QuestionSBA
QuestionChoice
Although this patient does have signs of heart failure (an "adverse feature"), this is chronic and long standing and doesn't appear to be secondary to her arrhythmia. Therefore, cardioversion is not indicated in this instance
31769
b
Direct current (DC) cardioversion: one shock only
QuestionChoice
Flecainide can be used to treat VT, but is not as effective as amiodarone
31771
d
Flecainide
QuestionChoice
Her heart failure is chronic and not secondary to her arrhythmia so this is not an indication for cardioversion. She has no other indications for cardioversion such as shock, syncope or myocardial ischaemia. If she did have any of these symptoms then up to 3 synchronised DC shocks can be given in attempt to cardiovert
31770
c
Direct current (DC) cardioversion: up to 3 shocks
QuestionChoice
According to NICE guidelines, amiodarone is the preferred drug to manage VT
31768
a
Amiodarone
QuestionChoice
IV furosemide would not treat this patient's ventricular tachycardia
31772
e
Bolus of IV furosemide
QuestionComment
The question does not clarify whether the VT is mono- or polymorphic. Although IV mag sulph isn't an answer, it does make the question more confusing
24806
QuestionComment
don't introduce what ifs. If the VT was polymorphic they would have to say so. 
42879
User
subscriber
Ale
User
subscriber
Supine Body
QuestionComment
She has  acute exacerbation of heart failure does this not mean DC cardioversion?
25055
QuestionComment
however she is haemodynamically stable

25551
User
subscriber
Kawasaki Gland
QuestionComment
no because heat failure is a long standing problem that is not caused by the arrhythmia 
42878
User
subscriber
Ale
User
subscriber
Abscess Sclerosis
QuestionComment
How do we know this is Broad Complex? 
25390
QuestionComment
VT is broad complex
25919
User
subscriber
Acute Body
User
subscriber
Embolism Hypertension
Concept
Chapter
# Summary 

Ventricular Tachycardia (VT) is a regular broad complex tachycardia that originates from the ventricles of the heart. The patient may have a pulse or not - if VT is pulseless it is one of the shockable cardiac arrest rhythms. Emergency management involves identification of VT on an ECG or heart monitor, then treating patients with a pulse and no adverse features with IV amiodarone. Patients who do not respond to this or have adverse features should be treated with synchronised DC cardioversion. Patients in cardiac arrest with VT should be treated as per the Advanced Life Support (ALS) algorithm with cardiopulmonary resuscitation (CPR), adrenaline and amiodarone as well as unsynchronised shocks. 

# Definition
 
Ventricular Tachycardia (VT) is a type of broad complex tachycardia characterised by a heart rate of more than 100 bpm and a QRS width of more than 120ms. Other types of broad complex tachycardias include Torsades de Pointes (which is a type of ventricular tachycardia described as polymorphic, where there are multiple ventricular foci) and Supraventricular Tachycardia with aberrant conduction.
 
[lightgallery]
 

# Aetiology
 
Factors that increase the risk of VT include:
 
- Electrolyte abnormalities such as hypokalaemia and hypomagnesaemia
- Structural heart disease including previous myocardial infarction and cardiomyopathies
- Drugs that cause QT prolongation e.g. clarithromycin, erythromycin (for Torsades de Pointes) 
- Inherited channelopathies e.g. Romano-Ward syndrome (for Torsades de Pointes)

# Management
 
**Pulseless VT:**

Pulseless VT is one of the four cardiac arrest rhythms, as so is managed as per Advanced Life Support guidelines:

- CPR will be in progress
- 120-360 J unsynchronised shock should be administered as early as possible, then every 2 minutes
- IV adrenaline (1mg of 10ml 1:10,000 solution) and IV amiodarone (300mg) should be administered after delivery of the 3rd shock
- Adrenaline should be administered every 3-5 minutes thereafter
- A further dose of amiodarone 150 mg IV should be given after 5 shocks

**Pulsed VT with adverse features:**

If a patient has a pulse, management is determined by whether they have any of the following adverse features:

 - Heart failure
 - Myocardial ischaemia (chest pain)
 - Shock
 - Syncope

If one or more of these are present, attempt to cardiovert the patient using synchronised DC shocks (up to 3 attempts). If the patient is conscious this will require sedation or anaesthesia.

If this is not effective, an amiodarone infusion would be the next step under expert guidance (300mg IV over 10-20 minutes followed by 900mg infusion over 24 hours).

**Pulsed VT with no adverse features:**

First line treatment is amiodarone 300mg IV over 10-60 minutes.

If this is ineffective then attempt to cardiovert using synchronised DC shocks (up to 3 attempts) with sedation or anaesthesia.

**Torsades de Pointes:**

This is a special situation which is managed differently to monomorphic VT - Torsades de Pointes often self-terminates but the risk is that it deteriorates into ventricular fibrillation (causing cardiac arrest).

IV Magnesium is the mainstay of treatment, along with treatment of any underlying cause identified (e.g. correcting electrolyte imbalance, stopping QT-prolonging medications).

# References
 
[Resuscitation Council UK - Adult advanced life support Guidelines](https://www.resus.org.uk/library/2021-resuscitation-guidelines/adult-advanced-life-support-guidelines)

[Resuscitation Council UK - Adult Tachycardia Algorithm](https://www.resus.org.uk/sites/default/files/2021-04/Tachycardia%20Algorithm%202021.pdf)

[Patient UK - Torsades de Pointes](https://patient.info/doctor/torsades-de-pointes)
669
Picture
Ventricular tachycardia seen on an ECG.
714
VT.png
images/fua0u2q41665036171705.jpg
images/fua0u2q41665036171705_256.jpg
images/fua0u2q41665036171705_512.jpg
NQgCBICvh4eJiHiGh3YAAAAAAA==
694
Emergency Management of Ventricular Tachycardia
Topic
39
Emergency Medicine
Video
Concept
694
Emergency Management of Ventricular Tachycardia
610
8JoZgLE
images/videos/cardiology.png
Quesmed Tutorial: Arrhythmias
6354
Amiodarone is the first-line treatment for stable ventricular tachycardia in patients with heart failure.
A medical emergency call is put out for a 70-year-old female patient on a medical ward. Ventricular tachycardia (VT) is present on her ECG. She is haemodynamically stable. On examination, she is well perfused, has a GCS of 15, and has pitting oedema to her knees bilaterally.

She was admitted to hospital three days prior for an exacerbation of heart failure and was being treated with intravenous furosemide.

Which of the following treatments is most appropriate to manage VT in this patient?
a