Ventricular tachycardia

A regular ventricular rhythm with 3 or more broad QRS complexes and at

rate between 100-200bpm

Causes
- Acute MI
- Cardiomyopathy
- Mitral valve prolapse
- Drug toxicity –digoxin
- Prolonged QT syndrome
Clinical features
- Hypotension
- Cardiogenic shock
- Pulmonary edema
- Assymptomatic
ECG findings
- 3 or more broad QRS complexes
- Rate more than 100bpm
- Regular with occasionally beat to beat variation
- QRS axis constant
- ST and T wave changes in a direction opposite to major QRS deflection
• Sustained VT – lasting more than 30 sec or associated with hemodynamic collapse
Acute therapy
Hemodynamically unstable
- Immediate cardioversion
- IV lignocaine administered concomitantly

Stable
- Antiarrythmias (not more than 2 drugs)
- If deteriorate, immediate cardioversion
A. Lignocaine IV
- IV bolus 50-100mg (1mg/kg)
- Repeats if necessary at 0.5mg/kg at intervals 10 mins, total dose of 3mg/kg
- Infusion of 4mg/min for 1hr, 3mg/min for 1hr, 1-2mg/min for maintanence
• Decrease dose by 50% - Acute MI, acute pulmonary edema, age more than
70 years old
• Toxicity – circumfral paresthesia, transient auditory disturbance,
drowsiness, delirium, muscle twitching, seizure, sinus bradycardia, AV
block, myocardial depression
B. Procainamide
- Loading dose : 100mg at 25-50mg-min every 5 mins until arrhythmias
terminates/max 1g achieved/adverse effect develop
- Maintanence: 1-4mg/min (mix 2g in 500ml D5%/NS = 4mg/ml)
- ECG and BP monitoring
- Toxicity: sinus arrest, AV block, ventricular arrhythmias, hypotension,
prolonged QT intervals and QRS widening
C. Amiodarone
- Loading dose: IV 300-600mg(5-10mg/kg) in 250ml 0f D5% over 2
hours, continue by 300-600mg in 250ml D% over 24 hours (max daily
1.2g)
- Infusion can continue for several days (max 2-3 weeks) before change
to oral
- Emergency loading dose : 100ml run over 10 mins
Additional note
• Can continue for several days
• Failure and VT persists – synchronized DC shock
• BUSE, serum calcium, serum magnesium, ABG should be sent
• Electrolytes abnormalities should be corrected
• Hypomagnesaemia in alcoholic and diuretics patient – magnesium
sulphate 1-2g in 50ml over 15mins
Chronic therapy
• Prevention – suppressive drugs: class 1 agent, B Blocker, amiodarone
• Electrophysiologic study – assess drug efficacy
• Implantation of a defribilator – in failure of drug therapy
• Radiofrequency ablation