Todays POTD inspired by a resuscitation case from Drs Kaplan and Odashima- a cardiac arrest pt whose reported initial rhythm was PEA got 4x Epi and bicarb and was then noted to have something similar to the following on EKG:
So lets talk Polymorphic Vtac and what we need to know
PVT- comes from multiple ventricular foci
- Varying QRS complexes with different amplitudes, axis and duration
- Normal QT? think ischemia
- Usually within 12hrs of onset of symptoms
- Can be from severe CHF or cardiogenic shock
- HIGH mortality with NO evidence of specific anti-arrythmic therapy improving mortality
- TRX:
- Unstable> Defib
- Stable> 5mg Metoprolol Q5min if BP tolerates
- IV amiodarone may prevent recurrence
- Urgent CATH, IABP
- Mag is less effective
- Can also be Familial catecholaminergic PVT
- TRX: Beta Blockers!
- Bidirectional VT- a/w Dig toxicity, herbal aconite poisoning
- QRS axis shifts 180 degress from L to R with each beat
- Learn more from our fabulous colleagues Drs Yang and Burmon on our BLOG!
- Torsades-must have PVT and QT prolongation
- QRS "twist " around the isoelectric line
- Often short lived and self terminating
- MCC: Drugs
- Electrolyte abnormalities- hypoK, hypoMg
- Hypoglycemia? Can cause prolonged QT , but not commonly a/w ventricular dysrhythmias
- The above patients BGM was around 30 could this be the cause of PVT?
- Attached is an article regarding hypoglycemia induced arrythmias! http://diabetes.diabetesjournals.org/content/63/5/1738
- Hypoglycemia? Can cause prolonged QT , but not commonly a/w ventricular dysrhythmias
- Initiates when PVC occurs during T wave= " R on T"
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- TRX:
- Unstable> Defib
- Stable>MAG!!!
- TV overdrive pacing at !100bpm
- Congenital long QT- use BB to shorten QT
- 2* bradycardia- Isoproterenol 2mcg/min
- TRX:
A few more Pearls courtesy of LITFL!
Sources: Uptodate, LITFL