ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction:
7.7.1.2. Ventricular Tachycardia
Class I
1. Sustained (more than 30 seconds or causing hemodynamic collapse) polymorphic VT should be treated with an unsynchronized electric shock with an initial monophasic shock energy of 200 J; if unsuccessful, a second shock of 200 to 300 J should be given, and, If necessary, a third shock of 360 J. (Level of Evidence: B)
2. Episodes of sustained monomorphic VT associated with angina, pulmonary edema, or hypotension (blood pressure less than 90 mm Hg) should be treated with a synchronized electric shock of 100 J of initial monophasic shock energy. Increasing energies may be used if not initially successful. Brief anesthesia is desirable if hemodynamically tolerable. (Level of Evidence: B)
3. Sustained monomorphic VT not associated with angina, pulmonary edema, or hypotension (blood pressure less than 90 mm Hg) should be treated with:
a. Amiodarone: 150 mg infused over 10 minutes (alternative dose 5 mg/kg); repeat 150 mg every 10 to 15 minutes as needed. Alternative infusion: 360
mg over 6 hours (1 mg/min), then 540 mg over the next 18 hours (0.5 mg/min). The total cumulative dose, including additional doses givenduringdiac arrest, must not exceed 2.2 g over 24 hours. (Level of Evidence: B)
b. Synchronized electrical cardioversion starting at monophasic energies of 50 J (brief anesthesia is necessary). (Level of Evidence: B)
Class IIa
It is reasonable to manage refractory polymorphic VT by:
a. Aggressive attempts to reduce myocardial ischemia, and adrenergic stimulation, including therapies such as beta-adrenoceptor blockade, IABP use, and consideration of emergency PCI/CABG surgery. (Level of Evidence: B)
b. Aggressive normalization of serum potassium to greater than 4.0 mEq/L and of magnesium to greater than 2.0 mg/dL. (Level of Evidence: C)
c. If the patient has bradycardia to a rate less than 60 bpm or long QTc, temporary pacing at a higher rate may be instituted. (Level of Evidence: C)
Нельзя не признать правоту данного руководства, а еще - ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death.
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