Nonsustained ventricular tachycardia is usually asymptomatic because of its short duration, but some patients complain about palpitations. It can be recorded at rest in asymptomatic individuals [1] and it can be a part of the “athlete's heart syndrome” [2]. In trained athletes with no structural heart disease, genetic channelopathies and early repolarization, it is considered to be benign, as it disappears during deconditioning periods [3]. However, the physician must inquire about the use of potentially proarrhythmic drugs and personal and familial history of heart disease, syncope and sudden death [4].

Longer arrhythmic episodes can cause lightheadedness and anxiety. Syncope, diaphoresis, pallor, hypotension and dyspnea are not usually encountered with nonsustained ventricular tachycardia episodes, but rather with sustained ones. Physical examination may reveal cannon a-waves if atrial fibrillation or flutter is absent and a variation of the first heart sound’s intensity on auscultation. However, these findings are only present during the acute episode, therefore the physician only finds them if he or she examines the patient during those few seconds, so the patient must have already been admitted to a hospital.

• Hypoxemia

  Sinus tachycardia Common Rule out hypoxemia and hypovolemia; provide adequate analgesia; evaluate for congestive heart failure. [aafp.org]

• Weight Loss

  Weight loss suggests hyperthyroidism. Palpitation can be precipitated by vomiting or diarrhea that leads to electrolyte disorders and hypovolemia. [en.wikipedia.org]

• Heart Disease

  Nonsustained ventricular tachycardia (NSVT) may trigger concern, particularly in patients with known congestive heart failure, structural heart disease, or prolonged QT interval. [ncbi.nlm.nih.gov]

  […] with known congestive heart failure, structural heart disease, or prolonged QT interval. [jhu.pure.elsevier.com]

  Random finding No adverse prognostic significance in the absence of occult pathology During or postexercise May predict IHD and increased cardiac mortality Ischemic heart disease Acute MI No adverse prognostic significance Ischemic heart disease Acute [gpnotebook.co.uk]

  Abstract In brief Nonsustained ventricular tachycardia can occur in athletes and healthy individuals in the absence of organic heart disease. [tandfonline.com]

• Hypertension

  SCD has been reported to account for approximately 30% of deaths in patients with pulmonary arterial hypertension (PAH). Objective. [ncbi.nlm.nih.gov]

  NSVT IN HYPERTENSION AND VALVE DISEASE The prognostic value of NSVT in patients with hypertension (without evidence for concomitant IHD) remains unclear. [heartlandcardiology.com]

  Introduction Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are characterized by progressive obliteration of precapillary pulmonary vessels leading to an increased pulmonary vascular resistance (PVR). [hindawi.com]

• Cardiac Signs and Symptoms

  The book and DVD package is designed to provide comprehensive coverage of every aspect of cardiovascular medicine from cardiac signs and symptoms and the full range of cardiac imaging techniques through management of peripheral vascular disease and the [books.google.it]

• Seizure

  Others may experience: Dizziness Shortness of breath Lightheadedness Feeling as if your heart is racing (palpitations) Chest pain (angina) Seizures Sustained or more serious episodes of ventricular tachycardia may cause: Loss of consciousness or fainting [mayoclinic.org]

  The presenting symptoms vary considerably based on the clinical scenario but may include palpitations, lightheadedness, dyspnea, angina, syncope, seizures, and shock. Patients may be clinically stable, unstable, or non-perfusing (pulseless VT). [clinicaladvisor.com]

• Agitation

  Signs reflect the degree of haemodynamic instability, including respiratory distress, basal fine lung crepitations, raised JVP, hypotension, anxiety, agitation, lethargy, coma. [patient.info]

Nonsustained ventricular tachycardia patients must undergo a thorough cardiac evaluation. The most frequent causes of the disease in middle-aged individuals are myocardial ischemia, valve diseases and cardiomyopathies, whereas younger people may suffer from long QT syndrome, arrhythmogenic right ventricular cardiomyopathy or Brugada syndrome.

Blood workup should include potassium, calcium, magnesium and phosphate evaluation, as well as measurement of serum digoxin and tricyclic antidepressants levels or toxicology screening where appropriate. Cardiac troponins should also be measured when acute myocardial ischemia is suspected.

A simple electrocardiogram is able to pinpoint the approximate location of the ventricular contractions and to describe the tachycardia as monomorphic or polymorphic. The location of the R/S transition may predict the presence of arrhythmogenic right ventricular cardiomyopathy [5], whereas the duration of the cardiac cycle during the episode is an indicator of concomitant polymorphic ventricular tachycardia [6]. Holter monitoring is usually indicated in symptomatic patients and accurately describes arrhythmic episodes [7]. Further information is added by electrophysiology testing. In patients where arrhythmic episodes can be induced, the mortality risk is higher [8].

Some episodes are exercise-induced and may be caused by ventricular outflow arrhythmias [9]. Right ventricular outflow ectopic loci cause a left bundle branch block pattern, whereas those located in the left ventricle outflow tract appear as right bundle branch block complexes. Structural abnormalities of these areas can be demonstrated by magnetic resonance imaging or myocardial biopsy [10] [11].

Echocardiography is another useful tool, as it is able to describe myocardial scars (visualized as akinetic regions), left ventricular hypertrophy (an indicator of long-term hypertension) and the presence and severity of valvulopathies. Cardiomegaly also predicts nonsustained ventricular tachycardia episodes [12]. If the arrhythmia is detected during the recovery period of an exercise test, it indicates cardiovascular mortality during the next decades [13].

• Wide QRS Complex

  Wide QRS Complex Tachycardias. Med Clin North Am. 2001 Mar; 85(2): 245-66. ↑ Gupta AK. Wide QRS Complex Tachycardias. Med Clin North Am. 2001 Mar; 85(2): 245-66. [wikem.org]

  Wide QRS complexes (QRS duration ≥0,12 s). Types of ventricular tachycardia The ECG allows for subclassification of ventricular tachycardia. [ecgwaves.com]

  Andries A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex Circulation, 83 (1991), pp. 1649-1659 [4.] G.F. Van Hare, P. [analesdepediatria.org]

  Depending on the etiology, onset of ventricular tachycardia can be paroxysmal (sudden) or nonparoxysmal, its wide qrs complexes can be uniform or polymorphic, and the ventricular beating may be independent of the atrial beating (av dissociation). [icd10data.com]

  Wide QRS complexes (>120 ms). Presence of AV dissociation. Fusion beats. Retrograde ventriculoatrial conduction may occur, which can generate an ECG complex similar to PSVT with aberrant conduction. [patient.info]

• Torsades De Pointes

  Torsades de pointes tachycardia See the separate article Torsades de Pointes. Polymorphic ventricular tachycardia Has the same ECG characteristics as torsades de pointes but in sinus rhythm the QT interval is normal. [patient.info]

  Morphology Monomorphic Polymorphic VT Torsades De Pointes (Polymorphic with QT prolongation) Right Ventricular Outflow Tract Tachycardia Fascicular Tachycardia Bidirectional VT Ventricular Flutter Ventricular Fibrillation 2. [lifeinthefastlane.com]

  However, at the current time, the term torsades de pointes is reserved for polymorphic VT occurring in the context of a prolonged resting QT interval. [en.wikipedia.org]

  VT, Torsade de Pointes, Paroxysmal Ventricular Tachycardia What is ventricular tachycardia? Ventricular tachycardia is an abnormal condition in which the ventricles of the heart beat abnormally fast. [nmihi.com]

• Right Bundle Branch Block

  Right ventricular outflow ectopic loci cause a left bundle branch block pattern, whereas those located in the left ventricle outflow tract appear as right bundle branch block complexes. [symptoma.com]

  QRS axis, and the left ventricular tachycardia where the QRS morphology is similar to right bundle branch block (RBBB) with a superior QRS axis, indicating its origin from the posterior-inferior interventricular septum. [sicped.it]

  The QRS complexes have a right bundle branch block pattern. Right ventricular outflow tract tachycardia Originates from the right ventricular outflow tract. The ECG typically shows right axis deviation, with a left bundle branch block pattern. [patient.info]

  Ventricular tachycardia with left bundle branch block morphology. [ecgwaves.com]

  Examples Ventricular tachycardia of 150 bpm with a right bundle branch block pattern and right heart axis. Mind the 5th and 6th complex from the right side. These are fusion complexes. [en.ecgpedia.org]

• T Wave Alternans

  We examined whether T-wave alternans (TWA) level is correlated with nonsustained ventricular tachycardia (NSVT) incidence in association with PCI in patients with acute ST-segment elevation myocardial infarction (STEMI). [ncbi.nlm.nih.gov]

  Alternans T-wave alternans (TWA) is a test that is thought to reflect dispersion of repolarization and has been shown to predict VT inducibility and future arrhythmic events better than SAECG. 101 In patients similar to those in MADIT II, a microvolt [clinicalgate.com]

  Promising results on the predictive ability of T-wave alternans tests have not been consistent (90–92). [onlinejacc.org]

  Signal-averaged ECG, baroreflex sensitivity, heart rate variability, and T-wave alternans were not helpful for arrhythmia risk stratification. [academic.oup.com]

Assuming NSVT as a potential prognostic marker for sudden death, amiodarone treatment may have exerted a beneficial effect in these patients, but this statement is only a presumption due to the limitations of our study. [ncbi.nlm.nih.gov]

It is important to approach a wide-complex tachycardia in a systematic manner, to ensure correct diagnosis and treatment. [jhu.pure.elsevier.com]

When NSVT occurs in patients with normal hearts, it usually has a benign prognosis. Therefore, establishing the presence or absence of structural or inherited heart disease is a critical step in each patient's evaluation. [jhu.pure.elsevier.com]

Unclear Valvular Disease Mechanism High incidence in AS, severe MR (25%) Mechanical stress from dysfunctional valvular apparatus Management Beta-blockade if symptomatic Prognosis No evidence that NSVT is an independent predictor of SCD. [ddxof.com]

Patients were then stratified by the etiology (ischemic or nonischemic) of cardiomyopathy. [ncbi.nlm.nih.gov]

Ambulatory* Female Humans Male Middle Aged Prevalence Retrospective Studies Risk Assessment Tachycardia, Ventricular/diagnosis* Tachycardia, Ventricular/epidemiology Tachycardia, Ventricular/etiology Time Factors [ncbi.nlm.nih.gov]

Background Definition[1][2] >3-5 consecutive beats originating below the AV node Rate > 100bpm Duration <30s Patient remains hemodynamically stable Epidemiology Occurs in 0-4% of ambulatory patients Increased frequency in males and with increasing age [wikem.org]

Given the epidemiology of SCD, the normal EF group is an extremely desirable target for intervention. However, in the MERLIN TIMI-36 clinical trial population, even the highest risk group had a SCD rate of only 4.3% at one year. [ahajournals.org]

Cardiovascular Magnetic Resonance and XRay Computed Tomography 245 Choosing Appropriate Imaging Techniques 269 DISORDERS OF RHYTHM AND CONDUCTION 283 Electrophysiology of Cardiac Arrhythmias 285 Treatment of Cardiac Arrhythmias 305 Syncope 329 HEART FAILURE 345 Pathophysiology [books.google.com]

However, indi¬vi¬duals with¬out these recogni¬zed traits and conditions also develop OSA making the etiology and pathophysiology unclear. [umu.se]

Pathophysiology of Heart Disease (3rd ed.). Lippincott Williams & Wilkins. ISBN 978-0-7817-4027-2. ^ G. Morris, Innasimuthu A L, J.P. Fox, R.A. [en.wikipedia.org]

The sympathetic nervous system in heart failure physiology, pathophysiology, and clinical implications. [scielo.br]

These results support the need for ICD implantation for primary prevention, with attention to careful programming of the detection rate to prevent inappropriate therapy. [ncbi.nlm.nih.gov]

The rationale of this trial is to study the efficacy of the eradication of arrhythmogenic substrate in ischemic cardiomyopathy with reduced LVEF and nonsustained VT on prevention of the occurrence of sustained VT/VF and ICD therapies. [clinicaltrials.gov]

1. Engstrom G, Hedblad B, Janzon L, et al. Ventricular arrhythmias during 24-h ambulatory ECG recording: incidence, risk factors and prognosis in men with and without a history of cardiovascular disease. J Intern Med.1999;246:363–72.
2. Biffi A, Maron BJ, Verdile L, et al. Impact of physical deconditioning on ventricular tachyarrhythmias in trained athletes. J Am Coll Cardiol.2004; 44:1053–8.
3. Biffi A, Maron BJ, Culasso F, et al. Patterns of ventricular tachyarrhythmias associated with training, deconditioning and retraining in elite athletes without cardiovascular abnormalities. Am J Cardiol.2011;107:697–703.
4. Zipes DP, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. J Am Coll Cardiol. 2006; 48(5):e247-346.
5. Hoffmayer KS, Machado ON, Marcus GM, et al. Electrocardiographic comparison of ventricular arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy and right ventricular outflow tract tachycardia. J Am Coll Cardiol. 2011;58:831–8.
6. Shimizu W. Arrhythmias originating from the right ventricular outflow tract: how to distinguish “malignant” from “benign”? Heart Rhythm. 2009; 6:1507–11.
7. Pastor-Pérez FJ, Manzano-Fernández S, Goya-Esteban R, et al. Comparison of detection of arrhythmias in patients with chronic heart failure secondary to non-ischemic versus ischemic cardiomyopathy by 1 versus 7-day Holter monitoring. Am J Cardiol. 2010;106:677–81.
8. Buxton AE, Lee KL, DiCarlo L, et al. Electrophysiologic testing to identify patients with coronary artery disease who are at risk for sudden death: Multicenter Unsustained Tachycardia Trial Investigators. N Engl J Med. 2000;342:1937–45.
9. Kim RJ, Iwai S, Markowitz SM, et al. Clinical and electrophysiological spectrum of idiopathic ventricular outflow tract arrhythmias. J Am Coll Cardiol. 2007;49:2035–43.
10. Carlson MD, White RD, Trohman RG, et al. Right ventricular outflow tract ventricular tachycardia: detection of previously unrecognized anatomic abnormalities using cine magnetic resonance imaging. J Am Coll Cardiol. 1004;24:720–7.
11. Chimenti C, Calabrese F, Thiene G, et al. Inflammatory left ventricular microaneurysms as a cause of apparently idiopathic ventricular tachyarrhythmias. Circulation. 2001;104:168–73.
12. Di Bella G, Passino C, Aquaro GD, et al. Different substrates of non-sustained ventricular tachycardia in post-infarction patients with and without left ventricular dilatation. J Card Fail. 2010;16:61–8.
13. Katritsis DG, Zareba W, Camm AJ.Nonsustained ventricular tachycardia. J Am Coll Cardiol. 2012;60(20):1993-2004.