, they’re gonna be frantically calling you if this is showing up on the monitor. Let’s talk about V-tach first.
Ventricular tachycardia, which is frequently just called V-tach, is a rapid heartbeat above 100, originating in the ventricles. It is defined as three or more pre-ventricular contractions, or also called PVCs, in a row that can lead to ventricular fibrillation. This is one of the shockable rhythms. Okay guys? The other one is V-fib, we’ll talk about that next. There are two types of V-tach: monomorphic, where the QRSs are the same size, and polymorphic, where the QRSs are different sizes and shapes. So how do you recognize this on an EKG strip? The rhythm is regular but the rate is fast. There is organization to this guys, okay? The QRS is wide and the P-waves can be difficult to identify, if you can find them at all. It’s pretty easy to glance at this and say, “Oh, that’s V-tach.” So I encourage you to take a look at our cheat sheet so you can visualize what this looks like. The way I like to differentiate it from what I’m about to talk about with V-fib is, there is a pattern to it. It is regular and that’s the best way to differentiate it from fib.
What causes this? Lots of heart disease issues can cause this, cardiomyopathy, heart failure, heart surgery, myocarditis, valvular heart disease. Or you can have issues with blood conditions like hypokalemia, pH changes in the blood, hypoxia, those are some general issues. What happens to someone in V-tach? A patient can be asymptomatic although I have personally not seen someone asymptomatic in V-tach. Signs and symptoms include dizziness, light-headedness, palpitations, shortness of breath, chest pain, syncope, and loss of consciousness. If left untreated, people die. All right? It makes sense that they’re having a loss of consciousness because they’re not getting blood flow up to their brain. All right? How do you treat this guys? You might already be ahead of me here. The immediate goal is to slow the heart rate. It’s managed through medications like lidocaine or amiodarone for example, there are others but those are just two quick examples, defibrillation and CPR. This is a shockable rhythm guys. If someone has an issue with this long-term of continually going into it, they are treated with an implantable cardioverter defibrillator, or an ICD.
All right, so that’s V-tach. Let’s talk about V-fib, also known as ventricular fibrillation. It is absolutely the most serious rhythm. Untreated, V-tach, which we just talked about, will lead to V-fib. Okay? The ventricles quiver because the electrical activity is disordered. This quivering causes the heart to not be able to pump blood to the rest of the body and the heart stops eventually, cardiac arrest. This is a code situation again, guys. This is the [serioust 00:05:41] of the [seriouses 00:05:41], if that makes sense. Like I said, the way to differentiate this from V-tach is it’s this fibrillation. It’s this rapid, chaotic, irregular wave form. The QRSs are variable in height and width and there are no P-waves. Contrast that with V-tach, there’s some order to that. Okay? Make sure you’re taking a look at these, like an example in our cheat sheet.
What causes this? An acute myocardial infarction, trauma, drug overdoses like with heroin, electrolyte imbalances. So without a doubt, ventricular tachycardia will become ventricular fibrillation if it’s left untreated guys. Electrolyte imbalances can cause V-fib because our muscles, and the heart is, in fact, a giant muscle, uses calcium and potassium to contract and magnesium to relax. So if those are out of whack, we’re gonna have an issue with this. All right, so what could happen to someone in V-fib? Your patient will lose consciousness and they will not have a pulse. V-fib needs to be recognized and treated immediately because it leads to cardiac arrest and death. Remember, their ventricles are fibrillating. They are not contracting so you will not feel a pulse because they’re not perfusing blood.
Going into how we treat it, you call a code blue. Get the crash cart. Okay, if you walk into your patient’s room and they’re in V-fib, you jump on their chest, and you start doing CPR. You scream it’s a code, you call, or hit your code button and get their people in there while you’re doing the CPR because the most important thing is getting on the chest and starting compressions. Their heart is not beating appropriately at all and you need to beat it for them with CPR. You start CPR if you’re the first person to notice this. You go in and you start CPR, hit the code button. Someone else gets the crash cart and the team should be coming in. Okay? Defibrillate as soon as possible. We have some posts about running codes and the ASLC algorithm, and that’s all part of this, but that’s important. This is part of your basic life support, important things to know.
That concludes our ventricular rhythm podcast episode. Our resources, again, are the cheat sheets, nrsng.com and click on Cheat Sheets. We’ve got a great EKG resource. We have our EKG course at nrsng.com/academy, and this wonderful blog post of all things EKG, how to interpret EKGs like a boss. Thank you guys so much for listening. Have a great day.
Date Published - May 12, 2017
Date Modified - May 29, 2019