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| {{SK}} WCT; fast and wide; wide and fast; wide-complex tachycardia; wide complex rhythm; SVT with aberrancy; SVT with aberrant conduction; supraventricular tachycardia with aberrancy; VT versus SVT | | {{SK}} WCT; fast and wide; wide and fast; wide-complex tachycardia; wide complex rhythm; SVT with aberrancy; SVT with aberrant conduction; supraventricular tachycardia with aberrancy; VT versus SVT |
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| == Treatment ==
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| ===Defibrillation===
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| Indications for defibrillation include the following:
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| * [[Chest pain]]
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| * [[Congestive heart failure]] ([[CHF]])
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| * [[Hypotension]] with symptoms
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| * [[Loss of consciousness]]
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| * [[Seizure]]
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| === Acute Pharmacotherapies ===
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| * '''If stable''': (More patients than you think)
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| * '''DO NOT USE''' Ca2+ Channel blocker, [[Digoxin]] or [[Adenosine]] if you don't not know the etiology of the Wide Complex Tachycardia. Ca2+ Channel blockers and Digoxin can lead to accelerated conduction down a bypass tract and [[VF]].
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| * Though ACLS guidelines recommend a diagnostic trial of [[Adenosine]], it can precipitate [[VF]] in some patients with SVT. Patients who have underlying coronary disease may become ischemic from coronary steal. Rhythm can degenerate and lead to [[VF]] that cannot be resuscitated. Furthermore, some [[VT]] (esp those with structurally normal hearts) are [[adenosine]] responsive and can terminate.
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| *:# Etiology Uncertain
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| *:#:* [[Pronestyl]] 15mg/kg load over 30 minutes then 2-6mg/min gtt
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| *:# [[Ventricular Tachycardia]] with active ischemia
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| *:#:* [[Lidocaine]] 1 mg/kg q5-10 min up to 3 times then 2-6mg.min gtt
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| *:#:* If unsuccessful, [[Pronestyl]] as above
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| *:#:* If unsuccessful, IV [[Amiodarone]] 150-300 load over 15-20min. 30-60mg/hr gtt for total of 1gram
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| *:# [[Ventricular Tachycardia]] in Setting of [[Cardiomyopathy]]
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| *:#:* Skip [[Lidocaine]] and go straight to [[Pronestyl]]
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| *:# Positively [[SVT]] with aberrancy
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| *:#:* [[Adenosine]] 6mg rapid IV bolus in large vein. May repeat with 12mg x2.
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| *:#:* [[Lopressor]] 2.5-5.0mg IV
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| *:#:* [[Diltiazem]] 10-20mg bolus followed by gtt 5-20mg/hr
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| *:#:* [[Verapamil]] 2.5-5.0mg bolus.
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| *:#:* Avoid [[Digoxin]]. Takes too long to work and can be proarrhythmic
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| *:#:* [[Pronestyl]] as above
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| *:# Antidromic AVRT
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| *:#:* If 100% positive [[AF]] is not underlying, can terminate with a nodal blocker
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| *:#:* If unsure, [[Pronestyl]] as above
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| ==Sources== | | ==Sources== |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: WCT; fast and wide; wide and fast; wide-complex tachycardia; wide complex rhythm; SVT with aberrancy; SVT with aberrant conduction; supraventricular tachycardia with aberrancy; VT versus SVT
Sources
Copyleft images obtained courtesy of ECGpedia, http://en.ecgpedia.org/index.php?title=Special:NewFiles&offset=&limit=500
References
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