Premature ventricular contractions and ventricular tachycardia/fibrillation

Question 1

What are premature ventricular contractions

Answer 1

Ventricular contaction that occurs before the next SA beat occurs

Question 2

T/F: PVCs should be treated aggressively

Answer 2

False: PVCs should get no treatment because unless there are significant side-effects present PVCs are benign and do not require therapy

Question 3

When is a PVC considered complex

Answer 3

More than 5 PVCs per minute, Occuring in couplets/triplets, multiform: source come from differemt areas of the heart, EAD in which ventricular stimulus causes premature depolarizaton of cells that have not completely repolarized

Question 4

T/F: Patients with complex PVCs and heart disease (coronary or structural) are at increased risk for death

Answer 4

True

Question 5

What was learned about PVCs due to the CAST trial

Answer 5

Avoid AADs for suppression of PVCs, Avoid class 1c agents in patients with heart disease, Amiodarone and dofetilide can be used for patients with HF because they are mortality neutral, beta-blockers can be used as treatment

Question 6

What is sudden cardiac death

Answer 6

Death due to cardiac causes, heralded by abrupt loss of consciousness within one hour of symptom onset

Question 7

What are the two types of ventricular tachycardias and characteristics of both

Answer 7

Non-sustained VTach: Three or more consecutive PVCs lasting less than 30 seconds that terminate spontaneously
Sustained VTach: Three or more consecutive PVCs lasting greater than 30 seconds or lasts less than 30 seconds but requires termination due to hemodynamic compromise

Question 8

What is usually the heart rate if a patient has Vtach, what are the symptoms

Answer 8

Greater than 100 beats/min/ dyspnea, syncope, palpitations

Question 9

What are the Vtach risk factors

Answer 9

Sleep apnea, myocardial scarring, CAD, NIDCM, electrolyte abnormalities, hypertrophic cardiomyopathy

Question 10

What is the difference in ECG characteristics between monomorphic Vtach and Polymorphich Vtach

Answer 10

In monomorphic the electrical impulse shows a uniform rhythm so each QRS complex looks identical while in polymorphic there are multiple foci causing QRS comlexes to vary in amplitude and duration

Question 11

What is torsdae de pointes

Answer 11

A type of polymorphic Vtach in which the LENGTHEND QT INTERVALS alternate with long R-R intervals producing R-on-T hills

Question 12

What are QTc prolongations in men, women, and a increased risk of Torsdae de pointes

Answer 12

Greater then 470 ms, greater than 480 ms, greater than 500 ms

Question 13

T/F: When looking at an ECG if the T- peak is to the right of the midpoint of the R-R interval QT is prolonged

Answer 13

True

Question 14

What are physiological condiations that cause torsade piontes/ pharmcological

Answer 14

myocarditis, MI, HF, hypokalemia, hypomagnesia, severe bradycardia/ Class 1a and Class 3 AAD

Question 15

What are risk factors for drug-induced TdP

Answer 15

Concurrent QT- prolonging drugs, QTc greater than 500 msec, bradycardia, electrolyte disturbances, recent conversion from AFib, advanced age, structural heart disease

Question 16

What drug or drug classes prolong QT intervals

Answer 16

Azole antifungals, Tricyclic antidepressants, Antipsychotics, AADs, SSRI/SNRIs, Antiemetics, antibiotics, arsenic

Question 17

What antibiotics prolong QT intervals, what type of antiemetics, other drugs as well

Answer 17

Fluroquinolones, Macrolides Trimethoprim/ Dopamine antagonists and Serotonin antagonists/ Methadone, amantadine, ranolazine

Question 18

What are characteristics of VFib

Answer 18

HR greater than 300 bpm, preceded by Vtach, may be secondary to MI, ABSENCE of pulse

Question 19

T/F: If a patient has acute sustained ventricular tachycardia the pulse should be checked first and if there is not pulse the ACLS algorithm must be referred too

Answer 19

True

Question 20

If a patient has acute sustained ventricular tachycardia and a pulse is present what should be done if they are hemodynamically stable

Answer 20

Give the patient a straw and have them blow through it for several seconds stimulating the vagus nerve to lower their HR, emerge face in cold water/ice for 10 seconds to slow the HR, Give amiodarone (IV/PO) and if there is no structural damage procainamide or flecanide can be used as well

Question 21

If a patient has acute sustained ventricular tachycardia and a pulse is present what should be done if they are hemodynamically unstable

Answer 21

Synchronized DC cardioversion, the current will need to be applied at the peak of the R wave or during ventricular depolarization

Question 22

If a patient has acute sustained ventruclar tachycardia and there is no pulse what should be done immediately, what acronym should be done after

Answer 22

CPR
Shock: Zap every 2 mins as needed
CPR: After shock pump
Rhythm check: check to see if the heart is pumping
Epinephine: 1mg IV/PO every 3 to 5 minutes
Antiarrhythmic Medications: Amiodarone first line for refractory VFib, pVTach, Lidocaine is 2nd line, Magnesium Sulfate is first line for TdP
Meds

Question 23

How should torsade de pointes be treated, what if the TdP is accompanied by bradycardia

Answer 23

Magnesium sulfate for 15 minutes/ Make sure potassium is greater than 4 and magnesium is greater than 2/ give isoproterenol 2-10 mg.min continuous IV infusion

Question 24

What are the treatment options of NSVT if the patient has no heart disease and is symptomatic, not symptomatic

Answer 24

Beta blockers, Non-DHP CCBs, Class 1c agents added to beta-blockers, ablation/ no treatment required

Question 25

What are the treatment options of NSVT if the patient has heart disease (post-MI or HF)

Answer 25

Positive EP study that may lead to ICD for primary prevention and secondary prevention unless they have reversible cause of VT

Question 26

If a patient has sustained VTach that recurs what are the options if the patient has heart failure, no heart failure

Answer 26

Amiodarone PLUS a beta-blocker, Sotalol