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Sustained Monomorphic Ventricular Tachycardia Clinical findings

Sustained Monomorphic Ventricular Tachycardia: Clinical findings Sustained Monomorphic Ventricular Tachycardia A wide QRS complex tachycardia originating from the ventricles lasting > 30 seconds. Common mechanisms include re-entry (e.g., scar-mediated) or a ventricular ectopic focus with increased automaticity. Refer to Sustained Monomorphic Ventricular Tachycardia: Pathogenesis slide for more details. Authors: Rahim Kanji Reviewers: Stephanie Happ, Raafi Ali, Derek Chew* * MD at time of publication The sinoatrial node continues to depolarize the atria while the ventricles depolarize independently and more rapidly Heart rate > 100 beats per minute The re-entrant circuit/ectopic focus uniformly and consistently depolarizes ventricular myocytes Occasionally, a sinoatrial impulse conducts to the ventricles Loss of coordination between the contractions of the atria and ventricles ECG Finding: AV Dissociation The impulse conducts normally through the His-Purkinje pathway and coincides with abnormal ventricular depolarization ECG Finding: Fusion beat Patient feels a forceful and rapid heart rate Palpitations Right atrium periodically contracts against a closed tricuspid valve Cannon A waves (intermittent irregular jugular venous pulsations with large amplitudes) ↓ Ventricular filling time ↓ Preload ↓ Stroke volume cardiac output Inadequate perfusion to organs ECG Finding: Uniform morphology of QRS complexes Direct myocyte-to- myocyte spread of the electrical impulse proceeds slower than an impulse conducted via the His-Purkinje pathway ECG Finding: Wide QRS complexes (≥ 120 milliseconds) The impulse conducts normally through the His-Purkinje pathway in between abnormal ventricular depolarizations ECG Finding: Capture beat Muscles and other organs General malaise Heart Chest pain Brain Presyncope/ syncope Inability to adequately respond to increased cardiac demand Shortness of breath Hemodynamic collapse Sudden cardiac arrest Death Hypotension Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published October 22, 2023 on www.thecalgaryguide.com