Sustained Ventricular Tachycardia (VT)

Introduction

Sustained ventricular tachycardia (VT) is a life-threatening cardiac arrhythmia that originates from the ventricles and lasts more than 30 seconds or requires intervention due to hemodynamic instability. It is commonly associated with underlying heart disease and requires urgent medical attention.

Causes of Sustained VT

The most common causes include: - Coronary artery disease (CAD) – especially after a myocardial infarction (heart attack) - Cardiomyopathies – such as hypertrophic or dilated cardiomyopathy - Electrolyte imbalances – low potassium or magnesium levels - Genetic conditions – such as Long QT Syndrome or Brugada Syndrome - Heart failure – which leads to electrical instability

Symptoms

• Palpitations (rapid or irregular heartbeat)
• Dizziness or fainting (syncope)
• Chest pain or discomfort
• Shortness of breath
• Sudden cardiac arrest (in severe cases)

Diagnosis

• Electrocardiogram (ECG) – to confirm VT pattern
• Holter monitoring – for intermittent episodes
• Echocardiography – to assess heart function
• Cardiac MRI – to detect structural abnormalities
• Electrophysiology study (EPS) – to assess arrhythmic risk and treatment options

Treatment

Immediate Treatment:

• If Unstable VT (with low blood pressure, chest pain, or loss of consciousness): Immediate electrical cardioversion (shock)
• If Stable VT (patient is conscious & stable): Medications such as antiarrhythmics (amiodarone, lidocaine)

Long-term Treatment:

• Implantable Cardioverter Defibrillator (ICD): Prevents sudden cardiac death in high-risk patients
• Catheter Ablation: Destroys abnormal electrical pathways causing VT
• Medications: Beta-blockers, antiarrhythmics, and drugs to manage underlying heart disease
• Lifestyle Changes: Controlling blood pressure, cholesterol, and avoiding triggers like caffeine and alcohol

Conclusion

Sustained VT is a serious condition that requires urgent intervention and long-term management. Early diagnosis and appropriate therapy significantly reduce the risk of sudden cardiac death. Regular follow-up with a cardiologist is essential for managing risk factors and preventing recurrent episodes.

Source recommendations

1. American College of Cardiology/American Heart Association (ACC/AHA) Guidelines on 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.sciencedirect.com/science/article/pii/S2405500X22010945
5. https://pubmed.ncbi.nlm.nih.gov/16935995/

2. European Society of Cardiology (ESC) Guidelines for the Management of Patients with Ventricular Arrhythmias

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/