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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.
Understanding Polymorphic Ventricular Tachycardia (VT) on ECG
Introduction
Polymorphic Ventricular Tachycardia (VT) is a life-threatening arrhythmia characterized by a rapid heart rate with continuously changing QRS complex morphology. It can lead to syncope (fainting) or sudden cardiac arrest if not promptly managed.
ECG Characteristics
- Irregular QRS Morphology: The hallmark of polymorphic VT is that the QRS complexes vary in shape and size from beat to beat.
- Rapid Ventricular Rate: Typically, the ventricular rate exceeds 150 beats per minute.
- Torsades de Pointes (TdP) Variant: If polymorphic VT occurs in the presence of a prolonged QT interval on a baseline ECG, it is called Torsades de Pointes and requires special treatment.
Causes of Polymorphic VT
Several conditions can predispose someone to polymorphic VT, including: - Electrolyte Imbalances (low potassium, magnesium, or calcium) - Ischemic Heart Disease (e.g., myocardial infarction) - Congenital Long QT Syndrome - Drug-Induced QT Prolongation (e.g., antiarrhythmic drugs, certain antibiotics, and antipsychotics) - Catecholaminergic Polymorphic VT (CPVT) (genetic disorder)
Management and Treatment
- Immediate Defibrillation: If the patient is unstable, electrical cardioversion or defibrillation is required.
- Magnesium Sulfate: The first-line treatment for Torsades de Pointes.
- Correction of Electrolyte Imbalances: Potassium and magnesium supplementation.
- Withdrawal of QT-Prolonging Drugs: Essential in cases of drug-induced QT prolongation.
- Beta-Blockers: Used in cases of CPVT to reduce arrhythmic episodes.
- ICD Placement: An implantable cardioverter defibrillator (ICD) may be needed for high-risk patients.
Conclusion
Recognizing polymorphic VT on ECG and identifying the underlying cause is crucial for effective treatment. Early intervention can prevent life-threatening complications like sudden cardiac death.
Source recommendations
1. 2022 ESC Guidelines on Ventricular Arrhythmias and Sudden Cardiac Death
- https://academic.oup.com/eurheartj/article/43/40/3997/6675633
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Ventricular-Arrhythmias-and-the-Prevention-of-Sudden-Cardiac-Death
- 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/
2. ACC/AHA/HRS Guideline for the Evaluation and Management of Patients with Ventricular Arrhythmias
- https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549
- https://www.hrsonline.org/guidance/clinical-resources/2017-accahahrs-guideline-evaluation-and-management-patients-syncope
- https://www.ahajournals.org/doi/10.1161/cir.0000000000000499
- https://pubmed.ncbi.nlm.nih.gov/29097320/
- https://www.jacc.org/doi/10.1016/j.jacc.2017.03.003
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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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