An elderly woman with a pmh of Ebstein’s anomaly with an ICD, rheumatoid arthritis, Sjogren’s syndrome and ILD who presented with nonexertional chest pain found to be in VT storm on admission.
Know the workup of VT -> Thyroid function tests, electrolytes including K, Mg, and Calcium; if appropriate measure levels of digoxin and TCAs, Tox screens also may be helpful; and of course troponin
-Remember that you cannot rule out ischemia if a patient is in a paced rhythm
-Ebstein’s is commonly associated with an ASD and presents with hypoxia from a L->R shunt.
-Shunt flow is driven by COMPLIANCE – the right side of the heart is more compliant, so therefore flow is left to right
-470 is a good cutoff to remember when thinking about prolonged QT
-VT Storm as Nishant pointed out is defined as 3 or more episodes of sustained VT or shocks from an ICD for VT in a 24 hour period