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Pathology
Broad complex tachycardias are VT until proven otherwise.
Non-sustained VT is defined as 3 continuous ventricular ectopics for <30seconds
Aetiology
Most cases due to damage to the myocardium and structural heart disease e.g. MI
Other causes of VT include:
Inherited channelopathies e.g. Brugada syndrome,
Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)
Long QT syndrome
Signs
Hypotension, tachypnoea, pallor, raised JVP, Cannon ‘a’ waves
Symptoms
Pre-syncope, syncope, SOB, chest pain, palpitations
Investigations
ECG: Monomorphic VT – Regular, Broad complex, AV dissociation, concordance
across chest leads, capture or fusion beats
Echo: To assess for structural abnormality
Diagnostic coronary angiography +/- PCI
Cardiac MRI: Useful when the cause is unclear
Treatment
Acute: Pulseless VT is a cardiac arrest and should be treated with ALS guidelines
Chronic: Amiodarone, beta-blockers or mexiletine ICD implantation
Prognosis
Death, syncope injuries, medication side effects, inappropriate ICD shocks
Prognosis without treatment is poor.
Treatment with ICD improves prognosis but mortality rate still increased
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