⚡ Ensure a defibrillator is immediately available, switched on, and ready for use. Follow the Adult Tachycardia Algorithm (Resuscitation Council UK / ALS 2021).

📋 Management Summary: IV Access & Defibrillator Preparedness
🩺 ABC approach: if pulseless → initiate Cardiac Arrest Protocol (ALS algorithm). 📈 ECG: wide-complex tachycardia >120 bpm. 💉 Establish IV/IO access, provide oxygen, correct reversible causes (High K⁺, ACS). 🚨 Unstable VT (shock, syncope, hypotension, angina, acute heart failure) → immediate synchronized DC cardioversion: ⚡ Synchronized DC shock (initial: 100–200 J biphasic; repeat if needed). 💤 Conscious patients: sedation/analgesia if possible. 💊 If arrhythmia persists after cardioversion: IV amiodarone 300 mg over 20–60 min; repeat shock if needed. ✅ Stable VT: IV amiodarone 5 mg/kg over 20–60 min (max 300 mg); then consider infusion 900 mg/24 h if ongoing.

📋 Management Summary: IV Access & Defibrillator Preparedness

🩺 ABC approach: if pulseless → initiate Cardiac Arrest Protocol (ALS algorithm).
📈 ECG: wide-complex tachycardia >120 bpm.
💉 Establish IV/IO access, provide oxygen, correct reversible causes (High K⁺, ACS).
🚨 Unstable VT (shock, syncope, hypotension, angina, acute heart failure) → immediate synchronized DC cardioversion:
- ⚡ Synchronized DC shock (initial: 100–200 J biphasic; repeat if needed).
- 💤 Conscious patients: sedation/analgesia if possible.
- 💊 If arrhythmia persists after cardioversion: IV amiodarone 300 mg over 20–60 min; repeat shock if needed.
✅ Stable VT: IV amiodarone 5 mg/kg over 20–60 min (max 300 mg); then consider infusion 900 mg/24 h if ongoing.

ℹ️ Key Points

📊 Broad-complex tachycardia (>120 bpm) usually ventricular in origin, commonly post-MI.
⚠️ Even seemingly stable patients can deteriorate → always prepare for rapid intervention.
🏥 Admit to CCU / high-dependency unit; continuous ECG monitoring and immediate defibrillator access required.

📌 Types of VT

Sustained VT: ≥30 seconds or requiring intervention due to haemodynamic compromise.
Non-sustained VT: ≥3 consecutive ventricular beats, lasting <30 seconds, rate >100 bpm.

🩺 Causes of VT

❤️ Ischaemic cardiomyopathy (most common)
💪 LVH (e.g., hypertension)
🫀 Idiopathic dilated cardiomyopathy
⚡ Channelopathies: Brugada syndrome, long QT syndromes
🧬 ARVC (Arrhythmogenic Right Ventricular Cardiomyopathy)
🦠 Myocarditis
🏋️ Hypertrophic cardiomyopathy
💊 Drugs / toxins: TCAs, digoxin, antiarrhythmics, cocaine
🧪 Electrolyte disturbances: hypo-/hyperkalaemia, hypomagnesaemia
💉 Phaeochromocytoma
➡️ RVOT VT (LBBB morphology + RAD)

👨‍⚕️ Clinical Presentation

Palpitations, dizziness, syncope
💨 Pulmonary oedema, 🩸 hypotension, chest pain
JVP: cannon a-waves possible
Sudden cardiac arrest in severe cases

📈 ECG Features

Wide QRS complex >120 ms
AV dissociation, fusion/capture beats
Extreme axis deviation or RS absence in precordial leads
Monomorphic vs polymorphic (torsades de pointes: polymorphic, twisting QRS around baseline)

12-Lead ECG - Ventricular Tachycardia

🔀 Differential Diagnosis of Regular Wide-Complex Tachycardia

⚡ Ventricular Tachycardia (assume VT if unsure)
↔️ SVT with bundle branch block
↔️ Atrial flutter with BBB
🧪 Severe hyperkalaemia
⚡ Pre-excited atrial tachycardia (WPW)

🧪 Investigations

Bloods: FBC, U&E, Mg²⁺, Ca²⁺, lactate, ABG, troponin
ECG: continuous monitoring, 12-lead for diagnosis
Echocardiography: assess LV function, structural disease
Coronary angiography if ACS suspected

🚑 Acute Management (NICE/RCUK ALS Compliant)

ABC assessment; pulseless → CPR + defibrillation per ALS
Unstable VT → immediate synchronized cardioversion
Stable VT → IV antiarrhythmics (amiodarone first-line; lidocaine or procainamide alternatives)
Torsades de pointes → IV magnesium sulfate 2 g over 15 min; correct K⁺, Mg²⁺, Ca²⁺; temporary pacing if recurrent
Treat reversible causes: ACS, electrolyte imbalance, hypoxia, drug toxicity

🩺 Long-Term Management

Beta-blockers for non-sustained VT in structurally normal hearts
EF <35–30% → consider ICD/AICD for primary prevention
Antiarrhythmic therapy guided by cardiology/EP team
Catheter ablation for recurrent, symptomatic VT
Regular follow-up with ECG, Holter, and echocardiography

⚡ Ventricular Tachycardia Management Flowchart (RCUK/NICE Compliant)

Wide-Complex Tachycardia >120 bpm

Pulseless / Cardiac Arrest

→ CPR + Defibrillation (ALS algorithm)
→ Treat reversible causes (H’s & T’s)

Pulse Present

→ Assess haemodynamic stability

Stable VT

IV access, oxygen, ECG
Correct electrolytes & reversible causes
IV Amiodarone 5 mg/kg over 20–60 min (max 300 mg)
Continuous monitoring, admit to CCU

Unstable VT

Signs: Low BP, shock, syncope, angina, acute HF
Immediate synchronized DC cardioversion (100–200 J biphasic)
Conscious → sedation if possible
Post-shock → IV amiodarone if VT persists

Torsades de Pointes (Polymorphic VT, prolonged QT)

IV Magnesium sulfate 2 g over 15 min
Correct K⁺, Mg²⁺, Ca²⁺
Stop QT-prolonging drugs
Temporary pacing if recurrent / symptomatic

🩺 Long-Term / Secondary Prevention

Beta-blockers for non-sustained VT in structurally normal hearts
EF <35–30% → ICD / AICD for primary prevention
Antiarrhythmic therapy under cardiology / EP guidance
Catheter ablation for recurrent VT
Regular follow-up: ECG, Holter, echocardiography

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Ventricular Tachycardia VT ✅