Understanding Ventricular Tachycardia (VT) on ECG

Introduction

Ventricular tachycardia (VT) is a life-threatening arrhythmia that originates from the ventricles. It is characterized by a fast heart rate, typically over 100 beats per minute (bpm), and can lead to severe complications, including cardiac arrest.

Recognizing VT on an ECG

An ECG (electrocardiogram) is used to diagnose VT by identifying its characteristic features: - Wide QRS complexes (≥ 120 ms) - Regular rhythm - Absence of P waves or P waves not related to QRS complexes - Monomorphic VT (uniform QRS morphology) vs. Polymorphic VT (varying QRS morphology)

Common Causes of VT

VT is often associated with the following conditions: - Coronary artery disease (CAD) , especially after a heart attack (myocardial infarction) - Cardiomyopathies , including dilated and hypertrophic cardiomyopathy - Electrolyte imbalances , such as low potassium or magnesium - Drug toxicity , including antiarrhythmics and illicit drugs - Genetic conditions , like Long QT Syndrome or Brugada Syndrome

Symptoms of VT

  • Palpitations (fast and strong heartbeats)
  • Dizziness or lightheadedness
  • Syncope (fainting)
  • Shortness of breath
  • Chest pain
  • In severe cases, cardiac arrest

Management of VT

Emergency Treatment

If VT leads to hemodynamic instability (low blood pressure, unconsciousness), immediate: - Cardioversion (electrical shock) is required. - CPR if cardiac arrest occurs .

Medications for VT

  • Antiarrhythmic drugs , such as amiodarone or lidocaine
  • Beta-blockers to prevent recurrence
  • Magnesium infusion for polymorphic VT (Torsades de Pointes)

Long-term Treatment

  • Implantable Cardioverter Defibrillator (ICD) for high-risk patients
  • Catheter Ablation to destroy abnormal electrical pathways
  • Lifestyle modifications (avoid stimulants, correct electrolytes)

Conclusion

VT is a serious condition requiring urgent evaluation and management. If you suspect VT, seek immediate medical attention.

Source recommendations

1. American Heart Association (AHA) Guidelines for the Management of Ventricular Arrhythmias

  1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549
  2. https://pubmed.ncbi.nlm.nih.gov/29097320/
  3. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193
  4. https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia/ventricular-fibrillation
  5. https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/algorithms

2. European Society of Cardiology (ESC) Guidelines for the Management of Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Ventricular-Arrhythmias-and-the-Prevention-of-Sudden-Cardiac-Death
  2. https://academic.oup.com/eurheartj/article/43/40/3997/6675633
  3. https://pubmed.ncbi.nlm.nih.gov/36017572/
  4. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2022/09/02/14/23/2022-ESC-Guidelines-for-VAs-ESC-2022
  5. https://pubmed.ncbi.nlm.nih.gov/26320108/

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