Ventricular Tachycardia - Wellington Hospital, New Zealand



Ventricular Tachycardia

15/11/10

2010 Resuscitation Guidelines

Life in the Fast Lane ECG’s

PY Mindmaps

= 3 or more VEB at a rate of > 130 beats/min

- > 30 seconds = sustained

- can be monophoric or polymorphic

TYPES

Monomorphic

- most common

- associated with MI

Polymorphic

- QRS at 200 beats/min or more which change amplitude and axis so they appear to twist around the baseline

-> treatment is the same for both

MECHANISMS

- enhanced automaticity (ectopic pacemaker activity)

- enhanced trigger activity

- re-entry

PREDISPOSTING CONDITIONS

Channelopathies (Na+ and K+)

- Lange-Neilsen syndrome (long QT + deafness)

- Romano-Ward syndrome (long QT and no deafness)

- Bugada syndrome

Other electrophysiology effects

- WPW

- catecholamine sensitive polymorphic VT

Drugs that cause QT Prolongation

- clarithromycin

- erythromycin

- metaclopramide

- haloperidol

- TCA

- methadone

- droperidol

Electrolytes

- hypokalaemia

- hyperkalaemia

- hypomagnesaemia

- hypocalcaemia

Hypothermia

Structural heart disease

- LV dysfunction

- coronary artery disease

- MI

- HOCM

DIFFERENTIATING VT from WIDE COMPLEX SVT

Criteria for diagnosis of VT using the 4-step Brugada algorithm:

(i) Is RS complex present in any lead? -> if NO the rhythm is VT

(ii) Is the RS duration >100ms in any lead? -> if YES then the rhythm is VT

(iii) Is there AV dissociation? (fusion or capture beats) -> if YES then the rhythm is VT

(iv) Is the rhythm morphologically consistent with SVT (looks like RBBB or LBBB)? -> if NO the rhythm is VT

-> fusion beats = complex looks half normal and half abnormal

-> capture beats = normal complex seen

MANAGEMENT

PULSELESS

ACLS protocol

Immediate unsynchronised defibrillation

CPR with minimal interruption (30:2, with 2 minute cycles)

Intubation

O2

IV access

Adrenaline 1mg Q3min

Amiodarone 300mg (following 3rd shock)

Exclude reversible causes (4 H’s and T’s)

CLINICALLY COMPROMISED

Haemodynamically unstable, chest pain, ischaemia, heart failure, VR > 150/min -> synchronised shock (x 3)

O2

IV access

Rapid exclusion of reversible factors (wire, PA catheter in RV, hypoK+ or Mg2+)

Amiodarone 5mg/kg -> infusion

Synchronised DC Shock (50J Bi, 100 Mono)

Consider:

-> procainamide 50mg/min

-> lignocaine 1mg/kg

-> sotalol 1mg/kg

Repeat DC Shock (150 Bi, 360 Mono)

Overdrive pacing

CLINICALLY STABLE

- controversial

- debate between cardioversion and pharmacological treatment

- still a medical emergency as can degenerate into unstable VT and VF

O2

Amiodarone or sotolol

Cardioversion if medical therapy fails (quickly) – will need sedation

Consider pacing if cardioversion no effective

Evaluation and treatment of cause (usually IHD)

If associated with long QT -> consider Mg2+

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download