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Cardiology — SVT & VT.
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Cardiology — SVT & VT.
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Cardiology — SVT & VTA 35yr old gentleman has collapsed twice in the last month.
His brother died in his 20s of sudden cardiac death.
ECHO reveals features of HCOM & a 24 hour ECG shows several short runs of non
sustained VT.
How do you manage the non sustained VT? - ANS-Implantable
Cardiovertor-Defibrillator (ICD).
Non-sustained VT — ↑ risk sudden cardiac death.
⇒ ICD is first-line therapy.
A supraventricular tachycardia arises from where? - ANS-The atria or AV node.
Broadly speaking, tachyarrhythmias are classified, by site of origin, into what 2
categories? - ANS-- Supraventricular (SVT)
- Ventricular (VT)
How do manage ventricular tachycardia (VT)? - ANS-Haemodynamically stable:
- Amiodarone + Mg²⁺ infusion
- If VT recurs — repeat
- If fails to terminate — DC cardioversion
Haemodynamically unstable:
- Urgent DC cardioversion
+ determine & treat underlying cause
(low Mg, K, acidosis, ischaemia)
NB. Low energies to cardiovert VT (e.g. 50J)
In heart arrhythmias, what is pre-excitation? - ANS-Early activation of the ventricles due
to impulses bypassing the AV node via an accessory pathway.
, In management of an acute SVT,
a) what drug is given if vagal manoeuvres are unsuccessful?
b) what doses of this drug are given?
c) what is given if this drug fails to cardiovert the patient?
d) what is the final step if this fails? - ANS-a) Adenosine.
b) 6mg ⇒ 12mg ⇒ 12mg.
c) Verapamil.
d) Electrical cardioversion.
In management of an acute SVT, outline the methods of cardioversion in order that they
are attempted. - ANS-1. Vagal manœuvres
(e.g. carotid massage)
2. Adenosine
(6mg ⇒ 12mg ⇒ 12mg)
3. Verapamil
(5mg over 3mins)
4. Electrical cardioversion
(100J ⇒ 200J ⇒ 360J)
In Wolff-Parkinson-White syndrome, what name is given to the pathological accessory
pathway (AV bypass tract)? - ANS-*Bundle of Kent*.
Name 7 subtypes of supraventricular tachycardia. - ANS-- Sinus tachycardia
- Atrial tachycardia
- Multifocal atrial tachycardia (MAT)
- Atrial fibrillation / flutter
- AV nodal re-entrant tachycardia (AVNRT)
- AV re-entrant tachycardia (AVRT)
- Junctional ectopic tachycardia (JET)
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