ventricular tachycardia

So I would say this is polymorphic ventricular tachycardia resembling torsades de poin.

And thinking of conduction disease, it can go both ways.

Because one of the most common causes of VT is really scar tissue from prior coronary events.

But I imagine if the heart is unhappy or the conduction system, it can all of a sudden send this electrical discharge.

So the next main question, and I don't, you know, with monomorphic VT, you can definitely have a pulse and the patient can be talking to you like with a good blood pressure, but I don't know if that's the case with polymorphic.

So pretty much like you sort of want to shock this patient and Start CPR, well, check a pulse, start CPR, shock, and transfer to the cath lab as soon as you get ROSC for intervention with a coronary injury.

I'm really curious to see what that, I'm sure like you can predict which vessel is based on this polymorphic CT.

Mr. opponent had rose risen from 367 to 1500.

But even this does not cinch the diagnosis of syncope, right? Because oodles of people can have nocturnal pauses of six seconds from sleep apnea, and this is not the cause of their syncopal event.

Many more people probably have non-sustained VT on a 14-day patch that has no relationship to their syncopal event.

But it's been argued whether we should do these 14-day patches in patients with undiagnosed syncope.

So the primary outcome of this trial was patient-reported syncopal episodes after one year.

Clinically significant arrhythmia noted on the patch, 22.0 versus 9.0, so that's an odds ratio of 2.95, almost 3x.

And it was found sooner with the ECG patch, 22 versus 54 days.

Now, clinically significant arrhythmia was defined as non-sustained VT, greater than 120 beats per minute for greater than 4 beats, pause greater than 6 seconds, sinus brady, less than 30 beats per minute, bradycardia, less than 40 beats per minute for greater than 30 seconds, sustained ventricular tachycardia, or Mobitz 2 or complete heart block.

All of these were considered... significant arrhythmias.

One, the implications of identifying those people with AFib, that can be a cult to make sure you're protecting them from stroke risk with appropriate anticoagulation.

And also, if you do identify a preponderance of non-sustained VT, you would want to kind of do further risk stratification for defibrillator therapy.

Historically, amyloid patients were often recommended not to pursue defibrillator therapy with the thought process being that infiltrated fibrils increased the defibrillation threshold and made for less successful ICD shock therapy.

That has since been disproven, and ICD therapy remains indicative for those amyloid patients that have ventricular arrhythmias with an expected survival based on their staging of their AL amyloid doses of greater than one year.

And then we really want to keep doing repeat ECGs and monitor for dynamic changes.

We want to keep that plan in the back of our mind that if this patient does deteriorate and, you know, goes into VF or VT or something like that, we can administer a shock quite rapidly.

with these patients, you know, if they do go into those rhythms, we know that the shock is the treatment and hopefully that shock is just going to be what works and we don't even need to commence CPR, but being prepared if we do.

That's probably a good point.

We know there's a thrombus and we know that that's definitively the cause and we know that treatment for that is PCI.

So getting them towards that PCI facility is key.

And even if you deliver a shock or, you know, if they do go into a conscious VT and you give them amiodarone or whatever it may be, that clot is still going to be there.

That occlusion is still going to be there and they need the PCI.

For the emergency management of Torsada Point, treating with IV magnesium and emergent cardioversion is the same, just like the ACLS protocols we use.

Now moving on to CPVT.

CPVT tends to be rare and not as common, but it also needs preconception planning, medication management, and monitoring.

In the preconception planning stage, confirming ventricular arrhythmias and also seeing if they are suppressed using exercise stress test is very important.

Discussing with the patient regarding preferred beta blockers, And the risk to benefit ratio of flaconide used during pregnancy is also important.

Sometimes.

We'll be beep bopping around and not realize that someone is in VT. Beep bop.

So, you know, essentially just what are all the other things we're looking at on a 12 lead EKG there? And I think, you know, the way I like to break it down is whenever I'm handed a 12 lead EKG, yes, first thing I'm looking for, and there's lots of faults to the STEMI system.

See our other podcasts related to that.

Eventually you can get a sine wave, right? in severe states.

Your EKG is very, very sensitive at picking up electrolyte abnormalities.

So what you were talking about was, you know, theoretical case of someone going into VT and let's say you take blood real quick and just see, okay, I'm suspicious this is related to potassium, right? I'm curious and I want to check.

They could have totally normal electrolytes.