Updated: 6/27/2021

Ventricular Arrhythmia

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
5
0
0
0%
0%
Evidence
3
0
0
Topic
 
Snapshot
  • A 57-year-old man presents to the emergency department after fainting. He was accompanied by his wife who witnessed the event. Prior to the event, he experienced lightheadedness and palpitations. When he fainted, cardiopulmonary resuscitation was performed. Defibrillator pads were placed on the patient, which demonstrates pulseless ventricular tachycardia. He is defibrillated with 200 Joules (biphasic.)
Introduction
  • A group of ventricular arrhythmias that include
    • ventricular premature beats (premature ventricular contractions)
      • action potentials are ectopically generated within the ventricles
      • typically benign and asymptomatic but can signify underlying pathology
        • ischemia
        • electrolyte derangements (most commonly Mg2+ and K+) 
    • ventricular tachycardia
      • if sustained ventricular tachycardia is not managed, it can result in ventricular fibrillation
      • can occur secondary to blunt chest trauma
        • consider commotio cordis (blunt trauma during ventricular repolarization) with focal trauma to the chest over the heart followed by ventricular tachycardia 
    • ventricular fibrillation
      • life-threatening, if not immediately managed 
      • most common cause of cardiac arrest after a STEMI
  • Epidemiology
    • risk factors
      • myocardial ischemia and infarction
      • ventricular hypertrophy
      • long QT syndromes
      • valvular heart disease
      • congenital cardiac abnormalities
      • short QT syndrome 
  • Symptoms
    • palpitations
    • symptoms of heart failure, which include
      • shortness of breath
      • chest discomfort
      • syncope
    • cardiac arrest

Ventricular Arrhythmias
Type
Electrocardiogram Findings
Treatment
Ventricular premature beats (VPBs)
  • Widened QRS complex with abnormal morphology 
  • Typically with reassurance or a β-blocker in healthy patients
Ventricular tachycardia
  • 3 or more consecutive VPBs, displaying a broad QRS complex tachyarrhythmia
  • Stable 
    • amiodarone  
    • lidocaine
    • procainamide
  • Unstable
    • synchronized cardioversion
  • Pulseless ventricular tachycardia
    • defibrillation
Ventricular fibrillation
  • Erratic rhythm with no discernable waves (P, QRS, or T waves)
  • Defibrillation for all patients  
 

Please rate topic.

Average 4.6 of 9 Ratings

Questions (5)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(M2.CV.15.114) A 75-year-old man presents to the emergency department with a sensation of a flutter in his chest. He has a past medical history of diabetes and hypertension but is generally not compliant with his medications. His temperature is 98.0°F (36.7°C), blood pressure is 122/78 mm Hg, pulse is 130/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for an obese man who is not confused, moving all extremities spontaneously, and has a rapid heart rate. An ECG is obtained as seen in Figure A. The patient is asked to bear down while he is laid flat and his legs are elevated resulting in no change in his symptoms or rhythm strip. Which of the following is the best next step in management?

QID: 104120
FIGURES:
1

Adenosine

0%

(0/4)

2

Amiodarone

75%

(3/4)

3

Aspirin and cardiac catheterization

0%

(0/4)

4

Cardioversion

25%

(1/4)

5

Defibrillation

0%

(0/4)

M 7 E

Select Answer to see Preferred Response

Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Evidence (3)
EXPERT COMMENTS (4)
Private Note