MAT là thường nhất có liên quan với tình trạng thiếu oxy trong các thiết lập của bệnh phổi, nhưng đôi khi có thể là do sử dụng của theophylline, rối loạn trao đổi chất, và bệnh cơ tim giai đoạn cuối. | CARDIAC ARRHYTHMIAS IN THE ICU TARDITI HOLLENBERG 225 and PR intervals. MAT is most often associated with hypoxia in the setting of pulmonary disease but may occasionally be due to use of theophylline metabolic derangements and end-stage cardiomyopathy. Treatment consists of correcting hypoxia by either or both treating underlying pulmonary disease and correcting electrolyte AV nodal blockers are sometimes useful to control the ventricular response in the interim. WIDE COMPLEX TACHYCARDIA The most frequently reported tachyarrhythmia in the ICU setting is a wide complex tachycardia. The first step in treatment is establishing the diagnosis because VT is more ominous than SVT with aberrancy. VT is defined by three or more consecutive ventricular beats. Sustained VT is defined as more than 30 seconds of ventricular beats at a rate of more than 100 28 Initial evaluation should include obtaining a 12-lead ECG and measurement of serum potassium calcium and magnesium. The ECG should be examined and compared with prior ECGs with attention to QRS width in sinus rhythm prior Q waves that may indicate prior myocardial infarction MI the presence of delta waves as well as the QT interval. A careful review of medications is paramount in excluding iatrogenic causes of VT. VT can be diagnosed using some clinical and electrocardiographic clues as outlined following here 1. Play the odds. VT is approximately four times more common than SVT with aberrancy. In one study of 200 consecutive patients with a wide QRS tachycardia 164 were ventricular 30 were SVT with aberrancy and six were SVT with antegrade 2. Ask the right questions. VT is much more common in patients who have a history of MI or heart failure. 3. Do not rely on hemodynamics alone. Circulatory collapse is more common with VT than with SVT but patients with VT may maintain a normal blood pressure. 4. Do not count on AV dissociation. This is present in less than 50 of cases of VT and .
