Wide complex tachycardia medical therapy: Difference between revisions

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==Medical Therapy==  
==Medical Therapy==  
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* If stable:  (More patients than you think)
* If stable:  (More patients than you think)
* Do not use Ca<sup>2+</sup> channel blocker, [[digoxin]] or [[adenosine]] if you don't not know the etiology of the wide complex tachycardia. Ca<sup>2+</sup> channel blockers and digoxin can lead to accelerated conduction down a bypass tract and [[VF]].   
* Do not use Ca<sup>2+</sup> channel blocker, [[digoxin]] or [[adenosine]] if you don't not know the etiology of the wide complex tachycardia. Ca<sup>2+</sup> channel blockers and digoxin can lead to accelerated conduction down a bypass tract and [[VF]].   

Revision as of 20:10, 3 August 2013

Wide complex tachycardia Microchapters

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

Medical Therapy

 
 
 
 
 
 
 
 
 
 
 
 
 
 
A01
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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B01
 
 
 
 
 
 
 
 
 
 
 
 
B02
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
C01
 
 
 
 
 
 
 
 
 
 
 
 
C02
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
D01
 
 
 
 
 
 
 
 
 
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E01
 
E02
 
E03
 
E04
 
E05
 
E06


  • 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:

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