Beta Blocker & Stable VTach

[slr]

I have something in my book that says: "NEVER give IV beta blockers to a patient in stable VTach"

Anyone know the reason for this? I've searched *everywhere*

Tx

Steve

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[TMP-SMX]

Because some IV beta blockers don't work in emergent stable VT. Others do because their other MoAs like those of sotalol on blocking the cardiac potassium channels and not having any beta antagonist activity on the heart. Ca++ channel blockers like verapamil can precipitate Vfibb if used. Either way, they aren't first line like procainamide is then amiodarone. FYI, I had fun revisiting amiodarone in the endocrine unit and its effect on the thyroid due to it being full of iodine.

 

[indo]

I don't think you want to use any agent that slows the conduction through the AV node in any kind of ventricular dysrhythmia. So, no Adenosine, ca2+ blockers, Amiodarone, I think is or was used in monomorphic (stable) vtach. Intraoperatively the patient would be on bypass while the pacing wires are being installed. Post-operatively, you should hope that nobody has removed the pacing wires on accident. On a cardiology floor they might treat with magnesium, sotalol, procainamide, and eventually use pacing.

Stable Vtach is just asympomatic vtach...if it turns to vfib it will become a disaster