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Updated: Jun 27 2021

Ventricular Arrhythmia
  • A 57-year-old man presents to the emergency department after fainting. He was accompanied by his wife who witnessed the event. Prior to the event, he experienced lightheadedness and palpitations. When he fainted, cardiopulmonary resuscitation was performed. Defibrillator pads were placed on the patient, which demonstrates pulseless ventricular tachycardia. He is defibrillated with 200 Joules (biphasic.)
  • A group of ventricular arrhythmias that include
    • ventricular premature beats (premature ventricular contractions)
      • action potentials are ectopically generated within the ventricles
      • typically benign and asymptomatic but can signify underlying pathology
        • ischemia
        • electrolyte derangements (most commonly Mg2+ and K+) 
    • ventricular tachycardia
      • if sustained ventricular tachycardia is not managed, it can result in ventricular fibrillation
      • can occur secondary to blunt chest trauma
        • consider commotio cordis (blunt trauma during ventricular repolarization) with focal trauma to the chest over the heart followed by ventricular tachycardia 
    • ventricular fibrillation
      • life-threatening, if not immediately managed 
      • most common cause of cardiac arrest after a STEMI
  • Epidemiology
    • risk factors
      • myocardial ischemia and infarction
      • ventricular hypertrophy
      • long QT syndromes
      • valvular heart disease
      • congenital cardiac abnormalities
      • short QT syndrome 
  • Symptoms
    • palpitations
    • symptoms of heart failure, which include
      • shortness of breath
      • chest discomfort
      • syncope
    • cardiac arrest

Ventricular Arrhythmias
Electrocardiogram Findings
Ventricular premature beats (VPBs)
  • Widened QRS complex with abnormal morphology 
  • Typically with reassurance or a β-blocker in healthy patients
Ventricular tachycardia
  • 3 or more consecutive VPBs, displaying a broad QRS complex tachyarrhythmia
  • Stable 
    • amiodarone  
    • lidocaine
    • procainamide
  • Unstable
    • synchronized cardioversion
  • Pulseless ventricular tachycardia
    • defibrillation
Ventricular fibrillation
  • Erratic rhythm with no discernable waves (P, QRS, or T waves)
  • Defibrillation for all patients  
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