Ventricular arrhythmias [classification, treatment]; Tricuspid and Pulmonary valve diseases

Question 1

Classification of Ventricular Arrhythmias

Answer 1

Premature Ventricular Contractions
- Monomorphic PVC
- Polymorphic PVC

Ventricular Tachycardia
- Non sustained V.tach
- Sustained V.tach

Torsades de Pointes

Ventricular Fibrillation

Question 2

Treatment strategies for Ventricular Arrhythmias

Answer 2

Premature Ventricular Contractions:
- Treat underlying CAD, Myocarditis, HF
- Treat Hypokalemia, Hypomagnesemia
- Beta Blockers/non-dihydropyridine CCBs if LVEF reduced OR symptomatic PVC with high burden
- Catheter Ablation for non-tolerant or ineffective medical treatment

Ventricular Tachycardia:
Hemodynamically Unstable:
- Polymorphic VT - Defibrilate
- Monomorphic VT - Synchronized Electic Cardioversion

Hemodynamically Stable:
- Pharmacologic cardioversion - Amiodarone | Procainamide
- Refractory VT - Electical Cardioversion

Unsustained VT/Previously resolved VT:
- Correct Hypokalemia, Hypomagnesemia, Hypocalcemia
- Stop QT prolonging drugs [ABCDs]
- Digoxin Fab test for toxicity
- Treat underlying myocardial ischemia
- Long term consider Antiarrhythmics [Class Ic, III], Implantable cardioverter defibrillator [AICD], Catheter Ablation
- Modify treatment for HF patients

Torsades de Pointes:
- IV Magnesium
- Correct Hypokalemia, Hypocalcemia
- Stop QT prolonging medications [ABCDs]
- Treat Hypothyroidism

Ventricular Fibrillation:
- Resuscitation [ACLS | Lidocaine/Procainamide/Magnesium if ACLS not responsive]
- ICU care [Control vital signs, Temperature control]
- IV amiodarone or IV lidocaine
- Consider Beta Blockers
- CAD treatment
- Implantable Cardioverter-Defibrillator

Question 3

Tricuspid Valve Classification and Etiology

Answer 3

Tricuspid Stenosis:
- Rheumatic Fever
- Infective Endocarditis [mostly IV drug abuse]

Tricuspid Regurgitation:
- Right heart failure, Pressure overload
- Infective Endocarditis
- Rheumatic Fever
- Connective Tissue Disorders [Marfan syndrome, Ehlers-Danlos]
- Carcinoid Syndrome
- Pulmonary Hypertension
- Left-heart Failure

Question 4

Pulmonary Valve Classification and Etiology

Answer 4

Pulmonary Stenosis:
- Congenital
- Carcinoid Syndrome

Pulmonary Regurgitation:
- Pulmonary Hypertension [Precapillary; Tetralogy of Fallot, VSD]
- Dilated Cardiomyopathy [Myocarditis, IHD, Pregnancy, HTN, Long term alcohol abuse]