Ventricular Tachycardia

Question 1

What is ventricular tachycardia (VT).

Answer 1

Sustained VT is VT that lasts >30seconds or causes haemodynamic compromise.

Question 2

What causes VT. (5)

Answer 2

Most commonly due to ischaemic heart disease (and a myocardial infarction).
Cardiomyopathy. 
Metabolic abnormalities. 
Drug toxicity. 
Long QT syndrome.

Question 3

What are the symptoms of VT. (3)

Answer 3

Palpitations.
Chest pain.
Syncope.

Question 4

What are the clinical signs of VT. (4)

Answer 4

Tachycardia with hypotension.
Varying 1st heart sound.
Occasional cannon waves (giant ‘a’ waves in JVP).

Question 5

What is the most appropriate investigation for VT.

Answer 5

ECG.

Question 6

What can be seen in the ECG in VT.

Answer 6

Wide complex tachycardia.

Question 7

What is the most appropriate treatment for VT. (3)

Answer 7

Anti-arrhythmics.
DC cardioversion.
Implantable cardiac defibrillator to treat recurrence.

Question 8

What anti-arrhythmics can be used in VT. (2)

Answer 8

Amiodarone.

Lidocaine.

Question 9

What is the main complication of VT.

Answer 9

Ventricular fibrillation (VF).

Question 10

What are the ECG changes that indicate VT. (2)

Answer 10

Rate >100 BPM.

QRS >120ms.

Question 11

What is included in VT.

Answer 11

Torsade de pointes.

Question 12

What is the differential diagnosis for a broad complex tachycardia. (2)

Answer 12

VT (includes torsade de pointes).

Supraventricular tachycardia.

Question 13

What are the main ECG findings that will indicate VT. (5)

Answer 13

Positive QRS concordance in chest leads.
Marked left axis deviation.
AV dissociation (occurs in 25%) or 2:1 or 3:1 AV block.
Fusion beats or capture beats.
QRS Brugada criteria.

Question 14

What does concordance mean.

Answer 14

Means that the QRS complexes are all positive or all negative.

Question 15

What is a fusion beat.

Answer 15

It is when a normal beat fuses with a VT complex to create an unusual complex.

Question 16

What is a captured beat.

Answer 16

A normal QRS between abnormal beats.

Question 17

How do you manage pulseless or unstable VT.

Answer 17

Use asynchronized DC shock.

Question 18

How do you manage stable VT. (7)

Answer 18

High flow oxygen by face maskl.
IV access (UandEs, cardiac enzymes, calcium, magnesium).
Correct low potassium or magnesium.
12 lead ECG.
ABG (if evidence of pulmonary oedema, reduced consciousness or sepsis).
Amiodarone.
ICD to prevent further recurrence.

Question 19

How do you treat torsade de pointes.

Answer 19

Magnesium sulphate.

Question 20

What is torsade de pointes.

Answer 20

Looks like VF, but is VT with a varying axis.

Question 21

What is the commonest post MI arrhythmia.

Answer 21

Ventricular extrasystoles (ectopics).

Question 22

What does the R on T pattern of ectopics indicate post MI.

Answer 22

Risk of VF.

Question 23

What is the brugada criteria used for.

Answer 23

To help differentiate SVT from VT.

Question 24

What does the presence of Q waves in V6 favour.

Answer 24

VT.

Question 25

What does no Q wave in V6 favour.

Answer 25

SVT.

Question 26

What does this pattern in V1 or V2 favour:
R>30ms.
>60ms to nadir S.
Notches S.

Answer 26

VT.

Question 27

What does a triphasic R in V6 favour.

Answer 27

SVT..

Question 28

What does a R to S ratio of

Answer 28

VT.

Question 29

What does a QS or QR in V6 favour.

Answer 29

VT.

Question 30

What does a monophasic R in V6 favour.

Answer 30

VT.

Question 31

What does an R;S ratio >1 favour in V6.

Answer 31

SVT.

Question 32

What does a triphasic RSR in V1 favour.

Answer 32

SVT.

Question 33

What does a monophasic R or QR or RS in V1 favour.

Answer 33

VT.