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Wide Complex Tachycardias originate in the Ventricles. Monomorphic ventricular tachycardia means that all of the complexes are the same size, direction and shape. Polymorphic tachycardia, known as Torsade de pointes, has multiple ventricular foci with the QRS complexes varying in axis, amplitude, and duration. The main problem with a fast wide complex tachycardia is hemodynamic instability. The heart rate is so fast, that it inhibits the atrium to prefill and preload the ventricles prior to their next contraction. Wide complex Ventricular Tachycardia can present with a pulse or without a pulse. Pulseless V tach is treated the same as Ventricular Fibrillation. Recognition and immediate treatment is vital to a potential positive outcome.