Mattu Recent Cardiol Articles Youve Got To Know Icem 2023 Litupdates

6/12/2023
Interested in some further

learning opportunities?
Check out these courses….
• Interested in short weekly video tutorials on

electrocardiography?
– Check out www.ecgweekly.com
– Subscription fee < cost of a cup of coffee/week
– Covers every aspect of electrocardiography imaginable,
focused on emergency medicine
– Subscription discounts for groups
– Click on “sample case” at the top of web page to

try it out
1
6/12/2023
Let’s meet in Rome for some great

CME! September 21-23, 2023
www.CORConference.com
Online 2-day Cardiology and

Advanced ECG Courses
Next course Nov 13-14, 2023
Check out www.EMCardio.com
Day 1
AM: Electrocardiography of Cardiac Ischemia
PM: ACS ECG Mimics, Syncope
Day 2
AM: Dysrhythmias
PM: Finish Dysrhythmias, WCTs
4
2
6/12/2023
Recent Cardiology Articles

You’ve Got to Know!
Amal Mattu, MD, FAAEM, FACEP

Professor and Vice Chair
Department of Emergency Medicine
University of Maryland School of Medicine
Baltimore, Maryland
Amal Mattu, MD, FAAEM, FACEP
No financial relationships with drug or

device-manufacturing companies
6
3
6/12/2023
Recent Cardiology Articles

You’ve Got to Know!
Full PDF copy of the slides can be downloaded at:
lectures.umem.org/LiteratureUpdates
Case
• 58 yo M presents with intermittent episodes
of palpitations
– History of cardiomyopathy, EF 30%
– Associated with lightheadedness, near- syncope
– 4 episodes today
4
6/12/2023
Case
• 58 yo M presents with intermittent episodes
of palpitations
– History of cardiomyopathy, EF 30%
– Associated with lightheadedness, near- syncope
– 4 episodes today
– On arrival he is currently having an episode
– ECG...
Case
10
5
6/12/2023
Case
11
Case
12
6
6/12/2023
Case
13
Case
14
7
6/12/2023
Case
15
Case
16
8
6/12/2023
Case
17
Recurrent Ventricular
Tachycardia
18
9
6/12/2023
”Electrical Storm”
19
Am J Emerg Med 2020
Eur Heart J—Acute

Cardiovasc Care 2018
20
10
6/12/2023
J Am Coll Cardiol
June 2023
21
• > 3 episodes of sustained VT, VF, or receipt of
appropriate shocks from an ICD within 24
hours
– May include incessant VF
22
11
6/12/2023
• > 3 episodes of sustained VT, VF, or receipt of
appropriate shocks from an ICD within 24
hours
– May include incessant VF
• Often occurs in patients with sick hearts

– CMPY, low EF, prior MIs, patients with ICDs
23
• Common precipitants
– Electrolyte abnormalities (hypoK, hypoMg)
– Binge drinking
– Acute infections
– Acute cardiac ischemia, heart failure
– Thyrotoxicosis
– Drug toxicities
– Antiarrhythmic medications (esp. Type IA)
24
12
6/12/2023
• Elevated sympathetic tone is common
25
tachycardia
emotional distress
pain from shocks
26
13
6/12/2023
tachycardia
emotional distress
pain from shocks
27
• Treatment
28
14
6/12/2023
• Treatment
– If unstable and ongoing  shock!
29
• Treatment
– If stable and ongoing/intermittent...meds...
• Polymorphic VT  Look for underlying cause and
treat aggressively, based on QTc
30
15
6/12/2023
• Treatment
–Normal QTc  cardiac ischemia, Brugada
31
• Treatment
–Long QTc  electrolytes, meds, etc.
»Mg++, overdrive pacing, etc.
32
16
6/12/2023
• Treatment
• Monomorphic VT  Amiodarone
• βBs help with sympathetic tone
33
• Treatment
• Non-selective βBs  better CNS penetration
JACC 2018
34
17
6/12/2023
• Treatment
• Non-selective βBs  better CNS penetration
• Sedation, e.g. propofol
35
• If patient converts to sinus rhythm...
– Sedation
– Look for and treat underlying cause
• Monomorphic?  empiric amiodarone
• PVT with normal QTc?  tx ACS, Brugada, etc.
• PVT with long QTc?  empiric Mg++
– Admit for further workup and tx!!
36
18
6/12/2023
Case
• Unfortunately...
37
Case
• Unfortunately...
38
19
6/12/2023
• What if...repeat defibs aren’t working!
39
• Incessant/intractable VF
40
20
6/12/2023
– Double sequential defibrillation?
41
Circulation 2020
Resuscitation 2020
AJEM 2020
AJEM 2020
Resuscitation 2020
AJEM 2020
42
21
6/12/2023
• Appears promising when used early (after 3rd
shock) and with A-P pad placement
Resuscitation 2020
43
• Appears promising when used early (after 3rd
shock) and with A-P pad placement
N Engl J Med 2022
44
22
6/12/2023
– β-blockade?
45
– β-blockade? Ann Emerg Med 2020
Resuscitation 2020
46
23
6/12/2023
– β-blockade  low level evidence suggesting
improved rates of ROSC and survival with
favorable neurologic outcome
47
Case
• 58 yo M presents with intermittent
episodes of palpitations
48
24
6/12/2023
Case
– Monomorphic VT
• Amiodarone
• Shocked x 2 (midazolam sedation)
49
Case
– Monomorphic VT
• Amiodarone
– VF
• Defib x 2, then DSD
• Propranolol, propofol, RSI
• DSD again
50
25
6/12/2023
Case
– Monomorphic VT
• Amiodarone
– VF
• Defib x 2, then DSD
• Propranolol, propofol, RSI
• DSD again  converted
51
Case
– Received an ICD
– Good neurologic outcome, discharged 1 week
later
52
26
6/12/2023
Takehome Points
53
Takehome Points
• Electrical storm
– For monomorphic VT
• Amiodarone
• Suppress catecholamines  βBs, sedation
• Shock when needed
54
27
6/12/2023
Takehome Points
• Amiodarone
– For incessant VF
• Consider DSD after 3rd shock, A-P pad position
• Give βBs
55
Takehome Points
• Amiodarone
– For incessant VF
• Consider DSD after 3rd shock, A-P pad position
• Give βBs
– Look for and treat the underlying cause
56
28
6/12/2023
Thanks!
amalmattu@comcast.net
57
Download slides at
lectures.umem.org/Literature Updates
58
29

Mattu Recent Cardiol Articles Youve Got To Know Icem 2023 Litupdates

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Mattu Recent Cardiol Articles Youve Got To Know Icem 2023 Litupdates

Uploaded by

Copyright:

Available Formats

6/12/2023

Interested in some further

Check out these courses….

• Interested in short weekly video tutorials on

– Click on “sample case” at the top of web page to

Let’s meet in Rome for some great

Online 2-day Cardiology and

Recent Cardiology Articles

Amal Mattu, MD, FAAEM, FACEP

Amal Mattu, MD, FAAEM, FACEP

No financial relationships with drug or

Recent Cardiology Articles

Full PDF copy of the slides can be downloaded at:

Am J Emerg Med 2020

Eur Heart J—Acute

• Often occurs in patients with sick hearts

pain from shocks

pain from shocks

N Engl J Med 2022

You might also like