Arrhythmia - broad complex / Brady / genetic Flashcards
What are broad complex tachycardia / ventricular
HR >100
QRS >120
If there is no clear QRS what is the Dx
VF (chaotic / no pattern)
Unusual to capture on ECG as cardiac arrest rhythm
What is DDX of broad complex tachycardia
Ventricular fibrillation
Ventricular tachycardia
SVT with BBB / metabolic disturbance
WPW with anti-dromic tachy
What causes irregular ventricular tachycardia (broaD)
Torsades de points
Any cause of SVT + BBB / metabolic usually AF if irregular
What is VF
Cardiac arrest
No P wave or QRS
Random signals generated through ventricles
What is VT
Signal from AV sets of own impulse instead of going down bundle of His
Very broad QRS
What types of VT can you get
Monomorphic - usually MI
Polymorphic - torsade de points
What are symptoms of ventricular tachycardia / broad complex tachy
Palpitations CHest pain SOB Dizzy Syncope if fast enough Low BP Heart failure
What are adverse signs suggesting immediate cardio version
Decreased consciousness Syncope BP <90 Clammy Oliguria Angina Pulmonary oedema
Who is at risk of broad complex tachycardia / ventricular
Post MI IHD for VT Long QT syndrome Cardiomyoapthy Hypokalaemia Hypomagneisum
How do you deal with VT / broad
12 lead ECG Cardiac monitor Have defibrillator close O2 sats Bloods - U+E
How do you differentiate SVT from VT
Hx
12 lead ECG showing broad vs narrow
Response to medication
If peri-arrest what do you assume
Ventricular and Rx as this
If no pulse
Cardiac arrest
If patient is stable what do you do
IV access O2 if low sats Correct electrolyte Identify underlying rhythm If in doubt treat as VT (most common cause)
What do you do if unstable VT or uncertain
HELP FAST
DC Cardioversion if adverse signs
CPR
Correct electorlyte
What do you follow up with
IV amiadarone 300mg then 24 hour infusion 900
Lidocaine if fails
ICD / EPS if this fails
Can have maintenance treatment of BB or amiadarone
When do you caution with lidocaine
Severe left ventricular impairment
What do you never use in ventricular tachy
Verapamil
What do you do after correct
Establish cause
Maintenance AA - BB / amiadarone
ICD / surgery may help esp if LV functional impairment
How do you Rx VF
Cardiac arrest
DC cardio version
AA
ICD
What is Tornado de point
Form of polymorphic VT associated with long QT
Have long QT syndrome then ectopic hits to generate abnormality
What is it associated with / what causes
Long QT syndrome Ischaemia - may see STEMI Drugs - Amiadarone - Sotolol - Anti-psychotics - TCA - Macrolide Ax - mycin Electrolyte - Hypocalcaemia - Hypomagnesium - Hypokalaemia SAH Hypothermia Myocarditis
What is seen on ECG
VT with polymorphic QRS so height changes
How do you Rx
Correct underlying cause
IV Mg sulphate
Stop any drugs that prolong QT
Long term
- BB (not sotolol)
- Pacemaker
What can it progress to
Usually revert back but can translate to VT and cardiac arrest
Cardiac arrest so have defibrillator ready
What is ventricular ectopic
Random beat originating out with atria
When is it common
Post MI / IHD / HF
Can occur in healthy
How does it present
Asymptomatic Palpitation Thumbing heart Heart missing a peace Irregular pulse if frequent
How does it present on ECG
Broad QRS with random extra