Ischemic heart disease remains a leading killer in industrialized nations. A significant cause of the morbidity and mortality in patients with ischemic heart disease is ventricular dysrhythmia events. There is a continued search for safe and effective treatment for patients with ventricular dysrhythmias. In this article, the author discusses current understanding of the mechanisms for dysrhythmias in the setting of acute ischemia and in the chronically infarcted ventricle. Therapy for patients with ventricular tachycardia and ventricular fibrillation is reviewed. Nurses caring for cardiac patients are continually involved in rhythm monitoring and dysrhythmia interpretation. The nurse is often the first responder present when a fatal dysrhythmia occurs. In addition, nurses can be involved at all levels of care, from, prevention of heart disease to assisting the patient cope with a sudden cardiac death episode.