Ventricular Fibrillation in Emergency Medicine Clinical Presentation

  • Author: Keith A Marill, MD; Chief Editor: David FM Brown, MD   more...
 
Updated: Jun 23, 2011
 

History

  • Ventricular fibrillation (VF) often occurs without forewarning. The following symptoms, while not necessarily specific for sudden cardiac death or VF, may develop before any major cardiac event:
    • Chest pain and other angina equivalents
    • Dyspnea
    • Easy fatigue
    • Palpitations
    • Syncope
    • Immediately preceding acute cardiac arrest, possible increase in heart rate, presence of premature ventricular contractions (PVCs), or period of VT
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Physical

Physical examination findings may include the following:

  • No pulse or respiration
    • Patients in cardiac arrest have no pulse. However, both lay rescuers and healthcare providers may have difficulty determining pulselessness. Current AHA guidelines do not recommend that lay rescuers check for a pulse. Healthcare providers should take no more than 10 seconds to check for a pulse. If no pulse is found, the provider should proceed with chest compressions.
    • Patients in cardiac arrest have absent or abnormal (gasping) respirations. Adults who are unresponsive or have been witnessed to collapse, and have absent or abnormal respirations are likely to be in cardiac arrest. AHA guidelines recommend activating the emergency response system (call 911) and initiating CPR.
    • Unconsciousness
  • Wide and chaotic QRS complexes on cardiac monitor
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Causes

  • Cardiac, structural heart disease
    • Myocardial ischemia or infarction due to coronary artery disease: Coronary atherosclerosis and its consequences are responsible for approximately 80% of sudden cardiac deaths in the United States.
    • Cardiomyopathy: Dilated and hypertrophic cardiomyopathies are the second most important cardiac causes of sudden death. The degree of functional and physiologic left ventricular impairment is correlated with the risk of sudden death: dilated, hypertrophic, or arrhythmogenic right ventricular cardiomyopathy or dysplasia.
    • Aortic stenosis
    • Aortic dissection
    • Pericardial tamponade
    • Congenital heart disease
    • Myocarditis
  • Cardiac, no structural heart disease
    • Catecholaminergic polymorphic ventricular tachycardia and right ventricular outflow tract tachycardia
    • Mechanical (commotio cordis)[4] or electrical accidents
    • Preexcitation (including Wolff-Parkinson-White syndrome)
    • Heart block
    • Drug-induced QT prolongation with torsades de pointes
    • Channelopathies: long QT syndrome, short QT syndrome, or Brugada syndrome
  • Noncardiac respiratory
  • Metabolic or toxic
    • Electrolyte disturbances and acidosis
    • Medications or drug ingestion
    • Environmental poisoning
    • Sepsis
  • Neurologic
    • Seizure
    • Cerebrovascular accident - Intracranial hemorrhage or ischemic stroke
    • Drowning
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Contributor Information and Disclosures
Author

Keith A Marill, MD  Faculty, Department of Emergency Medicine, Massachusetts General Hospital; Assistant Professor, Harvard Medical School

Keith A Marill, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: Medtronic Ownership interest None; Cambridge Heart, Inc. Ownership interest None; General Electric Ownership interest None

Coauthor(s)

A Antoine Kazzi  MD, Deputy Chief of Staff, American University of Beirut Medical Center; Associate Professor, Department of Emergency Medicine, American University of Beirut, Lebanon

A Antoine Kazzi is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Mazen K Khalil, MD  Post Doctoral Research Fellow, Department of Cell Biology, Lerner Research Institute, Cleveland Clinic Foundation

Mazen K Khalil, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Aaron A Bright, MD  Assistant Professor of Clinical Emergency Medicine, Department of Emergency Medicine, LAC+USC Medical Center, Keck School of Medicine of the University of Southern California

Aaron A Bright, MD is a member of the following medical societies: American College of Emergency Physicians and Los Angeles County Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Steven A Conrad, MD, PhD  Chief, Department of Emergency Medicine; Chief, Multidisciplinary Critical Care Service, Professor, Department of Emergency and Internal Medicine, Louisiana State University Health Sciences Center

Steven A Conrad, MD, PhD is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American College of Emergency Physicians, American College of Physicians, International Society for Heart and Lung Transplantation, Louisiana State Medical Society, Shock Society, Society for Academic Emergency Medicine, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gary Setnik, MD  Chair, Department of Emergency Medicine, Mount Auburn Hospital; Assistant Professor, Division of Emergency Medicine, Harvard Medical School

Gary Setnik, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: SironaHealth Salary Management position; South Middlesex EMS Consortium Salary Management position; ProceduresConsult.com Royalty Other

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

David FM Brown, MD  Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital

David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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Ventricular fibrillation. Rapidly recurrent despite electrical biphasic defibrillation. Notice that recurrence begins after completion of the T wave and is not due to an R-on-T phenomenon in this case. This episode of ventricular fibrillation (VF) occurred in the emergency department and was present for less than 30 seconds prior to defibrillation, hence the course morphology. Also an undulating amplitude suggestive of torsades de pointes was present; however, the QT interval during sinus rhythm was normal, and the only known predisposing factors for tachydysrhythmia were newly diagnosed coronary artery disease with acute right coronary artery occlusion and a history of rheumatoid pericarditis.
 
 
 
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