(!) Ventricular tachycardia

Question 1

Define ventricular tachycardia

Answer 1

Ventricular rythma faster than 100 bpm with wide broad complex QRS (120), coming from ventricles and not conduction (e.g. RBBB)

can be sustained, if lasting over 30seconds
Non-sustained if under 30s
Or pulseless-cardiac arrest

Question 2

Aetiology and risk factors of ventricular tachycardia

Answer 2

Both sustained and non sustained can be idiopathic
but more commonly associated with ischemic heart disease, long QT syndrome,
non-sus–cardiomyopathy, heart failure
sus-électrolyte imbalance, drug toxicity

risk factors:
age
men
FHx (NSVT)
CAD, ischemic heart disease, smoking
Heart failure
cardiac myopathy
Long QT syndrome

Question 3

Epidiemology of Ventricular tachycardia

Answer 3

400 000 sudden death every year in Europe, with majority from VT or VF

NSVT is though to be present in 4% of pop-more common with age
super common with cardiomyopathy

Question 4

Signs and Sx of Ventricular tachycardia

Answer 4

NSVT-very transient-often the patient is asymtomatic
complains of transient tachycardia/palpitation,
dizziness, lighthead, syncope
focus of Hx of heart disease, etc

VT-by definition, tachycardia
as it goes on longer-hypotension-signs of heamolytic instability

idiopathic VT-tend to just be pre-syncope and palp

weak pulses, syncope/dizzy, SOB, chest discomfort, nausea, sweating ->similar to SVT (supraventricular)
try and find Hx of MI/CAD/any predispose factor->VT
examination might need to be on carotid for pulse if hypotenuse
unable if pulse weak, hypotense, low GCS

Question 5

Investigations of ventricular tachycardia

Answer 5

NSVT-ECG
Wont always catch it-consider 24h doppler (severity and frequency)
evidence of MI/hypetrophy should be sought, or long QT etc
electrolytes-can be normal or not
troponin-raised if prior MI

VT-Broad complex QRS (120) at rate over 100
electrolyse-can have hypokalaemia/hypomagnesia (torsade de pointes)
Trop-elevated if prior MI

torsade de pointes-twisting appearance in baseline

Question 6

Management of Ventricular tachycardia

Answer 6

NSVT-self terminating so no intervention here
if no underlying cardiac disease-reassurance

if symptomatic-b-blcokers or CCB
and make sure any MI is treated, electrolytes etc

if heart failure -Indwelling defib to stop it

VT-treat even if pt is stable
unstable-CPR and DC cardio shock before medication
amiodarone/lidocaine can be used in conjunction

Stable-debatable
amiodarone first- or lidocaine
if doesn’t word, DC cardioversion
if long QT-magnesium (torsade de pointe -Mg related)

if really not causing issues-B-block or CCB

Question 7

Complications of Ventricular tachycardia

Answer 7

VT-death
sternum/rib break
hypoxic brain, 
devolve to cardiac arrest/VF
cardiomyopathy

NSVT-sudden death
cardiomypathy

Question 8

Prognosis of ventricular tachycardia

Answer 8

idiopathic VT-favorable-non progressive, stable and can even stop

non-idiopathic0
can get re-entrant rhythm and devolve to VF
ICD can help that-prophylactic ICD to consider

NSVT-very positive
often bare a cause of concern-especially if idiopathic

if cardiac cause-ICD or risk of sudden death/VF