Tag Archives: VTach

Thursday case presentation with Nishant and Dr. Meadows: VTach storm

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

7/14 Noon conference: Ventricular tachycardias w/ Nora Goldschlager  

*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)
*ST Elevation
*Rate-dependent interventricular conduction delay (benign)
*V-paced complexes
Lytes and toxins (produce very wide, sinusoidal patterns):
*TCA toxicity