Ventricular tachycardia - Revision history

Rossdonaldson1: /* Video */

2024-04-17T18:48:27Z

Video

← Older revision		Revision as of 18:48, 17 April 2024
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	*[[Polymorphic ventricular tachycardia]]		*[[Polymorphic ventricular tachycardia]]
	*[[Electrical storm]]		*[[Electrical storm]]

	~~==Video==~~
	~~{{#widget:YouTube\|id=wXgqct8B2tk}}~~

	==References==		==References==
	<references/>		<references/>
	[[Category:Cardiology]]		[[Category:Cardiology]]

Rossdonaldson1: /* Other considerations */

2023-03-29T19:17:39Z

Other considerations

← Older revision		Revision as of 19:17, 29 March 2023
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	*Sodium channel blockade (e.g. from [[Benadryl\|benadryl]], [[TCA toxicity\|TCA]], or [[Cocaine toxicity\|cocaine]] toxicity) may cause very wide complex (>0.2msec) tachycardia with rate <120bpm		*Sodium channel blockade (e.g. from [[Benadryl\|benadryl]], [[TCA toxicity\|TCA]], or [[Cocaine toxicity\|cocaine]] toxicity) may cause very wide complex (>0.2msec) tachycardia with rate <120bpm
	**Treat with [[Bicarbonate\|sodium bicarbonate]]		**Treat with [[Bicarbonate\|sodium bicarbonate]]
	**[[Procainamide]], [[Flecanide]], [[Amiodarone]] all block Na channels and may result in asystole in patients with intrinsic or extrinsic Na-channel blockade. [[Lidocaine]] can be considered in for ventricular dysrhythmias in TCA toxicity if ~~bicarobante~~ is ineffective as it inhibits the sodium channel blockade effects of TCAs.		**[[Procainamide]], [[Flecanide]], [[Amiodarone]] all block Na channels and may result in [[asystole]] in patients with intrinsic or extrinsic Na-channel blockade. [[Lidocaine]] can be considered in for ventricular dysrhythmias in [[TCA toxicity]] if [[bicarbonate]] is ineffective, as it inhibits the sodium channel blockade effects of TCAs.

	==Disposition==		==Disposition==

TCNZ: /* Other considerations */

2023-03-19T08:34:31Z

Other considerations

← Older revision		Revision as of 08:34, 19 March 2023
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	*Sodium channel blockade (e.g. from [[Benadryl\|benadryl]], [[TCA toxicity\|TCA]], or [[Cocaine toxicity\|cocaine]] toxicity) may cause very wide complex (>0.2msec) tachycardia with rate <120bpm		*Sodium channel blockade (e.g. from [[Benadryl\|benadryl]], [[TCA toxicity\|TCA]], or [[Cocaine toxicity\|cocaine]] toxicity) may cause very wide complex (>0.2msec) tachycardia with rate <120bpm
	**Treat with [[Bicarbonate\|sodium bicarbonate]]		**Treat with [[Bicarbonate\|sodium bicarbonate]]
	**[[~~Lidocaine~~]], [[~~Procainamide~~]], [[Amiodarone]] all block Na channels and may result in asystole in patients with intrinsic or extrinsic Na-channel blockade		**[[Procainamide]], [[Flecanide]], [[Amiodarone]] all block Na channels and may result in asystole in patients with intrinsic or extrinsic Na-channel blockade. [[Lidocaine]] can be considered in for ventricular dysrhythmias in TCA toxicity if bicarobante is ineffective as it inhibits the sodium channel blockade effects of TCAs.

	==Disposition==		==Disposition==

Farmersj333: /* Differential Diagnosis */

2020-12-22T00:54:10Z

Differential Diagnosis

← Older revision		Revision as of 00:54, 22 December 2020
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{Tachycardia (wide) DDX}}		{{Tachycardia (wide) DDX}}
			{{Tachycardia (narrow) DDX}}

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Differential Diagnosis */

2019-04-05T06:34:01Z

Differential Diagnosis

← Older revision		Revision as of 06:34, 5 April 2019
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{Tachycardia (wide) DDX}}		{{Tachycardia (wide) DDX}}

	~~{{Tachycardia DDX}}~~

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Clinical Features */

2019-04-05T06:15:50Z

Clinical Features

← Older revision		Revision as of 06:15, 5 April 2019
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	==Clinical Features==		==Clinical Features==
	*~~Depends on etiology~~		*[[Syncope]]
	*~~Range from asymptomatic/~~[[~~palpitations~~]] to [[cardiac arrest]]		*[[Palpitations]]
			*[[Altered level of consciousness]]
			*May present with [[cardiac arrest]]

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1 at 06:15, 5 April 2019

2019-04-05T06:15:14Z

← Older revision		Revision as of 06:15, 5 April 2019
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	**Non-sustained if lasts < 30 seconds		**Non-sustained if lasts < 30 seconds
	**Sustained if lasts >30 seconds		**Sustained if lasts >30 seconds

	===Etiology<ref>Gupta AK, Thakur RK. Wide QRS complex tachycardias. Med Clin North Am. 2001;85(2):245–66– ix–x.</ref><ref>Akhtar M, Shenasa M, Jazayeri M, Caceres J, Tchou PJ. Wide QRS complex tachycardia. Reappraisal of a common clinical problem. Ann Intern Med. 1988;109(11):905–912.</ref><ref>Stewart RB, Bardy GH, Greene HL. Wide complex tachycardia: misdiagnosis and outcome after emergent therapy. Ann Intern Med. 1986;104(6):766–771.</ref>===
	*Due to true ventricular tachycardia in 80% of cases
	**For patients with underlying cardiac disease, increases to > 90%
	*Consider:
	**[[Hyperkalemia]]
	**[[Digoxin toxicity]]
	**Severe metabolic acidosis

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* See Also */

2019-04-05T06:13:09Z

Rossdonaldson1: Removed redirect to Wide-complex tachycardia

2019-04-05T06:12:38Z

Removed redirect to Wide-complex tachycardia

← Older revision		Revision as of 06:12, 5 April 2019
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	~~#REDIRECT~~[[Wide-complex tachycardia]]		==Background==
			*3 wide complexes in a row is considered ventricular tachycardia
			**Non-sustained if lasts < 30 seconds
			**Sustained if lasts >30 seconds

			===Etiology<ref>Gupta AK, Thakur RK. Wide QRS complex tachycardias. Med Clin North Am. 2001;85(2):245–66– ix–x.</ref><ref>Akhtar M, Shenasa M, Jazayeri M, Caceres J, Tchou PJ. Wide QRS complex tachycardia. Reappraisal of a common clinical problem. Ann Intern Med. 1988;109(11):905–912.</ref><ref>Stewart RB, Bardy GH, Greene HL. Wide complex tachycardia: misdiagnosis and outcome after emergent therapy. Ann Intern Med. 1986;104(6):766–771.</ref>===
			*Due to true ventricular tachycardia in 80% of cases
			**For patients with underlying cardiac disease, increases to > 90%
			*Consider:
			**[[Hyperkalemia]]
			**[[Digoxin toxicity]]
			**Severe metabolic acidosis

			==Clinical Features==
			*Depends on etiology
			*Range from asymptomatic/[[palpitations]] to [[cardiac arrest]]

			==Differential Diagnosis==
			{{Tachycardia (wide) DDX}}

			{{Tachycardia DDX}}

			==Evaluation==
			[[File:Lead II rhythm ventricular tachycardia Vtach VT.jpg\|thumb\|Ventricular tachycardia]]
			*Assume ventricular tachycardia until proven otherwise
			*See also [[rhythm diagnosis in regular wide complex tachycardia]]

			==Management==
			{{ACLS Wide Regular Tachycardia}}
			{{ACLS Wide Irregular Tachycardia}}

			===Recurrent===
			*≥3 episodes within 24 hours considered [[electrical storm]] and may require alternate treatment (i.e. beta blockade, sedation, ablation)

			===Other considerations===
			*True Vtach generally has rate >120bpm. If rate <120bpm or refractory to other therapy, consider other causes
			*When in doubt, use cardioversion for treatment of regular WCT. In irregular WCT, consider Afib with [[WPW]] in which [[Procainamide]] is the treatment of choice.
			*In very wide complex (>0.2 msec) and <120 bpm in a patient with significant history, consider giving [[Calcium chloride\|calcium chloride]] to treat [[Hyperkalemia\|hyperkalemia]]
			*Consider [[Acidosis]]
			*Sodium channel blockade (e.g. from [[Benadryl\|benadryl]], [[TCA toxicity\|TCA]], or [[Cocaine toxicity\|cocaine]] toxicity) may cause very wide complex (>0.2msec) tachycardia with rate <120bpm
			**Treat with [[Bicarbonate\|sodium bicarbonate]]
			**[[Lidocaine]], [[Procainamide]], [[Amiodarone]] all block Na channels and may result in asystole in patients with intrinsic or extrinsic Na-channel blockade

			==Disposition==
			*Admit all patients (even if converted to normal sinus rhythm in ED)

			==See Also==
			*[[ACLS: Tachycardia]]
			*[[ACLS (Main)]]
			*[[Rhythm diagnosis in regular wide complex tachycardia]]
			*[[Paroxysmal supraventricular tachycardia]]
			*[[Nonsustained ventricular tachycardia]]
			*[[Polymorphic ventricular tachycardia]]
			*[[Electrical storm]]

			==Video==
			{{#widget:YouTube\|id=wXgqct8B2tk}}

			==References==
			<references/>
			[[Category:Cardiology]]

Rossdonaldson1: Changed redirect target from Wide complex tachycardia to Wide-complex tachycardia

2019-04-05T06:05:14Z

Changed redirect target from Wide complex tachycardia to Wide-complex tachycardia

← Older revision		Revision as of 06:05, 5 April 2019
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	#REDIRECT[[Wide complex tachycardia]]		#REDIRECT[[Wide-complex tachycardia]]

← Older revision		Revision as of 06:13, 5 April 2019
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	==See Also==		==See Also==
	*[[ACLS: Tachycardia]]		*[[ACLS: Tachycardia]]
	*[[~~ACLS (Main)~~]]		*[[Wide-complex tachycardia]]
	*[[Rhythm diagnosis in regular wide complex tachycardia]]		*[[Rhythm diagnosis in regular wide complex tachycardia]]
	*[[Paroxysmal supraventricular tachycardia]]
	*[[Nonsustained ventricular tachycardia]]		*[[Nonsustained ventricular tachycardia]]
	*[[Polymorphic ventricular tachycardia]]		*[[Polymorphic ventricular tachycardia]]