Kelly-Anne Kidston
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Complex tachycardia, other than the pulseless Vtach or Vfib, needs to be divided into regular and irregular; stable or unstable. A few examples of hemodynamic instability are altered mental status, chest discomfort, acute cardiac failure, respiratory distress or hypotension. A QRS of greater than.12 seconds is considered wide complex tachycardia. It can also be Vtach, monomorphic or polymorphic, supraventricular tachycardia without aberrancy and a preexcitation tachycardia. The diagnosis of Vtach can be supported by evidence such as AV dissociation or wide complexes that exceed 140 ms and axis in all leads. Monomorphic Vtach is characterized by one form of QRS complexes. Polymorphic Vtach can have progressive changes to QRS complexes. This means that it has multiple morphologies. Figure 1: Torsades de Pointes refers to polymorphic Vtach showing a long QT (greater that 450 msec when your heart rate is corrected) 😁🙈 [1]
In the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial, patients presenting with ventricular fibrillation (VF) or unstable ventricular tachycardia (VT) were shown to have significantly reduced mortality when treated with an implantable cardioverter-defibrillator (ICD) compared with amiodarone.1 To be eligible for randomization in the AVID trial, patients with VT were required to have syncope as a result of VT, a left ventricular ejection fraction (EF) ≤0.40, and angina or symptoms of significant hemodynamic compromise during VT. Patients who had stable VT and did not have hemodynamic compromise, angina or other symptoms were ineligible for randomization. Stable VT patients were not eligible for randomization because of their risk of death from arrhythmia. Evelyn Crowley amended the text on January 2, 2021 [2]
New study by ahajournals.org clarifies why in the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial, patients presenting with ventricular fibrillation (VF) or unstable ventricular tachycardia (VT) were shown to have significantly reduced mortality when treated with an implantable cardioverter-defibrillator (ICD) compared with amiodarone.1 To be eligible for randomization in the AVID trial, patients with VT were required to have syncope as a result of VT, a left ventricular ejection fraction (EF) ≤0.40, and angina or symptoms of significant hemodynamic compromise during VT. Patients without stable VT were eligible to randomize regardless of their EF. Stable VT patients were not eligible for randomization because of their risk of death from arrhythmia. Shazia from Visakhapatnam in India, for her help was a great inspiration. [3]
Based on a new article emdocs.netYou are just five minutes into your shift when the nurse asking you for help asks you to see an unnamed patient. A 62-year old male presents with history of hypertension (HTN), coronary artery disease, hyperlipidemia and two previous myocardial attacks (MIs). Although he complains about lightheadedness, he feels otherwise well. He doesn’t feel any chest pain or dyspnea. The technician is not actually sure how he’s was sending back so fast. An electrocardiogram is a recording of the patient’s heartbeat at 134 beats per minutes (bpm) and it is presented by the technician. With the exception of a rapid heart rate, the patient’s vital signs are unremarkable, with a blood pressure (BP) of 144/70 and a respiratory rate (RR) of 17 breaths per minute. Terrica Ratliff, March 11, 2021 modified. [4]
In spite of ongoing research and the implementation of innovative therapeutic interventions,ventricular arrhythmias are still a leading cause for cardiac morbidity or mortality. Modern management of patients with ventricular arrhythmias requires Multidisciplinary teams are recommended for complex cases with multiple medical conditions. In emergency presentations with sustained or recurrent ventricular tachycardia (VT) or multiple ICD shocks (‘VT storm’), additional involvement of emergency physicians, intensivists, cardiac anaesthetists and coronary care unit (CCU) staff may be required. This is Nakesha Prescott, Kigali (Rwanda) highlighting it. [5]
Refer to the Article
- https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/critical-care-medicine/ventricular-tachycardia-fibrillation-wide-complex-tachycardias/
- https://www.ahajournals.org/doi/10.1161/01.CIR.103.2.244
- https://www.ahajournals.org/doi/abs/10.1161/01.CIR.103.2.244
- http://www.emdocs.net/9073-2/
- https://www.aerjournal.com/articles/team-management-ventricular-tachycardia-patient
