Ventricular tachycardia + fibrillation

Question 1

What is ventricular tachycardia?

Answer 1

• Fast abnormal heart rate that starts in the hearts ventricles
• Regular
• Defined as 3 or more heartbeats in a row at rate of >100

Question 2

What are the categories of ventricular tachycardia?

Answer 2

• Life threatening sustain ventricular tachyarrhythia
• Torsade de pointes (long QT syndrome drug induced)
• Normal heart VT
• Non-sustained VT
• Ventricular premature beats

Question 3

What are the causes of ventricular tachycardia?

Answer 3

*Disruption in normal electrical impulse
>Abnoramalities of heart that result in scaring
>Poor blood flow to heart due to ACS
>Congenital heat disease
>Imbalance of electrolytes (K+)
>Medication side effects
>Use of drugs: cocaine or methamphetamine

Question 4

What is torsade de pointes (Long QT syndrome)?

Answer 4

*Ventricular tachycardia that is drug induced

Question 5

What is the presentation of brief ventricular tachycardia?

Answer 5

• Asymptomatic
• Dizziness
• SOB
• Lightheadedness
• Palpitations
• Chest pain

Question 6

What is the presentation of sustained ventricular tachycardia?

Answer 6

• VT >30seconds
• Syncope
• Hypotensions
• Cardiac arrest
• Pulse rate typically 120-220bpm

Question 7

What is the immediate management of sustained ventricular tachycardia for a heamodynamically unstable patient?

Answer 7

• Immediate Defib

* If fails IV amiodarone hydrochloride and direct cardio version repeated

Question 8

What is the immediate management of sustained VT for a haemodynamically stable patient?

Answer 8

• IV antiarrhythmis drugs: amiodarone

* Cardioversion no restored direct cardio version or pacing considered

Question 9

What is the management of tornado de pointes (Prolonged QT syndrome)?

Answer 9

• Magnesium sulphate 8mmol over 10-15mins
• Heart rate maintain with beta blocker
• IV isoprenaline may be effective when QT prolongations acquired

Question 10

What are QT prolonging drugs?

Answer 10

• Antipsychotics
• Antidepressants
• Antimicrobials: Erythromycin, clarithromycin, flucanozole, *antiarrhythmics: amiodarone

Question 11

What is ventricular fibrillation?

Answer 11

*Rapid and irregular ventricular activation with no mechanical effect

Question 12

What is the presentation of a patient in ventricular fibrillation?

Answer 12

• Pulseless
• Unconscious
• Respiration ceases
• Cardiac arrest
• Rarely reverses spontaneously

Question 13

What is the management of ventricular fibrillation?

Answer 13

*Electric defib