Electrical Storm Core EM - Emergency Medicine Podcast
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- Medicina
We discuss Electrical Storm (VT storm) and how to care for the very irritable heart.
Hosts:
Brian Gilberti, MD
Reed Colling, MD
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Electrical_Storm.mp3
Download
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Tags: Cardiology
Show Notes
Background/Overview of VT:
Definition: What makes it a storm
Three or more sustained episodes of VF, VT, or appropriate ICD shocks in a 24-hour period
Pathophysiology: Understanding the origin and mechanism
Sympathetic drive/adrenergic surge
Underlying pathology: Sodium channelopathies, infiltrative disease like cardiac sarcoidosis, etc.
RF’s / trigger / population (reversible cause in ~25% of patients)
MI
Electrolyte Derangements (emphasis on potassium and magnesium)
New/worsening heart failure
Catecholamine Surge
Drugs (stimulants, cocaine, amphetamines, etc)
QT Prolongation
Thyrotoxicosis
Clinical Presentation:
Symptoms of VT: spectrum of symptoms – from palpitations to syncope to cardiac arrest
Differentiating VT from other potential ER presentations.
Diagnostics in ER:
Electrocardiogram (ECG): Recognizing VT patterns.
Monomorphic vs polymorphic (Torsades) may change management
Wide QRS
Fusion best
Capture beats
Concordance
AV-dissociation
Lab tests: Potassium, magnesium, troponins, TFTs, etc.
Acute Management in the ER:
Hemodynamically stable vs. unstable V
Unstable = cardioversion
Sedation
Catecholamine surge should be considered
No ideal agent
Etomidate or propofol can be considered
Ketamine may worsen irritability
Pharmacological treatments:
Amiodarone
Class III antiarrhythmic
Most studied in VT storm
First line
Beta Blockers
Propranolol
B1 and B2 activity
Non-pharmacological approaches:
Immediate synchronized cardioversion
* IABP / ECMO considered for HD unstable patient
Cath lab if ischemic etiology suspected
Stellate Ganglion Block
Take Home Points
Definition: VT Storm is commonly defined as three or more sustained episodes of ventricular fibrillation, ventricular tachycardia, or appropriate ICD shocks within a 24-hour period.
Varied Presentation: Patients may experience a range of symptoms from palpitations to severe hemodynamic instability.
ECG and Diagnosis: Initial ECG may not show VT; continuous cardiac monitoring or device interrogation may be required for diagnosis.
VT Identification: Look for wide QRS, rate over 100, fusion beats, capture beats, and AV dissociation to identify VT.
Management in Hemodynamic Instability: Cardiovert if t...
We discuss Electrical Storm (VT storm) and how to care for the very irritable heart.
Hosts:
Brian Gilberti, MD
Reed Colling, MD
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Electrical_Storm.mp3
Download
Leave a Comment
Tags: Cardiology
Show Notes
Background/Overview of VT:
Definition: What makes it a storm
Three or more sustained episodes of VF, VT, or appropriate ICD shocks in a 24-hour period
Pathophysiology: Understanding the origin and mechanism
Sympathetic drive/adrenergic surge
Underlying pathology: Sodium channelopathies, infiltrative disease like cardiac sarcoidosis, etc.
RF’s / trigger / population (reversible cause in ~25% of patients)
MI
Electrolyte Derangements (emphasis on potassium and magnesium)
New/worsening heart failure
Catecholamine Surge
Drugs (stimulants, cocaine, amphetamines, etc)
QT Prolongation
Thyrotoxicosis
Clinical Presentation:
Symptoms of VT: spectrum of symptoms – from palpitations to syncope to cardiac arrest
Differentiating VT from other potential ER presentations.
Diagnostics in ER:
Electrocardiogram (ECG): Recognizing VT patterns.
Monomorphic vs polymorphic (Torsades) may change management
Wide QRS
Fusion best
Capture beats
Concordance
AV-dissociation
Lab tests: Potassium, magnesium, troponins, TFTs, etc.
Acute Management in the ER:
Hemodynamically stable vs. unstable V
Unstable = cardioversion
Sedation
Catecholamine surge should be considered
No ideal agent
Etomidate or propofol can be considered
Ketamine may worsen irritability
Pharmacological treatments:
Amiodarone
Class III antiarrhythmic
Most studied in VT storm
First line
Beta Blockers
Propranolol
B1 and B2 activity
Non-pharmacological approaches:
Immediate synchronized cardioversion
* IABP / ECMO considered for HD unstable patient
Cath lab if ischemic etiology suspected
Stellate Ganglion Block
Take Home Points
Definition: VT Storm is commonly defined as three or more sustained episodes of ventricular fibrillation, ventricular tachycardia, or appropriate ICD shocks within a 24-hour period.
Varied Presentation: Patients may experience a range of symptoms from palpitations to severe hemodynamic instability.
ECG and Diagnosis: Initial ECG may not show VT; continuous cardiac monitoring or device interrogation may be required for diagnosis.
VT Identification: Look for wide QRS, rate over 100, fusion beats, capture beats, and AV dissociation to identify VT.
Management in Hemodynamic Instability: Cardiovert if t...