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    VT storm

    Electrical storm

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    Assessment & Plan (long)

    #Electrical storm
    Admitted with electrical storm as defined by >= 3x *** [ symptoms or shocks ] within 24 hours with confirmed VT on *** [tele, device interrogation ]. Considered triggers include QT-prolonging drugs or substances, electrolyte disturbance, heart failure, ACS, thyrotoxicosis.
    ## Dx:
    - [ ] BMP/Mg, UDS, BNP, TFTs
    - [ ] EKG/trop
    - [ ] CXR
    - [ ] TTE (if c/f CHF)
    - [ ] Med review (for QT prolonging medications)
    - [ ] Device interrogation (if s/p PPM, CRT)

    ## Initial tx
    - HDUS —> ACLS (electrical cardioversion!); if successful, initiate antiarrhythmic therapy with amio as below
    - HDS —> IV amio (150 mg  x 10 min f/b 1 mg/min x 6h f/b 0.5 mg/min x 18 h)  + propranolol (PO 40 mg Q6H x 48 h); Amio preferred over lido, procainamide given superior efficacy for VT termination; Beta blockade reduces adrenergic surge associated with VT and defibrillator shocks (which contributes to VT via increased sympathetic output); Propranolol, a non-selective beta-blocker, is more efficacious than B1-selective agents (eg metop)
    - If component of ischemia, urgent revascularization indicated

    ## Long-term arrhythmia control:
    - Catheter ablation: recommended for patients with persistence of electrical storm or incessant VT despite medical rx with amio and beta blocker
    - Maintenance oral antiarrhythmic therapy indicated for recurrence of VT after catheter ablation
    - If component of heart failure, initiate or uptitrate GDMT
    - Initiate appropriate GDMT

    Organ systems
    • Cardiovascular
    Medical field
    • Internal medicine
    Setting
    • Inpatient
    Author
    Alw45
    Page info

    Originally created: September 7, 2021 by Alw45

    [xyz-ips snippet="lastupdated"] [xyz-ips snippet="sectioneditor"] [post-views]

    Number of revisions: [xyz-ips snippet="numrevisions"]

    References
    [xyz-ips snippet="easyfootnote"]
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