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We provide our users the most up-to-date and accurate information on the treatment and prevention of cardio pathologies in accordance with current American and European clinical guidelines.
The information provided on this website is for educational purposes only and should not be considered medical advice. Always consult a licensed physician for diagnosis and treatment.
Polymorphic Ventricular Tachycardia (PVT) Treatment
Introduction
Polymorphic ventricular tachycardia (PVT) is a dangerous arrhythmia characterized by irregular, varying QRS complexes. It can be life-threatening, leading to sudden cardiac arrest if not managed promptly. Effective treatment depends on identifying the underlying cause.
Types and Causes
There are two primary types of PVT, each with distinct causes and management strategies:
Torsades de Pointes (TdP):
- Typically associated with a prolonged QT interval.
- Causes include electrolyte imbalances (low potassium, magnesium), medications (antiarrhythmics, antibiotics, antipsychotics), congenital Long QT Syndrome, or heart disease.
Non-TdP PVT:
- Occurs without a prolonged QT interval.
- Often related to ischemia (e.g., during a heart attack), structural heart disease, or genetic arrhythmias.
Emergency Treatment
Immediate Management:
- If the patient is unstable (loss of consciousness, no pulse): Perform immediate defibrillation.
- If the patient is stable: Treat the underlying cause.
Specific Treatments:
Torsades de Pointes:
- First-line: Intravenous magnesium sulfate (2g bolus IV over 10-15 min).
- Stop offending medications and correct electrolyte imbalances.
- If refractory, use isoproterenol infusion or temporary pacing (to increase heart rate and shorten the QT interval).
Non-Torsades PVT:
- Treat underlying ischemia (consider revascularization if due to coronary artery disease).
- Antiarrhythmic drugs like amiodarone or lidocaine may be used in some cases.
Long-Term Management
- Identify and treat the cause (e.g., managing electrolyte disturbances, stopping QT-prolonging drugs).
- Implantable Cardioverter Defibrillator (ICD) for patients at high risk of recurrent PVT.
- Beta-blockers for congenital Long QT Syndrome.
- Lifestyle changes, such as avoiding triggers and ensuring electrolyte balance.
Conclusion
Polymorphic VT requires rapid identification and treatment. Emergency measures include defibrillation and medication, while long-term care focuses on preventing recurrence and addressing underlying conditions.
Source recommendations
1. American Heart Association (AHA) Guidelines for Ventricular Arrhythmias
- https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549
- https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/algorithms
- https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193
- https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia/ventricular-fibrillation
- https://www.sciencedirect.com/science/article/pii/S2405500X22010945
2. European Society of Cardiology (ESC) Guidelines on Ventricular Arrhythmias and Sudden Cardiac Death
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Ventricular-Arrhythmias-and-the-Prevention-of-Sudden-Cardiac-Death
- https://academic.oup.com/eurheartj/article/43/40/3997/6675633
- https://pubmed.ncbi.nlm.nih.gov/36017572/
- https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2022/09/02/14/23/2022-ESC-Guidelines-for-VAs-ESC-2022
- https://pubmed.ncbi.nlm.nih.gov/26320108/
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If you or your loved ones experience any of these symptoms, you should consult a doctor in time. Remember that self-medication can be dangerous, and timely diagnosis will preserve the quality and life expectancy.
The heart is an organ that does not know how to "keep silent" if something goes wrong. Chest pain, shortness of breath, swelling, dizziness, and rhythm disturbances are the symptoms that require our attention. The best prevention of heart disease is careful attention to your health, regular checkups with a doctor, and a healthy lifestyle. Take care of your heart, and it will serve you for many years!
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