Sustained ventricular tachycardia in the emergency department

Part 8: Advanced Life Support

“…370 Indirect evidence was also provided by 3 case studies (LOE 4). 344,371,372 Treatment Recommendation Procainamide is recommended for patients with hemodynamically stable monomorphic ventricular tachycardia (mVT) who do not have severe congestive heart failure or acute myocardial infarction. Amiodarone is recommended for patients with hemodynamically stable mVT with or without either severe congestive heart failure or acute myocardial infarction.…”

Are Available Electrocardiographic Methods Accurate Enough to Diagnose Ventricular Tachycardia in the Emergency Department?

“…This is due to both the characteristics and circumstances of this setting 1 and the importance of achieving a correct diagnosis as soon as possible, taking into account the implications of immediate management, the prognosis, and consequent follow-up and definitive treatment. 2,3 On occasion, emergency physicians are faced with this dilemma. 4 They should therefore acquire knowledge to identify ventricular tachycardia (VT) and distinguish it from supraventricular tachycardia (SVT) with alteration of intraventricular conduction or preexcitation, 5 as well as from other less frequent causes.…”

“…7 Delay in diagnosis or misdiagnosis of VT may cause impairment of the hemodynamic situation or even progression to ventricular fibrillation or cardiac arrest due to inadequate treatment. 7,8 However, on three out of four occasions WCT occurs in hemodynamically stable patients when arriving to the ED, 3 thereby allowing not only differential diagnosis but also pharmacologic treatment as the first option. 2,3 Twelve-lead electrocardiogram (ECG) remains the cornerstone test in the differential diagnosis of WCT within the ED setting.…”

“…7,8 However, on three out of four occasions WCT occurs in hemodynamically stable patients when arriving to the ED, 3 thereby allowing not only differential diagnosis but also pharmacologic treatment as the first option. 2,3 Twelve-lead electrocardiogram (ECG) remains the cornerstone test in the differential diagnosis of WCT within the ED setting. The diagnosis of VT is complex and is based on the presence of several ECG criteria.…”

“…If after all, reasonable doubt remains regarding the mechanism of the WCT, it should be assumed that it is VT until proven otherwise, 7 because it is usually the most frequent mechanism and, overall, because a delay in the diagnosis or an incorrect treatment of a VT may have fatal consequences. 2,3 In this sense, it is critical to remember that in the case of any doubt in the diagnosis of any patient attending with WCT, treatment with intravenous verapamil should never be used. 2 …”