Pulseless VT/VT

Editorial Team / Admin · Mar 5, 2016

Pulseless VT means the patient does not have a pulse. This is where you would do a defibrillation. VT with a pulse requires synchronized cardioversion because shocking unsynchronized can cause a shock to occur during a phase of electrical activity that will actually cause the rhythm to deteriorate. It's not the speed that determines pulselessness but whether or not the patient has a pulse.

edvardsoz · Mar 5, 2016

i know that pulseless ventricular tachycardia is a ventricular tachycardia without a pulse, but what does make it pulseless?

Lev, MSN, RN, NP · Mar 7, 2016

Lack of adequate/any perfusion makes it pulseless.

nursej22, MSN, RN · Mar 9, 2016

Perfusion and cardiac output depend on stroke volume, or how much blood the the heart pushes out with each contraction and heart rate. If blood volume is low, or the heart is not pumping effectively, less is pushed out. So a hypovolemic patient or one with a weak heart may become pulseless with lower heart rate.

Regarding sync vs. non sync. : if you have time, say in v tach with a pulse, you can sync and deliver the shock on the r wave. This decreases the chance of causing v fib and allows a lower dose of electricity. However, your defibrillator may not be able to detect the r wave, in which case you need to defibrillate (deliver a larger dose of unsynchronized electricity).

akulahawkRN, ADN, RN, EMT-P · Mar 9, 2016

i know that pulseless ventricular tachycardia is a ventricular tachycardia without a pulse, but what does make it pulseless?

Quite simply, what makes it "pulseless" is that cardiac output is so low (effectively zero) that there are no palpable pulses anywhere. Any rhythm that does not generate a pulse is, by definition of no pulse, pulseless. You can have a beautiful looking normal sinus rhythm on the monitor and no pulses. That's called "Pulseless Electrical Activity" and it used to be called "Electromechanical Dissociation" meaning that there was no mechanical activity (no pumping) in response to the electrical stimulation.

It's not so much a specific rate that is the problem, it's that at whatever rate that's going, it's that the rate happens to be too fast for that particular patient's heart to pump effectively at that time. The rhythm only has to be a ventricular tachycardia.

offlabel · Mar 9, 2016

i know that pulseless ventricular tachycardia is a ventricular tachycardia without a pulse, but what does make it pulseless?

You have a very bright future ahead of you, I think. Very insightful question.

Patients have pulseless rhythms for all kinds of different reasons. In VT, it's just a matter of whether or not the patient can tolerate the faster heart rate, and that is determined by a lot of factors, not the least of which is the baseline cardiovascular status of the patient in the first place.

In VT, there are two impediments to adequate filling of the heart with blood. The first is the lack of atrial 'kick' filling of the ventricles, the second is that the ventricles don't fully relax and fill because there isn't enough time between heart beats.

If you're 22 years old, you have a better chance of having a pulse with that. If you're 82 years old, not so much.

Get it, Hot Shot?

edvardsoz · Mar 10, 2016

i kinda start to get it, thank you! :) i want to study cardiology/electrophysiology but the long years of studying scare me. almost 10 years of intensive studying, i'd rather be a stripper

offlabel · Mar 10, 2016

i kinda start to get it, thank you! :) i want to study cardiology/electrophysiology but the long years of studying scare me. almost 10 years of intensive studying, i'd rather be a stripper

Well, you can pick being 10 years older as a stripper or 10 years older as an electrophysiologist. Either way, 10 years is going to pass. Good luck!