[Cheryl ~ STH]

I got a question: I have a 60 yr. with a history of severe COPD and CHF and has repeated runs of V-Tach. Mg and Kcl replacement given. Would you give Amiodarone or Lidocaine? any suggestions?

[NurseGirlKaren]

Amiodarone until you can get him an ICD! Is his CHF to the point that a biventricular ICD would benefit him?

[Cheryl ~ STH]

This patient also has a positive anteriogram. would Amiodarone still be the drug of choice?

[CCURN]

Would probably use Amiodarone per ACLS if the VTach was symptomatic and life threatening. However might try Lido first, as amio takes a minute to prepare.

[whipping girl in 07]

I would try Amiodorone, as it can be used for wide complex supraventricular tachycardias as well as v-tach. Sometimes in these old people with damaged hearts, it's hard to tell if it's really v-tach or a wide-complex (due to bundle branch block) SVT, especially if you don't have access to old tele/EKGs.

What is the patient's rhythm when not in v-tach?

[Bermuda]

amiodorone for sure....althoughyou have to check out the whole scenario..of course..

[MollyMo]

Definitely amiodarone. Sometimes VT is malignant and overrides the ICD/PPM. We had one like that recently. Amiodarone was the only thing that worked.

[Allison P]

In my unit cordarone is almost always the first choice. We do have one doc who still likes to try lidocaine.

Allison

[lee1]

amniodarone is the latest one most MDS are now using. Rarely anymore Lidocaine is used.

[RNCENCCRNNREMTP]

Originally posted by konni
I would try Amiodorone, as it can be used for wide complex supraventricular tachycardias as well as v-tach. Sometimes in these old people with damaged hearts, it's hard to tell if it's really v-tach or a wide-complex (due to bundle branch block) SVT, especially if you don't have access to old tele/EKGs.

What is the patient's rhythm when not in v-tach?

The fact that these are old people with damaged hearts greatly increases the chance that the rhythm is VT and not SVT (Brugada et al). Use the following algorithm to tell the difference:

VT vs SVT (Brugada)
Favors VT
>50 years of age
Prior MI (95% specific)
Hx: Angina, CHF
AV Dissociation (100%)
QRS>0.14 or >0.16 LBBB
Axis: NML
Concordance (precordial)
V1 or V2 w LBBB
R>0.03
>0.07sec to S nadir
V6 w LBBB
QR or QS
V1 w RBBB
Monophasic R
QR
RS
V6 w RBBB
R/S < 1
QS
QR
Favors SVT:
<35 years
Prior SVT
V1 or V2 w LBBB
Triphasic QRS
R'>R
V6 w RBBB
Triphasic QRS

1) RS absent all precordial?
YES = VT
2) R to S >100msec in 1
precordial lead?
YES = VT
3) AV Dissociation?
YES = VT
4) V1-2,V6 VT criteria met?
YES = VT
ALL ABOVE NO?
Aberrant SVT likely!!