Key Points
- Confirm diagnosis early with highest-yield tests (e.g., MRV for CVST, CTA for mesenteric ischemia).
- Dose-and-route precision for high-risk medications; monitor for adverse effects.
- Explicit ICU criteria and consultation triggers.
Clinical Synopsis & Reasoning
Polymorphic VT with prolonged QT; correct precipitants (electrolytes, QT-prolonging meds), give magnesium, increase heart rate via overdrive pacing or isoproterenol if bradycardic, and treat hemodynamic instability per ACLS.
Treatment Strategy & Disposition
Stabilize airway/breathing/circulation; initiate guideline-concordant first-line therapy; tailor escalation or de-escalation to clinical response and objective metrics; define clear disposition criteria (e.g., ICU triggers, ward acceptability, outpatient safety).
Epidemiology / Risk Factors
- Risk varies by comorbidity and precipitating factors
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| CBC | Anemia/leukocytosis | Context-specific | Trend with therapy |
| BMP | Electrolytes/renal | Derangements common | Renal dosing |
| Condition-specific imaging | See topic | Diagnostic hallmark | Do not delay when red flags present |
Pharmacology
| Medication | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Magnesium sulfate | Stabilizes myocardium | Minutes | 2 g IV bolus; may repeat | Flushing, hypotension |
| Isoproterenol / Pacing | β-agonist / Device | Minutes | Increase HR to shorten QT in pause-dependent TdP | Avoid in ischemia |
| Potassium chloride | Electrolyte | Immediate | Replete to high-normal (e.g., 4.5–5.0) | Avoid hyperkalemia |
Prognosis / Complications
- Outcome depends on timeliness of diagnosis and definitive therapy
Patient Education / Counseling
- Explain red flags, adherence, and follow-up plan
References
- Authoritative guideline/review; see internal bibliography — Link