Vtach

[mugs]

How many beats of vtach would be of real concern??

[Rose_Queen, BSN, MSN, RN]

What does the patient assessment tell you? What type of v tach- monomorphic or polymorphic?

Nonsustained ventricular tachycardia (NSVT) has been recorded in a wide range of conditions, from apparently healthy individuals to patients with significant heart disease. In the absence of heart disease, the prognostic significance of NSVT is debatable. When detected during exercise, and especially at recovery, NSVT indicates increased cardiovascular mortality within the next decades. In trained athletes, NSVT is considered benign when suppressed by exercise. In patients with non–ST-segment elevation acute coronary syndrome, NSVT occurring beyond 48 h after admission indicates an increased risk of cardiac and sudden death, especially when associated with myocardial ischemia. In acute myocardial infarction, in-hospital NSVT has an adverse prognostic significance when detected beyond the first 13 to 24 h. In patients with prior myocardial infarction treated with reperfusion and beta-blockers, NSVT is not an independent predictor of long-term mortality when other covariates such as left ventricular ejection fraction are taken into account. In patients with hypertrophic cardiomyopathy, and most probably genetic channelopathies, NSVT carries prognostic significance, whereas its independent prognostic ability in ischemic heart failure and dilated cardiomyopathy has not been established. The management of patients with NSVT is aimed at treating the underlying heart disease.

​Nonsustained ventricular tachycardia (NSVT) is defined as 3 (sometimes 5) or more consecutive beats arising below the atrioventricular node with an RR interval of 100 beats/min) and lasting 1). This definition, however, is not universal. NSVT has also been defined as runs of ≥16 beats with a rate ≥125 beats/min (2) or >120 beats/min (3), using a time cutoff of 15 s (4), or even without strictly defined diagnostic criteria (5). Thus, reliable epidemiological data on NSVT are difficult to obtain, particularly because reproducibility of NSVT recordings on Holter monitoring is documented in only half of the patients with this arrhythmia (6). Although NSVT may cause symptoms of palpitations, usually it is asymptomatic because of its brevity and the nature of the short-lived episodes of arrhythmia may not allow a clear distinction between monomorphic and polymorphic ventricular rhythms. When NSVT is documented in the context of a history of established monomorphic VT, it is usually monomorphic and may demonstrate the same morphology and share the same mechanism with the clinical sustained arrhythmia, especially in cases of idiopathic VT.

In several clinical settings, NSVT is a marker of increased risk for subsequent sustained tachyarrhythmias and sudden cardiac death (SCD), whereas it may have no prognostic significance in others. The important tasks of the physician are to detect those apparently healthy individuals in whom NSVT represents a sign of occult disease, and to risk-stratify patients with known disease who present with this arrhythmia to provide therapy that mitigates associated risks. This may not always be easy in clinical practice. Whether NSVT provokes sustained, life-threatening arrhythmias or is simply a surrogate marker of a more severe underlying pathology is still unknown in most clinical settings.

Non sustained ventricular tachycardia

[Lev, MSN, RN, NP]

3 PVCs in a row is Vtach. It really depends on the patient scenario. Is this patient throwing a lot of PVCs and then has a 3 beat run of vtach? Is this new onset? Was the patient symptomatic? It's always better to be safe than sorry and notify. However, most physicians will not get excited unless it is more than 5-6 beats which is enough for a patient to lose consciousness.

[MsBruiser]

Cardiac device nurse here. I will give you a simple answer. Generally, anything less than 10 beats does not really get my attention. That is a very simple rule of thumb. The most important way to look at this is by looking at the patient's clinical history. Do they have regular runs of ventricular tachycardia? If a patient has no history of ventricular tachycardia and then has 12 6-beat runs in a single month, I will kick these findings up to the attending, pronto. But lets say I was back in the PACU and a patient had a 7 beat run. With what I know now it would not get me very excited. And if the patient already has an ICD, well, what is the worst thing that can happen?

[MrBlueSky]

Check a K and a mag for sure. Thats pretty much all they will do

[Pheebz777, BSN, RN]

I wouldn't be worried about a few runs of VT. I would be more worried of how frequent the runs are occuring, how long they sustain, and the effect on the patients clinical status.

Check lytes esp. Mg and K and let the MD know. Most likely they'll be on an amiodarone drip, lidocaine drip, or if very unstable they could be cardioverted (synchronized).

[AgentBeast, BSN, RN]

V-Tach that starts and doesn't stop is concerning, or a patient that is in VT more than he/she is not in VT is concerning. Short Non-Sustained runs of VT are generally not of any particular concern if the patient is otherwise not symptomatic.