Myocardial Infarction & Peripheral Vascular Diseases Q 47

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A client has frequent bursts of ventricular tachycardia on the cardiac monitor. A nurse is most concerned with this dysrhythmia because:

  

     A. It is uncomfortable for the client, giving a sense of impending doom.

     B. It produces a high cardiac output that quickly leads to cerebral and myocardial ischemia.

     C. It is almost impossible to convert to a normal sinus rhythm.

     D. It can develop into ventricular fibrillation at any time.

    

    

Correct Answer: D. It can develop into ventricular fibrillation at any time.

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Ventricular tachycardia is a life-threatening dysrhythmia that results from an irritable ectopic focus that takes over as the pacemaker for the heart. Ventricular tachycardia is characterized as a wide complex (QRS duration greater than 120 milliseconds) tachyarrhythmia at a heart rate greater than 100 beats per minute. The physical examination findings of cannon A waves and variable intensity of the S1 heart sound suggest AV dissociation, a criterion favoring the diagnosis of ventricular tachycardia.

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Option A: The client has frequently experienced a feeling of impending death. Ventricular tachycardia is treated with antiarrhythmic medications or magnesium sulfate, cardioversion (client awake), or defibrillation (loss of consciousness). The prognosis of VT depends on the cause and cardiac status. Patients who develop VT can suffer from hemodynamic failure and the mortality can exceed 30% if no treatment is provided.

Option B: The low cardiac output that results can lead quickly to cerebral and myocardial ischemia. Patients who undergo an episode of unexplained sudden cardiac arrest secondary to a ventricular tachyarrhythmia, CT, or coronary angiography can be used to confirm the presence or absence of ischemic heart disease.

Option C: Ventricular tachycardia can deteriorate into ventricular fibrillation at any time. In-hospital cardiac arrest shares the similarity with out-of-hospital cardiac arrest in that early cardiopulmonary resuscitation (CPR), and defibrillation are important factors in survival. (Level I) Every minute that treatment is delayed reduces survival by approximately 10%.

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