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

Physical Examination

Physical examination findings may include no pulse or respiration as well as wide and chaotic QRS complexes on cardiac monitors.

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.

Patients in cardiac arrest become unconscious.

Differential Diagnoses

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Media Gallery

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 coarse 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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Author

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

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

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: InCarda Therapeutics<br/>Received ownership interest from General Electric and Medtronic for none. for: Equity ownership: GE Healthcare; Medtronic; Gilead; Cytodyn; Amgen; Pfizer.

Coauthor(s)

Amin Antoine Kazzi, MD Professor of Clinical Emergency Medicine, Department of Emergency Medicine, American University of Beirut, Lebanon

Amin Antoine Kazzi, MD 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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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

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

Disclosure: Medical Director for: SironaHealth.

Chief Editor

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Additional Contributors

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, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Sections Ventricular Fibrillation in Emergency Medicine
Overview
Presentation
DDx
Workup
Treatment
Medication
References

Ventricular Fibrillation in Emergency Medicine Clinical Presentation

History

Physical Examination

References

Tables

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