Treatment of Ventricular Arrhythmias Flashcards
Drug classes used in ventricular arrhythmias
Class 1b antiarrhythmics Class 3 amiodarone and sotalol online BB (management and prevention) Vasoconstrictors (epinephrine and vasopressin) - complete CV collapse DCC ICD
Define ICD
Implantable Cardioverter Defibrillator
Device implanted in the patient that monitors dangerous ventricular rhythms and delivers electrical shocks to reset the heart rhythm
- only for high risk pts
Define Premature Ventricular Contractions (PVC)
Early depolarization of the ventricles
Not dangerous unless repeated frequently
Management of PVC
Aysymptomatic: none
Symptomatic (palpitations or syncope) –> beta blocker
Tosades de pointes =
Polymorphic Ventricular Tachycardia
Define Polymorphic Ventricular Tachycardia
A unique type of ventricular tachycardia that increases in frequency with prolong QTc interval
Management of Polymorphic VT or Torsades
ID and d/c drug-related causes
Correct electrolyte abnormalities (K.4 or Mg >2.2)
Mg 1-2 g IV bolus (repeat PRN up to 16g/24hrs)
Define Ventricular Tachycardia
Multiple (3+) premature ventricular contraction with tachycardia (HR > 100)
Define Monomorphic
All the beats are the same (equal QRS on EKG)
Define Non-sustained VT:
Lasting less than 30 seconds
Symptomatic nSVT
Palpitations, uncomfortable beats or syncope
Structural Heart Disease nSVT
“Structural heart disease for our purposes would be those with left ventricular hypertrophy, heart failure, or ischemic heart disease (acute or chronic).”
Define Sustained VT
Lasting more than 30 seconds
Stable SVT
Hemodynamically stable with BP and HR within normal range
Unstable SVT
Hemodynamically unstable, BP and HR outside of normal range
May include changes in metnation, lack of pulse
Define Ventricular Fibrillation
Cause of sudden cardiac deaht, electrical anarchy of the ventricle with cardiovascular collapse
Lidocaine Class? AE?
1b Hypotension Bradycardia NYSTAGMUS Dizziness Confusion Seizures
Lidocaine Notes
Requires drug monitoring
Amiodarone Class? AE?
3 Bradycardia Heart Block Hypotension Pulmonary toxicity Hypo/hyperthyroidism Corneal deposits Skin discoloration QT prolongations
Nystagmus and dizzines are early signs of
toxicity for lidocaine
Amiodarone Notes
MD is higher than for AF and this increases risk for side effects and toxicity
Amiodarone Monitoring Chronic Therapy
CXR and pulmonary function tests at baseline and with symptoms
Thyroid panel at baseline x 6 months
LFT at baseline x 6 months
Eye exam at baseline x 12 months
Vtac (monomorphic) and Vfib first things to do
Correct underlying cause
Remove arrhythmogenic drugs
Replace K > 4 and Mg > 2.2
nSVT Asymptomatic Treatment
No SHD: No therapy
Yes SHD: BB or amiodarone
nSVT Symptomatic Treatment
No SHD: BB
Yes SHD: treat like stable SVT
Stable SVT Treatment
Amiodarone IV then PO (maybe lidocaine)
Unstable/Pulseless SVT Treatment
Treat like VF
VF Treatment (don’t need to focus much on this)
CPFI and Defibrillate PRN
Epinephrine IV OR Vasopressin IV
Consider: Amiodarone 300 mg IV x 1 then 150 mg x 1 OR lidocaine 1.5 mg/kg x1 then 0.75 mg/kg x2
**Common Medications that prolong QTc
Class 1a anti-arrhythmics Class 3 anti-arrhythmics Macrolides Quinolone Antipsychotics Methadone Ranolazine
** Additional RF that prolong QTc
HypoK HypoMg HypoCa >480 msec QTc HF or Acute MI Bradycardia Genetic predisposition
