Antiarrhythmics

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, RN]

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

QS

QR

Favors SVT:

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!!

[Dave ARNP]

Amiodarone, Amiodarone, Amiodarone,

and if you want to try something else....

Amiodarone.

And if that doesn't work...

Amiodarone.

I also like to order... Amiodarone

Any questions?

David Adams, ARNP

-ACNP, FNP

[Dinith88]

Cheryl, it would depend on the patient's symptoms. If he's symptomatic, then certainly IV-Amio is a good choice. If he's relatively asymptomatic then po cordarone would be good...but it depends on his ovrall 'picture'...

Most Cadriologists i work with would probably recommend an angio to redefine the pt's coronaries. If the NSVT is 'ischemic', then it could perhaps be remedied without the Amio (and it's (unfortunately!) not too uncommon side effects!).

If it's non-ischemic and more related to the guy's anatomy (how was his LV?) Then amio-loading is probably the 'best' medical Tx,...EP-studies with potential icd-implantation would be a 'last line' thing...in my opinion..

I Like amiodarone. It's great at what it does and can be applied to a wide-variety of 'bad-rythm' situations (incl. code situations).

Though side-effects do occur(esp. w/chronic use), i beleive it's potential benefits outweigh them.