There are several other tachycardia rhythms that can be seen with both stable and unstable tachycardia. These rhythms include monomorphic ventricular tachycardia and polymorphic ventricular tachycardia both of which are wide-complex tachycardias.
Wide complex tachycardias are defined as a QRS of ≥ 0.12 second. Expert consultation should be considered with these rhythms.
These wide-complex tachycardias are the most common forms of tachycardia that will deteriorate to ventricular fibrillation.
Monomorphic Ventricular Tachycardia
With monomorphic VT all of the QRS waves will be symmetrical. Each ventricular impulse is being generated from the same place in the ventricles thus all of the QRS waves look the same.
Treatment of monomorphic VT is dependent upon whether the patient is stable or unstable. Expert consultation is always advised, and if unstable, the ACLS tachycardia algorithm should be followed.
Polymorphic Ventricular Tachycardia
With polymorphic ventricular tachycardia, the QRS waves will not be symmetrical. This is because each ventricular impulse can be generated from a different location. On the rhythm strip, the QRS might be somewhat taller or wider.
One commonly seen type of polymorphic ventricular tachycardia is torsades de pointes. Torsades and other polymorphic VT are advanced rhythms which require additional expertise and expert consultation is advised.
If polymorphic VT is stable the ACLS tachycardia algorithm should be used to treat the patient. Unstable polymorphic ventricular tachycardia is treated with unsynchronized shocks (defibrillation). Defibrillation is used because synchronization is not possible.
These wide complex tachycardias tend to originate in the ventricles rather than like a normal rhythm which originates in the atria.
Top Questions Asked On This Page
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Q: What are the doses for synchronized cardioversion?
A: Here are the cardioversion voltage doses:- Narrow regular: 50-100 J
- Narrow irregular: 120-200 J biphasic or 200 J monophasic
- Wide regular: 100 J
- Wide irregular: defibrillation dose (not synchronized)”
All of this information is covered on the tachycardia algorithm page.
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Q: Is it necessary to memorize the doses listed above?
A: It is necessary to understand the concepts and be familiar with the shock dosages.
The repetition that is built into the website is designed to help you become very familiar with all of the concepts and use them in emergencies. -
Q: What sort of a pulse would you be feeling with a polymorphic VT?
A: You may feel a weak pulse or a strong pulse depending on how long the polymorphic VT has been going on. One thing is for sure….You won’t be feeling a pulse for very long if this rhythm continues.
kim tane says
how do you tell the differnce between a monomorphic VT and VT (the VT wave looks sl different – more rounded). do you just treat them the same and follow the adult algorithm (wide QRS>0.12) for both?
Jeff with admin. says
Monomorphic VT is ventricular tachycardia and is treated as VT. The difference in treatment will be determined upon if the patient is stable, unstable, or pulsleless.
dr cardozo NJB says
Kindly make more modules to the public
FANTASTIC VERY INFORMATIC SITE
Rebecca Broadaway says
Wondering why the new protocol for stable wide complex tachycardia with adenosine?
Roxanne Corff says
Well, in my readings ….”use of AV nodal blocking agents such as Adenosine may cause transient ventriculoatrial block leading to AV dissociation that establishes the diagnosis of VT….” therefore, I take that to mean that at the very least, if it is monomorphic wide complex well-tolerated VT you can at least diagnose it with Adenosine.
Patrim Lam, MD – Approach to the Evaluation and Management of Wide Complex Tachycardias – Indian Pacing Electrophysiology J. 2002 Oct-Dec 2(4) 120-126
Maybe that’s what lead to them deciding to go ahead and try it – and then get expert consultation, during the trial.
faiza shahbal says
Enjoyed the quizes ,mega code and rhythm recognition.Makes everything easy..i commend you all for the site,
Mary Albert says
So you shock a polymorphic v-tach. Question is….what if they have a pulse? I thought you only shock vfib or pulseless v-tach.
Jeff with admin. says
You would shock unstable polymorphic VT. If they are stable you would treat them with the tachycardia algorithm and quickly seek an expert consultation. You will treat them differently depending on if they are stable or unstable. If stable, your best option would be to use the medication protocols outlined in the tachycardia algorithm.—Jeff
leonie Coetzee says
Is there a website for ACLS EP?
william wheeler says
This site is excellent. I am also curious to know if there is an ACKS EP site?
Veronica says
Fantastic learning website!! I learned so much and everything is coming together. Keep up the great work and thank you!
Radhika says
your website and videos are amazing. please keep it up and add more EKG learning tools and arrythmia’s as you can. thank you. god bless.
Omana Vincent says
Excellent Site. Could you please provide more details
Jeff with admin. says
Hi Omana,
Thanks for the encouragement. We regularly add content to the website and will continue to do so. Kind regards, Jeff
Margo Turner says
Excellent acls study tool – I’m so enjoying it !
jmercurio-hem says
great stuff
jmercurio-hem says
this is great i can treat’em just have trouble reading them thanks
anil says
nice
Jeff Taylor PA says
Great job on the site. Thanks so much for putting htis together. Very well organized and the visuals are so helpful. Kudos…
Dr Surpreet says
please talk about other tachycardias as well. soon