Patients of ventricular fibrillation usually present with sudden loss of consciousness [10]. Signs and symptoms of ventricular fibrillation include chest pain, rapid heartbeat, dizziness, nausea, shortness of breath and collapse. If untreated, the person usually has a seizure and then becomes limp and unresponsive. The patient suddenly collapses, turns deathly pale, stops breathing, and has no detectable pulse, heartbeat, or blood pressure. The patient develops irreversible brain damage after 5 minutes because of lack of oxygen to the brain. This leads to sudden cardiac arrest and death of the patient.

• Unconsciousness

  Unconsciousness Jean-Martin Charcot demonstrating hypnosis on a "hysterical" Salpêtrière patient, "Blanche" (Marie Wittmann), who is supported by Joseph Babiński.[1] Specialty Psychiatry Neurology Unconsciousness is a state which occurs when the ability [en.wikipedia.org]

  He was found unconscious but breathing normally, and had a seizure for more than 30 minutes. He was no previous history of systemic disease, previous operation, medication and any known allergy. [ncbi.nlm.nih.gov]

  Such asynchronous ventricular quivering or fibrillation prevents any effective cardiac output and results in unconsciousness (syncope). [icd9data.com]

  The patient becomes unconscious and perfusion to all parts ofthe body ceases. C. Characteristics - rapid, repetitive, chaotic waves; no uniformity; cannot identify PQRST waves. Fine V-Fib. Coarse V-Fib. Treatment 1. Check pulse. [micunursing.com]

  Such asynchronous ventricular quivering or fibrillation prevents any effective cardiac output and results in unconsciousness (SYNCOPE). It is one of the major electrocardiographic patterns seen with CARDIAC ARREST. [sideeffects.embl.de]

• Asymptomatic

  During 7 months of follow-up, the patient was asymptomatic and free of arrhythmic events. As far as we know, the patient is the oldest patient reported to have BrS. [ncbi.nlm.nih.gov]

  The patient evolved without complications, was discharged 5 days later and remained asymptomatic after a 10 month follow-up. Figure. 1. A: basal angiogram of right coronary artery; in insert, vasospasm areas. [revespcardiol.org]

  Persons who are heterozygous for mutations in these genes may be asymptomatic or may manifest Romano-Ward syndrome, but they will have normal hearing. [emedicine.medscape.com]

• Anemia

  […] emergency room) are: – Chest X-ray : may show pulmonary edema, cardiomegaly, injuries, aspiration pneumonia; – Laboratory determinations of serum levels of electrolytes, including calcium and magnesium, cardiac enzymes; – CBC (to determine if there is anemia [heartupdate.com]

  An analysis of data from the Israeli ICD Registry suggests that the presence of anemia in patients with ICDs is an independent factor that increases the risk for ventricular arrhythmias over the long term. [97] Clinically at-risk patients with anemia [emedicine.medscape.com]

  As a result, the arterial pressure falls abruptly to very low levels, and death results within six to eight minutes from anemia [ischemia] of the brain and spinal cord".[29] Spontaneous conversion of ventricular fibrillation to a more benign rhythm is [en.wikipedia.org]

• Aspiration

  Other investigations performed in patients with ventricular fibrillation (after their condition is stabilized or after being brought to the emergency room) are: – Chest X-ray : may show pulmonary edema, cardiomegaly, injuries, aspiration pneumonia; – [heartupdate.com]

  Complications Central nervous system ischaemic injury Myocardial injury Post-defibrillation arrhythmias Aspiration pneumonia Defibrillation injury to self or others Injuries from CPR and resuscitation Skin burns Death Prognosis Prognosis for survivors [patient.info]

  […] congenital) causing TdP –> VF and Brugada syndrome Aortic stenosis Aortic dissection Myocarditis Cardiac tamponade Blunt trauma ( Commotio Cordis ) Respiratory Tension pneumothorax Pulmonary embolism Primary pulmonary hypertension Sleep apnoea Bronchospasm Aspiration [lifeinthefastlane.com]

• Dyspnea

  The most common presentation is acute substernal chest pain, although occasionally dyspnea and syncope, and rarely shock with ST-segment elevation and elevated cardiac biomarkers have been observed. [ncbi.nlm.nih.gov]

  An hour before the patient faints, symptoms that may indicate a possible heart condition: – Chest pain ( angina pain ); – Dyspnea (shortness of breath); – Fatigue – intense; – Palpitations; – Syncope; – Tachycardia (especially in serious cases). [heartupdate.com]

  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 Immediately preceding acute cardiac arrest, possible [emedicine.medscape.com]

  […] cases of decompression sickness (Class IIa, LOE C-LD).updated for 20152015Oxygen Use in First AidFor first aid providers with specific training in the use of oxygen, the administration of supplementary oxygen to persons with known advanced cancer with dyspnea [doi.org]

• Agonal Respiration

  ACLS Algorithm Cardiopulmonary resuscitation For an adult who is unresponsive, pulseless, and not breathing (or has only agonal respirations), activate the emergency response system, dial 911 or the emergency number, and retrieve an automated external [emedicine.medscape.com]

• Abnormal Breathing

  breathing after acquiring the requisite information to determine the location of the event (Class I, LOE C-LD).updated for 20152015Dispatcher Recognition of Cardiac ArrestIf the patient is unconscious with abnormal or absent breathing, it is reasonable [doi.org]

• Nausea

  A 56-year-old woman presented to the emergency department with complaints of chest pain, nausea, and vomiting. [ncbi.nlm.nih.gov]

  Symptoms of VF may include palpitations (sensations of a racing heart), lightheadedness, chest tightness, shortness of breath, nausea and fainting. [scripps.org]

  The following symptoms may occur within minutes to 1 hour before the collapse: Chest pain Dizziness Nausea Rapid or irregular heartbeat ( palpitations ) Shortness of breath A cardiac monitor will show a very disorganized ("chaotic") heart rhythm. [medlineplus.gov]

• Mouth Breathing

  This involves pushing hard and quickly in the center of the person’s chest, with no mouth-to-mouth breathing. [healthline.com]

• Tachycardia

  tachycardia (diagnosis), ventricular tachycardia, V.tach, Tachycardia ventricular, Tachycardia, ventricular, Tachycardia, Ventricular [Disease/Finding], v tach, vt, ventricular tachyarrhythmia, ventricular tachycardia (V-tach), Ventricular tachycardia [fpnotebook.com]

  Adenosine remains a safe and highly efficacious therapy for supraventricular tachycardia. [ncbi.nlm.nih.gov]

  It is also used in the emergent treatment of wide complex tachycardias, including ventricular tachycardia, when a pulse is present. [rn.com]

  There are two other potential causes of ventricular tachycardia. The first is a special type of ventricular tachycardia called right ventricular outflow tract tachycardia (RVOT). [healthcentral.com]

• Chest Pain

  A 33-year-old man presented with waxing and waning severe substernal chest pain. The patient was on no prior medications, and had no risk factors for acute coronary syndrome. [ncbi.nlm.nih.gov]

  A 60 year old man with 2 hours of "crushing" chest pain suddenly collapses. [ecglibrary.com]

• Palpitations

  A 26-year-old woman of Cypriot origin presented to our emergency department with a sudden onset of palpitations and chest discomfort. She was healthy, with no previous medical history and no regular medications. [ncbi.nlm.nih.gov]

  On evaluation, the patient was conversant and without complaint of lightheadedness or palpitations. Bilateral radial and femoral pulses were absent. An automated cuff was unable to measure a brachial blood pressure in either arm. [jamanetwork.com]

  Symptoms of VF may include palpitations (sensations of a racing heart), lightheadedness, chest tightness, shortness of breath, nausea and fainting. [scripps.org]

  Signs and Symptoms Diagnosis Treatment Ventricular fibrillation may cause the following symptoms: Chest pressure or pain Fatigue Lightheadedness or dizziness Palpitations, which can be skipping, fluttering or pounding in the chest Shortness of breath [ucsfbenioffchildrens.org]

  진료기록부상 Syncope시 trauma Hx(+), dizzy(+), palpitation 30min, #1-2/wk, weakness, sudden onset and termination, chest discomfort로 기록되어 있으며, Epinephrine provocation test:negative, Flecainide provocation test 및 관상동맥조영술은 시행하지 않은 것으로 확인됨. [m.whosaeng.com]

• Cyanosis

  This is also known as cyanosis. That's the blue-color skin when you're not circulating oxygen through the body. An EKG in someone in V-fib looks like this. You're going to see course squiggly lines. [khanacademy.org]

  […] appears obstructed or if PPV is required (Class IIb, LOE C).not reviewed in 20152010Assessment of Oxygen Need and Administration of OxygenIt is recommended that oximetry be used when resuscitation can be anticipated, when PPV is administered, when central cyanosis [doi.org]

• Dizziness

  Signs and Symptoms Diagnosis Treatment Ventricular fibrillation may cause the following symptoms: Chest pressure or pain Fatigue Lightheadedness or dizziness Palpitations, which can be skipping, fluttering or pounding in the chest Shortness of breath [ucsfbenioffchildrens.org]

  진료기록부상 Syncope시 trauma Hx(+), dizzy(+), palpitation 30min, #1-2/wk, weakness, sudden onset and termination, chest discomfort로 기록되어 있으며, Epinephrine provocation test:negative, Flecainide provocation test 및 관상동맥조영술은 시행하지 않은 것으로 확인됨. [m.whosaeng.com]

  You should see him as soon as possible if you’ve felt lightheaded or dizzy, had rapid heartbeats, or you’ve fainted. Call 911 if you have chest pain and a hard time breathing, along with a rapid pulse. [webmd.com]

  Call 911 or other emergency services immediately if you have palpitations, dizziness, near-fainting, or chest pain. Talk with your doctor before changing your diet. [northshore.org]

• Irritability

  Now, let's go back to the irritable ventricular cells. What would cause ventricular cells to be irritated? Well, the most classic example is coronary artery disease. [khanacademy.org]

  It's treated no differently than asystole (rescuers attempt to wake the heart up using a combination of CPR and drugs known to make the heart irritable again). [heartdisease.about.com]

  Some electrolyte imbalances, most importantly affecting potassium, can cause irritation of the myocardium and VF. Acidosis in any form can be a prelude to an arrest. [acls.com]

  Fecal transplant is used to treat gut infections and is now being studied as a treatment for obesity, urinary tract infections, irritable bowel syndrome and more. [nytimes.com]

• Flaccid Paralysis

  Andersen-Tawil syndrome Andersen-Tawil syndrome is chiefly characterized by the triad of periodic flaccid paralysis, prolonged QT interval, and dysmorphic facies. [emedicine.medscape.com]

Ventricular fibrillation is always diagnosed in an emergency setting.

• Cardiac monitor: A cardiac monitor reveals a very disorganized heart rhythm. In addition, there is no pulse.
• Electrocardiogram: The presence of ventricular fibrillation can be confirmed only with an electrocardiogram which shows a chaotic, irregular pattern. In the begin of ventricular fibrillation, coarse and irregular waves are present. After a few seconds the electrocardiogram changes into a new pattern of low-voltage, irregular waves. The voltages of the waves in the electrocardiogram are usually about 0.5 millivolt when ventricular fibrillation begins, but they decrease to 0.2 or 0.3 millivolt. 0.1 millivolt or less may be seen 10 minutes or longer after ventricular fibrillation begins.
• Echocardiogram: This test uses sound waves to produce video images of the heart, thereby detecting any underlying abnormality. A decrease in the ejection fraction and worsening wall-motion abnormalities may confer increased risk for the development of ventricular fibrillation.
• Coronary angiography: It helps to determine if coronary arteries are narrowed or blocked. A liquid dye is injected through a long, thin tube that makes the arteries become visible on X-ray, revealing areas of blockage. Coronary angiography may precipitate ventricular fibrillation in susceptible individuals and should be used with caution [11] [12] [13].
• Cardiac computerized tomography or magnetic resonance imaging: These tests are commonly used to diagnose heart failure due to sudden cardiac arrest. It helps detect the presence, extent and location of ischemia.
• Chest X-ray: It helps check the size and shape of heart and blood vessels.
• Blood tests: Blood samples are tested for the presence of certain cardiac enzymes that leak into circulation by damaged heart. Other laboratory studies may include serum electrolyte levels, arterial blood gases, thyroid stimulating hormone and B-type natriuretic peptide.

• Hypercapnia

  […] rescuers to target normoxemia after ROSC (Class IIb, LOE B-NR).new for 20152015Postarrest Care UpdatesIt is reasonable for practitioners to target a Pa co 2 after ROSC that is appropriate to the specific patient condition, and limit exposure to severe hypercapnia [doi.org]

• T Wave Alternans

  RESULTS: Frequencies of history of syncope and spontaneous type 1 ECG, r-J interval in V1, QRS duration in V6, and LAS40, Tpeak-Tend dispersion, and max T-wave alternans were significantly associated with VF occurrence in univariate analyses. [ncbi.nlm.nih.gov]

  alternans testing can also be done. [healthline.com]

  Long QT syndrome diagnostic criteria (Open Table in a new window) Category Criteria Points Electrocardiographic Findings Corrected QT interval ≥480 ms 3 460-479 ms 2 450-459 ms (in males) 1 Torsade de pointes 2 T wave alternans 1 Notched T waves in three [emedicine.medscape.com]

• P Wave Absent

  Answers Rhythm: Irregular Rate: Unable to determine P Wave: absent PR interval: absent QRS: absent Interpretation: Ventricular Fibrillation (Fine) [ekg.academy]

• Electrocardiogram Change

  After a few seconds the electrocardiogram changes into a new pattern of low-voltage, irregular waves. [symptoma.com]

Ventricular fibrillation is treated by delivering a quick electric shock through the chest, within a few minutes of attack, using a device called an external defibrillator. Although a moderate alternating-current voltage applied directly to the ventricles almost invariably throws the ventricles into fibrillation, a strong high-voltage alternating electrical current passed through the ventricles for a fraction of second can stop fibrillation by throwing all the ventricular muscle into refractoriness simultaneously. This is accomplished by passing intense current through large electrodes placed on two sides of the heart. The current penetrates most of the fibers of the ventricles at the same time, thus stimulating essentially all parts of the ventricles simultaneously and causing them to become refractory. All action potentials stop, and the heart remains quiescent for 3 to 5 seconds, after which it begins to beat again, usually with the sinus node or some other part of the heart becoming the pacemaker. When electrodes are applied directly to the two sides of the heart, fibrillation can usually be stopped using 110 volts of 60-cycle alternating current applied for 0.1 second or 1000 volts of direct current applied for a few thousandth of a second. When applied through two electrodes on the chest wall, the usual procedure is to charge a large electrical capacitor up to several thousand volts and then to cause the capacitor to discharge for a few thousandth of a second through the electrodes and through the heart.

Unless ventricular fibrillation is defibrillated within a minute from its onset, the heart is usually too weak to be revived because of the lack of nutrition from coronary blood flow. A technique for pumping the heart without opening the chest consists of intermittent thrusts of pressure on the chest wall along with artificial respiration. This technique in combination with the use of a defibrillation is called cardiopulmonary resuscitation.

The prognosis of ventricular fibrillation involves consideration of the underlying cause of cardiac arrest and presence of co-morbidities such as metastatic cancer and dementia [5] [6]. The chances of survival after an acute attack of ventricular fibrillation depend on cardiopulmonary resuscitation rapid availability, advanced life support and transport to a hospital. The probability of success generally declines at a rate of 2-10% per minute. An estimated 20% of patients with cardiac arrest survive to hospital discharge. After return of heart function, there is a moderately higher risk of death due to recurrent ventricular fibrillation when compared to myocardial infarction patients [7] [8] [9]. With immediate angioplasty and stent placement, the prognosis is good.

The most common cause of ventricular fibrillation is myocardial infarction, particularly due to inadequate blood flow to the heart muscle because of coronary artery disease [2]. The patients with a previous episode of ventricular fibrillation or a previous heart attack are more prone to develop this condition. Moreover, increased risk for the development of ventricular fibrillation is also found in conditions such as congenital heart disease, cardiomyopathy, myocarditis, heart surgery, hypoxic ischemia, narrowed coronary arteries, damage to the heart muscles by electrocution, use of illegal drugs (such as cocaine and methamphetamine), commotio cordis in athletes and electrolyte abnormalities involving potassium and magnesium [3].

A number of people with ventricular fibrillation have no history of heart disease. However, they often have risk factors of cardiovascular disease, such as smoking, high blood pressure, obesity, dyslipidemia, sedentary lifestyle and diabetes.

Sudden cardiac arrest is the leading cause of death in the developed world. The World Health Organization estimates a significant mortality with approximately 70,000 to 90,000 sudden cardiac deaths each year in the United Kingdom with survival rates of only 2%. Up to 30% survivors of cardiac arrest may experience recurrent ventricular fibrillation in the first year after the heart complication [4]. According to one study, 31% of deaths are sudden in people aged between 20 to 29 years and a greater proportion have been common in blacks than in whites. The incidence of ventricular fibrillation is usually higher in men than in women. If prompt treatment is not given, death usually occurs within minutes.

Ventricular fibrillation is a life-threatening cardiac arrhythmia which results from cardiac impulses that have gone berserk within the ventricular muscle mass, stimulating one portion of the ventricular muscle, then another portion, then another, and eventually feeding back onto itself to re-excite the same ventricular muscle over and over again without never stopping. When this happens, many small portions of the ventricular muscle will be contracting at the same time, while as many other portions will be relaxing. Thus, there is never a coordinated contraction of all the ventricular mass at once, which is required for a normal pumping cycle of the heart. Despite massive movement of stimulatory signals throughout the ventricles, the ventricular chambers neither enlarge nor contract but remain in an indeterminate stage of partial contractions, pumping either no blood or negative amounts of it. Therefore, after fibrillation begins, unconsciousness occurs within 4 to 5 seconds due to lack of blood flow to the brain, and irretrievable death of tissues begins to occur throughout the body within a few minutes.
Ventricular fibrillation is based upon the phenomenon of re-entry that leads to “circus movements”.

It is a condition that causes the cardiac impulse to continue to travel around in a circle resulting in the”re-entry” of the impulse into muscle that has already been excited. A long conductive pathway and decreased rate of conduction frequency results in repetitive electrical stimulation. Thus, in many cardiac disturbances, re-entry can cause abnormal patterns of cardiac contraction that ignore the pace-setting effects of the sinus node.

People who are successfully resuscitated from ventricular fibrillation and survive are at high risk of another episode. In order to reduce the risk of future ventricular fibrillation, the treatment options include the following.

• Medications: Various anti-arrhythmic drugs may help control rhythm disturbances. Beta blockers are commonly used in people at risk of ventricular fibrillation.
• Implantable cardioverter-defibrillator: It is a device that can be implanted in the chest wall of people at increased risk of rhythm disorder. It detects the dangerous heart rhythm and sends out energy shocks to reset the heart to a normal rhythm.
• Coronary angioplasty and stent placement: The procedure is used for the treatment of severe coronary heart disease and thus reduces the risk of future episodes of ventricular fibrillation.
• Coronary bypass surgery: This also improves blood supply to the heart and reduces the risk of rhythm disorder.

Ventricular fibrillation is an abnormally irregular heart rhythm caused by rapid, ineffective, uncoordinated contraction of the ventricles; producing no peripheral pulse. It is a life-threatening medical emergency which, if not stopped within 1 to 3 minutes, is almost invariably fatal [1]. The lower chambers of the heart quiver and it fails to pump any blood to the vital organs, causing cardiac arrest. The patient can sustain irreversible brain damage and possibly become brain-dead due to effects of cerebral hypoxia. Ventricular fibrillation is very common during electric shock and during ischemia of conductive system. It also occurs in conditions like coronary artery disease, chloroform anesthesia, heart muscle disease and trauma to heart. Emergency treatment includes cardiopulmonary resuscitation and shocks delivered to the heart with a defibrillator.

Ventricular fibrillation is a severely abnormal heart rhythm. It is a life-threatening emergency and causes death within few minutes. Emergency treatment requires immediate resuscitation and defibrillation. Drug therapy and defibrillators can correct abnormal rhythms in high-risk patients.

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2. Micchia MT, Beccia F, Ariano M. Etiology and pathogenesis of ventricular fibrillation. Acta anaesthesiologica. 1968;19:Suppl 9:224+.
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13. Wolf GL, Le Veen RF, Mulry C, Kilzer K. The influence of contrast media additives upon ventricular fibrillation thresholds during coronary angiography in ischemic and normal canine hearts. Cardiovascular and interventional radiology. 1981;4(3):145-147.