Internal Medicine

0521779407-22 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:23

1530 Ventricular Tachycardia

management

What to Do First

■12-lead ECG to assess acute myocardial ischemia or infarction

■Vital signs to assess hemodynamic response

■Immediately begin cardiopulmonary resuscitation and Advanced

Cardiac Life Support protocol if cardiopulmonary collapse occurs.

General Measures

■Correction of electrolyte imbalance

■Magnesium replacement

■Evaluation and treatment for acute coronary syndrome or myocar-

dial infarction

specific therapy

Immediate

■Emergency DC cardioversion (synchronized to R wave) to restore

NSR in patients with a rapid ventricular response resulting in hemo-

dynamic instability or angina

■Infusion of IV amiodarone

■Ventricular overdrive pacing

Chronic

■Implantation of an internal cardioverter defibrillator (ICD), Class I

indications:

■Cardiac arrest due to VF or VT without a reversible cause

■Spontaneous sustained VT with structural heart disease

■History of syncope and hemodynamically significant VT or VF

induced at EP study

■Nonsustained VT with prior MI and LV dysfunction and inducible

VT at EPS

■Spontaneous sustained VT without structural heart disease and not

amenable to other treatments

■RF ablation of VT focus, especially in idiopathic right or left ventricu-

lar tachycardia or refractory ischemic VT with recurrent shocks after

ICD implantation

Side Effects & Contraindications

■Prorhythmic effects from drug therapy (not recommended)

follow-up

■Treatment of underlying diseases. Coronary angiography with revas-

cularization.