266.4 📌 章末速蚘

266.4.0.0.1 Spectrum
  • PVCs (benign usually; ablation if symptomatic + LV dysfunction)
  • NSVT (≥ 3 beats < 30 sec)
  • Sustained VT (monomorphic vs polymorphic)
  • VF (chaotic)
  • Torsades de pointes (polymorphic VT + QT prolongation)
266.4.0.0.2 Sudden Cardiac Death (SCD)
  • ~ 50% of CV deaths
  • Ischemia (60-80%) > structural > channelopathy
  • ~ 7-9 million deaths globally
266.4.0.0.3 ICD Primary Prevention
  • HFrEF EF ≀ 35% + NYHA II-III on optimal Tx ≥ 3 months
  • HCM with risk factors (family SCD, syncope, NSVT, LVH ≥ 30 mm, abnormal BP exercise, LGE)
  • LQTS with recurrent syncope despite β-blocker
  • Brugada + cardiac arrest / syncope
  • CPVT + recurrent VT despite β-blocker
  • ARVC + high-risk features
266.4.0.0.4 Acute VT/VF Management
  • Pulseless VT/VF: immediate defibrillation (200 J biphasic) + CPR + epinephrine + amiodarone 300 mg IV
  • Stable sustained VT: procainamide IV (PROCAMIO) or amiodarone or lidocaine
  • Unstable sustained VT: synchronized cardioversion
  • Torsades: magnesium 2 g IV + correct K + Mg + Ca + stop offending drug
266.4.0.0.5 Long QT Drugs
  • Antiarrhythmics + macrolides + FQ + antifungals + antipsychotics + antidepressants + methadone + ondansetron
266.4.0.0.6 Channelopathies
  • LQT1 (KCNQ1, exercise) → β-blocker
  • LQT2 (KCNH2, startle) → β-blocker
  • LQT3 (SCN5A, sleep) → β-blocker + mexiletine
  • Brugada → ICD + quinidine for storm
  • CPVT → β-blocker + flecainide + LCSD for refractory
  • ARVC → ICD + exercise restriction
266.4.0.0.7 Wide-Complex Tachycardia
  • Treat as VT until proven otherwise
  • Brugada algorithm
  • Stable: procainamide IV
  • Unstable: cardioversion
266.4.0.0.8 Familial Screening
  • First-degree relatives of SCD victims
  • ECG + echo + cardiac MRI + Holter + exercise + genetic testing
266.4.0.0.9 盧醫垫 hint
  • Sustained wide-complex tachycardia + unstable: synchronized cardioversion
  • Stable wide-complex tachycardia: procainamide IV (PROCAMIO)
  • Torsades + QT prolonged: magnesium IV + correct electrolytes + stop offending drugs
  • HFrEF EF ≀ 35% + NYHA II-III: ICD primary prevention
  • HCM + family hx SCD + LGE + LVH ≥ 30 mm: ICD
  • Familial SCD survivor’s relatives: comprehensive screening
  • Brugada + cardiac arrest: ICD; avoid Na+ channel blockers + fever
  • CPVT + recurrent VT: β-blocker + flecainide + LCSD if refractory