Ineffective Pumping: Pulseless Ventricular Tachycardia

Pulseless ventricular tachycardia (PVT) is a critical and life-threatening cardiac arrhythmia where the ECG shows ventricular tachycardia, but the patient has no palpable pulse.¹⁶⁵ This indicates that although there is electrical activity in the ventricles, they are not contracting effectively enough to pump blood and generate cardiac output.¹⁶⁵

Analogy: “The rapid drum solo is so fast and uncoordinated that it no longer contributes to the rhythm of the song.”

ECG Characteristics

The ECG appearance of pulseless ventricular tachycardia is similar to that of ventricular tachycardia with a pulse. It typically shows a rapid heart rate, usually greater than 180 beats per minute, and wide QRS complexes (greater than 0.12 seconds).¹⁶⁵ The rhythm may be monomorphic (with QRS complexes of similar shape) or polymorphic (with QRS complexes varying in shape).¹⁶⁵ The absence of a palpable pulse is the key clinical finding that distinguishes pulseless ventricular tachycardia from ventricular tachycardia with a pulse.²⁰²

Other Symptoms

The clinical presentation of pulseless ventricular tachycardia is characterized by the signs of cardiac arrest. The patient will be unconscious and unresponsive, and there will be no detectable pulse or breathing.²⁰² This condition requires immediate emergency treatment, including cardiopulmonary resuscitation (CPR) and defibrillation, to attempt to restore an effective heart rhythm and circulation.²⁰²

Analogy

“Like an engine revving at high speed but not connected to the wheels, the ventricles are contracting rapidly but not pumping blood effectively.”