Makindo Medical Notes Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

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Ventricular Tachycardia (VT)

Ensure that a defibrillator is nearby, switched on, and ready for use. Follow the Adult Tachycardia Algorithm as outlined.

Management Summary: IV Access and Obtain Defibrillator
ABC approach: if pulseless, initiate Cardiac Arrest Protocol. ECG shows wide complex regular tachycardia > 120 bpm. Secure IV access, provide oxygen, and treat electrolyte disturbances or ACS. If symptoms such as shock, syncope, angina, or severe heart failure are present, proceed with immediate DC shock: Synchronized DC shock (up to 3 attempts). Sedation or anesthesia if the patient is conscious. If unsuccessful, administer Amiodarone 300 mg IV over 10–20 minutes and repeat synchronized DC shock. If BP is stable, give Amiodarone 300 mg IV over 10–60 minutes.

Management Summary: IV Access and Obtain Defibrillator

ABC approach: if pulseless, initiate Cardiac Arrest Protocol.
ECG shows wide complex regular tachycardia > 120 bpm.
Secure IV access, provide oxygen, and treat electrolyte disturbances or ACS.
If symptoms such as shock, syncope, angina, or severe heart failure are present, proceed with immediate DC shock:
- Synchronized DC shock (up to 3 attempts).
- Sedation or anesthesia if the patient is conscious.
- If unsuccessful, administer Amiodarone 300 mg IV over 10–20 minutes and repeat synchronized DC shock.
If BP is stable, give Amiodarone 300 mg IV over 10–60 minutes.

Broad complex tachycardia with a rate > 120 bpm is often due to Ischemic Heart Disease.
Some patients may appear stable but can deteriorate rapidly; all cases should be treated as having the potential for cardiac arrest.
Immediate admission to the Coronary Care Unit (CCU) and access to defibrillation are vital.

Sustained VT: Lasts more than 30 seconds.
Non-Sustained VT: Defined as 3 or more consecutive beats below the AV node, with an RR interval < 600 ms (>100 bpm) and lasting < 30 seconds.

Ischemic Cardiomyopathy
Left Ventricular Hypertrophy (LVH), e.g., due to Hypertension
Idiopathic Dilated Cardiomyopathy
Brugada Syndrome
Arrhythmogenic Right Ventricular Cardiomyopathy
Myocarditis
Hypertrophic and Dilated Cardiomyopathy
Drug Overdose: Tricyclics, Digoxin, antiarrhythmics
Electrolyte Imbalance: Hypo/hyperkalaemia, Hypomagnesaemia
Substance Use: Cocaine, Phaeochromocytoma
Long QT Syndromes (Congenital/Acquired)
Right Ventricular Outflow Tract (RVOT) Ventricular Tachycardia with LBBB and RAD

Symptoms range from mild palpitations to cardiac arrest.
Other symptoms include pulmonary edema, hypotension, syncope, presyncope, chest pain, and dizziness.
JVP may show a "cannon a-wave," depending on rate and LV function.

Classical VT is the most common cause of wide complex regular tachycardia. If unclear, treat as VT and follow the Adult Tachycardia Algorithm.

ABC protocol: If pulseless, initiate CPR + DC shock. Oxygen as per guidelines.
For stable patients:
- 12-lead ECG, IV access, and blood tests
- Be ready to administer a DC shock
Pharmacologic Management (Stable):
- IV Metoprolol 5 mg
- IV Amiodarone 300 mg over 30 mins, then 900 mg over 24 hours via central line
- IV Lidocaine 50 mg over 2 mins, repeatable every 5 mins up to 200 mg
- IV Magnesium Sulfate 2 g (8 mmol) over 15 mins
Unstable/Pulseless: ABC, immediate DC countershock. Bloods, IV Amiodarone if needed.
If ACS/STEMI, proceed with PCI and treat accordingly.

Non-Sustained VT: Consider beta blockers. If LV function is poor (EF<30%), assess for AICD (Automated Implantable Cardioverter-Defibrillator).
Chronic Therapy: Long-term antiarrhythmic drugs, cause investigation (Echo, Angiography, EP studies, Holter monitoring).
AICD: Consider for patients with a history of life-threatening arrhythmias.
Catheter Ablation: Option for recurrent VT cases.