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==Medical Therapy==  
==Medical Therapy==  
* If stable:  (More patients than you think)
* If stable:  (More patients than you think)

Revision as of 18:02, 3 August 2013

Wide complex tachycardia Microchapters

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Patient Information

Overview

Causes

Differentiating VT from SVT with aberrant conduction

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

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Electrocardiogram

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Treatment

Medical Therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Medical Therapy

  • 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 (specially those with structurally normal hearts) are adenosine responsive and can terminate.
    1. Etiology uncertain
      • Pronestyl 15 mg/kg load over 30 minutes then 2-6 mg/min gtt
    2. Ventricular tachycardia with active ischemia
      • Lidocaine 1 mg/kg q5-10 min up to 3 times then 2-6 mg/min gtt
      • If unsuccessful, pronestyl as above
      • If unsuccessful, IV amiodarone 150-300 load over 15-20 min. 30-60 mg/hr gtt for total of 1 gram
    3. Ventricular tachycardia in setting of cardiomyopathy
    4. Positively SVT with aberrancy
    5. Antidromic AVRT
      • If 100% positive AF is not underlying, can terminate with a nodal blocker
      • If unsure, pronestyl as above

Defibrillation

Indications for defibrillation include the following:

References

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