Wide complex tachycardia medical therapy

Jump to navigation Jump to search

Wide complex tachycardia Microchapters

Home

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

Physical Examination

Laboratory Findings

Electrocardiogram

EKG Examples

Electrophysiologic testing

Treatment

Medical Therapy

Primary Prevention

Case Studies

Case #1

Wide complex tachycardia medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Wide complex tachycardia medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Wide complex tachycardia medical therapy

CDC on Wide complex tachycardia medical therapy

Wide complex tachycardia medical therapy in the news

Blogs on Wide complex tachycardia medical therapy

Directions to Hospitals Treating Wide complex tachycardia

Risk calculators and risk factors for Wide complex tachycardia medical therapy

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

Medical Therapy

 
 
 
 
 
 
 
 
 
 
 
 
 
 
Wide complex tachycardia
QRS ≥ 120ms
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Do the following simultaneously:
- Assess and support ABC's as needed
- Give oxygen
- Monitor ECG, BP, oxymetry
- Identify and treat reversible causes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Is the patient stable?
Unstable signs include:
- Chest pain
- Congestive heart failure
- Hypotension
- Loss of consciousness
- Seizures
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Is the rhythm regular?
 
 
 
 
 
 
 
 
 
 
 
 
Immediate synchronized cardioversion
-Establish IV access

- Give IV sedation if the patient is conscious

- Consider expert consultation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Regular
 
 
 
 
 
 
 
 
 
Irregular
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ventricular tachycardia or uncertain rhythm?

Amiodarone 150 mg IV over 10 min
Repeat as needed for a maximal dose of 2.2g/24h

Prepare for elective synchronized cardioversion
 
SVT with aberrancy?

Adenosise 6 mg rapid IV push

If no conversion give 12 mg IV push

May repeat 12 mg dose once
 
Afib with aberrancy?

Consider expert consultation

Control rate e.g diltiazem or beta blockers
Use beta blockers with caution in pulmonary diseases or CHF
 
Pre-excited Afib (Afib + WPW)

Consider expert consultation

Avoid AV nodal blocking agents
e.g adenosine, digoxin, diltiazem and verapamil

Consider amiodarone 150 mg IV over 10 min
 
Recurrent polymorphic VT?

Consider expert consultation
 
Torsades de pointes?

Magnesium
Load with 1-2 g over 5-60 min, then infusion

[[


  • 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

Template:WH Template:WS