NTG for VT ?

[daj72]

A colleagues and I have a little debate;

If an awake patient has VT (+180) with a BP of approximately 100/something.
The ECG shows depression due to the rapid pulse! but orienterteret and dry skin, but complain of chest pain would you give Nitroglycerin?

 

[STXmedic]

No. Fix the VT, and you're likely to fix the chest pain.

 

[NYMedic828]

Why would NTG even be of consideration?

NTG is a large vessel dilator for reducing preload/afterload in an overworked heart be it chronic or acute in nature.

If anything with VT, reducing preload would further hinder the already poor/non-existent ventricular filling.

Anything that reduces blood flow to the heart or heavily increases workload will will cause chest pain. VT does both.

Fix the VT, underlying problems diminish.

It's like fighting a fire, there may be someone in the building trapped but if I put out the fire, my problems go away. (don't take that very literally)


Mind you, if the cause of VT is insult to the heart, you may still have chest pain. But VT is easily the primary concern.

 

[daj72]

No. Fix the VT, and you're likely to fix the chest pain.

Thank you. That's what I say.

I say that the pain is triggered by the VT and not by e.g. ACS. But I can not get him to understand it! :blink:

 

[NYMedic828]

Thank you. That's what I say.

I say that the pain is triggered by the VT and not by e.g. ACS. But I can not get him to understand it! :blink:

Mind you VT can and often does follow severe MI.

So technically, you are both right in some situations.

 

[MSDeltaFlt]

Fix the problem and you'll fix the symptom. Convert the VT and you'll more than likely fix the pain.

 

[Merck]

VT + NTG = horrible idea.

 

[Veneficus]

So the question is:

When you see a condition that creates acute pathology because of lack of prefil is the plan is to reduce the prefil further a good idea?

...

What exactly is the physiologic argument to use nitro?

Because I really don't understand why anyone would try to differentiate an ACS of angina from an MI in the field when the number one lethal complication of MI is arrhythmia and you are looking at it on the monitor.

I have seen unstable angina cause both A-fib and VT. But that was diagnosed and treated in the cardiac ICU.

 

[Doczilla]

Depression might come from early global ischemia due to the tachycardia.

In a peri-arrest rhythm, the goal is to terminate the rhythm. In the event it turns into a pulseless v-tach, we not only terminate the rhythm using juice, we terminate it or at least supress with an anti-arrythmic.

What other drug do we use? Vasopressors. This is to boost coronary perfusion pressure as an adjunct to CPR. We all know this.

If you think about how nitro controls cardiac "pain", it refers to pain from partial or subendocardial ischemia due to vasospasm or blockage. If the pain is from v tach, its a safe bet that its from low CPP from global ischemia cause of the low cardiac output.

What's nitro going to do to CPP when its already low? What about the reflex tachycardia when you tank the blood pressure?

Something for your "collegues" to consider.

 

[Doczilla]

So the question is:

When you see a condition that creates acute pathology because of lack of prefil is the plan is to reduce the prefil further a good idea?

...

What exactly is the physiologic argument to use nitro?

Because I really don't understand why anyone would try to differentiate an ACS of angina from an MI in the field when the number one lethal complication of MI is arrhythmia and you are looking at it on the monitor.

I have seen unstable angina cause both A-fib and VT. But that was diagnosed and treated in the cardiac ICU.

Damn, beat me to it. <_<