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A 75-year-old male with a past medical history significant for hypertension, diabetes, and coronary artery disease presents to the emergency department with a 1-hour history of sudden shortness of breath and generalized weakness.

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On examination, he is noted to have a blood pressure of 90/58. He is clammy and diaphoretic. His lungs are clear to auscultation. His heart examination reveals tachycardia.

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His EKG is shown in Figure 13-1.

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1. What is your diagnosis?

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Answer

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  1. VT.

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Ventricular Arrhythmias

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Ventricular Tachycardia

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Diagnosis
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VT is the most frequently encountered life-threatening arrhythmia. It is defined as a series of 3 or more ventricular complexes that occur at a rate of 100 to 250 bpm. Typically, the QRS complex is wide (usually >120 milliseconds). In the setting of significant structural heart disease, sustained VT (defined as an episode longer than 30 seconds) predicts a poor prognosis. This is a potentially life-threatening arrhythmia because it may lead to ventricular fibrillation (VF), asystole, and sudden death.

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Treatment
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Patients suffering from pulseless VT or unstable VT are hemodynamically compromised and require immediate cardioversion. For patients who are hemodynamically stable, antiarrythmic agents such as amiodarone, lidocaine, procainamide, or sotolol should be used.

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  • Quick recognition of arrhythmias is important and comes with practice and experience.
  • Anticoagulation with warfarin has significant risks, so should be reserved for patients with high CHADS2 scores.
  • Mortality outcomes are similar for patients with atrial fibrillation who are treated with rhythm control compared with those treated with rate control.

Ahya SN, Flood K, Paranjothi S. Cardiac Arrhythmias. The Washington Manual of Medical Therapeutics. 30th ed. Philadelphia: Lippincott Williams & Wilkins; 2001:153–167.
Cheng A, Kumar K. Overview of atrial fibrillation. In: Zimetbaum P, Saperia G, eds. UpToDate. 2012.
Phang R. Overview of the evaluation and management of atrial flutter. In: Zimetbaum P, Saperia G, eds. UpToDate. 2012.

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