Ventricular Antiarrhythmatics

Question 1

Prevention of Ventricular Arrhythmias

(Primary vs Secondary)

Answer 1

Primary Prevention: At elevated risk, but have never had an episode

• Post MI (>40 days after MI), with EF less than 30-35%
• Ventricular arrhythmias found on ambulatory monitoring
• Hx of syncope/cardiac arrest where all other causes are r/o

Secondary Prevention: Have survived or experienced V tach without a precipitating cause or experience syncope though to be caused by tachyarrhythmia

Question 2

Long term treatment of ventricular arrhythmias

Answer 2

1. Electrophysiology assessment
2. Automatic Implantable Cardioverter/Defibrillator (AICD, ICD)
3. Antiarrhythmic drug therapy may still be needed to decrease number of shocks

• CAST trial has shown that drug therapy alone increases mortality because proarrhythmic

Question 3

Treatment of Acute Ventricular Arrhythmia

Non Cardiac Arrest–Stable and Unstable

Answer 3

Drugs used more often:

• Amiodarone
• Lidocaine
• Procainamide

For Torsades de pointes with prolonged baseline QT interval

• Correct electrolytes
• Give magnesium

Unstable: first line is to use syncronized cardioversion

Question 4

Arrhythmia recognized for ACLS

Answer 4

V fib

V tach

Asystole

PEA

Question 5

If peripheral drug administration used, what should a bolus injection be followed with?

Answer 5

IV fluid flush

Question 6

If IV access isn’t available, what is another route of administration that is equally effective?

Answer 6

interosseous

Question 7

Drugs to improve perfusion

Answer 7

Epinephrine

Vasopressin

Question 8

Drugs to fix the rhythm

Answer 8

Amiodarone

Lidocaine

Procainamide

Question 9

Epinephrine

Answer 9

Augments perfusion to heart and brain during CPR

Increases aortic diastolic pressure and increased cardiac conduction

Stimulates adrenergic nervous system

Question 10

Vasopressin

Answer 10

Alternative to epinephrine

Nonadrenergic peripheral vasoconstrictor

Increase coronary perfusion pressure, vital organ blood flow, cerebral blood flow

Question 11

Amiodarone

Answer 11

has effects on potassium, sodiu, and calcium channels as well as alpha and beta adrenergic effects

helps to fix the rhythm

Question 12

Lidocaine

Answer 12

2nd behind amiodarone to fix the rhythm if unresponsive to defibrillation

Question 13

Magnesium Sulfate Indications

Answer 13

Torsades de pointes

suspected hypomagnesemic state

dig toxicity

refractory ventricular arrhythmias

Question 14

Atropine

Answer 14

Drug to fix the rhythm in Asystole or PEA

Question 15

Asystole/PEA

Potential reversible causes

Answer 15

5 H’s

• Hypovolemia
• Hypoxia
• Hydrogen ions (acidosis)
• hyper/hypokalemia
• hypothermia

5 T’s

• Tablets (OD)
• Tamponade
• Tension Pneumothorax
• Thrombosis, coronary (MI)
• Thrombosis, pulmonary (PE)