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Ventricular Tachycardia

VT

Ventricular tachycardia is characterized by increased heart rate arising in the ventricles. It is a life threatening condition, indicating immediate medical intervention.


Presentation

In the condition of ventricular tachycardia, the heartbeat is increased causing a sudden drop in the blood pressure, resulting in inability of the heart to pump blood to other body organs. Such sequence of events gives rises to the following symptoms:

  • Development of discomfort in the chest followed by angina pain
  • Fainting
  • Dyspnea
  • Palpitations
  • Feeling of dizziness or light headedness
  • In many cases, it may so happen that individuals may not experience any signs and symptoms [7].
Gangrene
  • Abstract A 10-year-old girl presented with sudden onset recurrent ventricular tachycardia and symmetrical distal peripheral gangrene. She also had pulmonary thromboembolism and cerebral sinus venous thrombosis.[ncbi.nlm.nih.gov]
Recurrent Chest Pain
  • Utility of 24-hour Holter rhythm monitoring and cold pressor test in patients with recurrent chest pain at night is demonstrated in this report.[ncbi.nlm.nih.gov]
Acute Abdomen
  • After urgent surgery according to the acute abdomen, she was referred to intensive care unit (ICU) of the emergency unit as she was intubated.[ncbi.nlm.nih.gov]
Persistent Vomiting
  • Abstract Hyperemesis gravidarum is persistent vomiting, seen more often in the first trimester of pregnancy, when the patient is unable to maintain adequate hydration.[ncbi.nlm.nih.gov]
Tachycardia
  • RVOT tachycardia is a type of monomorphic ventricular tachycardia originating in the right ventricular outflow tract. RVOT morphology refers to the characteristic pattern of this type of tachycardia on an ECG.[en.wikipedia.org]
  • Prognosis is excellent in individuals with idiopathic ventricular tachycardia. Heart diseases are the most common cause of ventricular tachycardia.[symptoma.com]
  • KEYWORDS: Atrioventricular nodal reentry tachycardia; Bidirectional ventricular tachycardia; Bundle branch block; Electrocardiogram; Supraventricular tachycardia[ncbi.nlm.nih.gov]
  • The purpose of this study was to assess whether the clinical history is of any value in the differentiation in the emergency department of ventricular tachycardia (VT) from supraventricular tachycardia (SVT) with aberration.[ncbi.nlm.nih.gov]
  • Ventricular tachycardias include ventricular tachycardia, ventricular fibrillation, and torsades de pointes; although these rhythms may be benign and asymptomatic, others may be life threatening and lead to increased morbidity and mortality.[ncbi.nlm.nih.gov]
Palpitations
  • Abstract A 61-year-old male patient was admitted to our hospital with recurrent palpitations and syncope. Electrocardiography, echocardiography, and contrast-enhanced computed tomography were performed.[ncbi.nlm.nih.gov]
  • Abstract The authors present the case of a 34-year-old male patient seen in our department due to palpitations. On the electrocardiogram monomorphic ventricular tachycardia (VT) was documented, treated successfully with amiodarone.[ncbi.nlm.nih.gov]
  • Prior to the event, he experienced lightheadedness and palpitations. When he fainted, cardiopulmonary resuscitation was performed. Defibrillator pads were placed on the patient, which demonstrates pulseless ventricular tachycardia.[step2.medbullets.com]
  • , but don’t loose consciousness; Not tolerated ventricular tachycardia: the patient starts to complain palpitations, extreme weakness, and then quickly loses consciousness.[af-ablation.org]
  • Symptoms: Symptoms of tachycardia include discomfort in chest, light headedness, dizziness and palpitations. In many cases, individuals also experience shortness of breath and can even faint.[symptoma.com]
Skipped Beats
  • Your heartbeat quickens, and you feel as if your heart is “skipping beats.” This rhythm may cause severe shortness of breath, dizziness, or fainting (syncope).[texasheart.org]
Irregular Heart Rhythm
  • If left untreated, some forms of ventricular tachycardia may get worse and lead to ventricular fibrillation (fast and irregular heart rhythm), which can be life-threatening.[wakemed.org]
  • It arises in the heart’s lower chambers (ventricles) from tissues that generate a rapid and irregular heart rhythm. Ventricular tachycardia is a life-threatening emergency that may require an electrical shock therapy called cardioversion.[sharecare.com]
Dizziness
  • Symptoms: Symptoms of tachycardia include discomfort in chest, light headedness, dizziness and palpitations. In many cases, individuals also experience shortness of breath and can even faint.[symptoma.com]
  • Seek immediate medical help if you feel lightheaded or dizzy, or have chest pain or a lasting rapid heartbeat.[cedars-sinai.org]
  • Types of Ventricular Tachycardia Monomorphic ventricular tachycardia Polymorphic ventricular tachycardia Torsades de pointe Symptoms Symptoms may include: Chest discomfort (angina) Fainting (syncope) Light-headedness or dizziness Palpitations Shortness[practicalclinicalskills.com]
  • This may lead to symptoms of dizziness, lightheadedness, unconsciousness and cardiac arrest. cvml_0082a 2019 Medmovie.com . All rights reserved. Medmovie.com creates and licenses medical illustrations and animations for educational use.[medmovie.com]
  • A heart that beats too fast or too slow can cause: Lightheadedness or dizziness Palpitations (skipping, fluttering or pounding in the chest) Fatigue Chest pressure or pain Shortness of breath Fainting spells Sometimes there are no symptoms at all.[ucsfhealth.org]
Vertigo
  • […] their careers cut short by exercise-induced ventricular tachycardia. [5] Symptoms [ edit ] Symptoms experienced by patients with both sustained and non-sustained ventricular tachycardia may include: [2] [4] Palpitations Breathlessness Light-headedness Vertigo[en.wikibooks.org]
Hyperactivity
  • Sympathetic hyperactivity may play critical role in development and continuation of ES.[ncbi.nlm.nih.gov]

Workup

  • The preliminary diagnosis is done using electrocardiogram that measures the electrical activity of the heart. In case when the patient is hemodynamically stable then, 12-lead ECG and electrolyte levels are first obtained. ECG would also provide appropriate information regarding the cause, which leads to development of ventricular tachycardia. This would also help differentiate between potential arrhythmias [8]. 
  • Following this, appropriate laboratory studies along with echocardiography and coronary angiography are indicated. These are required for designing a suitable treatment regime.
  • Chest radiography is conducted in conditions, when presenting symptoms suggest heart failure or any other cardiopulmonary pathology as the causative factor. Imaging studies such as CT scan and MRI do not provide useful information for diagnosing ventricular tachycardia.
Wide QRS Complex
  • KEYWORDS: Algorithms; VT score; Ventricular tachycardia; Wide QRS complex tachycardia[ncbi.nlm.nih.gov]
  • First, the rate is usually greater than 180 beats per minute, and the rhythm generally has a very wide QRS complex. Second, the patient will be pulseless. And third, the rhythm originates in the ventricles.[acls-algorithms.com]
  • And you notice that on EKG you have these course wide QRS complexes. And a wide QRS complex means that the QRS complex is greater than three small boxes.[khanacademy.org]
  • Ventricular tachycardia refers to a wide QRS complex heart rhythm — that is, a QRS duration beyond 120 milliseconds — originating in the ventricles at a rate of greater than 100 beats per minute.[healio.com]
Atrioventricular Dissociation
  • Atrioventricular dissociation (including fusion/capture beats and partial dissociation) was assigned two points. We recommend 3 VT score points for a firm diagnosis of VT.[ncbi.nlm.nih.gov]
  • Atrioventricular dissociation usually is present. This means that the sinus node is depolarizing the atria in a normal manner at a rate either equal to, or slower than, the ventricular rate.[sjo.org]
  • Note the presence of a premature and early narrow QRS complex (*) and atrioventricular dissociation ( ) indicative of ventricular origin.[revespcardiol.org]
  • Do you see atrioventricular dissociation? If AV dissociation is present, the diagnosis is VT. AV dissociation occurs when P waves, representing atrial depolarization, are seen at different rates than the QRS complexes.[healio.com]
T Wave Alternans
  • Prognostic utility of microvolt T-wave alternans in risk stratification of patients with ischemic cardiomyopathy . J Am Coll Cardiol. 2006May2; 47 ( 9 ):1820-1827 Epub 2006 Apr 19 [ PubMed ] 34. Nolan J, Batin PD, Andrews R, et al.[ncbi.nlm.nih.gov]

Treatment

  • The major goal of treatment of ventricular tachycardia is to manage any underlying disease condition. In emergency situations, patients are given cardiopulmonary resuscitation to stabilize the abnormal heart beats.
  • Long term management of the condition includes administration of anti-arrhythmic medications. These however, have several side effects and should therefore be used with caution. In addition to medications, individuals are also given implantable cardioventer-defibrillator and catheter ablation [9]. Cardiac ablation is indicated in patients with recurrent ventricular tachycardia. This method is safer when compared to anti-arrhythmic medications and can also be safely used in patients with advanced heart diseases [10].
  • Cardioverter–defibrillator is a type of device that is implanted under the skin, for constant monitoring and controlling heart’s rhythm. It is one of the most effective treatment regimens to avoid development of life threatening complications of ventricular tachycardia.
  • In many cases, combination of treatment methods for managing the condition of patients with structural heart diseases is required.

Prognosis

Prognosis of ventricular tachycardia depends on the functioning of left ventricles. The underlying disease conditions and severity of the symptoms also affect the prognosis. However, left ventricular functioning may not always be the determining factor for prognosis of ventricular tachycardia. Studies have shown that individuals with good left ventricular functioning, but having long QT syndrome, and hypertrophic cardiomyopathy are at an increased risk of sudden death. It has been estimated that, about 30% individuals with non-sustained ventricular tachycardia and ischemic cardiomyopathy are more likely to suffer sudden death within 2 years of onset of disease. Prognosis is excellent in individuals with idiopathic ventricular tachycardia [6].

Etiology

Heart diseases are the most common cause of ventricular tachycardia. Individuals with cardiomyopathy, myocarditis, heart failure, or valvular heart disease are at an increased risk of developing this condition. Ventricular tachycardia often is a common accompaniment in patients, who have undergone heart surgery.

In addition to underlying heart disorders the following factors can predispose an individual to develop ventricular tachycardia:

Epidemiology

The incidence rate of ventricular tachycardia is higher in the developed nations. In developing countries, the prevalence of these diseases is relatively low. It has been estimated that, in the US, ventricular tachycardia was the major cause of sudden death in about 300,000 cases each year [3].

Statistics have revealed that ventricular tachycardia accounts for 5.6% of all mortality. Men are more prone to develop the disease condition, mainly because of higher incidence of ischemic heart diseases in them. Females, who have long QT syndrome, are more prone to develop ventricular tachycardia [4].

Sex distribution
Age distribution

Pathophysiology

Under normal physiological conditions, the heart rate is effectively controlled by the electrical signals, which are transmitted across the heart muscles. Various conditions may cause the signals to be sent too rapidly, leading to development of ventricular tachycardia. Rapid heartbeats in turn lead to decreased cardiac output which results from decreased ventricular filling. In conditions of ischemic heart disease and mitral valve insufficiency, there is also significant decrease in ventricular stroke output as well as reduced hemodynamic tolerance [5].

Prevention

Majority of the cases of ventricular tachycardia cannot be prevented. However, individuals with underlying heart diseases should get it treated in order to prevent the onset of ventricular tachycardia.

Summary

Ventricular tachycardia (VT) is a dangerous form of arrhythmia, which can call for development of debilitating complications. Individuals affected by ventricular tachycardia, have heart rate of more than 100 beats/minute, accompanied by 3 or more irregular beats. Underlying disease condition, heart diseases, myocardial infarction and heart surgery, all can cause ventricular tachycardia to develop [1].

Patient Information

  • Definition: Ventricular tachycardia is a condition, characterized by rapid heartbeats, which initiates from the ventricles. In this disorder, the pulse rate of the affected individuals goes beyond 100 beats/minute. 
  • Cause: Patients with underlying disease conditions are at an increased risk of contracting ventricular tachycardia. Conditions such as cardiomyopathy, myocarditis, heart failure and valvular heart disease favor development of ventricular tachycardia. The condition can also occur as a complication in patients who have undergone heart surgery.
  • Symptoms: Symptoms of tachycardia include discomfort in chest, light headedness, dizziness and palpitations. In many cases, individuals also experience shortness of breath and can even faint. 
  • Diagnosis: Conducting electrocardiogram forms the basis of diagnosis procedure. This is done to measure the electrical activity of the heart. In addition to this, certain other tests such as chest radiography and coronary angiography would also be required.
  • Treatment: In emergency situations, stabilizing the heart rate and bringing it to a normal state is the primary goal of treatment. Medications, catheter ablation and cardioverter defibrillation are also indicated depending on condition of the patient.

References

Article

  1. Turker Y, Ozaydin M, Acar G, Ozgul M, Hoscan Y, Varol E, et al. Predictors of ventricular arrhythmias in patients with mitral valve prolapse. Int J Cardiovasc Imaging. Feb 2010;26(2):139-45.
  2. Brugada J, Brugada R, Brugada P. Channelopathies: a new category of diseases causing sudden death.Herz. May 2007;32(3):185-91
  3. McNally B, Robb R, Mehta M, Vellano K, Valderrama AL, Yoon PW, et al. Out-of-hospital cardiac arrest surveillance --- Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005--December 31, 2010. MMWR Surveill Summ. Jul 29 2011;60(8):1-19
  4. Buxton AE. Patients with nonsustained ventricular tachycardia. In: Sudden Cardiac Death: Prevalence, Mechanisms, and Approach to Diagnosis and Management, Akhtar M, Myerburg R, Ruskin J (Eds), Williams & Wilkins, Baltimore 1994.
  5. Sarter BH, Finkle JK, Gerszten RE, Buxton AE. What is the risk of sudden cardiac death in patients presenting with hemodynamically stable sustained ventricular tachycardia after myocardial infarction? J Am Coll Cardiol 1996; 28:122.
  6. Turakhia M, Tseng ZH. Sudden cardiac death: epidemiology, mechanisms, and therapy. Curr Probl Cardiol. Sep 2007;32(9):501-46.
  7. Monserrat L, Elliott PM, Gimeno JR, et al. Non-sustained ventricular tachycardia in hypertrophic cardiomyopathy: an independent marker of sudden death risk in young patients. J Am Coll Cardiol 2003; 42:873.
  8. Josephson ME, Callans DJ. Using the twelve-lead electrocardiogram to localize the site of origin of ventricular tachycardia. Heart Rhythm. Apr 2005;2(4):443-6.
  9. Wellens HJ, Bär FW, Lie KI. The value of the electrocardiogram in the differential diagnosis of a tachycardia with a widened QRS complex. Am J Med. Jan 1978;64(1):27-33
  10. Sarkozy A, Tokuda M, Tedrow UB, et al. Epicardial ablation of ventricular tachycardia in ischemic heart disease. Circ Arrhythm Electrophysiol 2013; 6:1115.

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Last updated: 2018-06-21 23:09