Ventricular Tachycardia (Assessment and Plan)

Author: William J Gibson MD,PhD

#Ventricular Tachycardia

Differential includes: SVT with aberrancy, SVT with pre-excitation, pacemaker mediated tachycardia.

Things to look for on baseline EKG: bundle branch block, QTc, Q-wave (-> scar), WPW, epsilon wave (-> ARVD), Brugada pattern

Monomorphic VT more commonly associated with scar. Polymorphic VT associated with ischemia.

Management:

- Medication review (QTc prolonging meds increase risk of polymorphic VT, Class IC antiarrhythmics)

-If unstable --> ACLS (including defibrillation)

-If stable: start either amiodarone 150 mg IV, then drip at 1 mg/min for 6 hours, then 0.5 mg/min for 18 hours or lidocaine 100 mg IV, then drip at 1 mg/ min [check levels]

-Replete electrolytes (K > 4, Mg > 2): give mag sulfate 2g-4g immediately if looks like Torsades