Dr. Usman's Cardiology Notes

Idiopathic Ventricular Tachycardia (VT) from M Usman Javed

  A 16 year old girl accompanying his father in cardiology clinic suddenly collapsed after listening fire alarm in hospital. Senior cardiology fellow successfully resuscitated her. On recovery her physical examination was normal. On inquiry his father informed that she fainted twice at home after doorbell with spontaneous recovery. a) What do you think happened to this young girl? b) Describe two characteristic ECG findings c) How will you manage her? d) Which genetic mutation cause this disease? e) Is flecainide indicated? Answers : a.       Polymorphic VT (Underlying long QT type II) b.       QTc > 480 msec, Low amplitude notched T wave c.        Beta-blockers   (Propanolol, Nidolol) and ICD if recurrent syncope despite on beta blockers or if contraindication to beta blocker and in survivors of cardiac arrest d.       KCNH2 e.       No Referenc...

A 40 years old male diabetic with previous history of myocardial infarction and LVEF 35% presented with shortness of breath and chest pain. His functional capacity is poor due to underlying dyspnea on exertion. He was apprehensive, tachycardiac and maintaining his BP around 100/60 mmHg. ECG showed gross ST depression in precordial leads more than 2mm with non-progressive R waves. Trops were negative. Immediately on arrival to CCU he suddenly collapse and started gasping, monitor showed monomorphic VT with rate of 200bpm. He was resuscitated with 200Jshock and CPR for 5minutes. On revival, he was shifted to cath lab where coronary angiogram showed TVCAD a)       What is the reason for monomorphic VT b)       Would you consider ICD for this patient during his hospital stay c)       What additional workup is indicated before surgery d)       What is the mortality of CABG? Answers: a.  ...

 A 40 year old man brought into the emergency room in a collapsed state with ECG given above. Carotid pulse was palpable (1+) and blood pressure was 80/45 mmHG. Thought 1: How to approach wide complex tachycardia? Thought 2: What is the first line drug in this case? This ECG has wide-complex tachycardia(QRS duration=120msec) at a rate of 180 bpm with a RBBB pattern, left superior axis deviation and R-S interval is hardly 80msec suggesting Idiopathic Fasicular Left Ventricular Tachycardia (ILVT) and due to left superior axis deviation its Posterior Fasicular VT . Right ventricular outflow tract tachycardia is also differential here but it is usually with LBBB morphology. During wide complex tachycardia the differentiation between supraventricular and ventricular origin of the arrhythmia is important to guide therapy. Several algorithms have been developed to aid in this differentiation which we will discuss in next sections. The patient was initially treated with success...