Snapshot A 57-year-old woman present to the emergency department after fainting. She complained of a rapid heart beat to her co-worked just before she passed out. Her EKG is shown. Introduction Appears as 3+ consecutive PVCs Associated with CAD, MI, and structural heart defects Presentation Asymptomatic if non-sustained Sustained V-tach defined as > 30 seconds presents with palpitations, hypotension, angina, and syncope May progress to ventricular fibrillation (VF) Evaluation Regular, rapid rhythm EKG demonstrates wide QRS complexes with no P-waves atrioventricular dissociation Differential Wide-complex supraventricular tachycardias, ventricular fibrillation Treatment Sustained VT requires immediate intervention risk of progressing to VF and death If asymptomatic (patient has a pulse) chemical cardioversion lidocaine, amiodarone, procainamide synchronized cardioversion If symptomatic (hypotension or absent pulse) treat as VF emergency defibrillation (200 > 300 > 360 J) Prognosis, Prevention, and Complications Can progress to ventricular fibrillation and sudden death if left untreated Patients might require long-term medication and follow-up