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Ventricular Tachycardia

• Differentials:
  1. Hypoxemia: try supplemental oxygen
  2. Electrolytes and acid-base: check blood panel
     • Hypokalemia, hypomagnesemia, hypocalcemia, hypercalcemia
  3. Sympathetic stimulation: pain, drugs, etc.
  4. Drugs: procainamide, sotalol, cisapride, chlorpromazine, erythromycin, and others can be proarrhythmic
• Treatment criteria:
  1. Poor perfusion parameters
  2. HR > 180-200 bpm
  3. R on T: next complex fires before the previous complex complete.
  4. Polymorphic: ventricular complexes look different = multiple areas of angry heart
  5. NOTE: Distinguish from accelerated idioventricular rhythm (AIVR)
     • HR < 180 bpm
     • Does NOT require treatment (self-limiting)
     • Common with GDV, trauma, pancreatitis, IMHA, and splenectomies
• Treatment options:
  1. Lidocaine
  2. Magnesium
  3. Procainamide
  4. Sotalol
  5. Mexiletine
  6. Esmolol
  7. Amiodarone