📋 Management Summary: IV Access and Obtain Defibrillator
🩺 ABC approach: if pulseless → initiate Cardiac Arrest Protocol. 📈 ECG shows wide complex regular tachycardia > 120 bpm. 💉 Secure IV access, provide oxygen, and treat electrolyte disturbances or ACS. 🚨 If symptoms (shock, syncope, angina, severe heart failure) → immediate DC shock: ⚡ Synchronized DC shock (up to 3 attempts). 💤 Sedation/anaesthesia if conscious. 💊 If unsuccessful: Amiodarone 300 mg IV over 10–20 mins, then repeat DC shock. ✅ If BP stable: give Amiodarone 300 mg IV over 10–60 mins.

📋 Management Summary: IV Access and Obtain Defibrillator

🩺 ABC approach: if pulseless → initiate Cardiac Arrest Protocol.
📈 ECG shows wide complex regular tachycardia > 120 bpm.
💉 Secure IV access, provide oxygen, and treat electrolyte disturbances or ACS.
🚨 If symptoms (shock, syncope, angina, severe heart failure) → immediate DC shock:
- ⚡ Synchronized DC shock (up to 3 attempts).
- 💤 Sedation/anaesthesia if conscious.
- 💊 If unsuccessful: Amiodarone 300 mg IV over 10–20 mins, then repeat DC shock.
✅ If BP stable: give Amiodarone 300 mg IV over 10–60 mins.

ℹ️ About

📊 Broad complex tachycardia with rate >120 bpm often due to IHD.
⚠️ Patients may look stable but can deteriorate → always prepare for arrest.
🏥 Admit to CCU and ensure defibrillation access.

📌 Types of Ventricular Tachycardia

Sustained VT: ⏱ Lasts >30 secs.
Non-Sustained VT: 3+ beats below AV node, RR <600 ms (>100 bpm), lasting <30 secs.

🩺 Causes

❤️ Ischemic cardiomyopathy
💪 LVH (e.g., Hypertension)
🫀 Idiopathic dilated cardiomyopathy
⚡ Brugada syndrome
🧬 ARVC (Arrhythmogenic RV Cardiomyopathy)
🦠 Myocarditis
🏋️ Hypertrophic cardiomyopathy
💊 Drug overdose (TCAs, Digoxin, Antiarrhythmics)
🧪 Electrolyte imbalance: Hypo/Hyper-kalaemia, Hypomagnesaemia
💉 Cocaine / Phaeochromocytoma
📏 Long QT syndromes (congenital/acquired)
➡️ RVOT VT (LBBB + RAD pattern)

👨‍⚕️ Clinical Presentation

Palpitations → cardiac arrest.
💨 Pulmonary oedema, 🩸 hypotension, syncope, chest pain, dizziness.
JVP: "cannon a-waves" possible.

📈 ECG Features

Examples of VT strips:

🔎 VT More Likely If:

Fusion/capture beats, AV dissociation
No RS waves in chest leads
QRS >0.14 (RBBB) or >0.16 (LBBB)
Extreme LAD

🔀 Differential Diagnosis: Regular Wide Rhythm >120 bpm

⚡ Ventricular Tachycardia
↔️ Atrial Flutter + BBB
SVT with BBB
🧪 Severe Hyperkalaemia
⚡ Pre-excited Atrial Tachycardia

🧪 Investigations

Labs: FBC, U&E, Mg²⁺, Ca²⁺, Lactate, ABG
ECG: wide QRS >3 small squares, regular rhythm
Troponin, BNP, Echo
Coronary angiography if ACS suspected

⚠️ Classical VT is the most common cause of wide complex tachycardia. If unsure → treat as VT and follow algorithm.

🚑 Acute Management

ABC protocol. If pulseless → CPR + ⚡ DC shock.
If stable:
- 12-lead ECG, IV access, bloods
- Be ready for DC shock
💊 Pharmacologic:
- Amiodarone 300 mg IV / 30 mins → then 900 mg / 24 hrs
- Lidocaine 50 mg IV → repeat up to 200 mg
- Magnesium sulfate 2 g IV over 15 mins
Unstable/pulseless → immediate ⚡ shock + amiodarone.
If ACS/STEMI → PCI as per guidelines.

🩺 Long-Term Management

Non-sustained VT: Beta blockers; EF <30% → AICD assessment.
Chronic therapy: Antiarrhythmics, Echo, Angiography, EP studies, Holter.
AICD: Consider if life-threatening arrhythmias.
Catheter Ablation: For recurrent VT.

12-Lead ECG - Ventricular Tachycardia

🩺 Case 1 — Stable Monomorphic VT

A 65-year-old man with a history of previous anterior MI presents with palpitations and dizziness. BP is 110/70 mmHg, pulse 160 bpm, and ECG shows a broad-complex regular tachycardia consistent with monomorphic VT. Management: 💊 IV amiodarone (or procainamide if available) with close monitoring; treat reversible causes (e.g. hypokalaemia, ischaemia). Electrophysiology review for ICD consideration. Avoid: ❌ Giving adenosine or verapamil — can cause haemodynamic collapse in VT.

🩺 Case 2 — Unstable VT

A 72-year-old woman with dilated cardiomyopathy presents with palpitations, chest pain, and confusion. BP is 70/40 mmHg and she has cool peripheries. ECG shows a regular wide-complex tachycardia at 180 bpm. Management: ⚡ Immediate synchronised DC cardioversion (ALS protocol); IV amiodarone after cardioversion; urgent cardiology review for ICD if recurrent. Avoid: ❌ Delaying cardioversion while trying antiarrhythmic drugs — shock is lifesaving here.

🩺 Case 3 — Torsades de Pointes

A 48-year-old woman with a history of prolonged QT (on sotalol and with recent electrolyte disturbance) presents with syncope. ECG shows polymorphic VT with twisting QRS complexes around the baseline — torsades de pointes. Management: 💉 IV magnesium sulphate is first-line; correct electrolytes (K⁺, Mg²⁺, Ca²⁺); stop QT-prolonging drugs; temporary pacing if recurrent. Avoid: ❌ Avoid giving amiodarone or other QT-prolonging agents as they worsen torsades.

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Ventricular Tachycardia (VT)