Metabolic derangements, electrolyte disorders and exogenous substances, ischemia etc may precipitate ventricular arrhythmias in all these patient groups. The causes are best remembered by the 6 H’s and the 6 T’s: Treatment includes emergency initiation of Advanced Cardiac Life Support (ACLS) protocols, which include treatment aimed at the etiology, if identifiable. Sudden cardiac death is defined as an unexpected death due to cardiac causes that occurs within 1 hour of symptom onset. View all chapters in Cardiac Arrhythmias. The patient dies if the rhythm is not restored. The death mechanism is usually the same regardless of the underlying disease: electrical instability triggers ventricular tachycardia which degenerates into ventricular fibrillation which leads to asystole. The pulseless ventricular tachycardia rhythm is primarily identified by several criteria. Ventricular tachycardia with rate 100 to 120 beats per minute is referred to as slow ventricular tachycardia. The following conditions may cause pulseless electrical activity: hypovolemia, hypoxia, cardiac tamponade, pressure pneumothorax, hypothermia, massive pulmonary embolism, drug overdose, massive myocardial infarction. Tell us what you think about Healio.com », Get the latest news and education delivered to your inbox. This case was submitted by my friend Dr. Victoria Stephens. Pulseless electrical activity is a term applied to any rhythm which is not accompanied by a detectable pulse. Management and diagnosis of tachycardias (narrow complex tachycardia and wide complex tachycardia), Premature ventricular beats (premature ventricular contractions / complex), Ventricular Rhythm, Accelerated Ventricular Rhythm (Idioventricular Rhythm), LQTS (Long QT Syndrome) & TdP (Torsde de Pointes), STEMI – ST Elevation Myocardial Infarction, NSTEMI – Non-ST Elevation Myocardial Infarction & Unstable Angina. Join our newsletter and get our free ECG Pocket Guide! Ventricular fibrillation is treated according to the resuscitation algorithm. Asystole and brady-asystole are treated according to the resuscitation algorithm. Terms of Use. ECG features of ventricular tachycardia ≥3 consecutive ventricular beats with rate 100–250 beats per minute (in most cases >120 beats per minute). Your email address will not be published. Moreover, the time limit (1 hour) is not absolute. Most of these have atherosclerotic heart disease (coronary artery disease) as the underlying cause. She is a third year Emergency Medicine Registrar from at the University of the Witwatersrand in Johannesburg, South Africa, and a great asset to FOAMed. Sudden cardiac death causes 7 million deaths annually worldwide. Pulseless ventricular tachycardia is a life-threatening cardiac emergency that ends in death without prompt and immediate treatment. Cardiomyopathies (dilated or hypertrophic), valvular disease, genetic mutations (LQTS, Brugada syndrome, early repolarization) etc, are much less common than ischemic heart disease. ECG features of ventricular fibrillation. Second, the patient will be … As seen in Figure 1, asystole occurs when there is no electrical activity in the heart. Clinical electrocardiography and ECG interpretation, Cardiac electrophysiology: action potential, automaticity and vectors, The ECG leads: electrodes, limb leads, chest (precordial) leads, 12-Lead ECG (EKG), The Cabrera format of the 12-lead ECG & lead –aVR instead of aVR, ECG interpretation: Characteristics of the normal ECG (P-wave, QRS complex, ST segment, T-wave), How to interpret the ECG / EKG: A systematic approach, Mechanisms of cardiac arrhythmias: from automaticity to re-entry (reentry), Aberrant ventricular conduction (aberrancy, aberration), Premature ventricular contractions (premature ventricular complex, premature ventricular beats), Premature atrial contraction (premature atrial beat / complex): ECG & clinical implications, Sinus rhythm: physiology, ECG criteria & clinical implications, Sinus arrhythmia (respiratory sinus arrhythmia), Sinus bradycardia: definitions, ECG, causes and management, Chronotropic incompetence (inability to increase heart rate), Sinoatrial arrest & sinoatrial pause (sinus pause / arrest), Sinoatrial block (SA block): ECG criteria, causes and clinical features, Sinus node dysfunction (SND) and sick sinus syndrome (SSS), Sinus tachycardia & Inappropriate sinus tachycardia, Atrial fibrillation: ECG, classification, causes, risk factors & management, Atrial flutter: classification, causes, ECG diagnosis & management, Ectopic atrial rhythm (EAT), atrial tachycardia (AT) & multifocal atrial tachycardia (MAT), Atrioventricular nodal reentry tachycardia (AVNRT): ECG features & management, Pre-excitation, Atrioventricular Reentrant (Reentry) Tachycardia (AVRT), Wolff-Parkinson-White (WPW syndrome), Junctional rhythm (escape rhythm) and junctional tachycardia, Ventricular rhythm and accelerated ventricular rhythm (idioventricular rhythm), Ventricular tachycardia (VT): ECG criteria, causes, classification, treatment (management), Longt QT interval, long QT syndrome (LQTS) & torsades de pointes, Ventricular fibrillation, pulseless electrical activity and sudden cardiac arrest, Pacemaker mediated tachycardia (PMT): ECG and management, Diagnosis and management of narrow and wide complex tachycardia, Introduction to Coronary Artery Disease (Ischemic Heart Disease) & Use of ECG, Classification of Acute Coronary Syndromes (ACS) & Acute Myocardial Infarction (AMI), Clinical application of ECG in chest pain & acute myocardial infarction, Diagnostic Criteria for Acute Myocardial Infarction: Cardiac troponins, ECG & Symptoms, Myocardial Ischemia & infarction: Reactions, ECG Changes & Symptoms, The left ventricle in myocardial ischemia and infarction, Factors that modify the natural course in acute myocardial infarction (AMI), ECG in myocardial ischemia: ischemic changes in the ST segment & T-wave, ST segment depression in myocardial ischemia and differential diagnoses, ST segment elevation in acute myocardial ischemia and differential diagnoses, ST elevation myocardial infarction (STEMI) without ST elevations on 12-lead ECG, T-waves in ischemia: hyperacute, inverted (negative), Wellen's sign & de Winter's sign, ECG signs of myocardial infarction: pathological Q-waves & pathological R-waves, Other ECG changes in ischemia and infarction, Supraventricular and intraventricular conduction defects in myocardial ischemia and infarction, ECG localization of myocardial infarction / ischemia and coronary artery occlusion (culprit), The ECG in assessment of myocardial reperfusion, Approach to patients with chest pain: differential diagnoses, management & ECG, Stable Coronary Artery Disease (Angina Pectoris): Diagnosis, Evaluation, Management, NSTEMI (Non ST Elevation Myocardial Infarction) & Unstable Angina: Diagnosis, Criteria, ECG, Management, STEMI (ST Elevation Myocardial Infarction): diagnosis, criteria, ECG & management, First-degree AV block (AV block I, AV block 1), Second-degree AV block: Mobitz type 1 (Wenckebach) & Mobitz type 2 block, Third-degree AV block (3rd degree AV block, AV block 3, AV block III), Management and treatment of AV block (atrioventricular blocks), Intraventricular conduction delay: bundle branch blocks & fascicular blocks, Right bundle branch block (RBBB): ECG, criteria, definitions, causes & treatment, Left bundle branch block (LBBB): ECG criteria, causes, management, Left bundle branch block (LBBB) in acute myocardial infarction: the Sgarbossa criteria, Fascicular block (hemiblock): left anterior & left posterior fascicular block on ECG, Nonspecific intraventricular conduction delay (defect), Atrial and ventricular enlargement: hypertrophy and dilatation on ECG, ECG in left ventricular hypertrophy (LVH): criteria and implications, Right ventricular hypertrophy (RVH): ECG criteria & clinical characteristics, Biventricular hypertrophy ECG and clinical characteristics, Left atrial enlargement (P mitrale) & right atrial enlargement (P pulmonale) on ECG, Digoxin - ECG changes, arrhythmias, conduction defects & treatment, ECG changes caused by antiarrhythmic drugs, beta blockers & calcium channel blockers, ECG changes due to electrolyte imbalance (disorder), ECG J wave syndromes: hypothermia, early repolarization, hypercalcemia & Brugada syndrome, Brugada syndrome: ECG, clinical features and management, Early repolarization pattern on ECG (early repolarization syndrome), Takotsubo cardiomyopathy (broken heart syndrome, stress induced cardiomyopathy), Pericarditis, myocarditis & perimyocarditis: ECG, criteria & treatment, Eletrical alternans: the ECG in pericardial effusion & cardiac tamponade, Exercise stress test (treadmill test, exercise ECG): Introduction, Exercise stress test (exercise ECG): Indications, Contraindications, Preparation, Exercise stress test (exercise ECG): protocols, evaluation & termination, Exercise stress testing in special patient populations, Exercise physiology: from normal response to myocardial ischemia & chest pain, Evaluation of exercise stress test: ECG, symptoms, blood pressure, heart rate, performance, Ventricular fibrillation, pulseless electrical activity (PEA) and sudden cardiac arrest, Synonym: electromechanic dissociation (EMD), Treatment of pulseless electrical activity, atherosclerotic heart disease (coronary artery disease).