This handout is for stemi complicated by ventricular electrical storm (≥3 sustained vt/vf/24 h). Your care team identified this based on: ≥3 episodes sustained vt/vf (or appropriate icd therapies) within 24 h post-mi = electrical storm.
Other reasons your team may use this plan: recurrent polymorphic vt on telemetry post-mi — peri-infarct ischemia until proven otherwise; recurrent appropriate icd shocks in post-mi patient (≥3 in 24 h) → icd storm.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| aspirin | 162-325 mg chewed | PO | load + 81 mg daily | ACC/AHA 2025 ACS Class I; same as parent |
| ticagrelor | 180 mg load → 90 mg BID | PO | BID × 12 mo | PLATO PMID 19717846; same as parent |
| metoprolol_iv | 5 mg IV q5min × 3 doses; titrate to HR 60-80 + storm suppression | IV | q5min × 3 then PO | AHA 2017 VA management Class I (PMID 29084731) — IV beta-blocker is first-line storm therapy; sympathetic surge drives storm |
| amiodarone | 150 mg IV bolus over 10 min → 1 mg/min × 6 h → 0.5 mg/min | IV | continuous infusion × 24 h | AHA 2017 VA management Class IIa (PMID 29084731); ALIVE trial; first-line AAD for storm + post-arrest VT/VF |
| lidocaine | 1-1.5 mg/kg IV bolus → 1-4 mg/min infusion | IV | continuous infusion | AHA 2020 ACLS Class IIb alternative when amiodarone unavailable or refractory; particularly useful in ischemic substrate |
| magnesium_sulfate | 2 g IV bolus over 5-10 min; repeat × 1-2 if torsades or persistent storm | IV | bolus | Class I for torsades; empiric repletion in storm regardless of serum level — intracellular Mg often depleted; AHA 2020 ACLS |
| propofol | 1-2 mg/kg IV bolus then 25-100 mcg/kg/min infusion (intubate first) | IV | continuous infusion | Deep sedation breaks the catecholamine-driven storm cycle; propofol preferred (rapid titration); intubation required; AHA 2017 VA Class IIa |
Plan: STEMI electrical-storm overlay — adds IV beta-blocker + amiodarone + lidocaine + magnesium + deep sedation to parent cardio.stemi.core.v1 reperfusion regimen
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Cardiology + EP follow-up; ICD secondary-prevention per AVID PMID 9411221 (any sustained VT/VF post-acute period not from reversible cause); WCD bridge during peri-MI window if EF <35; cardiac rehab; mental health (PTSD risk after recurrent shocks)
Guideline: 2025 ACC/AHA ACS Guideline + AHA 2017 VA Management Consensus + ESC 2022 Ventricular Arrhythmias