Monomorphic Ventricular Tachycardia ECG Example
Figure 1: Monomorphic Ventricular Tachycardia - Characteristic ECG Pattern
🔑 Key Points at a Glance
- Heart Rate: 100-250 bpm (typically 140-200 bpm)
- Primary Significance: Life-threatening arrhythmia, usually indicates structural heart disease, can degenerate to VFib
- Key Management: If unstable: immediate synchronized cardioversion. If stable: amiodarone or procainamide, identify underlying cause, ICD evaluation
- Clinical Category: Clinical
Overview and Clinical Significance
Monomorphic Ventricular Tachycardia represents a critical cardiac rhythm pattern that requires immediate recognition and intervention. Life-threatening arrhythmia, usually indicates structural heart disease, can degenerate to VFib
Understanding this ECG finding is essential for emergency physicians, cardiologists, intensivists, and all healthcare providers involved in acute cardiac care. Early recognition and appropriate management can significantly impact patient outcomes and prevent life-threatening complications.
ECG Characteristics and Recognition
📊 Diagnostic ECG Criteria
- Wide QRS complexes >120ms
- Regular rhythm
- Uniform QRS morphology
- AV dissociation
- Capture or fusion beats (pathognomonic)
Systematic ECG Analysis Approach
When analyzing any ECG, including suspected Monomorphic Ventricular Tachycardia, follow this systematic approach:
- Rate: Calculate ventricular rate using the 300-150-100-75-60-50 rule or count QRS complexes in 6 seconds × 10
- Rhythm: Assess regularity by measuring R-R intervals across the entire strip
- P Waves: Identify presence, morphology, and relationship to QRS complexes
- PR Interval: Measure from start of P wave to start of QRS (normal: 0.12-0.20 seconds or 3-5 small squares)
- QRS Complex: Assess duration (normal: Always assess hemodynamic stability FIRST - unstable patients require immediate intervention regardless of the specific ECG diagnosis
Evidence-Based Management
Acute Management Strategy
Primary Treatment Approach: If unstable: immediate synchronized cardioversion. If stable: amiodarone or procainamide, identify underlying cause, ICD evaluation
🚨 Emergency Protocol - Time-Critical Actions
- Immediate ABC assessment (Airway, Breathing, Circulation)
- Attach continuous cardiac monitoring and obtain 12-lead ECG
- Establish large-bore IV access (×2) and check bedside glucose
- Administer supplemental oxygen if SpO₂ Recommendations for management of Monomorphic Ventricular Tachycardia are primarily supported by Level A evidence (multiple high-quality randomized controlled trials and meta-analyses).
Summary and Clinical Bottom Line
📋 Clinical Bottom Line
Monomorphic Ventricular Tachycardia is characterized by wide qrs complexes >120ms on ECG. Life-threatening arrhythmia, usually indicates structural heart disease, can degenerate to VFib Primary management: If unstable: immediate synchronized cardioversion. If stable: amiodarone or procainamide, identify underlying cause, ICD evaluation Key takeaway: This is a life-threatening emergency requiring immediate recognition and treatment - time-critical intervention saves lives
About the Author
Dr. Raj K
Emergency Medicine Physician Dr. Raj K is a board-certified Emergency Medicine physician with extensive experience in acute cardiac emergencies, advanced ECG interpretation, and critical care. He is passionate about medical education and bringing evidence-based emergency medicine knowledge to healthcare providers worldwide through E-PulsePoints. His clinical expertise includes STEMI management, complex arrhythmia recognition, and emergency cardiac procedures.
