Ventricular tachycardia physical examination
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Differentiating Ventricular Tachycardia from other Disorders |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in Chief: Avirup Guha, M.B.B.S.[2]
Overview
Physical examination should consist of a thorough cardiac exam, lung exam, and close monitoring of vital signs. Findings on physical exam may include hemodynamic instablity, cannon a wave in jugular venous pulsation, rales in lung fields, lower limbs edema, evidence of sternotomy scar due to previous CABG, and ICD pocket.
Physical Examination
Physical findings depend in part on the P-to-QRS relationship with/without signs of AV dissociation.[1]
Vital Signs
- Carotid sinus massage may slow the atrial rate and, in some cases, expose AV dissociation.
Blood Pressure
- Hemodynamic compromised (hypotension, shock) are often, but not always present.
- Highly inconsistent fluctuations in the blood pressure can occur because of the variability in the degree of left atrial (LA) contribution to LV filling, stroke volume, and cardiac output.
Neck
- Intermittent cannon A waves can be observed on examination of the jugular pulsation in the neck, and they reflect simultaneous atrial and ventricular contraction.
Heart
- Variability in the occurrence and intensity of heart sounds (especially S1) may also be observed and is heard more frequently when the rate of the tachycardia is slower.
- Look for evidence of preexisting conditions like a pacemaker/AICD or scar mark from previous cardiothoracic surgery.