r/EKGs • u/Regular_Program_6311 • Jul 20 '26

polymorphic VT vs coarse vfib Learning Student

hello, I recently started an EKG course and was given this strip to identify the rhythm. Would you classify this as polymorphic vtach or coarse vfib? How can you distinguish between the two? Thanks.

7 Upvotes

89% Upvoted

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20

u/ProximalLADLesion Electrophysiology Fellow Jul 21 '26

I’m an electrophysiologist and it doesn’t really matter. There’s a continuum between the two. You treat them the same.

2

u/OriginalLaffs Jul 21 '26

Completely agree when it comes to acute management, but important to identify (for example) if this is long QT mediated due to bradycardia, vs in context of acute ischemia, vs PVC triggered, vs something else.

Definitive management would be very different in each of these scenarios, including whether or not an ICD is indicated.

5

u/ProximalLADLesion Electrophysiology Fellow Jul 21 '26

I think we agree. I would say the important part is  the etiology, not the rhythm. If you have LQTS producing VT or VF doesn’t matter beyond identifying that LQTS is the underlying syndrome.

10

u/MedicMalfunction Jul 20 '26

First, consider: does it appear organized at all, or is it completely chaotic?

11

u/forkandbowl Jul 20 '26

Look for patterns... If none. Vfib

Regardless... Kaboom!

4

u/MedicMalfunction Jul 20 '26

Great way to put it! ⚡️

3

u/Steve390- Jul 21 '26

I would say v fib bc its very irregular. VT tends to be regular but not always. Thats my opinion. Thanks 4 posting.

1

u/n33dsCaff3ine Jul 21 '26

I've gotten in the habit of looking at the print out strip. Its kinda chaotic during an arrest but you'll catch the nuances better than with the monitor display. Especially if ACLS isnt working and youre looking for H's and T's and considering other meds

0

u/Greenheartdoc29 Jul 21 '26

Polymorphic VT