The typical presentation of ventricular tachycardia (VT) is represented by palpitations. If there is cardiovascular compromise then symptoms are much more severe and consist of vertigo, syncope, chest pain, dyspnea due to decreased cerebral and myocardial irrigation or venous pulmonary hypertension. The term "paroxysmal" entails that the beginning and the end of the episode occur abruptly.

Patients with personal or familial history of sudden death should be evaluated for long and short QT syndromes, Brugada syndrome, arrhythmogenic right ventricular dysplasia and catecholaminergic polymorphic VT [1] [2], as family history of these diseases may indicate that the condition is present in the examined patient [3] [4].

If there is a loss of consciousness in the supine position or the patient has no aura, then the patient should be evaluated for VT, as vasovagal syncope usually appears in other contexts [5]. It is also important to determine what medication the patient is taking since certain drugs are known to have proarrhythmic effects.

• Labored Breathing

  Respiratory rate was 30 per min with labored breathing pattern. There was no wheeze or crepitations. Oxygen saturation by pulse oximetry was 100%. Her previous vital signs recordings were normal and all her symptoms had started just after delivery. [joacc.com]

• Diarrhea

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

• Tachycardia

  Rapid ventricular pacing, at a rate of up to 50 beats/min faster than the tachycardia rate terminated 7 of the tachycardias. [ncbi.nlm.nih.gov]

  […] nodal re-entrant tachycardia, atrioventricular reciprocating tachycardia, and focal atrial tachycardia. [portal.findresearcher.sdu.dk]

• Heart Disease

  […] your risk of developing heart disease. [mayoclinic.org]

  In contrast to the ominous prognosis of paroxysmal ventricular tachycardia associated with organic heart disease, 15, 20 this arrythmia, occurring without underlying heart disease, is generally a benign disorder and the prognosis is good. 12, 20 The patients [annals.org]

  The patient had been asymptomatic up to the episode of cardiac arrest and referred no prior history of ischemic heart disease. [ncbi.nlm.nih.gov]

  This arrhythmia is associated with the following conditions [12, 23, 11] : Rheumatic heart disease Hypertension Ischemic heart disease Pericarditis Thyrotoxicosis Alcohol intoxication Mitral valve prolapse and other disorders of the mitral valve Digitalis [emedicine.medscape.com]

• Vascular Disease

  High-risk surgery, associated with >5% risk of death or MI at 30 days, involves either peripheral vascular disease procedures, major aortic or vascular procedures (due to underlying comorbidities, large volumes of blood loss), and may be physiologically [clinicaladvisor.com]

  […] in patients with risk factors.[ 34 ][ 37 ] CHA2DS 2 VASc score to estimate stroke risk Risk Factor Points C: Congestive heart failure 1 point H: Hypertension 1 point A: Age>75years 2 point D: Diabetes 1 point S: Stroke/Embolism 2 points V: Vascular Disease [textbookofcardiology.org]

• Ventricular Bigeminy

  RVOT non-sustained monomorphic ventricular tachycardia (on the left side) and LVOT ventricular bigeminy (on the right side). Figure 2. Fascicular VT with RBBB morphology and left anterior fascicular block pattern. [escardio.org]

• Visual Impairment

  The bleeding may cause visual loss if it obstructs the visual axis, and patients may note floaters in their visual field. Usually this causes no permanent visual impairments, and sight is fully restored. [en.wikipedia.org]

• Facial Pain

  Experiences from a facial pain unit. J Craniomand Cont Dent Ed. 1990;114:267–272. [PubMed] [Google Scholar] 186. Heckmann SM, Heckmann JG, Ungethum A, Hujoel P, Hummel T. [ncbi.nlm.nih.gov]

• Lethargy

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

  The majority of patients with inappropriate sinus tachycardia are asymptomatic, but some patients may have significant symptoms, ranging from regular palpitations to extreme lethargy and fatigue. [clinicaladvisor.com]

Physical examination findings depend on whether the evaluation is performed during the crisis or between episodes. During the interval between episodes, patients may show signs of structural heart conditions such as murmurs or other pathological features of decompensated heart disease. During the VT episode, patients are tachycardic, possibly tachypneic and may either be anxious, lethargic or comatose, depending on the cerebral perfusion and blood pressure. Diminished peripheral perfusion manifests as pallor and diaphoresis.

The main tool that establishes the diagnosis of ventricular tachycardia is electrocardiography. The arrhythmia may be monomorphic or polymorphic, depending on the number of hyperexcitable loci, commonly located in the ventricular outflow tracts, aortic root or left ventricular septum [6]. When VT occurs in a patient with long QT syndrome, this entity is called "torsade de pointes" and has a particular morphology. Reentrant tachycardia has a structural substrate, most commonly consisting of scar tissue and in this case, an electrophysiological study offers relevant information. QRS complex aspect depends on the origin site of the tachycardia [7] [8].

The distinction between monomorphic VT and supraventricular tachycardia with aberrant conduction is made using Brugada [9] and Verekei [10] criteria, like atrioventricular dissociation, captures and fusion beats or a negative QRS complex in aVR during abnormal conduction of SVT. Signal-averaged ECG is also useful in differentiating between the two entities [11].

Blood workup in VT patients should include potassium, magnesium, calcium levels, toxicology screening, digoxin, troponin I or T levels. Echocardiography should be performed, as it may find the structural etiology of the arrhythmia like right ventricular or global cardiomyopathies or post-ischemic scars. Genetic testing for Brugada and long QT syndromes and catecholaminergic polymorphic VT is also useful.

• Wide QRS Complex

  (ii) Orthodromic AVRT is characterized by a narrow QRS complex. (iii) Antidromic AVRT is characterized by a wide QRS complex. (iv) RP segment > 100 msec 5 (b). [clinicaladvisor.com]

  Fifthly, the first narrow-QRS beat occurring after the burst of wide-complex tachycardia is followed by long-coupled, polymorphic wide-QRS complexes consistent with polymorphic ectopic ventricular beats. [academic.oup.com]

  […] in AVRT Orthodromic AVRT: Antidromic AVRT: Shortened PR interval Delta wave (ECG) = slurred upstroke in QRS complex due to pre-excitation → wide QRS complex This feature of pre-excitation can not be observed during tachycardia or in a patient with "concealed [amboss.com]

  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]

• 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]

  When VT occurs in a patient with long QT syndrome, this entity is called "torsade de pointes" and has a particular morphology. [symptoma.com]

  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]

  de pointes Torsades type ventricular tachycardia Ventricular tachycardia, monomorphic Ventricular tachycardia, nonsustained Ventricular tachycardia, paroxysmal Ventricular tachycardia, polymorphic Ventricular tachycardia, sustained Clinical Information [icd10data.com]

  Amongst the most worrying side effects are QT-interval prolongation and risk of proarrhythmia, including torsade de pointes (TdP) [ 21 ]. [omicsonline.org]

• Atrioventricular Dissociation

  The distinction between monomorphic VT and supraventricular tachycardia with aberrant conduction is made using Brugada and Verekei criteria, like atrioventricular dissociation, captures and fusion beats or a negative QRS complex in aVR during abnormal [symptoma.com]

  Atrioventricular dissociation is present VT present; stop and treat Proceed to 4 4. [aafp.org]

  Specific ECG findings for junctional tachycardias (i) inverted P waves in inferior leads (II, III, aVF) (ii) narrow QRS (iii) atrioventricular dissociation 7. [clinicaladvisor.com]

• Ventricular Bigeminy

  RVOT non-sustained monomorphic ventricular tachycardia (on the left side) and LVOT ventricular bigeminy (on the right side). Figure 2. Fascicular VT with RBBB morphology and left anterior fascicular block pattern. [escardio.org]

• Sinus Arrhythmia

  日本語階層 英語 調律、リズム rhythm 心調律 cardiac rhythm 正常洞調律 normal sinus rhythm 洞調律 sinus rhythm 房室調律 atrioventricular rhythm 不整脈 arrhythmia, dysrhythmia 【同】調律異常 rhythm disturbance 洞不整脈 sinus arrhythmia 呼吸[性]不整脈 respiratory arrhythmia 異所性調律；異所性リズム ectopic rhythm [jams.med.or.jp]

• T Wave Alternans

  Ambulatory (Holter) ECG: An ambulatory ECG can be necessary if the diagnosis needs to be clarified, by detecting arrhythmias, QT-interval changes, T-wave alternans (TWA) or ST-segment changes. [textbookofcardiology.org]

Treatment PSVT that occurs only once in a while may not need treatment if you don't have symptoms or other heart problems. You can try the following techniques to interrupt a fast heartbeat during an episode of PSVT: Valsalva maneuver. [pennstatehershey.adam.com]

(0:10) • Diagram (0:50) • Treatment for SVT (2:37) • Risks of SVT treatment (3:44) • Conclusion (5:25) [youtube.com]

The clinical course of two otherwise healthy pregnant patients with this arrhythmia in whom treatment was withheld is outlined. The indications and guidelines for treatment in relatively asymptomatic patients is discussed. [ncbi.nlm.nih.gov]

Treatment for more serious cases of SVT, like atrial fibrillation, is necessary for continued health. Supraventricular Tachycardia Treatment In some cases, supraventricular tachycardia treatment is not needed. [baptisthealth.com]

But you may need treatment in hospital if you keep having long episodes. [nhs.uk]

Significant ventricular arrhythmia in the patient after infarction is said to carry a poor prognosis with regard to survival. [ncbi.nlm.nih.gov]

In contrast to the ominous prognosis of paroxysmal ventricular tachycardia associated with organic heart disease, 15, 20 this arrythmia, occurring without underlying heart disease, is generally a benign disorder and the prognosis is good. 12, 20 The patients [annals.org]

Prognosis Although CPVT is a severe and often deadly disease, early diagnosis and proper treatment can greatly increase life expectancy. [orpha.net]

[…] of palpitations is long, and in some cases, the etiology is unable to be determined.[1] In one study reporting the etiology of palpitations, 43% were found to be of cardiac etiology, 31% of psychiatric etiology and approximately 10% were classified as [en.wikipedia.org]

The etiology and therapy of this condition are briefly discussed. Received March 24, 1958. Accepted April 21, 1958. [pediatrics.aappublications.org]

[…] rheumatic heart disease, pericarditis, pneumonia, chronic lung disease, current alcohol intoxication,Digoxin toxicity (medscape) most common SVT. accelerated sinus rate that is a physiologic response to a stressor. regular rhythm, HR>100 sinus tachycardia etiologies [quizlet.com]

Etiology Atrioventricular nodal reentrant tachycardia (AVNRT): tachycardia caused by a dysfunctional AV node that contains two electrical pathways Atrioventricular reciprocating tachycardia (AVRT): tachycardia caused by an accessory pathway between the [amboss.com]

Echocardiography should be performed, as it may find the structural etiology of the arrhythmia like right ventricular or global cardiomyopathies or post-ischemic scars. [symptoma.com]

Epidemiology References:[1][2] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

Summary Epidemiology The prevalence of CPVT in Europe is 1/10,000. Clinical description Typical age of onset of CPVT is between 7 and 9 years of age with no sex difference. [orpha.net]

Epidemiology VT is a fairly frequently observed dysrhythmia but actual incidence is difficult to quantify because of the overlap with VF. [patient.info]

Top Your questions, contributions and commentaries will be answered by the lecturer or experts on the subject in the Prevention and Epidemiology list. Please fill in the form (in Spanish, Portuguese or English) and press the "Send" button. [fac.org.ar]

Permanent junctional reciprocating tachycardia (PJRT) References:[1][3][4] Pathophysiology AVRT Do not confuse atrioventricular reentrant (or reciprocating) tachycardia (AVRT) with atrioventricular nodal reentrant tachycardia (AVNRT)! [amboss.com]

The pathophysiology and management of arrhythmias due to accessory pathways differ in important ways and are discussed separately below. [accessmedicine.mhmedical.com]

"Paroxysmal Supraventricular Tachycardia: Pathophysiology, Diagnosis, and Management". Critical Care Nursing Clinics of North America. 28 (3): 309–16. doi:10.1016/j.cnc.2016.04.005. [en.wikipedia.org]

Pathophysiology The AV node in these patients behaves functionally as if there were two separate pathways through the node. The two pathways (alfa and beta pathways ) are differentiated by their characteristic electophysiologic pr operties. [af-ablation.org]

The scheme indicates the pathophysiological mechanism of dual nodal pathway and common nodal reentrant tachycardia (A) and uncommon nodal reentrant tachycardia (B). [revespcardiol.org]

Nine patients with recurrent paroxysmal ventricular tachycardia underwent chronic electrophysiologic studies to delineate effective drug therapy for prevention of recurrence of this arrhythmia. [ncbi.nlm.nih.gov]

There are ways to prevent SVT at home by avoiding certain triggers. Common triggers include alcohol, caffeine, smoking, some over-the-counter decongestants, diet pills, and drugs such as cocaine and methamphetamine. [umcvc.org]

Drugs such as beta-blockers, digoxin or ones to prevent arrhythmias may be used to help prevent future episodes. More and more often, radiofrequency ablation is done to destroy the tissues where paroxysmal supraventricular tachycardia starts. [cedars-sinai.edu]

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2. Patel U, Pavri BB. Short QT syndrome: a review. Cardiol Rev. 2009;17(6):300-3.
3. Jouven X, Desnos M, Guerot C, Ducimetiere P. Predicting sudden death in the population: the Paris Prospective Study I. Circulation 1999;99:1978–1983.
4. Friedlander Y, Siscovick DS, Weinmann S, et al. Family history as a risk factor for primary cardiac arrest. Circulation 1998;97:155–160.
5. Moya A, Sutton R, Ammirati F, et al. Guidelines for the diagnosis and management of syncope. Eur Heart J 2009;30:2631–2671.
6. Arya A, Piorkowski C, Sommer P, et al. Idiopathic outflow tract tachycardias: current perspectives. Herz. 2007;32(3):218-25.
7. Josephson ME, Callans DJ. Using the twelve-lead electrocardiogram to localize the site of origin of ventricular tachycardia. Heart Rhythm. 2005;2(4):443-6.
8. Noda T, Shimizu W, Taguchi A, et al. Malignant entity of idiopathic ventricular fibrillation and polymorphic ventricular tachycardia initiated by premature extrasystoles originating from the right ventricular outflow tract. J Am Coll Cardiol. 2005; 46(7):1288-94.
9. Brugada P, Brugada J, Mont L, et al. A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex. Circulation. 1991;83(5):1649-59.
10. Vereckei A, Duray G, Szénási Get al. New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia. Heart Rhythm. 2008;5(1):89-98.
11. [Guideline] 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.