Cardiac exam med surg 1 Medical Surgical Nursing (Bridgewater College) Cardiac Exam Chapter 26, 27 and 28 Ventricular Tachycardia -

Ventricular Tachycardia - Three or more PVCs in a row, occurring at a rate exceeding 100 bpm > Causes are similar to that of PVC - Higher risk of lethal VT with larger MIs and lower ejection fraction Ventricular and atrial rate: ventricular rate = 100 - 200 bpm, atrial depends on underlying rhythm Ventricular and atrial rhythm: regular, atrial rhythm may be irregular QRS shape and duration: duration is 0.12 seconds or more; bizarre, abnormal shape P Wave: very difficult to detect, so the atrial rate and rhythm may be indeterminable PR interval: very irregular, if P waves are seen P:QRS ratio: difficult to determine, but if P waves are apparent, there are usually more QRS complexes than P waves Treatment Determine whether VT is monomorphic (consistent QRS shape and rate), or polymorphic (varying QRS shape and rate) - Procainamide may be used for monomorphic stable VT (n no MI or HF) - IV amiodarone for pt with imparied cardiac function or acute MI - Lidocaine immediate short term for pt with imparied cardiac function - Cardioversion is the treatment for symptomatic patients. - Defibrillation is the treatment of choice for pulseless VT. Long term management - Pt with ejection