Ventricular Storm Flashcards
What is ventricular storm?
Persistent ventricular dysrhythmias leading to symptoms or ICD intervention
Usually 3 or more times in 24 hours, or persistent VT for an hour or more
What is the cause of ventricular storm?
Usually structural heart disease, decompensated heart failure, drug toxicity, ischemia
Reversible causes: hyperthyroidism, electrolyte disturbance, infection, drug toxicity, HF
Fundamental cause is catecholamine surge
Other causes include Brugada syndrome
What are the basic principles of management for electrical storm VT?
Electricity
Reversible causes
Anti-arrhythmic drugs
Sedate
What is the first step and decision point for pt’s with ES VT?
Hemodynamic stability
If unstable, go into ACLS algorithm and shock
If stable, manage appropriately
Pt with ES VT and found to be hemodynamically stable. What are the first steps in management?
Interrogate the ICD to reprogram for anti-tachycardia pacing and to stop shocks, if possible
Look for reversible causes
Risk stratify
What are the reversible causes of ES VT?
Ischemia, electrolyte disturbance, hyperthyroidism, Heart Failure, drug toxicity, infections
What factors help to risk stratify pt’s with ES VT?
Hemodynamic stability
Comorbidities: Heart Failure, CKD, COPD
What are the preferred anti-dysrhythmic drugs for ES VT?
Amiodarone and Propranolol
Besides hemodynamic support, ICD interrogation and anti-dysrhythmic drugs, what other management is important initially?
Sedation and pain control to help control the catecholamine surge
Can use benzos and opioids
Can ultimately intubate under general anesthesia if needed in the highest risk patients
What is the definitive management of ES VT?
Cardiac ablation
If needed, may use ECMO, LVAD, or IABP to bridge to surgery
PCI may also be considered if ischemia is present
