Pulseless ventricular tachycardia natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]

Overview

On initial presentation, patients with impending pulseless ventricular tachycardia may show signs of inadequate cardiac perfusion such as chest pain, shortness of breath, diaphoresis, palpitations, and syncope. Physical examination may be positive for hypotension, tachycardia, tachypnea, increased JVD, and an S1. Eventually, Pulseless ventricular tachycardia ensues and patients become unconscious and unresponsive with no detectable pulse. If defibrillation is not begun as soon as possible patients may progress to cardiac arrest and death. ^[1]

Natural History, Complications, and Prognosis

On initial presentation, patients with impending pulseless ventricular tachycardia may present with signs of inadequate cardiac perfusion such as chest pain, shortness of breath, diaphoresis, palpitations, and syncope.
Physical examination may be positive for hypotension, tachycardia, tachypnea, increased JVD, and an S1.
Eventually, Pulseless ventricular tachycardia ensues and patients become unconscious and unresponsive with no detectable pulse.^[1]

Prognosis of pulseless ventricular tachycardia is majorly based on two considerations; the presence of prior expressed or unexpressed cardiac issues, and the time from the beginning of the dysrhythmia to defibrillation and conversion to sinus rhythm and adequate perfusion.^[1]
Up to 50% of patients who are defibrillated within seconds of the onset of tachycardia have high survival rates, while patients who experience delays of up to 15 minutes have a survival rate of as low as 5%.^[4]
While the most significant factors affecting prognosis are underlying structural and ischemic cardiac issues, the presence of other comorbidities also play a significant role.^[1]

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 Foglesong A, Mathew D. PMID 32119354 Check |pmid= value (help). Missing or empty |title= (help)
↑ Kang Y (August 2019). “Management of post-cardiac arrest syndrome”. Acute Crit Care. 34 (3): 173–178. doi:10.4266/acc.2019.00654. PMC 6849015 Check |pmc= value (help). PMID 31723926.
↑ Kang JY, Kim YJ, Shin YJ, Huh JW, Hong SB, Kim WY (August 2019). “Association Between Time to Defibrillation and Neurologic Outcome in Patients With In-Hospital Cardiac Arrest”. Am. J. Med. Sci. 358 (2): 143–148. doi:10.1016/j.amjms.2019.05.003. PMID 31200920.
↑ Holmberg M, Holmberg S, Herlitz J (March 2000). “Incidence, duration and survival of ventricular fibrillation in out-of-hospital cardiac arrest patients in sweden”. Resuscitation. 44 (1): 7–17. doi:10.1016/s0300-9572(99)00155-0. PMID 10699695.

Overview