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Under current resuscitation guidelines symptomatic ventricular tachycardia (VT) with a palpable pulse is treated with synchronised cardioversion to avoid inducing ventricular fibrillation (VF), whilst pulseless VT is treated as VF with rapid administration of full defibrillation energy unsynchronised shocks.
Apply defibrillator pads (or paddles) and shock the patient with 120-200 Joules on a biphasic defibrillator or 360 Joules using a monophasic.
Sustained ventricular tachycardia often requires urgent medical treatment, as this condition may sometimes lead to sudden cardiac death. Treatment involves restoring a normal heart rate by delivering a jolt of electricity to the heart. This may be done using a defibrillator or with a treatment called cardioversion.
Pulseless electrical activity and asystole or flatlining (3 and 4), in contrast, are non-shockable, so they don’t respond to defibrillation. These rhythms indicate that the heart muscle itself is dysfunctional; it has stopped listening to the orders to contract.
Cardioversion of ventricular tachycardia (VT, vtach) involves shocks of 50-100 joules initially, and then 200 joules if unsuccessful. Either external paddles or stick-on electrode pads may be used to deliver the electric shocks.
Shockable Rhythm: Pulseless V-tach V-tach is a poorly perfusing rhythm and patients may present with or without a pulse. Most patients with this rhythm are pulseless and unconscious and defibrillation is necessary to reset the heart so that the primary pacemaker (usually the SA node) can take over.
Amiodarone is a potent antiarrhythmic agent that is used to treat ventricular arrhythmias and atrial fibrillation. The drug prevents the recurrence of life-threatening ventricular arrhythmias and produces a modest reduction of sudden deaths in high-risk patients.
Ventricular tachycardia may last for only a few seconds, or it can last for much longer. You may feel dizzy or short of breath, or have chest pain. Sometimes, ventricular tachycardia can cause your heart to stop (sudden cardiac arrest), which is a life-threatening medical emergency.
Ventricular tachycardia (VT or V-tach) is a type of abnormal heart rhythm, or arrhythmia. It occurs when the lower chamber of the heart beats too fast to pump well and the body doesn’t receive enough oxygenated blood.
Asystole is a non-shockable rhythm. Therefore, if asystole is noted on the cardiac monitor, no attempt at defibrillation should be made. High-quality CPR should be continued with minimal (less than five seconds) interruption.
Atropine is inexpensive, easy to administer, and has few side effects and therefore can be considered for asystole or PEA. The recommended dose of atropine for cardiac arrest is 1 mg IV, which can be repeated every 3 to 5 minutes (maximum total of 3 doses or 3 mg) if asystole persists (Class Indeterminate).
Asystole is treated by cardiopulmonary resuscitation (CPR) combined with an intravenous vasopressor such as epinephrine (a.k.a. adrenaline). Sometimes an underlying reversible cause can be detected and treated (the so-called “Hs and Ts”, an example of which is hypokalaemia).
Medical treatment of pulseless VT usually is carried out along with defibrillation and includes intravenous vasopressors and antiarrhythmic drugs. 1 mg of epinephrine IV should be given every 3 to 5 minutes. Epinephrine can be replaced by vasopressin given 40 units IV once.
Currently, the ACLS protocol for v fib and pulseless v tach recommends that epinephrine be given after the second defibrillation. Many hospitals and EMS systems, however, have been giving it earlier.
Five cases of amiodarone-induced polymorphous ventricular tachycardia (torsade de pointes) are presented. All patients had recurrent syncope or dizziness due to polymorphous ventricular tachycardia and in all cases the QT interval was prolonged.
Amiodarone has been shown to be effective for both the termination of ongoing ventricular arrhythmia, as well as for the prevention of recurrence of ventricular tachycardia/ventricular fibrillation (VT/VF) during electrical storm or after the arrhythmia has subsided.
After intravenous administration, amiodarone acts to relax smooth muscles that line vascular walls, decreases peripheral vascular resistance (afterload), and increases the cardiac index by a small amount. Administration by this route also decreases cardiac conduction, preventing and treating arrhythmias.
Furthermore, beta-blockers have been advocated for use in patients with ventricular fibrillation (VF) and ventricular tachycardia (VT), in whom these agents appear to reduce the incidence of recurrent ventricular tachyarrhythmias 6, 7.
Ventricular tachycardia (VT) is a fast, abnormal heart rate. It starts in your heart’s lower chambers, called the ventricles. VT is defined as 3 or more heartbeats in a row, at a rate of more than 100 beats a minute. If VT lasts for more than a few seconds at a time, it can become life-threatening.
Emotional stressors can lead to ventricular ectopic beats and ventricular tachycardia. Though disturbances of cardiac rhythm due to emotional stress are often transient, sometimes the consequences can be seriously damaging and even fatal .
Ventricular tachycardia (v-tach) typically responds well to defibrillation. This rhythm usually appears on the monitor as a wide, regular, and very rapid rhythm.
Complications of tachycardia depend on the type of tachycardia, how fast the heart is beating, how long the rapid heart rate lasts and if you have any other heart conditions. Possible complications include: Blood clots that can cause a stroke or heart attack.
Vfib is rapid totally incoordinate contraction of ventricular fibers; the EKG shows chaotic electrical activity and clinically the patient has no pulse. Vtach is defined by QRS greater than or equal to . 12 secs and a rate of greater than or equal to 100 beats per minute.
Cardioversion can correct a heartbeat that’s too fast (tachycardia) or irregular (fibrillation). Cardioversion is usually done to treat people who have atrial fibrillation or atrial flutter.
Shockable rhythms include pulseless ventricular tachycardia or ventricular fibrillation. Nonshockable rhythms include pulseless electrical activity or asystole.
The Advanced Life Support guidelines do not recommend defibrillation in asystole. They consider shocks to confer no benefit, and go further claiming that they can cause cardiac damage; something not really founder in the evidence.
For symptomatic high-degree (second-degree or third-degree) AV block, begin pacing without delay. 5. Atropine should be administered by rapid IV push and may be repeated every 3-5 minutes, to a maximum dose of 3 mg. Atropine is ineffective and should be avoided in heart transplant patients.
Standard drug therapy for asystole during cardiac arrest includes epinephrine, atropine, and calcium chloride (CaCl). Recent studies have shown that ventricular fibrillation (VF) can appear to be asystole when recorded from the chest surface.
When treating asystole, epinephrine can be given as soon as possible but its administration should not delay initiation or continuation of CPR. After the initial dose, epinephrine is given every 3-5 minutes.
Ventricular standstill (also called ventricular asystole) is a potentially lethal arrhythmia if not treated promptly. It occurs when there is cessation of supraventricular impulse formation or blockage in the transmission of these impulses from the atria to the ventricles resulting in asystolic cardiac arrest.