Snapshot A 47-year-old woman with a history of heart problems was found unconscious at her desk by a co-worker. She was rushed to the emergency department by ambulance. Her EKG is shown. Introduction Associated with coronary artery disease, MI, and structural heart defects May develop from sustained ventricular tachycardia Presentation Symptoms/Physical exam syncope severe hypotension pulselessness sudden death Evaluation EKG shows erratic pattern of impulses rate 300-600 extremely irregular no P waves Differential Sustained ventricular tachycardia, 3rd degree heart block Treatment Immediately initiate ACLS Emergency electrical defibrillation (200 > 300 > 360J) the earlier that defibrillation is performed, the better Prognosis, Prevention, and Complications Most cases result in sudden death Immediate intervention necessary for survival in vast majority of cases