Ventricular Tachyarrhythmias

Question 1

Identify three pathological mechanisms of ventricular tachyarrhythmia

Answer 1

• Ventricular ectopic beats
• Ventricular tachycardia
• Ventricular fibrillation

Question 2

What is torsade des pointes?

Answer 2

• Type of ventricular tachycardia

Question 3

Identify two causes of torsades des pointes

Answer 3

• Congenital long QT syndrome

- Class 3 antidysrhythmics (amiodarone and sotalol)

Question 4

What is Brugada syndrome?

Answer 4

• Type of ventricular tachycardia
• Caused by mutation in SCN5A gene
• Common in young males in south east Asia

Question 5

What is seen on ECG in ventricular ectopic beats?

Answer 5

• Single wide QRS complex with no p wave

- Otherwise normal

Question 6

What is seen on ECG in ventricular tachycardia?

Answer 6

• Wide QRS complexes

- Absent P waves

Question 7

What is seen on ECG in Brugada syndrome?

Answer 7

• Coved ST elevation in V1-V3

Question 8

What is seen on ECG in torsades des pointes?

Answer 8

• Broad complex tachycardia

- Alternating directions of QRS complexes

Question 9

What is the treatment of ventricular ectopics?

Answer 9

• Not normally required

- Beta blockers if significant arrhythmia

Question 10

What is the first line treatment for haemodynamically stable patients with VT?

Answer 10

• Intravenous amiodarone

Question 11

What is the second line treatment for haemodynamically stable patients with VT?

Answer 11

• Intravenous lidocaine

Question 12

What is the first line treatment for haemodynamically unstable VT?

Answer 12

• Emergency cardioversion

Question 13

What is the first line treatment for haemodynamically stable VT?

Answer 13

• Intravenous amiodarone

Question 14

What is the first line treatment for torsades des pointes?

Answer 14

• Magnesium sulfate

Question 15

Outline the treatment options for acquired long QT syndrome

Answer 15

• Correct electrolyte disturbances
• Stop causative drug
• Magnesium sulfate
• Intravenous isoprenaline