VT

Question 1

X

Answer 1

X

Question 2

C

Answer 2

C

Question 3

X

Answer 3

X

Question 4

X

Answer 4

X

Question 5

X

Answer 5

C

Question 6

C

Answer 6

X

Question 7

X

Answer 7

C

Question 8

congenital causes for torsades de pointes ?

Answer 8

congenital
Jervell-Lange-Nielsen syndrome
Romano-Ward syndrome

Question 9

antiarrhythmic causes for tornadoes de pointes ?

Answer 9

amiodarone, sotalol, class 1a antiarrhythmic drugs

Question 10

electrolyte and other causes for torsa de pointes ?

Answer 10

hypocalcaemia, hypokalaemia, hypomagnesaemia (esp happening with refeeding syndrome) , hypothermia

Question 11

neurological causes for torsa de pointes ?

Answer 11

subarachnoid haemorrhage

antipsychotics - respiridone

tricyclic antidepressants - amitriptyline

Question 12

drug causes for torsa de pointes ?

Answer 12

chloroquine
terfenadine
erythromycin
antipsychotics - respiridone
tricyclic antidepressants - amitriptyline

Question 13

Cardiological causes for torsa de pointes ?

Answer 13

myocarditis

Question 14

F

Answer 14

D

Question 15

What is given to treat POLYMOROHIC VTACH -torsa de pointes

Answer 15

IV magnesium

Question 16

Management of stable VTACH

Answer 16

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

Question 17

What are the adverse sign of unstable VTACH

Answer 17

Chest pain
Cardiac syncope
Heart failure
Systolic BP less than 90 mmhg

Question 18

What do we give for adverse signs VTACH

Answer 18

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

Question 19

What do we do if cardioversion with shock and drug fails ?

Answer 19

electrophysiological study (EPS)
implant able cardioverter-defibrillator (ICD) - this is particularly indicated in patients with significantly impaired LV function

Question 20

Which drug is absolutely CONTRAINDICATED FOR VTACH?

Answer 20

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).

Question 21

what increases likelihood of VT

Answer 21

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