Ventricular Tachycardia

Key points

• VT = broad-complex tachycardia from a ventricular ectopic focus; can precipitate VF → urgent treatment. Monomorphic VT is most commonly caused by MI; polymorphic VT includes torsades de pointes (prolonged QT).
• Adverse signs (systolic BP <90 mmHg, chest pain, heart failure) → immediate cardioversion; without them use antiarrhythmics, then synchronised DC shocks if drugs fail.
• Drugs: amiodarone (ideally via a central line) · lidocaine (caution in severe LV impairment) · procainamide; flecainide has limited use in certain VT.
• Verapamil must NOT be used in VT — class IV agent acting only on nodal tissue, significantly ↑ risk of ventricular fibrillation.
• If drug therapy fails: electrophysiological study (EPS) and/or ICD — ICD particularly indicated with significantly impaired LV function.

Decision points in this pathway

• Adverse signs present (systolic BP <90 mmHg, chest pain, heart failure)?
• Drug therapy effective?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.