Ventricular tachycardia Flashcards

1
Q

What is ventricular tachycardia?

A

a regular broad-complex tachycardia originating from a ventricular ectopic focus. Rate usually > 120 bpm.

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2
Q

What is the aetiology of ventricular tachycardia?

A

Electrical impulses arise from a ventricular ectopic focus

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3
Q

Summarise the epidemiology of ventricular tachycardia

A

Fairly common
A shockable rhythm seen in cardiac arrest patients
VT incidence peaks at middle age

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4
Q

List 4 symptoms of ventricular tachycardia

A

Chest pain
Palpitations
Dyspnoea
Syncope

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5
Q

What do the symptoms of VT mimic? Why?

A

Symptoms of IHD or haemodynamic compromise due to poor perfusion

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6
Q

List 8 signs of ventricular tachycardia on physical examination

A
Respiratory distress 
Bibasal crackles  
Raised JVP  
Hypotension 
Anxiety  
Agitation 
Lethargy 
Coma
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7
Q

What are 4 investigations for ventricular tachycardia?

A

ECG: difficult to distinguish between VT + SVT with aberrant conduction. If in doubt, treat as a VT
Electrolytes: derangement can cause arrhythmias
Drug levels: e.g. digoxin toxicity
Cardiac enzymes: e.g. troponins to check for recent ischaemic event

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8
Q

how do you treat a haemodynamically unstable patient with ventricular tachycardia?

A

With pulse: cardioversion

Without pulse: defibrillation

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9
Q

List 4 Risk Factors for VT

A

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

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10
Q

List 3 complications of VT

A

Congestive cardiac failure
Cardiogenic shock
VT may deteriorate into VF

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11
Q

Summarise the prognosis of ventricular tachycardia

A

GOOD if treated RAPIDLY

Long-term prognosis depends on the underlying cause

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12
Q

What is the presence of signs dependent on?

A

Degree of haemodynamic instability

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13
Q

List 3 features of the ECG seen in VT

A

Rate > 100 bpm
Broad QRS complexes
AV dissociation

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14
Q

What causative factors should you look for in patients with VT? How do you treat these?

A
Electrolyte abnormalities (e.g. hypokalemia): correct imbalances
Medication-induced QT prolongation: remove offending medication, digoxin immune fab (fragment antigen-binding) for digoxin toxicity
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15
Q

How do you treat a haemodynamically stable patient with ventricular tachycardia?

A

Antiarrhythmics: lidocaine, procainamide, amiodarone

Cardioversion if medical therapy fails

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16
Q

What are 3 long term therapies for VT?

A
ICD; indicated in case of VT that does not respond to therapy 
Catheter ablation 
Antiarrhythmics (usually class I or III)
17
Q

Which drug is contraindicated in broad complex tachycardia as can precipitate severe hypotension, ventricular fibrillation or cardiac arrest?

A

Verapamil
Do not know whether SVT or VT
(can only be used in SVT)

18
Q

What is Torsades de pointes?

A

A Polymorphic ventricular tachycardia a/w long QT interval
May deteriorate into VF + lead to sudden death

19
Q

Give 2 congenital causes of long QT

A

Jervell-Lange-Nielsen syndrome
Romano-Ward syndrome

20
Q

List 3 anti-arrhythmics that can cause long QT

A

Amiodarone
Sotalol
Class 1a antiarrhythmics: Lidocaine, Procainamide, Flecainide

21
Q

What electrolyte abnormalities cause long QT?

A

Hypocalcaemia
Hypokalaemia
Hypomagnesaemia

22
Q

What 3 conditions/ states can cause long QT?

A

Myocarditis
SAH
Hypothermia

23
Q

List 5 drugs/ classes that can cause long QT

A

TCAs
Antipsychotics
Chloroquine
Terfenadine
Erythromycin

24
Q

What is given in management of torsades de pointes?

A

IV Magnesium Sulphate