Condition- Ventricular fibrillation

Question 1

Define Ventricular Fibrillation

Answer 1

Irregular broad complex tachycardia

Can cause cardiac arrest and sudden death

Question 2

What happens to the cardiac muscle in VF?

Answer 2

• Ventricular fibres contract randomly causing complete failure of ventricular function

Question 3

List some risk factors leading to the development of VF

Answer 3

• Thrombus (coronary artery syndrome)
• Toxins (drugs)
• Hypoxia
• Hyper/hypokalaemia
• Cardiomyopathy
• Congenital Heart Disease (WPW, long QT, valvular disease)
• AF

Question 4

List some of the symptoms of VF

Answer 4

• Chest pain
• Fatigue
• Palpitations

Question 5

List some pre-existing conditions a patient with VF may have

Answer 5

• Coronary artery disease
• Cardiomyopathy
• Valvular heart disease
• Long QT syndrome
• Wolff-Parkinson-White syndrome

Question 6

What does this ECG show and why?

Answer 6

VF = very fucked up

• chaotic irregular defections
• No p waves, QRS complexes or T waves

Question 7

Other than ECG which investigations might you need to conduct on someone with VF?

Answer 7

• Cardiac enzymes (trops)
• TFTs
• Electrolyte levels
• Drugs + Tox screen
• Coronary angiography to check myocardial perfusion

Question 8

How would you manage a patient acutely presenting with VF?

Answer 8

• VF requires urgent defibrillation and cardioversion à non-synchronised DC shock

Question 9

What will VF survivors need as part of their long-term management?

Answer 9

1. Full assessment of heart function and perfusion and bloods
2. Most survivors will need an implantable cardioverter defibrillator (ICD)
3. Empirical beta-blockers
4. Some may be treated with radiofrequency ablation (RFA)

Question 10

What is the main complication seen in survivors of VF? List two other complications

Answer 10

• Anoxic encephalopathy due to loss of CO
• Post-defib arrhythmias
• Myocardial injury
• Skin burns
• Sudden cardiac death

Question 11

For a patient with VF to survive, how quickly must they be defibrillated?

Answer 11

Within 4-6mins of onset