Emergency Medicine: Cardiology 213 Ventricular Arrhythmias Summary: Ventricular Arrhythmias

Lesson 6, Topic 9

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Summary: Ventricular Arrhythmias

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Monomorphic VT is characterized by a regular, monomorphic wide complex tachycardia, often occurring in structural heart disease
- Hemodynamically unstable patients warrant immediate electrical cardioversion
- For stable VT, procainamide is first-line based on recent evidence showing superiority over amiodarone
- Lidocaine offers an alternative with less negative inotropy but lower efficacy
- All medications should be paired with monitoring for effectiveness, recurrence of VT, and adverse events
- Correct reversible causes and consult electrophysiology for recurrent VT refractory to medications
- Clinical pharmacists play a vital role in appropriate antiarrhythmic selection, dosing, administration, and monitoring to optimize outcomes in monomorphic VT

Polymorphic VT is characterized by irregular, continuously changing QRS complexes, often with QT prolongation
- It is caused by heterogeneous repolarization that facilitates triggered activity and reentry
- Precipitants include electrolyte disturbances, medications, bradycardia, myocardial ischemia, and congenital channelopathies
- Diagnosis is by 12-lead ECG along with testing to identify reversible triggers
- IV antiarrhythmics like magnesium and amiodarone are first-line for acute termination
- Avoid amiodarone if QTc is markedly prolonged as it may worsen torsades de pointes
- Correct any reversible electrolyte, medication, or bradycardia triggers
- ICDs help provide backup protection against sudden death from recurrence
- Quinidine, ablation, or ICDs manage refractory cases