Cardiology - Arrhythmias: Ventricular Arrhythmias

Question 1

DDx for Wide Complex Tachycardia

Answer 1

• supra ventricular rhythm with underlying conduction block
• pre excitation
• paced rhythm
• VT

Question 2

What is VT defined as?

Answer 2

NONSUSTAINED: <30 seconds
SUSTAINED: >30 seconds or terminated by intervention

Question 3

Most frequent site of origin of PVC?

Answer 3

RV outflow tract

Question 4

75% of healthy adults get benign PVCs

What are some non-benign causes of PVC?

Answer 4

CARDIAC: ACS, IHD, Myocarditis

HYPOXIA and HYPERCAPNEA

DRUGS: Digoxin / TCA / caffeine / sympathomimetics

EUCS: Low Mg, K or Ca

Question 5

What defines PVC-induced ventricular dysfunction?

Answer 5

If >10-20% of beats are PVCs in 24 hours

Question 6

When to treat PVCs?

Answer 6

If high burden or symptoms:

Can treat with:

• Beta blocker or nonhydropyridine CCB
• amiodarone
• EP Study and ablation

Question 7

How to DDx VT from SVT with abberancy?

Answer 7

In VT:

• AV dissociation
• fusion beats or capture beats
• no RS pattern
• > 100ms from start of R to nadir of S

Question 8

Management of VT in NON-STRUCTURAL?

Answer 8

Beta blocker or CCB

If symptoms persists then ablate

Question 9

Management of VT in STRUCTURAL HEART DISEASE?

Answer 9

Need ICD (mortality benefit)

If persists despite ICD add beta blocker

THEN add amiodarone (**improves QoL)

THEN ablation
(ablation reduces ICD shocks and improves QoL if persisting despite pharmacological)

Question 10

Indications for ICD for PRIMARY prevention?

Answer 10

If AT LEAST 40 DAYS post acute coronary syndrome AND:

• LVEF <30% NYHA I
• LVEF <35% NYHA II and III
• LVEF <40% and nonsustained VT or EP-induced VT or VF

OR

Nonischaemic patients with:

• LVEF <35%
• NYHA II and III

Genetics cardiac conditions:

• Long QT
• Brugada
• HOCM
• ARVC
• Catecholamine polymorphic VT

Question 11

Genetic cardiac conditions that are indicated to get ICD?

Answer 11

Genetics cardiac conditions:

• Long QT
• Brugada
• HOCM
• ARVC
• Catecholamine polymorphic VT

Question 12

Indications for CRT?

Answer 12

HF with NYHA Class II to ambulatory Class IV on guideline directed medical therapy

PLUS

• LVEF<35%
• LBBB >150ms

NO BENEFIT IF QRS<120!!!
(In fact worse outcomes with more hospitalisations and increased 6MWT

Question 13

What should you NOT use in a broad complex tachycardia?

Answer 13

Verapamil