Ventricular Tachycardias (VT)

Question 1

3 types of VTs?

Answer 1

Monomorphic, polymorpic and sinusoidal

Question 2

Monomorphic VT Suggests?

Answer 2

structural abnormalities

Question 3

Monomorphic VT – order of diagnostic tests?

Answer 3

#ECHO
#Cardiac MR (good for finding scars)
#If Cardiac MR fails, EP study

Question 4

Idiopathic Monomorphic VT – typical locations?

Answer 4

#RV Outlow tract
# LV intrafasicular (verapamil sensitive)

Question 5

Idiopathic Monomorphic VT – typically brought on by?

Answer 5

Exercise

Question 6

Idiopathy Monomorphic VT – Drug therapy? If fails?

Answer 6

#Beta Blocker or Ca-channel Blocker
#If fails, EP ablation

Question 7

Polymorphic VT can degenerate into?

Answer 7

Ventricular Fibrillation

Question 8

Polymorphic VT - type of reentry?

Answer 8

Spiral Wave pattern

Question 9

Polymorphic VT - unlike monomorphic, does not require?

Answer 9

Structural substrate

Question 10

Polymorphic VT - Mostly commonly seen when? Also seen in?

Answer 10

Acute MI; Long QT, Brugada

Question 11

Pt with an MI has VT – when to consider ICD?

Answer 11

Repeated Monomorphic VT

Question 12

Drugs that decrease rate of polymorphic VT?

Answer 12

Decrease SNS tone (Betablockers, IV mag, amiodarone, lidocaine, sedation)

Question 13

TELE with pause-dependent VT)? Will see what on EKG?

Answer 13

Torsades de pointes (see bursts of VT with pauses)

Question 14

Torsades linked to what electrolyte abnormalities?

Answer 14

HypoK, hypoMg, HypoCa

Question 15

Abx associated with Torsades?

Answer 15

Erythromycin, pentamidine, Bactrim

Question 16

Treatment of Torsades?

Answer 16

#IV Mag
#Increase HR (isoproterenol, pacing)

Question 17

Do not give Isoproterenol for arrythmia if?

Answer 17

Congenital long QT

Question 18

Check for Mg overdose based on what physical exam sign?

Answer 18

Reflexes

Question 19

Treatment of VT Storm?

Answer 19

Reduce SNS tone (sedation, gnereal anestehsia, BBs, epidural anesthesia)

Question 20

Treatment of Idiopathic VF or Brugada?

Answer 20

Quinidine

Isopreterenol

Question 21

Sinusoidal VT - how to tell on EKG?

Answer 21

Duration of QRS depolarization is same as repolarization

Question 22

Causes of Sinusoidal VT?

Answer 22

Slowed depol (hyperK) or rapid tachycardia (flutter)

Question 23

See Sinusoidal VT – treat with?

Answer 23

Calcium Gluconate (for hyperK)

Question 24

Wide QRS Tachycardia – could be VT or?

Answer 24

SVT with aberency

Question 25

New wide complex Tachycardia – treatment?

Answer 25

``` #IV amiodarone #IV procainamide #IV lidocaine ```

Question 26

EKG markers of VT (and not SVT with aberency)?

Answer 26

``` #AV dissociation (on physical, cannon A waves present but not on every beat) #Initial R in AVR (in sinus, always negative) ``` (Inital Q in AVR) (Wide slurred AVR) (Absense of RS in V1-V6)

Question 27

Who gets an ICD?

Answer 27

``` #VT/VF cardiac arrest patients if no reversible cause #Sustained VT with structural heart disease #Syncope with VT #Unexplained syncope and significant LV dysfunction ```

Question 28

Become worried if Non-Sustained VT (NSVT) and...?

Answer 28

``` #Unexplained syncope #Family History of sudden death #T wave inversion in V1-V3 (ARVC/D); or IVCD/LVH #Abnormal ECHO ```