Ventricular tachycardia

Have a quick question for anyone experienced with tele monitoring. I had a patient last night who was normal sinus on the monitor for the whole night. Well, one of my colleagues pointed out to me a strip that printed out of her clearly in the v-tech mode. She showed this to me after, but the patient remained sinus rhythm. Should I have contacted someone or does this happen to some patients?
Remember how they teach us in nursing school to treat the patient and not the monitor? There are a few things that can make a heart rhythm appear to be VT on the monitor when it's really sinus (or something else). The key one that comes to mind is brushing teeth. It could be what printed out was artifact. However, what was the assessment of the patient? Sometimes people have brief runs of multiple PVCs or (if I remember correctly) it's considered a run of VT if it's over 6 beats- but isn't pulseless. The patient may feel as though they're having palpitations. The assessment is important in deciding how to proceed.

Patients can have self limiting runs of vent tach. They can be asymptomatic but often they may be lightheaded, syncopal or actually pass out. Yes I would notify the MD if this was new and maybe if it wasn't new depending how long it was. They might want to check K+ and Mg+. Everybody is initially in some normal kind of rhythm before they aren't.

Thanks for the reply. She was sleeping for the most part. She might've gotten up to use the bathroom; I don't know for sure though. She doesn't have a hx of being tachy, however she does have a hx of a-fib. I'm just unsure of what to do in these situations. This isn't the first time I've questioned myself about it and thought about it after. I know I have to use my clinical judgement but at the same time, what if there is something wrong, but the patient appears stable and fine.

Typically small runs of nonsustained vtach are harmless. As a pp replied, I would want to know what the k and mg levels were as abnormalities of these electrolytes can lead to cardiac arrest (vfib or vtach). Afib usually causes frequent pvcs that can lead to r on t and then torsades. You can have the appearance of vtach on the monitor just by tapping on one of your leads or shivering. If it is sustained vtach you have to assess the patient and check for a pulse follow ACLS protocols from there. Some patients frequently go into vtach and are totally asymptomatic. That's the point of an AICD.

Also hypoxia can cause frequent pvcs that can lead to runs of vtach. Make sure the patient has their oxygen on if they're normally O2 dependent. Too much opioids can cause respiratory depression and hypoxia as well. In that case you would wake the patient up and make them breathe or give narcan. If it is a new thing for the patient and you are sure it's not artifact, get a set of vitals and call the doctor. It could also be the case that the patient didn't get their anti arrhythmic meds that day (cordarone). Just throwing some scenarios out their, not necessarily r/t your patient's situation.

You said the patient has a history of a-fib - you should trace out the person's strip and see if the "V-tach" is perfectly regular. V-tach is usually pretty regular unless it's torsades, which looks totally different from regular V-tach. If the V-tach is irregular, it may actually be a-fib with ectopy - which looks a heck of a lot like V-tach but isn't quite the same thing. I have seen a lot of my patients with active a-fib flip into into a-fib with ectopy with HRs over 130-140. The QRS widens just like V-tach, and I've reported possible V-tach to my physicians, but gotten shot down. Now, I just say, "the patient went into a tachyarrythmia with a wide QRS." You live and you learn, I guess. It still usually looks like V-tach to me.Either way I would let the physician know and show him/her the strip because it is a rhythm change.

Check your hospital policy. I work on a tele floor and the hospital has a policy to call if pt has more than 6 beats of VT. However, one time had pt having 2+ minutes of it frequently (going for AICD) and the EP said don't call unless it lasts for over 2 minutes