You may find my tweaking guide useful:
1) Determine if screen tearing is annoying or not by turning VSYNC OFF. If it's not then simply tweak settings to maintain at least 40FPS (using FRAPS) average and you're done.
If screen tearing is annoying then continue to STEP #2.
2) Start FRAPS. Start Game. VSYNC is OFF (for now).
3) Tweak the various quality settings (AA, Shadows, resolution) for the best experience while maintaining 60FPS at least 90% of the time (for a 60Hz monitor).
4) If you can maintain MAXIMUM QUALITY while always above 60FPS (for 60Hz monitor) then enable VSYNC and you're done. If not...
5) Then force on Adaptive VSYNC for the game in the NVidia Control Panel ("Manage 3D Settings"..."Add game"...)
Other:
for 144Hz monitors you can force on the "Half Adaptive VSYNC" method. This synchs at 72FPS if you can output at least 72FPS but auto disables if not.
SUMMARY:
*The secret to proper PC gaming is to know what your GOAL is when tweaking the settings rather than just picking "Medium" and hoping for the best. For that you should understand how VSYNC ON, VSYNC OFF, and Adaptive VSYNC differ and tweak accordingly.
This probably will take a little bit of use to sink in so I suggest copying it for reference.