Torsades is what we most commonly think of when we hear polymorphic VTach, however, the most common cause is cardiac ischemia. This results in QRS complexes of varying size (amplitude), axis, and width of QRS complex (see example of Torsades below). Polymorphic VTach is a type of VTach where there are multiple foci present in the ventricle conducting depolarization. Polymorphic Ventricular Tachycardia (VTach) LITFL: Monomorphic VTach with Positive Precordial Leads acute ischemia, old ischemic scarring, cardiomyopathy, electrolyte abnormalities, etc.) Causes can broadly be worked up using H+Ts but more often VTach is caused by cardiac injury (e.g. antiarrhythmic drugs as well as treatment of underlying cause. Management depends on stabilization with electricity vs. VTach is often easy to recognize, however, a few notable characteristics on EKG include a broad QRS complex (often >160) with positive precordial QRS complexes (seen below). I’m sure we can all remember our sign-outs from the ICU of patients who had “few runs of non-sustained VTach.” This is defined as 3 beats or more of VTach lasting 30 seconds or VTach requiring intervention due to hemodynamic compromise. Monomorphic VTach is the most common type of VTach, and is often divided into non-sustained and sustained VTach. Monomorphic Ventricular Tachycardia (VTach) This group includes Na Channel blocker toxicity, hyperkalemia, and severe acidosis. It’s also important to note that these syndromes can also present with HRs in the normal range depending on other factors. This group often presents as a regular wide complex tachycardia but can also present as an irregular wide complex tachycardia. There is also a group of wide complex tachycardias caused by toxic metabolic syndromes that is discussed last in this post. Afib with RVR, AFlutter with variable block, etc.) In much the same way, an irregular wide complex tachycardia is almost always from a patient who has a baseline EKG with a wide QRS complex who then develops an irregular tachycardia (e.g. SVT, sinus tachycardia, etc.), this will be seen as a wide complex tachycardia. If the patient then develops tachycardia in the background of this BBB (e.g. If an old EKG is available, the baseline wide QRS will be present. Aberrancy implies the patient has an EKG with baseline wide QRS (from a bundle branch block (BBB)). This group also includes antidromic AVRT and regular tachycardias with aberrancy. Regular wide complex tachycardia is most common and often represents VTach. The differential for wide complex tachycardia can be broken down into the below groups: regular and irregular wide complex tachycardias as well as toxic-metabolic syndromes. It is also important to note that in any unstable patient with a wide complex tachycardia (or narrow complex tachycardia) that electricity is always safe. While this is true as do not want to miss any potentially lethal arrhythmia, it is also important to understand the differential for wide complex tachycardias so that we can tailor our potential treatments to the specific arrhythmia.
There’s an old adage that wide complex tachycardia is VTach until proven otherwise.
0 kommentar(er)
