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Old 03-28-2014
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Default VF / VT after MI

how do we treat VA/VF after MI , it is supposed by cardioversion and other meausres for traeting VF/VT but in MBT2 it mentions that it should be treated by angioplasty??
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Old 03-28-2014
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its depend stability of patient..
VT+stable=lidocaine
VT+unstable(confuse,SOB,persistent pain..)=CARDIOVERSION...rule to do shock is=shock x3 -->lidocaine-->shockx3-->lidocaine /additinal to this need to give magnesium for torsades
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Old 03-29-2014
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Quote:
Originally Posted by DrAGA View Post
its depend stability of patient..
VT+stable=lidocaine
VT+unstable(confuse,SOB,persistent pain..)=CARDIOVERSION...rule to do shock is=shock x3 -->lidocaine-->shockx3-->lidocaine /additinal to this need to give magnesium for torsades

I understand this , but at end of MTB 2 there is a question on page 559 and the pateint got VT after MI and th right choice was angioplasty , my question is why we used this , not the regular treatment that you mentioned above for VT ???
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Old 03-29-2014
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I havent seen that question, but my guess would be that it would depend on the whole context and the "initial" vs "definitive" crap in this exam

For example, if a patient turned up in the ER with cardiac chest pain and then had a VF/VT arrest, the definitive management would be PCI (or thrombolysis if PCI wasnt available within 90mins), although the initial management would be to attempt to cardiovert out of VF/VT as per the ACLS protocol. In some cardiac centers both are done simultaneously in the cath lab.


Also to my knowledge amiodarone is currently preferred over lidocaine for chemical cardioversion of VT? (and in pulseless VT or VF in ACLS)
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Old 03-30-2014
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Quote:
Originally Posted by USMLEUK. View Post
I havent seen that question, but my guess would be that it would depend on the whole context and the "initial" vs "definitive" crap in this exam

For example, if a patient turned up in the ER with cardiac chest pain and then had a VF/VT arrest, the definitive management would be PCI (or thrombolysis if PCI wasnt available within 90mins), although the initial management would be to attempt to cardiovert out of VF/VT as per the ACLS protocol. In some cardiac centers both are done simultaneously in the cath lab.


Also to my knowledge amiodarone is currently preferred over lidocaine for chemical cardioversion of VT? (and in pulseless VT or VF in ACLS)


thanks for this , the question is in arrythmia bonus question page 559 as i have in MTB 2 , and the patient is on second day of MI , my question is why we used angioplasty , why not the regular treatment for VT/VF and is that regular for management of VT as a complication for MI ???

i hope any one can read the question and explain , thanks
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Old 03-31-2014
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i am ot sure but i think second day postMI WITH VT DUE TO SEPTAL or valve rupture so angioplasty can be most accurate tx...
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Old 04-01-2014
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Quote:
Originally Posted by hydrocephalus View Post
thanks for this , the question is in arrythmia bonus question page 559 as i have in MTB 2 , and the patient is on second day of MI , my question is why we used angioplasty , why not the regular treatment for VT/VF and is that regular for management of VT as a complication for MI ???

i hope any one can read the question and explain , thanks
If you post the whole question maybe we'll be able to work at it?
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Old 05-21-2014
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it is women who had MI and got to hospital , on second day she has Vt , what is most appropriate next step ??
and the answer is angiography for angioplasty or bypass
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Old 05-21-2014
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Quote:
Originally Posted by hydrocephalus View Post
it is women who had MI and got to hospital , on second day she has Vt , what is most appropriate next step ??
and the answer is angiography for angioplasty or bypass
u do bypass if 3 there is 3 vessel involvement, Left main coronary or DM with 2 vessel involvement (MTB2 p62)
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Old 05-21-2014
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They didn't mention thrombolytics or PCI in the management of patient on the first day. Sure enough her ischemia isn't getting by the meds she is taking. The time for thrombolytic is finished in 12 hrs but angioplasty can still be done. Moreover there is no choice of cardioversion or amiodarone/lidocaine in the question also it's v tach with stable patient because they didn't write hemodynamics . Ischemia is what needs to be corrected.
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