Pulseless Ventricular Tachycardia (VT)

Introduction

Pulseless ventricular tachycardia (VT) is a life-threatening cardiac arrhythmia where the heart beats rapidly but ineffectively, leading to no palpable pulse and no meaningful circulation.

Causes

Pulseless VT is often caused by severe heart disease, including: - Coronary artery disease (CAD) – Heart attacks (myocardial infarction) can trigger VT. - Cardiomyopathy – Certain diseases weaken the heart muscle, making it more prone to arrhythmias. - Electrolyte imbalances – Low potassium or magnesium levels can increase the risk of VT. - Drug toxicity – Certain medications, including antiarrhythmics or stimulants, can trigger VT.

Symptoms

Pulseless VT results in sudden loss of consciousness and collapse. Because the heart isn’t pumping blood effectively, it leads rapidly to cardiac arrest.

Diagnosis

  • VT is diagnosed using an electrocardiogram (ECG), which shows wide, fast QRS complexes.
  • No pulse is detected despite ECG activity.

Emergency Management

Immediate Actions

  1. Check for pulse – If absent, begin CPR immediately.
  2. Call emergency services – Activate emergency medical response.
  3. Initiate chest compressions – 100-120 compressions per minute.
  4. Defibrillation – Pulseless VT is a shockable rhythm; use an automated external defibrillator (AED) or manual defibrillator ASAP.

Advanced Cardiac Life Support (ACLS)

  • Defibrillate as soon as possible.
  • Administer epinephrine (1 mg every 3–5 minutes).
  • Consider antiarrhythmic drugs like amiodarone (300 mg IV bolus, followed by 150 mg if needed).
  • Address underlying cause, such as electrolyte imbalances or ischemia.

Prevention

  • Cardiac evaluation – Patients with heart problems should see a cardiologist.
  • Implantable Cardioverter Defibrillator (ICD) – For high-risk patients to prevent recurrent episodes.
  • Lifestyle modifications – Managing hypertension, diabetes, and quitting smoking can reduce risks.

Conclusion

Pulseless VT is a critical emergency requiring rapid CPR and defibrillation. Early recognition and effective treatment save lives.

Source recommendations

1. American Heart Association Advanced Cardiovascular Life Support (ACLS) Guidelines

  1. https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/algorithms
  2. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001194
  3. https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/adult-basic-and-advanced-life-support
  4. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000916
  5. https://shopcpr.heart.org/acls-provider-manual

2. European Resuscitation Council Guidelines

  1. https://cprguidelines.eu/guidelines-2021
  2. https://www.erc.edu/
  3. https://cprguidelines.eu/
  4. https://www.sciencedirect.com/science/article/pii/S0300957221000551
  5. https://pubmed.ncbi.nlm.nih.gov/33773835/

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