{"id":9630,"date":"2021-12-28T17:54:54","date_gmt":"2021-12-28T15:54:54","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/ventricular-arrhythmias-icd\/"},"modified":"2022-01-03T17:29:19","modified_gmt":"2022-01-03T15:29:19","slug":"ventricular-arrhythmias-icd","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/ventricular-arrhythmias-icd\/","title":{"rendered":"Ventricular arrhythmias. ICD"},"content":{"rendered":"\n

Ventricular arrhythmias<\/h3>\n<\/span>\n\n<\/span>\n

Types<\/h4>\n<\/span>\n\n\n
  • Ventricular premature contraction<\/li>
  • Ventricular tachycardia<\/li>
  • Ventricular fibrillation<\/li><\/ul>\n\n\n<\/span>\n

    Ventricular premature contraction<\/h4>\n<\/span>\n\n\n

    PVCs are single beats that originate in the ventricles. <\/p>\n\n\n\n

    • Caused due to abnormal electrical activity within the vetricle.<\/li>
    • May be felt as palpitations.<\/li>
    • They are extremely common, and generally harmless.<\/li>
    • In case of frequent VPC, beta-blockers or EP study and catheter ablation can be used.<\/li><\/ul>\n\n\n<\/span>\n

      Ventricular tachycardia<\/h4>\n<\/span>\n\n\n

      VT is defined as a tachycardia (>100BPM) with at least 3 consecutive beats originating in the ventricle. It is a potentially life-threatening condition.<\/p>\n\n\n\n

      • The ventricles do not have enough time to fill up, severely reducing the cardiac output.<\/li>
      • VT can be nonsustained <\/strong>(<30s) or sustained<\/strong> (>30s), and monomorphic<\/strong> (same QRS morphology) or polymorphic<\/strong> (varying QRS morphology).
        • Monomorphic VT has a single abnormal focus or reentry patheway<\/li>
        • Polymorphic VT has multiple foci or reentry pathways<\/li>
        • The longer VT lasts, the higher the chance it will turn into VF<\/li><\/ul><\/li>
        • Other forms include:
          • Accelerated idioventricular rhythm<\/strong> (slow VT) describes ventricular rhythm less than 100BPM; it is usually benign.<\/li>
          • Incessant VT<\/strong> is VT that lasts hours in hemodynamically stable patients.<\/li>
          • Ventricular flutter<\/strong> is a severe form of monomorphic VT with rates of ~300BPM and no isoelectric intervals. <\/li>
          • Torsades de Pointes<\/strong> (twisting of peaks) is a severe form of polymorphic VT with gradual changes in the amplitude.<\/li><\/ul><\/li>
          • Presents with weakness, angina, dyspnea, palpitations, and syncope.<\/li>
          • ECG pattern shows wide-complex tachycardia.<\/li>
          • Treatment<\/strong>
            • Any wide-complex tachycardia must be considered as VT.<\/li>
            • Unstable patients require emergency defibrillation<\/li>
            • Stable sustained VT can be treated with DC cardioversion, or class I\/III antiarrhythmics (lidocaine, procainamide, amiodarone)<\/li>
            • Stable nonsustained VT requires no treatment, but follow-up and additional tests are warranted.<\/li>
            • ICD implantation with beta blockers to prevent recurrence<\/li>
            • Torsades de Pointes <\/strong>is treated with 2g IV magnesium and potassium<\/li><\/ul><\/li><\/ul>\n\n\n<\/span>\n

              Ventricular fibrillation<\/h4>\n<\/span>\n\n\n

              VF is a life-threatening condition in which ventricular muscle fibers contract independently, producing no productive contractions.<\/p>\n\n\n\n

              • This is the most severe arrhythmia, producing no cardiac output, and fatal if not treated immediately. The patient is usually unconcious.<\/li>
              • Caused due to multiple wavelet reentrant electrical activity.<\/li>
              • VF is the most common cause of sudden cardiac death post-MI.<\/li>
              • Most cases have an underlying cardiac disease (CHF, MI, cadiomyopathy, channelopathies).
                • Examples for channelopathies include Brugada syndrome, and long QT syndrome<\/li>
                • Brugada syndrome: pseudo-RBBB, ST-elevation<\/li>
                • Long QT syndrome: may lead to Torsades de Pointes and VF<\/li><\/ul><\/li>
                • ECG pattern is bizzare and chaotic; no P waves or QRS complexes.<\/li>
                • Treatment<\/strong>
                  • CPR involving emergency defibrillation (95% success rate if done within 3 minutes)<\/li>
                  • ICD implantation<\/li><\/ul><\/li><\/ul>\n\n\n<\/span>\n

                    ICD<\/h3>\n<\/span>\n\n\n

                    An implantable cardioverter-defibrillator is a device that is implanted into the patient (subcutaneously or subpectorally, with electrodes in the right ventricle) that senses the electrical activity of the heart and defibrillates in case of VT or VF.<\/p>\n\n\n\n

                    • ICDs are indicated for patients with previous VF\/VT who are at risk for developing additional episodes of VF\/VT.<\/li>
                    • They terminate arrhythmias but not prevent them. Patients at risk should also use antiarrhythmic drugs (class I\/III).<\/li>
                    • Biventricular ICD has an electrone in the left ventricle as well, allowing for resynchronization therapy (known as CRT-D).<\/li><\/ul>\n<\/span>

                      Ventricular arrhythmias<\/h3>

                      Types<\/h4>

                      Ventricular premature contraction<\/h4>

                      Ventricular tachycardia<\/h4>

                      Ventricular fibrillation<\/h4>

                      ICD<\/h3><\/div>","protected":false},"excerpt":{"rendered":"

                      Ventricular arrhythmias Types Ventricular premature contraction Ventricular tachycardia Ventricular fibrillation Ventricular premature contraction PVCs are single beats that originate in the ventricles. Caused due to abnormal electrical activity within the vetricle. May be felt as palpitations. They are extremely common, and generally harmless. In case of frequent VPC, beta-blockers or EP study and catheter ablation […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":410,"menu_order":18,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-9630","page","type-page","status-publish","hentry"],"yoast_head":"\nVentricular arrhythmias. 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