Ventricular tachycardia

Question 1

Define ventricular tachycardia

Answer 1

Regular broad-complex tachycardia originating from a ventricular ectopic focus

Rate usually >120 bpm

Question 2

Aetiology of ventricular tachycardia

Answer 2

Electrical impulses arise from a ventricular ectopic focus

Question 3

Risk factors for ventricular tachycardia

4

Answer 3

Coronary heart disease
Structural heart disease
Electrolyte deficiencies (e.g. hypokalaemia, hypocalcaemia, hypomagnesaemia)
Use of stimulant drugs (e.g. caffeine, cocaine)

Question 4

Epidemiology of ventricular tachycardia

prevalence, arrest, age

Answer 4

Fairly common
One of the shockable rhythms seen in cardiac arrest patients
VT incidence peaks in middle decades of life

Question 5

Presenting symptoms of ventricular tachycardia

general +4

Answer 5

Symptoms of ischaemic heart disease or haemodynamic compromise due to poor perfusion

Chest pain
Palpitations
Dyspnoea
Syncope

Question 6

Signs of ventricular tachycardia on physical examination

general +8

Answer 6

Signs dependent on degree of haemodynamic instability

Respiratory distress
Bibasal crackles
Raised JVP
Hypotension
Anxiety
Agitation
Lethargy
Coma

Question 7

Investigations for ventricular tachycardia

4 types

Answer 7

ECG
Electrolytes
Drug levels
Cardiac enzymes

Question 8

Investigations for ventricular tachycardia - ECG

4

Answer 8

Can be difficult to distinguish VT & SVT w/ aberrant conduction
if in doubt, treat as VT
Rate >100 bpm
Broad QRS complexes
AV dissociation

Question 9

Investigations for ventricular tachycardia - electrolytes

Answer 9

Derangement can cause arrhythmias

Question 10

Investigations for ventricular tachycardia - drug levels

Answer 10

e.g. check for digoxin toxicity

Question 11

Investigations for ventricular tachycardia - cardiac enzymes

Answer 11

e.g. troponins to check for recent ischaemic event

Question 12

Management of ventricular tachycardia

5 groups

Answer 12

ABC approach
Pulseless VT
Unstable VT
Stable VT
Implantable cardioverter defibrillator (ICD)

Question 13

Management of ventricular tachycardia - ABC

Answer 13

CHECK WHETHER PATIENT HAS A PULSE OR NOT

Question 14

Management of ventricular tachycardia - pulseless

Answer 14

Follow advanced life support algorithm

Question 15

Management of ventricular tachycardia - unstable

4

Answer 15

Reduced cardiac output
Synchronised cardioversion
Correct electrolyte abnormalities
Amiodarone

Question 16

Management of ventricular tachycardia - stable

4

Answer 16

DO NOT experience symptoms of haemodynamic compromise
Correct electrolyte abnormalities
Amiodarone
Synchronised DC shock (if above steps are unsuccessful)

Question 17

Management of ventricular tachycardia - ICD

4

Answer 17

Considered if:
sustained VT causing syncope
sustained VT w/ ejection fraction < 35%
previous cardiac arrest due to VT or VF
MI complicated by non-sustained VT

Question 18

Complications of ventricular tachycardia

3

Answer 18

Congestive heart failure
Cardiogenic shock
VT may deteriorate into VF

Question 19

Prognosis of ventricular tachycardia

2

Answer 19

GOOD if treated rapidly

Long term prognosis depends on underlying cause