From the FDA Drug Label
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From the Research
The next step in managing this 80-year-old female patient with wide complex tachycardia and nonsustained ventricular tachycardia (NSVT) on Holter monitor should be a comprehensive cardiac evaluation including an echocardiogram to assess cardiac structure and function, particularly left ventricular function, as NSVT is a significant prognostic indicator for life-threatening ventricular arrhythmia events, as shown in a recent meta-analysis 1. The patient should be referred to a cardiologist for urgent consultation. Initial management should include:
- Correction of any electrolyte abnormalities, especially potassium and magnesium levels, as these can trigger arrhythmias.
- If the patient is hemodynamically stable, beta-blockers such as metoprolol 25-50mg twice daily should be considered to suppress ventricular arrhythmias, unless contraindicated. Given her recent hospitalization for cellulitis and osteomyelitis, it's essential to ensure adequate treatment of the infection, as systemic inflammation can exacerbate cardiac arrhythmias. Additionally, a 12-lead ECG should be performed to further characterize the arrhythmia and rule out structural abnormalities. The patient's medication list should be reviewed for QT-prolonging drugs that might contribute to ventricular arrhythmias. This comprehensive approach is necessary because NSVT in elderly patients, particularly with comorbidities, can indicate underlying cardiac disease and carries risk for sustained ventricular tachycardia, which can be life-threatening if not properly managed, as highlighted in recent studies 1.