ZyraDoc #11 - August 13, 2026

A 65-year-old man with a history of ischemic cardiomyopathy presents with sustained monomorphic ventricular tachycardia at 175 beats per minute.

Because he is initially hemodynamically stable, a 150 mg IV amiodarone bolus is administered over 10 minutes.

During the infusion, the arrhythmia persists, and he develops severe central chest pain, diaphoresis, and a blood pressure drop to 82/48 mmHg.

Case Summary

Clinical Focus:

A 65-year-old male with sustained monomorphic ventricular tachycardia who initially presents hemodynamically stable deteriorates into unstable VT following chemical antiarrhythmic administration.

Unstable Ventricular Tachycardia is associated with:

Tachyarrhythmia originating below the AV node with wide QRS complexes (> 0.12 seconds)
Presence of acute hemodynamic instability or end-organ hypoperfusion: severe hypotension, acute ischemic chest pain, altered mental status, or acute pulmonary edema

When a patient with ventricular tachycardia exhibits signs of acute hemodynamic instability, immediate electrical synchronization takes absolute priority over further chemical antiarrhythmic therapy.

Here is the Management Strategy:

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