| ECG-QT interval
| Brugada Syndrome
| Long QT syndrome (LQTS) Acquired
| Long QT syndrome (LQTS) Congenital
| Torsades de Pointes
| Wolff-Parkinson White syndrome (WPW)
| Supraventricular Tachycardia (SVT)
| Atrial Flutter
| Atrial Fibrillation
| Ventricular Tachycardia
| Ventricular Fibrillation
| Resuscitation - Adult Tachycardia Algorithm
| Resuscitation - Advanced Life Support
Ventricular fibrillation is a shockable rhythm seen n cardiac arrest and requires electrical countershock within three minutes to change this life-threatening rhythm to normal heartbeats
- Causes Cardiac Arrest and Death if untreated
- Seen in 75% of cardiac arrests
- First described in Ebers Papyrus
- Increased automaticity and reentrant pathways
- Loss of ventricular systole
- Cardiac output drops and death ensues
- May follow VT
- IHD/Acute coronary syndrome
- Electrocution, Drug toxicity e.g. TCA overdose
- Electrolyte abnormalities
- Long QT syndromes
- Brugada syndrome
- Valvular heart disease e.g severe aortic stenosis
- Idiopathic ventricular tachycardia
- Dilated, hypertrophic
right ventricular dysplasia [ARVD]
- Post cardiac surgery
- Wolff Parkinson White syndrome
- Severe electrolyte disturbance
- Sudden loss of responsiveness
- Absence of normal breathing
- Absence of a palpable pulse
- Asystole - Get ECG monitoring
- Coma - pulse and breathing should be present
- Agonal rhythm
- Bradycardia/Complete heart block - pace !
- FBC, U&E, ABG, Troponin
- Coronary angiography +/- PCI
- 12 lead and ECG monitoring
- Cardiac MRI
- CPR: to support circulation - see ACLS
- Defibrillation: quicker the better. See ACLS
- Antiarrhythmics: See ACLS
- Treat cause e.g. electrolytes, drug toxicity, STEMI (PCI/Thrombolysis)
- Acute Management: Resuscitation - Advanced Life Support
- Treat potential underlying causes. VF in the first 24 hrs of MI is usually a good prognosis depending on LV function. Late VF has a worse prognosis and needs consideration for ICD.
- Implantable defibrillator (ICD) in subgroup with high risk of recurrence.
- Indications for ICD
- Patients with left ventricular dysfunction due to prior myocardial infarction who are at least 40 days post-MI with LVEF <30-40%, are NYHA class II or III and are receiving chronic optimal medical therapy and with life expectancy > 1 year. IA
LV dysfunction due to prior MI, presenting with hemodynamically unstable sustained VT.
- Patients with non-ischemic dilated cardiomyopathy (NI DCM) with LV dysfunction who have sustained VT or VF.
- INI DCM LVEF<30-35%. NYHA II-III. Chronic medical therapy. Life expectancy > 1 year.
- Hypertrophic cardiomyopathy with sustained VT or VF.
- Arrhythmogenic right ventricular cardiomyopathy with documented sustained VT or VF. OMT, LE>1y.
- Sustained VT, hemodynamically unstable VT, VT with syncope, or VF. LVEF< 40%.
- LQTS with previous cardiac arrest
- Brugada syndrome with previous cardiac arrest.
- CPVT with previous cardiac arrest.
- An ICD is recommended in a patient with heart failure with a ventricular arrhythmia causing haemodynamic instability. LE>1y.