A 66yoM with advanced CHF s/p LVAD, who was in his usual state of health, presents because he felt his AICD fire multiple times. In the ED, his rhythm shows ventricular tachycardia. A pulse, blood pressure or oxygen saturation cannot be obtained but the patient appears well, is mentating well, and has no complaints. What is the risk of allowing this patient to remain in VT for an extended period of time?
Answer: Right ventricular failure or a thromboembolic event. Electric cardioversion should be considered, particularly if the patient is unstable. The LVAD team should be spoken to before an attempt is made as they may be able to internally defibrillate the patient. Initial or concomitant pharmacological management is also an option. Check the link for a similar case
Credit to Phil Blanc for the case.