Wide complex tachycardias: Difference between revisions

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{{SK}} WCT; fast and wide; wide and fast; wide-complex tachycardia; wide complex rhythm; SVT with aberrancy; SVT with aberrant conduction; supraventricular tachycardia with aberrancy; VT versus SVT
{{SK}} WCT; fast and wide; wide and fast; wide-complex tachycardia; wide complex rhythm; SVT with aberrancy; SVT with aberrant conduction; supraventricular tachycardia with aberrancy; VT versus SVT
== Treatment ==
===Defibrillation===
Indications for defibrillation include the following:
* [[Chest pain]]
* [[Congestive heart failure]] ([[CHF]])
* [[Hypotension]] with symptoms
* [[Loss of consciousness]]
* [[Seizure]]
=== Acute Pharmacotherapies ===
* '''If stable''':  (More patients than you think)
* '''DO NOT USE''' Ca2+ Channel blocker, [[Digoxin]] or [[Adenosine]] if you don't not know the etiology of the Wide Complex Tachycardia. Ca2+ Channel blockers and Digoxin can lead to accelerated conduction down a bypass tract and [[VF]]. 
* Though ACLS guidelines recommend a diagnostic trial of [[Adenosine]], it can precipitate [[VF]] in some patients with SVT. Patients who have underlying coronary disease may become ischemic from coronary steal. Rhythm can degenerate and lead to [[VF]] that cannot be resuscitated. Furthermore, some [[VT]] (esp those with structurally normal hearts) are [[adenosine]] responsive and can terminate.
*:# Etiology Uncertain
*:#:* [[Pronestyl]]  15mg/kg load over 30 minutes then 2-6mg/min gtt
*:# [[Ventricular Tachycardia]] with active ischemia
*:#:* [[Lidocaine]] 1 mg/kg q5-10 min up to 3 times then 2-6mg.min gtt
*:#:* If unsuccessful, [[Pronestyl]] as above
*:#:* If unsuccessful, IV [[Amiodarone]] 150-300 load over 15-20min.  30-60mg/hr gtt for total of 1gram
*:# [[Ventricular Tachycardia]] in Setting of [[Cardiomyopathy]] 
*:#:* Skip [[Lidocaine]] and go straight to [[Pronestyl]]
*:# Positively [[SVT]] with aberrancy
*:#:* [[Adenosine]] 6mg rapid IV bolus in large vein. May repeat with 12mg x2.
*:#:* [[Lopressor]] 2.5-5.0mg IV
*:#:* [[Diltiazem]] 10-20mg bolus followed by gtt 5-20mg/hr
*:#:* [[Verapamil]] 2.5-5.0mg bolus.
*:#:* Avoid [[Digoxin]].  Takes too long to work and can be proarrhythmic
*:#:* [[Pronestyl]] as above
*:# Antidromic AVRT
*:#:* If 100% positive [[AF]] is not underlying, can terminate with a nodal blocker
*:#:* If unsure, [[Pronestyl]] as above


==Sources==
==Sources==

Revision as of 19:25, 7 February 2013