VT mimics Flashcards
What is the minimum HR for VT?
Variable but 140 really is a baseline
Below what HR must you consider VT mimics?
ANYTHING LESS THAN 140 you must consider the VT mimics!!!!
What are the VT mimics?
- Hyperkalaemia
- Type 1A VW class agents e.g. TCA, cocaine
- Reperfusion arrythmias e.g. AIVR
What is the problem with treating VT mimics?
If you treat VT mimics with lignocaine/amiodarone/procainamide THEY WILL LIKELY GO INTO ASYSTOLE AND DIE
Why are standard VT medications dangerous in VT mimics?
Hyperkalaemia is a sodium channel poison independently
Type IA = Na channel blockade (giving more Na channel blocker is BAD)
AIVR is an escape rhythm -> if you block the escape rhythm with a sodium channel blocker the patient will go into asystole and die!!!!!
Sodium channel blocking activity includes amiodarone, propranolol, lignocaine, procainamide, TCAs, venlafaxine, cocaine, fleicanide
What is this ECG showing?
Peaked T-waves
Suggestive of hyperkalaemia
After sux ECG below
Computer says VTACH - but the HR is 105!!! Got lidocaine = dead
This patient was intubated with sux!!! Eeeeep
Why is this NOT ventricular tachycardia?
The rate is 105!!!
It cannot be Vtach
Pt got amiodarone - died
Should’ve had a VBG -> hyperkalaemia
What does this post-thrombolysis ECG show?
Regular wide complex tachycardia at 100bpm
it’s NOT vtach - it’s too slow! -> it is AIVR which is a benign reperfusion arrythmia
This patient got IV lidocaine and died - they were haemodynamically stable so they got an IV therapy for VT -> great badness
What can cause AIVR?
Myocardial reperfusion - typically 45-90 mins post thrombolysis
Adrenaline/isoprenaline
Digoxin/cocaine/inhaled anaesthetics
Myocarditis
ROSC in cardiac arrest
Electrolyte abnormalities
Usually only lasts for 3-5 minutes
What’s this?
It’s a sodium channel blocker overdose
Rate is 116bpm
The QRS is massive! almost 200msec
Vtach treatments will KILL this patient
Got sodium bicarbonate though and did well!
What happens if you give sodium bicarbonate 1-2mmol/kg to someone with VT?
Nothing!
It doesn’t help but it doesn’t hinder so if in doubt - try sodium bicarb first!!!!
What’s this?
Its NOT ventricular tachy
really wide complexes it’s really important to calculate rate with whole rhythm strip then x by 6
It’s under 120 bpm!
Nothing happened with x2 doses of IV calcium gluconate
After x2 vials of sodium bicarbonate this was the ECG…
Fleicanide toxicity!!!!
