*There are pre-made “preference lists” under the labs tab – use these! They are a good reminder of potential tests you need to order for certain conditions, and will save you time. Let us know if you can’t find this list when ordering*
*Take home points: 1) Have a framework for approaching wide complex tachycardia 2) Treatment pearls: a) you’re almost never wrong to give amiodarone in the acute setting, b) push at least 2gm magnesium of any suspicion of polymorphic VT 3) Recognize mimics of ventricular tachycardia*
Stepwise framework for diagnosis wide complex tachycardia
1. Distinguish SVT w/ aberrancy from VT using Brugada criteria (when in doubt, treat as if VT)
2. If VT, monomorphic or polymorphic?
3. If polymorphic VT, long QT (i.e. torsades) or normal QT (i.e. almost certainly 2/2 ischemia)?
Ventricular Tachycardia Mimics
Other cardiac disease:
*Rate-related aberrancy (sinus tach or afib w/ bundle branch block)
*Rate-dependent interventricular conduction delay (benign)
Lytes and toxins (produce very wide, sinusoidal patterns):
*Take home points: 1) The drugs that improve mortality in HFrEF are BB, ACEI, Spironolactone, and hydralazine/nitrates for African Americans. These drugs are NOT necessarily all helpful in HFpEF, HOCM, and valvular cardiomyopathy 2) Entresto = sacubitril/valsartan, an ARB/neprilysin inhibitor that may further improve mortality in chronic heart failure*