Ventricular Arrhythmias Flashcards
Types of ventricular arrhytmias
-Premature ventricular complexes (PVC)
-ventricular tachycardia
-ventricular fibrillation
Premature Ventricular Complexes ECG
-wide (sometimes inverted? QRS complexes)
-normal P wave, rhythym
Types of PVCs
-simple (single isolated)
-frequent repetitive: q2 beat= bigeminy etx
-Frequent: at least one PVC on 12 lead ECG
->30PVCs per hour
PVC mech
-inc automaticity of ventricular muscle/purkinje fibers
-QRS wide bc impulse is in ventricle = slower contraction (no effect on HR tho)
PVC risk factors
-ischemic HD
-MI
-anemia
-hypoxia
-cardiac surgery for just a moment, then goes away
-HFrEF
PVT sx
-plpitations, dizziness, lightheadedness
PVC prognostics
-can influence long-term risk in pt >30y.
-frequent PVC usually CVD and mortality
-Very frquent PVCs (10-20k/day
-associated w cardiomyopathy
-in most pt w established CAD, PVCs associated w inc mortality
-in surviviors of MI, freq/repetitive PVCs associated w risk of SCD
PVC tx
-DO NOT TX ASX PVC (stong Na channels in MI can cause tachycardia
-in sx pt w/o HF (CAD is fine): BB, diltiazem, verapamil (amiodarone if unresponsive, catheter ablation if still unresponsive)
-harder to find signal than Afib ablation
-In sx pt w HF: no diltiazem or verapamil
Ventricular tachycardia
-No Pwave?
-wide QRS
-regular rythym
->3 consecutive PVCs at rate of 100bpm
Types of ventricular tachycardia
-nonsustained: >3 that terminate spontaneously
-sustained: VT > 30s or requires terminatino bc instability < 30 s
-sustained monomorphic VT in pt w no structural HD
-sustained monomorphic VT in pt w no structural heart disease
-idiopathic VT
-“verapamil sensitive VT”
-may also occur in right or left VT outflow tract
Ventricular tachycardia mech
-inc ventricular automacity
-reentry sustained, triggered when stimulus @ T wave
Ventricular tachycardia risk factors
-CAD
-MI
-HFrEF
-HYPOkalemia
-HYPOmagnesemia
-drugs: flecinide, propafenone, digoxin
Ventricular tachycardia sx
-maybe asx (nonsustained VT)
-palpitations
-hypotension
-dizziness
-lightheadedness
-syncope
-angina
Ventricular tachycardia prognostic significance
-sustained VT may progress to ventricular fibrillation (life threatening)
-pt w sustained VT at risk for sudden cardiac death
Goals of therapy of ventricular tachycardia
-terminate VT, restore sinus
-prevent recurrence of VT
-reduce risk of sudden cardiac death
Drugs for termination of Ventricular tachycardia
-Procainamide
-amiodarone
-sotalol
-verapamil
-B-blockers
Termination of VT in structural heart disease
-most pt
1. DCC, 2. Procainamide, 3. IV amiodarone or IV sotalol
-if not tx, DCC
-if tx, tx for recurrence by underlying Heart disease
Termination of VT in no structural heart disease
-no MI, HFrEF, etc (idiopathic)
-if verapamil sensitive VT = verapamil
-if outflow tract VT, B-blocker
-DCC if VT not terminated
Prevention of recurrence and sudden cardiac death in ventricular tachycardia
- implantable cardioverter defibrilator (shock if VT develops, doesnt actually prevent)
-amiodarone or sotalol for pt w ICDs w sx or frequent shocks
-ablation (takes longer than Afib ablaton)
Ventricular fibrillation ECG
-looks like me trying to draw a straight line
-no recognizable complexes
-irregular, disorganized
Ventricular fibrillation risk factors
-MI
-HFrEF
-CAD
Ventricular fibrillation sx
-syndrome of sudden cardiac death
Ventricular fibrillation tx goal
-terminate VFib, restore sinus
-only effective tx is defibrillation
-drugs alone will not terminate
Drugs for Ventricular fibrillation
-Defibrillation
-Epinephrine
-amiodarone
-lidocaine
Vfib tx (VT w/o pulse, cardiac arrest)
-VF
-CPR x 2min (obtain IV/IO access
-Defib shock
-CPR
-epinephrine 1mg IV/IO
-defib
-CPR
-amiodarone 300mg IV/IO (OR lidocaine 1-1.5mg/kg IV/IO)
-defib
-CPR
-Epinephrine
-defib
-epinephrine
-defib CPR
-1/2 dose of amiodarone/lidocaine
-defib
-cpr
-epinephrine
-continue defib, CPR, epinephrine every 3-5 min until resuscitated or give up
