Ventricular Tachycardia (VT) and Heart Rate

Introduction

Ventricular tachycardia (VT) is a potentially serious heart rhythm disorder originating from the ventricles. It is characterized by a fast heart rate, typically above 100 beats per minute (bpm), which can compromise the heart’s ability to pump blood efficiently.

Key Characteristics of VT

  • Heart Rate: Usually between 100-250 bpm.
  • Regular or Irregular Rhythm: It can be monomorphic (same QRS morphology) or polymorphic (varying QRS morphologies).
  • Symptoms: May include palpitations, dizziness, chest pain, shortness of breath, or even loss of consciousness.
  • Causes: Coronary artery disease, myocardial infarction, heart failure, electrolyte imbalances, or congenital conditions (e.g., Long QT syndrome).

Classification

  1. Sustained VT (lasting >30 sec) - Requires immediate medical attention.
  2. Non-sustained VT (lasting <30 sec) - May be asymptomatic but needs evaluation.
  3. Polymorphic VT - Includes Torsades de Pointes, associated with QT prolongation.

Diagnosis

  • Electrocardiogram (ECG): Primary tool to identify VT.
  • Holter monitoring: For detecting intermittent episodes.
  • Electrophysiologic study (EPS): To evaluate arrhythmia mechanisms.
  • Blood tests: Check electrolyte imbalances or cardiac biomarkers.

Treatment Strategies

Emergency Management:

  • Stable VT: Antiarrhythmic medications (amiodarone, lidocaine, procainamide).
  • Unstable VT: Requires immediate synchronized cardioversion or defibrillation if pulseless.

Long-term Management:

  • Medications: Beta-blockers, antiarrhythmics.
  • Implantable Cardioverter Defibrillator (ICD): Prevents sudden cardiac death in high-risk patients.
  • Catheter Ablation: For drug-resistant cases.

Conclusion

VT is a serious condition that needs urgent recognition and management. If you have symptoms like a racing heartbeat or dizziness, seek medical attention promptly.

Source recommendations

1. 2022 AHA/ACC/HRS Guidelines for the Management of Ventricular Arrhythmias

  1. https://www.sciencedirect.com/science/article/pii/S2405500X22010945
  2. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193
  3. https://pubmed.ncbi.nlm.nih.gov/29084733/
  4. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000548
  5. https://www.jacc.org/doi/10.1016/j.jacc.2024.02.014

2. 2022 ESC Guidelines for the Management of Ventricular Arrhythmias

  1. https://pubmed.ncbi.nlm.nih.gov/36017572/
  2. https://academic.oup.com/eurheartj/article/43/40/3997/6675633
  3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Ventricular-Arrhythmias-and-the-Prevention-of-Sudden-Cardiac-Death
  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://www.sciencedirect.com/science/article/pii/S2405500X22010945

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