Pulseless Ventricular Tachycardia

What is pulseless ventricular tachycardia?

Your heart has four chambers. There are two upper chambers (atria) and two lower chambers (ventricles). The ventricles are the main pumping chambers of your heart. With each heartbeat, they contract forcefully to send blood out to your body and lungs.

Pulseless ventricular tachycardia occurs when the ventricles beat too fast. It is a type of ventricular arrhythmia or abnormal heartbeat of the ventricles.

In pulseless ventricular tachycardia, the heart contracts too fast (tachycardia). This prevents the ventricles from filling with blood and stops blood flow to the body. Without blood flow, a person has no pulse. This lack of blood flow can quickly lead to organ failure, heart failure and sudden cardiac arrest. Pulseless ventricular tachycardia can be monomorphic (heart beats have similar electrical waveforms) or polymorphic (heart beats have varying waveforms).

Sudden cardiac arrest is a life-threatening emergency. If you suspect you or someone you're with is experiencing cardiac arrest, do not hesitate to call 911 (or your local emergency services phone number). Time is critical in treating cardiac arrest, and a delay of even a few minutes can result in permanent damage or death.

Is ventricular tachycardia always pulseless?

Ventricular tachycardia is not always pulseless. In ventricular tachycardia, the heart rate usually exceeds 100 beats per minute. A normal resting heart rate is 60 to 100 beats per minute. The severity of ventricular tachycardia depends on how:

• Fast the heart beats.
• Long the rapid heart rate lasts.
• Often the rapid heart rate occurs.

Ventricular tachycardia is often treatable. If it becomes severe it can lead to pulseless ventricular tachycardia. It is more likely to occur in people who have other heart conditions.

How common is pulseless ventricular tachycardia?

Each year in the U.S., about 350,000 people, mostly over age 35, die from sudden cardiac death. The majority of deaths from sudden cardiac arrest are due to ventricular arrhythmias.

How does pulseless ventricular tachycardia occur?

Your heartbeat is controlled by electrical signals (impulses) that travel through the heart. This condition can occur when the electrical signals don’t follow the normal pathway. This can result in rapid heartbeats.

What causes pulseless ventricular tachycardia?

Many conditions can alter the electrical signals in the heart. Structural heart diseases are the most common cause. These include:

• Valvular heart disease.
• Cardiomyopathy.
• Coronary artery disease.
• Heart attack (myocardial infarction).
• Heart failure.

Other causes of pulseless ventricular tachycardia include:

• Heart rhythm diseases such as long Q-T syndrome and Brugada syndrome.
• Drugs that can alter the heart’s electrical activity such as erythromycin (an antibiotic) or methadone.
• Imbalances in electrolytes that help regulate your heart’s electrical signals.

What are the symptoms of pulseless ventricular tachycardia?

People with pulseless ventricular tachycardia are:

• Unconscious.
• Unresponsive.
• Without a pulse.

Before becoming unconscious, you may experience symptoms of ventricular tachycardia, including:

• Chest pain.
• Dizziness.
• Heart palpitations (racing, pounding or skipped heartbeats).
• Lightheadedness.
• Shortness of breath.

How is pulseless ventricular tachycardia diagnosed?

Because it is a medical emergency, it's not always possible to diagnose. Call 911 and start CPR right away.

How is pulseless ventricular tachycardia treated?

If it occurs outside the hospital, first responders will perform CPR, as well as:

• Defibrillation, an electrical shock, to restore the heartbeat.
• Supplemental oxygen, to raise oxygen levels in the blood.
• Medications, to increase blood pressure and correct an abnormal heartbeat.

The goal is to get your heart beating normally again. Then healthcare providers will check for any health problems caused by cardiac arrest. To protect the brain from damage, they may cool your body. If a heart attack occurred, they will provide immediate treatment.

Your provider may recommend an implantable cardioverter defibrillator (ICD). This device monitors your heartbeat 24/7. If it detects an abnormal heart rhythm, it sends an electrical shock to correct it. Studies show that defibrillators are highly effective at reducing sudden cardiac death.

How can I prevent pulseless ventricular tachycardia?

A heart-healthy lifestyle can reduce your chance of developing many types of heart conditions and diseases. Important habits include:

• Consuming a healthy diet that is low in salt and cholesterol.
• Controlling stress.
• Exercising regularly.
• Limiting alcohol and caffeine.
• Maintaining a healthy weight.
• Managing your blood pressure.
• Quitting smoking and tobacco use.

How can I prevent pulseless ventricular tachycardia if I already have heart disease?

Follow your treatment plan and check in with your healthcare provider routinely. This will help reduce your chance of developing a more dangerous heart condition.

What is the prognosis for people with pulseless ventricular tachycardia?

The outlook depends on how long it takes to restore a person’s pulse. Survival rates are only about 5% if the delay is more than 15 minutes.

What are complications of pulseless ventricular tachycardia?

Damage to the brain can occur if cardiac arrest lasts longer than three to five minutes. Other life-threatening complications can include:

• Heart failure.
• Organ failure.
• Respiratory distress.
• Widespread blood clotting.

Your healthcare team will coordinate your care to help minimize these complications and optimize your recovery.

When should I contact my healthcare provider?

Seek medical care right away if you have symptoms of ventricular tachycardia, including:

• Chest pain.
• Dizziness.
• Heart palpitations (racing, pounding or skipped heartbeats).
• Lightheadedness.
• Shortness of breath.

A note from Cleveland Clinic

Pulseless ventricular tachycardia is a serious condition that must receive immediate emergency treatment. Though the prognosis is poor, it can be prevented. The first and most important step is to adopt a heart-healthy lifestyle. If you have any type of heart condition, check in with your provider regularly and follow your treatment plan. Your provider should be your go-to resource for any questions or concerns you may have about your heart health.