#nonsustained VTach

[mcatmemoranda]

Management on Non-Sustained Ventricular Tachycardia:

Definition – The most common definition is three or more consecutive ventricular beats, a heart rate of greater than 100 beats per minute, and a duration of arrhythmia of less than 30 seconds.

●Symptoms – Patients with nonsustained ventricular tachycardia (NSVT) are usually asymptomatic, although some patients may notice symptoms associated with episodes of NSVT. Symptoms may include palpitations, chest pain, shortness of breath, syncope, or presyncope. Symptoms may vary depending upon the rate and duration of the NSVT along with the presence or absence of significant comorbid conditions.

●Physical examination – By definition, the pulse rate is greater than 100 beats per minute.

Few physical examination findings are unique and specific for NSVT.

If the physical examination coincides with an episode of NSVT, this can reveal evidence of atrioventricular (AV) dissociation, including marked fluctuations in blood pressure, variability in the occurrence and intensity of heart sounds (especially S1), and cannon A waves.

●Evaluation – All patients with suspected NSVT should have a 12-lead electrocardiogram (ECG), although NSVT is frequently identified on continuous telemetry monitoring, in which case only one or two leads may be available for review.

•Reversible causes – Once identified, reversible causes of NSVT should be sought, including electrolyte imbalances, myocardial ischemia, hypoxia, adverse drug effects, anemia, hypotension, and heart failure.

•Single asymptomatic episode – Often, for these patients, no further investigation is required.

•Multiple or symptomatic episodes – For patients with multiple episodes or with symptoms felt to be related to NSVT, a thorough diagnostic evaluation to exclude structural heart disease is warranted, including cardiac imaging and ambulatory ECG monitoring for most patients and invasive electrophysiology studies (EPS) only on rare occasions.

●Treatment

•Asymptomatic patients – In general, asymptomatic patients do not require any specific therapy directed toward the NSVT.

However, some asymptomatic patients with NSVT who are found to have infarct-related cardiomyopathy with significantly reduced left ventricular systolic function may be evaluated for implantable cardioverter-defibrillator placement for primary prevention of sudden cardiac death related to sustained ventricular tachyarrhythmias.

•Symptomatic patients

-Initial therapy – For the initial treatment of patients with symptomatic NSVT, we suggest beta blockers rather than calcium channel blockers or antiarrhythmic medications (Grade 2C).

For patients with NSVT who remain symptomatic in spite of beta blockers, or who are unable to tolerate beta blockers due to side effects, we suggest adding a nondihydropyridine calcium channel blocker (ie, verapamil or diltiazem) rather than an antiarrhythmic medication (Grade 2C).

-Alternative therapy – For some patients who have frequent, highly symptomatic NSVT not adequately suppressed by beta blockers or calcium channel blockers, the addition of antiarrhythmic medications (table 1) may be helpful. We suggest amiodarone as the initial choice, rather than other antiarrhythmic drugs, based on its efficacy (Grade 2C).

In patients with very frequent symptomatic monomorphic NSVT not controlled by medications or who are unable or unwilling to take medications, catheter ablation can be effective for reducing or eliminating NSVT and associated symptoms.

#tachycardia #NSVT #nonsustained VTach

[doctorfoxtor]

my brain is just white noise these days

100 days of productivity

day 25 + 26

(because I'm a doumbeassé who forgot to post yesterday's post)

CVS/RS

HTN therapy should be started latest within 2 weeks of hospital discharge

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ID/Immuno

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Genetics/Misc

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#100 days of productivity #studying #studyblr #med school #medblr #mine #long post