In an unstable ventricular tachycardia with a pulse, what is the recommended treatment?

In the setting of unstable ventricular tachycardia (VT) with a pulse, the recommended treatment is synchronized cardioversion. Synchronized cardioversion involves delivering an electrical shock at a specific point in the cardiac cycle, which is coordinated with the R wave of the QRS complex. This synchronization helps to avoid the critical phase of the cardiac repolarization (the T wave), thus minimizing the risk of precipitating ventricular fibrillation.

When a patient presents with unstable VT, they may exhibit symptoms such as hypotension, altered mental status, chest pain, or shortness of breath, indicating that the arrhythmia is compromising their hemodynamic status. Given these serious symptoms, immediate intervention is necessary to restore a stable rhythm and correct the underlying instability.

Other treatments listed, such as defibrillation, are utilized for pulseless VT or ventricular fibrillation but are not appropriate for unstable VT with a pulse. Medications like amiodarone can be effective for managing certain arrhythmias, but in cases of acute instability, immediate mechanical intervention with synchronized cardioversion is preferred for a rapid response to restore normal rhythm and hemodynamics. IV magnesium is generally used in contexts like torsades de pointes and is not a first-line