Paramedic Education at Monroe Community College, Rochester, New York

A

is correct

This 60 year old male patient is undenyably in Ventricular Tachycardia.

Some common misconceptions you'll hear medics say:

"a patient with stable VS can't be in VT" --- Not so, about 30% can maintain stable VS

"a patient in this rhythm for days can't be in VT" --- Not so, some patients have had weeks of continuous, documented VT

"I don't see cannon A waves so it can't be VT" --- Not so, only patients with a functioning SA node and no junctional retrograde depolarization have this finding. (Less than 50%)

"I have narrow complexes in V4 and V5 so it can't be VT" --- VT, like any other ventricular depolarization has a vector and when the lead axis is perpedicular to it some energy can't be graphed

"I think I see P waves in leads V4 or V5." --- Dr Henry Marriott calls this P preoccupation. (trying to make some other wave into a P)

"it doesn't make a difference anyway because I'm not going to treat it" --- Not so, and perhaps the most dangerous misconception, VT is the only exception to the rule "if it ain't broke, don't fix it". You should attempt to terminate this arrhythmia ASAP.

Major risk factors for VT are advancing age and a history of myocardial infarction

A useful flow chart that is 98% accurate in identifying VT in a subset of patients is as follows:

                   History of Myocardial Infarction
                       |                         |
                       |                         |
                      YES                        NO
                       |                         |
                       |                         |
                Has history of               Consider VT
             tachycardia before MI
               |             |
               |             |
              Yes            NO
               |             |
               |             |
            Consider      98% chance of VT
              VT
             until
            proven
           otherwise


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Updated: September 17, 1997
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