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% )

Regular WQRS tachycardia

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

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