Stable Vtach

[Matthew89]

Hello, Here for learning. I have a question can we shock stable Vtach with a HR 140s to 160s? SBP 113/60s, alert and oriented, no chest pain.  Asymptomatic. Amio bolus was not even finished was only half way through. Decision was made to shock at 100J. He turned pale, hypotensive and rapidly decompensated. Not sure what the right decision was. Asking for medical advice. TY

[MaxAttack, BSN, RN]

Adenosine works on the AV node so it would be ineffective in afib. Amio is a good first-line drug, but procainamide and sotalol can be effective. I don't know that there's a time per se to wait before a patient is shocked. I know stable vs unstable vtach is controversial, but I've seen it go on for some time in a perfectly awake and happy patient. 

It sounds like the patient was sicker than he looked and tachycardic as a compensatory mechanism to maintain their cardiac output (CO = HR x SV). When they were shocked into a normal rhythm their output plummeted and their hemodynamic status with it.

You can't always predict it. It doesn't sound like anything was done wrong. Sometimes sick bodies don't play nice.