Super helpful, thanks. At what point would you call Cards (if at all)? I feel like this is probably commonly managed in the ICU where VT seems to happen more frequently, but if on the floor, is it normal to just push the amio and start the bolus yourself as a hospitalist?
I’m a resident and usually start the bolus while getting in contact with cards if I am sure of what is going on. Sometimes the consultant doesn’t answer right away and you have to make a decision based on your judgement with the readily available info.
I had 2 minutes of VT during an episode of spontaneous pneumomediastinum. No cardiac history or family history whatsoever. Lifelong asthmatic. Didn't follow up with cardio after a week with holter. What caused it? Didn't even lose consciousness, just crazy pain. Never happened since. Was the air pushing on my heart the culprit?
@@Sixdays_aweek I should have. You're right. But the office didn't even call me about my mistakenly missed appointment nor to talk about results prior. I can't imagine the holter showed anything approaching arrhythmia if it was taken so lackadaisically
I have several problem in my heart • LVH (moderate) • non sustain vt • aterial fibrillation And the doctors have suspicious of amyloidosis My symptoms are : - palpitations - anxiety - chest pain - chocking - atrial fibrillation attack me each 10 or 15 days and it last 24 hours My medicine is - sotalol (1) year and my doctor change it to beta blockers, cardinor 200 The doctors suggested to me * Septal ablition * ICD I am 38 years old, living in Iraq ,
Actually it is also indicated for monomorphic VT. LVOT and RVOT cAMP mediated VTs will respond to adenosine. It’s actually in the ACLS algorithm for VT.
Hmm well as in the previous video I would definitely be trying to see if this is VT or SVT with aberrancy if the patient is stable, and I think looking at the baseline ECG is always a great idea. From what I understand though the biggest worry is giving any AV blockers in afib with WPW, which would present with irregular wide complex tachycardia. I would definitely avoid BBs in that situation. For regular WPW with a BBB I think you could still give a beta blocker? Might need someone to double check that
@@ConanLiuMD Thx for the prompt reply! Sry I guess what I meant was using the baseline ECG & Brugada criteria to see if this is true non-sustained VT or bouts of SVT w/ aberrancy (since you have the luxury of looking at the baseline more easily given that it's non-sustained, which would give you a better picture than using the criteria alone). But yeah I was thinking caution with beta blockers use in existing BBB or WPW w/ flutter/afib. And even rhythms like antidromic AVRT (which would present as SVT w/ aberrancy) you should be careful using beta blockers.
Amiodarone is no longer considered a viable treatment, especially in younger patient cohorts (ref. Dr. Roderick Tung). RF Ablation is the go to for long term control of sustained VT. Short term, a shock to get the patient out of the VT is best. Anti-Arrhythmics are not well tolerated and should be considered only as a secondary treatment option. WPW should be investigated on your initial baseline ECG.
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I’m a cards fellow, this is a nice overview. Good work
Just talking about VT gives me Anxiety
Would also add esmolol to your stable VT algorithm. Metoprolol IV push is also an option if esmolol is not readily available.
We have found IV push metoprolol to be very helpful for recurrent/refractory VT/VF.
Great explanation! 👍🏻😃
This was great
Super helpful, thanks. At what point would you call Cards (if at all)? I feel like this is probably commonly managed in the ICU where VT seems to happen more frequently, but if on the floor, is it normal to just push the amio and start the bolus yourself as a hospitalist?
I’m a resident and usually start the bolus while getting in contact with cards if I am sure of what is going on. Sometimes the consultant doesn’t answer right away and you have to make a decision based on your judgement with the readily available info.
I had 2 minutes of VT during an episode of spontaneous pneumomediastinum. No cardiac history or family history whatsoever. Lifelong asthmatic. Didn't follow up with cardio after a week with holter. What caused it? Didn't even lose consciousness, just crazy pain. Never happened since. Was the air pushing on my heart the culprit?
Should have followed up.
@@Sixdays_aweek I should have. You're right. But the office didn't even call me about my mistakenly missed appointment nor to talk about results prior. I can't imagine the holter showed anything approaching arrhythmia if it was taken so lackadaisically
I have several problem in my heart
• LVH (moderate)
• non sustain vt
• aterial fibrillation
And the doctors have suspicious of amyloidosis
My symptoms are :
- palpitations
- anxiety
- chest pain
- chocking
- atrial fibrillation attack me each 10 or 15 days and it last 24 hours
My medicine is
- sotalol (1) year and my doctor change it to beta blockers, cardinor 200
The doctors suggested to me
* Septal ablition
* ICD
I am 38 years old, living in Iraq ,
I'm curious as to why no mention of Adenosine as it is currently the firstline EMS choice for attempt at a quick conversion.
thats for supravent
Adenosine for VT is CONTRAINDICATED. YOU WILL KILL THE PATIENT 😮😢😮😢😮😢😮😢😮. DON’T DO THAT MATE
Adenosine may work if it starts in the upper chambers (atria). VT occurs in the lower chambers so different treatment.
Actually it is also indicated for monomorphic VT. LVOT and RVOT cAMP mediated VTs will respond to adenosine. It’s actually in the ACLS algorithm for VT.
Great video! I assume you would check for any existing BBB/WPW syndrome on the baseline ECG before giving beta blockers for NSVTs?
Hmm well as in the previous video I would definitely be trying to see if this is VT or SVT with aberrancy if the patient is stable, and I think looking at the baseline ECG is always a great idea. From what I understand though the biggest worry is giving any AV blockers in afib with WPW, which would present with irregular wide complex tachycardia. I would definitely avoid BBs in that situation. For regular WPW with a BBB I think you could still give a beta blocker? Might need someone to double check that
@@ConanLiuMD Thx for the prompt reply! Sry I guess what I meant was using the baseline ECG & Brugada criteria to see if this is true non-sustained VT or bouts of SVT w/ aberrancy (since you have the luxury of looking at the baseline more easily given that it's non-sustained, which would give you a better picture than using the criteria alone). But yeah I was thinking caution with beta blockers use in existing BBB or WPW w/ flutter/afib. And even rhythms like antidromic AVRT (which would present as SVT w/ aberrancy) you should be careful using beta blockers.
nodal blockers in wide vtach ? isnt it contraindicated ?
First line treatment for non sustained VT to reduce risk of having more VT
@@ConanLiuMD nonsustained meaning ?
@@zuhairyassin505 It does not last more than 30 seconds
Stellate ganglion block should also be considered for true refractory/incessant VT/VF.
Does the block cure it long-term?
I once did an interscalene block.
What are the “symptoms” of no sustained vtach?
Most commonly would be asymptomatic or perhaps sensation of palpitations!
What if you just went with a bolus push of Amio 300mg to see if it will just knock it out rather than 150mg gtt?
Why block calcium.
Slow the heart down basically
In functional medicine we use high dose magnesium for people who can't tolerate a CCB.
Hi
Amiodarone is no longer considered a viable treatment, especially in younger patient cohorts (ref. Dr. Roderick Tung). RF Ablation is the go to for long term control of sustained VT. Short term, a shock to get the patient out of the VT is best. Anti-Arrhythmics are not well tolerated and should be considered only as a secondary treatment option.
WPW should be investigated on your initial baseline ECG.