Nonsustained ventricular tachycardia - Revision history

ClaireLewis: /* Evaluation */

2019-09-25T15:56:52Z

Evaluation

← Older revision		Revision as of 15:56, 25 September 2019
Line 22:		Line 22:
	**History: including arrhythmogenic medications/substances, pertinent family history		**History: including arrhythmogenic medications/substances, pertinent family history
	**Physical examination		**Physical examination
	**[[ECG]]/CXR		**[[ECG]]/[[CXR]]
	**TTE		**[[Echocardiography\|TTE]]
	*In selected patients		*In selected patients
	**Exercise testing		**Exercise testing

Rossdonaldson1: /* Differential Diagnosis */

2019-04-05T07:08:56Z

Differential Diagnosis

← Older revision		Revision as of 07:08, 5 April 2019
Line 15:		Line 15:

	==Differential Diagnosis==		==Differential Diagnosis==
	{{~~ACLS Wide Regular~~ Tachycardia}}		{{Tachycardia (wide) DDX}}


	==Evaluation==		==Evaluation==

Rossdonaldson1 at 07:07, 5 April 2019

2019-04-05T07:07:52Z

@@ Line 15: / Line 15: @@
 ==Differential Diagnosis==
-Most important distinction is whether dysrhythmia is associated with underlying structural heart disease.
+{{ACLS Wide Regular Tachycardia}}
 ==Evaluation==
@@ Line 51: / Line 34: @@
 [[File:PMC2922873 ipej100357-01.png|thumb|Sinus rhythm with a five beat run of nonsustained ventricular tachycardia]]
 *Based on [[ECG]]
 ==Management==

Rossdonaldson1: /* Diagnosis */

2019-04-05T03:27:09Z

Diagnosis

← Older revision		Revision as of 03:27, 5 April 2019
Line 49:		Line 49:

	===Diagnosis===		===Diagnosis===
			[[File:PMC2922873 ipej100357-01.png\|thumb\|Sinus rhythm with a five beat run of nonsustained ventricular tachycardia]]
	*Based on [[ECG]]		*Based on [[ECG]]

Rossdonaldson1: /* Diagnosis */

2019-04-05T03:18:40Z

Diagnosis

← Older revision		Revision as of 03:18, 5 April 2019
Line 49:		Line 49:

	===Diagnosis===		===Diagnosis===
			*Based on [[ECG]]

	==Management==		==Management==

Rossdonaldson1: /* Evaluation */

2019-04-05T03:15:19Z

Evaluation

← Older revision		Revision as of 03:15, 5 April 2019
Line 36:		Line 36:

	==Evaluation==		==Evaluation==
	===~~In all patients:~~===		===Workup===
	*History: including arrhythmogenic medications/substances, pertinent family history		*All patients
	*Physical examination		**History: including arrhythmogenic medications/substances, pertinent family history
	*[[ECG]]/CXR		**Physical examination
	*TTE		**[[ECG]]/CXR
			**TTE
			*In selected patients
			**Exercise testing
			**Advanced imaging (CT/C-MR)
			**Electrophysiologic studies
			**Genetic testing

	===~~In selected patients:~~===		===Diagnosis===
	*Exercise testing
	*Advanced imaging (CT/C-MR)
	*Electrophysiologic studies
	*Genetic testing

	==Management==		==Management==

Rossdonaldson1: /* Management */

2019-04-05T03:13:59Z

Management

← Older revision		Revision as of 03:13, 5 April 2019
Line 49:		Line 49:

	==Management==		==Management==
	~~===Algorithm for the Evaluation and Management of NSVT===~~		[[File:Nonsustained Ventricular Tachycardia.png\|thumb\|Algorithm for the Evaluation and Management of NSVT<ref>Adapted from Katritis et al (2012)</ref>]]
	[[File:Nonsustained Ventricular Tachycardia.png\|thumb\|Adapted from Katritis et al (2012)]]

	===AHA Guidelines<ref>Zipes DP, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death--executive summary: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Eur Heart J. 2006;27(17):2099–2140. doi:10.1093/eurheartj/ehl199.</ref>===		===AHA Guidelines<ref>Zipes DP, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death--executive summary: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Eur Heart J. 2006;27(17):2099–2140. doi:10.1093/eurheartj/ehl199.</ref>===
	*Nonsustained Repetitive Monomorphic VT: amiodarone, beta-blockade (if tolerated), procainamide (IIA, C)		*Nonsustained Repetitive Monomorphic VT: amiodarone, beta-blockade (if tolerated), procainamide (IIA, C)

Rossdonaldson1: /* Management */

2019-04-05T03:13:10Z

Management

← Older revision		Revision as of 03:13, 5 April 2019
Line 50:		Line 50:
	==Management==		==Management==
	===Algorithm for the Evaluation and Management of NSVT===		===Algorithm for the Evaluation and Management of NSVT===
	[[File:Nonsustained Ventricular Tachycardia.png\|~~800px~~\|Adapted from Katritis et al (2012)]]		[[File:Nonsustained Ventricular Tachycardia.png\|thumb\|Adapted from Katritis et al (2012)]]

	===AHA Guidelines<ref>Zipes DP, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death--executive summary: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Eur Heart J. 2006;27(17):2099–2140. doi:10.1093/eurheartj/ehl199.</ref>===		===AHA Guidelines<ref>Zipes DP, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death--executive summary: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Eur Heart J. 2006;27(17):2099–2140. doi:10.1093/eurheartj/ehl199.</ref>===

SLuckettG: /* Disposition */

2019-03-10T19:38:07Z

Disposition

← Older revision		Revision as of 19:38, 10 March 2019
Line 71:		Line 71:

	==Disposition==		==Disposition==
	*High-risk patients ~~(age~~ > ~~45yo, symptomatic, or with known~~ structural heart disease) warrant immediate and appropriate evaluation, may need admission or observation for echo, stress testing, and/or other specialized testing (e.g. EPS, genetic testing in young symptomatic patients, or those with concerning family ~~histories).~~		*Admit:
			**High-risk patients
			***Age >45 years
			***Symptomatic
			***Known structural heart disease
			***Concerning family history

	==See Also==		==See Also==

ClaireLewis at 21:13, 31 August 2017

2017-08-31T21:13:50Z

← Older revision		Revision as of 21:13, 31 August 2017
Line 18:		Line 18:
	===NSVT in the absence of apparent structural heart disease===		===NSVT in the absence of apparent structural heart disease===
	*Idiopathic [[Ventricular Tachycardia]]: Ventricular outflow arrhythmias (RVOT > LVOT). Good prognosis, rarely associated with tachycardia-induced cardiomyopathy and sudden cardiac death (SCD).		*Idiopathic [[Ventricular Tachycardia]]: Ventricular outflow arrhythmias (RVOT > LVOT). Good prognosis, rarely associated with tachycardia-induced cardiomyopathy and sudden cardiac death (SCD).
	*Polymorphic ~~Ventricular Tachycardia~~: Inherited or acquired [[long QT syndrome]], familial catecholaminergic PMVT. Increased risk of ~~SCD~~, consideration for ICD if symptomatic (syncope, arrest) or asymptomatic QTc > 550ms.		*[[Polymorphic ventricular tachycardia]]: Inherited or acquired [[long QT syndrome]], familial catecholaminergic PMVT
			**Increased risk of sudden cardiac death, consideration for ICD if symptomatic (syncope, arrest) or asymptomatic QTc > 550ms.
	*Arrhythmogenic Right Ventricular Cardiomyopathy: Fibro-fatty deposition in RVIT/RVOT/RV apex. Increased risk of SCD, consideration for catheter ablation with ICD backup.		*Arrhythmogenic Right Ventricular Cardiomyopathy: Fibro-fatty deposition in RVIT/RVOT/RV apex. Increased risk of SCD, consideration for catheter ablation with ICD backup.

	===NSVT with apparent structural heart disease===		===NSVT with apparent structural heart disease===
	*Hypertension and LVH: ~~Occurrence of NSVT~~ warrants evaluation for ischemic heart disease, aggressive medical management of hypertension (including beta-blockade). Prognosis unclear.		*Hypertension and LVH: warrants evaluation for ischemic heart disease, aggressive medical management of hypertension (including beta-blockade). Prognosis unclear.
	*[[Valvular disease]]: Highest incidence in AS and MR. No evidence that occurrence of NSVT associated with SCD.		*[[Valvular disease]]: Highest incidence in AS and MR. No evidence that occurrence of NSVT associated with SCD.
	*Ischemic heart disease: Monomorphic NSVT around myocardial scars, active ischemia associated with both mono/polymorphic VT and VF. In ED, early NSVT (<24h) after NSTEMI/STEMI common and not associated with adverse outcomes.		*Ischemic heart disease: Monomorphic NSVT around myocardial scars, active ischemia associated with both mono/polymorphic VT and VF. In ED, early NSVT (<24h) after NSTEMI/STEMI common and not associated with adverse outcomes.
	*Hypertrophic cardiomyopathy~~: Genetic myocardial disease,~~ myocyte disarray produces arrhythmogenic substrate. NSVT associated with increased risk of SCD.		*[[Hypertrophic cardiomyopathy]]; myocyte disarray produces arrhythmogenic substrate. NSVT associated with increased risk of SCD.
	*Other conditions:		*Other conditions:
	**Non-ischemic dilated cardiomyopathy		**Non-ischemic dilated cardiomyopathy
	**Giant-cell myocarditis		**Giant-cell [[myocarditis]]
	**Repaired TOF		**Repaired [[TOF]]
	**Amyloidosis		**[[Amyloidosis]]
	**Sarcoidosis		**[[Sarcoidosis]]
	**[[Chagas]] cardiomyopathy		**[[Chagas]] cardiomyopathy

Line 57:		Line 58:

	===Symptomatic Patients<ref>Gupta AK. Wide QRS Complex Tachycardias. Med Clin North Am. 2001 Mar; 85(2): 245-66.</ref>===		===Symptomatic Patients<ref>Gupta AK. Wide QRS Complex Tachycardias. Med Clin North Am. 2001 Mar; 85(2): 245-66.</ref>===
	*Beta blockers ~~are initial~~ therapy. May benefit patients with coexisiting cardiac conditions (CAD, CHF)		*[[Beta blockers]]
	*Verapamil ~~and~~ diltiazem ~~are second~~ line therapies. Do not use in patients with uncontrolled heart failure.		**Initial therapy
			**May benefit patients with coexisiting cardiac conditions (CAD, CHF)
			*[[Verapamil]], [[diltiazem]]
			**Second line therapies
			**Do not use in patients with uncontrolled heart failure.
	*Antiarrhythmic medications are generally reserved for patients that have failed beta blocker or calcium channel blocking who are NOT candidates for ablation procedures. Expert consultation is advised.		*Antiarrhythmic medications are generally reserved for patients that have failed beta blocker or calcium channel blocking who are NOT candidates for ablation procedures. Expert consultation is advised.

Line 66:		Line 71:

	==Disposition==		==Disposition==
	High-risk patients (age > 45yo, symptomatic, or with known structural heart disease) warrant immediate and appropriate evaluation~~. This includes echocardiography to identify underlying structural heart disease~~, ~~exercise~~ testing ~~to evaluate whether NSVT represents underlying ischemic heart disease~~, and specialized testing ~~in selected patients~~ (ex. EPS, genetic testing in young symptomatic patients, or those with concerning family histories).		*High-risk patients (age > 45yo, symptomatic, or with known structural heart disease) warrant immediate and appropriate evaluation, may need admission or observation for echo, stress testing, and/or other specialized testing (e.g. EPS, genetic testing in young symptomatic patients, or those with concerning family histories).

	==See Also==		==See Also==