The management of<unk><unk>  tachycardia should begin by assessing the patient's ABCs (airway, breathing, and circulation).  If the patient is unstable and either hypotension, altered mental status, chest pain, heart failure or seizures are present, then immediate synchronized cardioversion should be performed.  If the patient is stable, the optimal management depends upon the differentiation of ventricular tachycardia versus supraventricular tachycardia with aberrant conduction as a cause of the<unk><unk>  tachycardia.  A<unk><unk>  tachycardia should be assumed to be and managed as though it is due to ventricular tachycardia until proven otherwise.  This is true even in a hemodynamically stable patient until proven otherwise (VT can often be hemodynamically stable).  The initial management strategy includes avoiding the use of a long acting AV nodal blocking agent and drugs that suppress left ventricular contractility such as verapamil which can induce hypotension in a previously stable patient.
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