Torsades and other polymorphic VT are advanced rhythms which require additional expertise and expert consultation is advised. Unstable polymorphic ventricular tachycardia is treated with unsynchronized shocks defibrillation. Defibrillation is used because synchronization is not possible.
These wide complex tachycardias tend to originate in the ventricles rather than like a normal rhythm which originates in the atria. Q : What are the doses for synchronized cardioversion? All of this information is covered on the tachycardia algorithm page. Q : Is it necessary to memorize the doses listed above? A : It is necessary to understand the concepts and be familiar with the shock dosages.
The repetition that is built into the website is designed to help you become very familiar with all of the concepts and use them in emergencies. Q : What sort of a pulse would you be feeling with a polymorphic VT? A : You may feel a weak pulse or a strong pulse depending on how long the polymorphic VT has been going on.
One thing is for sure…. Register for Full Access. Learn more about the course…. Im not sure if this is right but i heard polymorphic VT is essentially VFIB and thought if you had that rhythm you are always on the cardiac arrest algorithm. Immediately after the shock, you would continue with CPR. After a round of CPR you would do a rhythm check and follow the appropriate algorithm depending on what the rhythm is. It is very unlikely that polymorphic VT will be stable for a long period of time.
In the case that it is, both magnesium and amiodarone would be appropriate antiarrhythmics to administer. Both can be given. You sure about that? Amiodarone prolongs the QT interval, the kiss of death in torsades. I would have somebody start a slow push of 2G mag while I charge the defibrillator….
With the presence of torsades, lidocaine would definitely be a better option. Thank you for pointing that out. Kind regards, Jeff. Sustained VT is any ventricular tachycardia that lasts for more than 30 seconds or is symptomatic. Non-sustained VT lasts for less than 30 seconds and is asymptomatic.
Ventricular tachycardia should be described by type monomorphic or polymorphic , duration sustained or non-sustained and heart rate — i. Electrophysiologists may also describe the location within the ventricles from where the VT is originating.
This can be determined by the morphology of the QRS complex. For example, VT that has a LBBB morphology must come somewhere from the right ventricle; this is because the electrical potential takes a long time to reach the left ventricle, similar to what occurs with a simple LBBB.
Polymorphic VT is best treated with intravenous magnesium. Patients with a prolonged QT interval have a higher risk for developing polymorphic VT. Removing offending drugs that prolong the QT interval and correcting potassium or calcium imbalances is crucial. Here is an example of polymorphic VT:.
Enlarge Ventricular tachycardia can be difficult to distinguish from supraventricular tachycardia , or SVT, with aberrancy. The Brugada Criteria are most commonly used to differentiate between these two entities — a clinically important distinction. The abnormal ventricular impulse then conducts retrograde backward across the atrioventricular node, colliding with the sinus impulse.
A capture beat is similar to a fusion beat, except the QRS morphology looks completely like the normal QRS complex, as the sinus node impulse conducts to the ventricles before the retrograde ventricular activation occurs. If the answer is yes, then VT is the diagnosis. The objective of this study was to assess the capability of wavelet transform WT analysis to differentiate between monomorphic MVTs and polymorphic ventricular tachycardias PVTs in a canine model and to relate these results to epicardial isochronal maps on a beat-by-beat basis.
Unipolar electrograms were simultaneously recorded from the surface of both ventricles with a lead sock electrode array in 24 open-chest anesthetized dogs. The sampling frequency was Hz. Atrioventricular block was induced by formaldehyde injection into the atrioventricular node.
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