VT Flashcards
X
X
C
C
X
X
X
X
X
C
C
X
X
C
congenital causes for torsades de pointes ?
congenital
Jervell-Lange-Nielsen syndrome
Romano-Ward syndrome
antiarrhythmic causes for tornadoes de pointes ?
amiodarone, sotalol, class 1a antiarrhythmic drugs
electrolyte and other causes for torsa de pointes ?
hypocalcaemia, hypokalaemia, hypomagnesaemia (esp happening with refeeding syndrome) , hypothermia
neurological causes for torsa de pointes ?
subarachnoid haemorrhage
antipsychotics - respiridone
tricyclic antidepressants - amitriptyline
drug causes for torsa de pointes ?
chloroquine
terfenadine
erythromycin
antipsychotics - respiridone
tricyclic antidepressants - amitriptyline
Cardiological causes for torsa de pointes ?
myocarditis
F
D
What is given to treat POLYMOROHIC VTACH -torsa de pointes
IV magnesium
Management of stable VTACH
CORRECT electrolyte abnormalities - ESP HYPOKALEMIA and HYPOMAGNESIA
If regular rhythm - assume VTACH and give amiodarone 300mg IV over 20 mins
Then 900 over 24 hours
If broad complex and irregular
Then AF with bundle branch block
Pre excited AF - consider amiodarone
POLYMOROHIC VT
What are the adverse sign of unstable VTACH
Chest pain
Cardiac syncope
Heart failure
Systolic BP less than 90 mmhg
What do we give for adverse signs VTACH
Check and correct electrolyte abnormalities
Cardio version
Up to 3 Synchronised shocks
150-200j the first
Then 150-360
====
Then cardio version drugs amiodarone 300mg over 20 mins
Then 900 mg over 24 hours
If refactory:
lidocaine: use with caution in severe left ventricular impairment
procainamide
What do we do if cardioversion with shock and drug fails ?
electrophysiological study (EPS)
implant able cardioverter-defibrillator (ICD) - this is particularly indicated in patients with significantly impaired LV function
Which drug is absolutely CONTRAINDICATED FOR VTACH?
VERAPAMIL should not be used - risk of causing significant hypotension, ventricular fibrillation
and cardiac arrest.
However, verapamil can be used safely in the management of supraventricular tachycardia (SVT).
what increases likelihood of VT
Absence of typical RBBB or LBBB morphology
atrio ventricular dissociation
Very broad complexes > 160ms
Capture beats: Occur when the sinoatrial node transiently “captures” the ventricles in the midst of AV dissociation, producing a QRS complex of normal duration
Fusion beats: Occur when a sinus and ventricular beat coincide to produce a hybrid complex (see Dressler beat)
positive QRS concordance in chest leads
marked left axis deviation
history of IHD
lack of response to adenosine or carotid sinus massage
