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Monomorphic ventricular tachycardia — SCE Acute Medicine MCQ

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HardAcute Cardiac PresentationsMonomorphic ventricular tachycardiaSCE Acute Medicine

A 61-year-old man with previous myocardial infarction presents with palpitations and light-headedness. ECG shows regular broad-complex tachycardia at 156/min with AV dissociation. Blood pressure is 118/72 mmHg and he is alert. Serum potassium is 4.4 mmol/L and magnesium is normal. What is the most appropriate next step in management?

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Correct answer: A — Treat as ventricular tachycardia and give intravenous amiodarone

Broad-complex tachycardia in a patient with structural heart disease should be treated as VT unless proved otherwise. He is currently stable, so IV amiodarone and expert review are appropriate. Verapamil can cause cardiovascular collapse in VT. The pearl is that AV dissociation is a strong clue to VT, but management should already be cautious in post-MI broad-complex tachycardia.

Reference: Resuscitation Council UK ALS