Pulseless Ventricular Tachycardia

Ventricular Tachycardia

Pulseless ventricular tachycardia is a life-threatening cardiac arrhythmia in which coordinated ventricular contractions are replaced by very rapid but ineffective contractions, leading to insufficient organ perfusion and heart failure. Pulseless ventricular tachycardia is a medical emergency.


Heart Rate: heart rate greater than 100/min

Rhythm: Wide Complex Ventricular Tachycardia (Monomorphic Tachycardia)

P wave:none present

QRS Complex: Wide greater than 0.14 seconds; 

ST segment: none present

Patient is Considered Unstable

  • Level of Consciousness (unresponsive)
  • Hypotension (Systolic Less than 90mmHg.)
  • Chest Discomfort or Shortness of Breath
  • Saturation: less than 92% 
  • HR greater than 100/min

Initial Considerations:

  • Consider Oxygenation
  • Monitor and Continue Observing
  • Obtain IV/IO Access
  • Attempt the Vagal - Include Outside link for Vagal Manuever
  • Adenosine (Antiarrythmic)
    • 1st dose: 6mg
    • 2nd dose: 12mg

Treat as Unstable

  • Shock:  Biphasic (120-200J)  Monophasic 360J
  • CPR (2min)
  • Drugs
    • Epi 1mg. 
    • Amiodarone 300mg or  Lidocaine 1 - 1.5mg/kg 
    • Amiodarone 150mg or Lidocaine .5-.75mg/kg


  • Structural heart disease
    • coronary artery disease
    • aortic stenosis
    • cardiomyopathy
    • congenital heart failure
    • hypertrophic obstructive cardiomyopathy
    • myocardial infarction
  • Electrolyte Disturbances
    • Hypokalemia
    • Hyperkalemia
    • Hypomagnesium
    • Hypocalcemia
  • Drugs/medications
  • Congenital
  • The most common cause of pulseless ventricular tachycardia is cardiac ischemia
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