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Cardiovascular Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Ventricular tachycardia is a life-threatening arrhythmia. It may lead to ventricular fibrillation, cardiac decompensation, and death. This arrhythmia type is encountered infrequently during pregnancy, and is especially infrequent in the absence of specific cardiac disease (e.g., myocardial infarction). Therapy is primarily electric cardioversion, especially if the patient has hemodynamic instability. Lidocaine (75–100 mg IV bolus followed by 1–4 mg/min infusion) should be given in conjunction with countershock and as initial therapy in the stable patient (Brown and Wendel, 1989). Lidocaine, procainamide, or bretylium may be used to prevent recurrence of tachycardia.
Congestive Heart Failure
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Adequate treatment and correction of potassium and magnesium abnormalities reduce risks of ventricular arrhythmias. Antiarrhythmic medications may be needed for sustained ventricular tachycardia if it persists even with correction of causative conditions or optimal HF treatment. Amiodarone, beta-blockers, and dofetilide are the drugs of choice. Since amiodarone increases levels of digoxin and warfarin, their doses are decreased by half or stopped. Drug toxicity with digoxin can occur even at therapeutic drug levels. Low doses of amiodarone are often used, with liver function and thyroid-stimulating hormone tests done every 6 months. Chest X-rays and pulmonary function tests are done once per year to assess pulmonary fibrosis, when there are abnormal previous chest X-rays or significantly worsened dyspnea.
Obstetrics: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
Attach 2 adhesive pads and connect to machine.If shock advised make sure ‘all clear’.Ventricular tachycardia and ventricular fibrillation.
Comparison of de novo versus upgrade cardiac resynchronisation therapy on clinical effect and long-term outcome
Published in Acta Cardiologica, 2021
Jan Stassen, Martijn Scherrenberg, Dagmara Dilling-Boer, Johan Vijgen, Pieter Koopman, Joris Schurmans, Lieven Herbots, Jan Verwerft, Matthew Schroyens, Philippe Timmermans
Evolution in NYHA functional class and echocardiographic response [difference in left ventricular ejection fraction (Δ LVEF) and left ventricular end diastolic diameter (Δ LVEDD)] were collected at 6 months. A clinical response was defined as an improvement of at least 1 NYHA functional class. Potential life-threatening ventricular arrhythmias were collected during long-term follow-up and were defined as the occurrence of sustained ventricular tachycardia (>30 s) not requiring therapy or appropriate therapy for ventricular tachycardia/ventricular fibrillation. Furthermore, 1-year and long-term mortality were collected and further categorised into cardiac death and non-cardiac death. Vital status was checked via the electronic health record that is linked to a national death registry (‘Belgian National Register Number’). The exact mode of death was retrieved from the patient’s individual EMR. For patients who died outside the hospital, mode of death was retrieved through information from the primary care physician if this was recorded in the individual EMR. In all other cases, mode of death was recorded as ‘unknown’. Sudden cardiac death (SCD) was defined as death due to electromechanical dissociation without a shockable rhythm or unexpected death during sleep. Tachyarrhythmic death was defined as death due to documented ventricular tachycardia or ventricular fibrillation.
Revascularisation of chronic total occlusions and recurrence rate of ventricular arrhythmias
Published in Acta Cardiologica, 2021
Ward Eertmans, Ief Hendrickx, Ruben Pauwels, Joren Maeremans, Keir McCutcheon, Peter Kayaert, Yoann Bataille, Johan Bennett, Jo Dens
Long-term outcome in terms of reoccurrence or freedom from ventricular arrhythmias was evaluated by reviewing patient records available until May 2019. Follow-up of ventricular arrhythmias after CTO-PCI was not systematically performed with adequate monitoring, such as a 24 hrs Holter monitoring, at the predetermined follow-up time points. Moreover, the decision to perform a control 24 hrs Holter monitoring or pacemaker/ICD analysis was taken by the treating cardiologist. Freedom of ventricular arrhythmias was defined as absence of reported non-sustained or sustained tachycardias, ventricular fibrillations and ventricular extrasystoles or a significant clinical reduction in ventricular extrasystoles (<2500 VES/24 h). Documented interventions from an implantable cardioverter-defibrillator (ICD) for ventricular tachycardia or fibrillation were classified as reoccurrence of ventricular arrhythmias. Follow-up in terms of freedom of ventricular arrhythmias was divided using following time periods: one, three, six months and one, two and three years following CTO-PCI.
The challenges of an aging tetralogy of Fallot population
Published in Expert Review of Cardiovascular Therapy, 2021
Jennifer P. Woo, Doff B. McElhinney, George K. Lui
Catheter ablation is well established as an important adjunct therapy for arrhythmias associated with CHD, especially for atrial tachyarrhythmias and refractory ventricular tachycardia. Catheter ablation for focal atrial arrythmias and intra-atrial reentrant tachycardia are extremely effective [74,78]. There are, unfortunately, much less data on the efficacy of atrial fibrillation ablation in CHD. Data on ventricular tachycardia ablation are mixed and limited to small case series. Intracardiac ventricular tachycardia mapping demonstrated macroreentry and slow conducting isthmuses related to tissue in the RVOT around surgical scars, patches and valves, which are sometimes amenable to catheter ablation [74,84]. When Sandhu et al. prospectively performed cryoablation on adults with TOF and inducible ventricular tachycardia during PVR surgery, 45% still had inducible ventricular tachycardia after ablation [87]. Another more promising small case series demonstrated no recurrent arrhythmia an average of 5 years after catheter ablation combined with antiarrhythmic therapy [88].