Ventricular tachycardia physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in Chief: Avirup Guha, M.B.B.S.[2]

Overview

Physical examination should consist of a thorough cardiac exam, lung exam, and close monitoring of vital signs. Jugular pulsation may be noted in the neck exam.

Physical Examination

Physical findings depend in part on the P-to-QRS relationship with/without signs of AV dissociation.

Vital Signs

Vitals are generally unaffected by carotid sinus massage, although this maneuver may slow the atrial rate and, in some cases, expose AV dissociation.

Blood Pressure

• Hemodynamic compromise (hypotension, shock) are often, but not always present.
• Highly inconsistent fluctuations in the blood pressure can occur because of the variability in the degree of left atrial (LA) contribution to LV filling, stroke volume, and cardiac output.

Neck

• Intermittent cannon A waves can be observed on examination of the jugular pulsation in the neck, and they reflect simultaneous atrial and ventricular contraction.

Heart

• Variability in the occurrence and intensity of heart sounds (especially S1) may also be observed and is heard more frequently when the rate of the tachycardia is slower.

• Look for evidence of preexisting conditions like a pacemaker/AICD or scar mark from previous cardiothoracic surgery.