Fear not, this is a common issue among nvidia graphics card users, primarily fermi cards of the 4xx series (might also be ati/amd card or older nvidia cards but seems to effect nvidia 4xx series mostly)
A user named JBCool over at guru3d.com forums has posted an easy fix for this - see the thread here: http://forums.guru3d.com/showthread.php?t=330933
Basically, you have to force the nvidia control panel to use Fallout 3's nvidia profile instead of the one for new vegas. This will fix the issue. In order to do this, first you need to download and extract a 3rd party tool called nvida inspector from here: http://blog.orbmu2k.de/tools/nvidia-inspector-tool
Then you must launch it and go to the tool for configuration and from the pulldown, point to fallout new vegas. You can either delete the new vegas profile, or copy the fallout 3 hex values to new vegas, or remove the falloutnv.exe association with the new vegas profile and add it to fallout 3's (easiest method). Afterward, the artificats will be gone! Please note that another gur3d user named Sr7 says the artifacts appear due to the game's faulty implementation of anti aliasing and will be fixed via a workaround in the next nvidia driver. Without the nvidia inspector, disabling anti aliasing and or HDR will 'fix' the issue but obviously the visuals will suffer. With this workaround, you can now override the AA settings and set it up to whatever AA value your card will allow!
You will also be able to use ambient occulution (enhances shadowy areas) but this comes at a heft penalty on FPS even on the best graphics cards and also introduces artifacts of its own (best left off). For fermi 4xx owners, as mentioned you can override the in-gam AA settings and choose whatever you want in the nvidia control panel. Some users hate messing around with these, but that is because they may not know how they work. In game settings are often lacking an profiles are the only way to force certain things. In NV's case, they allow you to increase AF to 16x (although at in game 15x it doesn't matter), set AA to the highest setting supported by the driver, clamp the negative LOD bias, turn of texture optimizations to potentially increase visual quality, etc. I saw a forum post from a user indicated they had a 460 GTX with 32xAA forced via the profile which is possible, but not unless you use the nvidia inspector as noted above. What they're seeing is whatever the in-game settings are since AA settings didn't apply before unless again using the inspector (at least on the latest drivers). You can also choose a transparency multisampling setting here (instead of the in-game one) which is superior to the in-game version but without any dithering (grass might look blockier, but fences will look more realism) and also the game will be bloodier.
Hope this helps! Now that HDR/AA is possible via the above method, the .dll fix corrects framerates, and the latest nvidia driver reduces stuttering, this along with the official patches to fix save games makes NV as playable as FO3 and I'm a happy camper!