Transcript
PHYSICIAN’S MEETECG of the week
Prof. S.SUNDAR’s unit,Dr. N.IDHAYACHANDRAN,PG
a 46 year old Rajeswari, a k/c of DCMP Admitted with the c/o palpitationsc/o breathlessness
BP- 80/? mmHg,pulse - feeble
• Ventricular rate: 300/min• QRS duration: 200 milliseconds• P-R interval: 120 milliseconds• QRS axis: +30 degree• Monophasic & polymorphic QRS complexes
WQRS TACH
IrregularRegular
QRS morphologyChanging beat to beat
QRS morphologysimilar
Polymorphic VT
Preexcited afib
QTC prolonged QTC
Monomorphic VT
Wide QRS TachycardiaWide QRS Tachycardia
VT AB Cond. AP Cond. ( 81% ) ( 14% ) ( 5% )
VT AB Cond. AP Cond. ( 81% ) ( 14% ) ( 5% )
If no AV dissociation for
Morphology criteria for VT present both inPrecordial leads V1-2 & V6?Yes No VT SVT with aberrant conduction
Wide QRS ECG
Is this VT :
Preexisting WQRSSinus TachSVT
VT
MMVTPMVT
Not sure Tt as VT
PMVT
• stop the offending drug.
• Correct Electrolyte abnormalities
• IV Mg bolus (1 to 2 g over 10 min followed by continuous infusions) are indicated.
• Pacing
Role ofi.v.Magnesium
• Drug of choice in– digitalis-toxicity related arrhythmias– hypokalemia-hypomagnesemia related– polymorphic VT of proarrhythmia– myocarditis
• Dose– 2-4 gm bolus infusion– 4-8 gm infusion over 24 hours
VT:Normal Heart
• We prefer IV beta blocker, as the drug of choice.
• Once acute episode is treated EP consultation is warranted , as most of them can be cured by catheter ablation
Refractory VT/ VF
• (1) intravenous amiodarone, and Beta blockers
• (3) overdrive pacing,
• (4) intraaortic balloon pump, and • (5) coronary revascularization
THANK YOU
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