Ventricular Tachycardia

• What is ventricular tachycardia?


  Severe cardiac arrhythmia originating from the ventricles

  Life-threatening

  HR > 100

  Can be monomorphic or polymorphic (e.g. Torsades de Pointes)
• What are the signs & symptoms of VT?

  Some pts may be asymptomatic

  • Chest pain
  • SOB
  • Syncope
  • May have haemodynamic instability
  • Tachycardia
  • Weak/no pulse
• What are the RFs of VT?


  Coronary artery disease

  MI

  LV systolic dysfunction

  QT syndrome

  Brugada syndrome

  Electrolyte imbalance

  Drug toxicity
• What are the Inx of VT?

  Obs

  Full Hx & examination

  ECG

  Bloods (FBC, U&Es, LFTs, CRP, troponin)

  CXR

  Echo
• What will an ECG show in VT?


  Regular, broad complex tachycardia

  Absent P waves
• What are the possible complications of VT?


  Cardiac arrest

  Pulseless Electrical Activity (PEA)

  Myocardial ischaemia & infarction

  CHF

  Tachycardia-induced cardiomyopathy
• What is the treatment of pulseless VT?

  ALS

  • Shockable rhythm
  • IV adrenaline & IV amiodarone
• What is the treatment of pulsed VT?


  Pulsed VT w/adverse features (shock, syncope, myocardial ischaemia or HF)

  • Synchronised DC shocks (may require sedation of anaesthesia)
  • Consider amiodarone

  Pulsed VT w/no adverse features

  • Amiodarone IV
  • Synchronised DC shocks

  Consider magnesium sulphate
• What is the long-term management of VT?


  ICD

  Anti-arrhythmic drug therapy

  Consider catheter ablation