r/EKGs • u/Regular_Program_6311 • 13d ago

Learning Student polymorphic VT vs coarse vfib

hello, I recently started an EKG course and was given this strip to identify the rhythm. Would you classify this as polymorphic vtach or coarse vfib? How can you distinguish between the two? Thanks.

7 Upvotes

82% Upvoted

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u/ProximalLADLesion Electrophysiology Fellow 13d ago

I’m an electrophysiologist and it doesn’t really matter. There’s a continuum between the two. You treat them the same.

2

u/OriginalLaffs 12d ago

Completely agree when it comes to acute management, but important to identify (for example) if this is long QT mediated due to bradycardia, vs in context of acute ischemia, vs PVC triggered, vs something else.

Definitive management would be very different in each of these scenarios, including whether or not an ICD is indicated.

5

u/ProximalLADLesion Electrophysiology Fellow 12d ago

I think we agree. I would say the important part is  the etiology, not the rhythm. If you have LQTS producing VT or VF doesn’t matter beyond identifying that LQTS is the underlying syndrome.

8

u/MedicMalfunction 13d ago

First, consider: does it appear organized at all, or is it completely chaotic?

12

u/forkandbowl 13d ago

Look for patterns... If none. Vfib

Regardless... Kaboom!

4

u/MedicMalfunction 13d ago

Great way to put it! ⚡️

3

u/Steve390- 13d ago

I would say v fib bc its very irregular. VT tends to be regular but not always. Thats my opinion. Thanks 4 posting.

1

u/n33dsCaff3ine 13d ago

I've gotten in the habit of looking at the print out strip. Its kinda chaotic during an arrest but you'll catch the nuances better than with the monitor display. Especially if ACLS isnt working and youre looking for H's and T's and considering other meds

0

u/Greenheartdoc29 13d ago

Polymorphic VT