Ventricular Tachycardia (VT)

Introduction

Ventricular tachycardia (VT) is a dangerous heart rhythm disorder that originates in the ventricles – the lower chambers of the heart. It is characterized by a fast heart rate, usually above 100 beats per minute, which can lead to serious complications if not managed properly.

Causes

VT can be caused by various conditions, including: - Coronary artery disease (CAD) – Reduced blood flow to the heart muscle. - Previous heart attack (myocardial infarction) – Scar tissue can disrupt electrical conduction. - Heart failure – Weakening of the heart muscle can provoke irregular rhythms. - Electrolyte imbalances – Abnormal levels of potassium, magnesium, or calcium. - Genetic conditions – Such as Long QT syndrome or Brugada syndrome. - Use of certain medications or stimulants (e.g., cocaine, excessive caffeine).

Symptoms

• Palpitations (rapid, strong, or irregular heartbeats)
• Dizziness or lightheadedness
• Shortness of breath
• Chest pain or discomfort
• Loss of consciousness (in severe cases)

Diagnosis

VT is diagnosed using: - Electrocardiogram (ECG) – The primary test to identify VT. - Holter monitor – A portable ECG worn for 24-48 hours to detect episodes. - Echocardiogram – To assess heart structure and function. - Cardiac MRI – Detailed imaging for structural abnormalities. - Electrophysiological study (EPS) – To provoke and analyze abnormal rhythms.

Treatment Options

Acute Management (if VT is life-threatening)

• Emergency defibrillation – If the patient is unstable and unconscious.
• Intravenous antiarrhythmic drugs (e.g., amiodarone, lidocaine).
• Cardioversion – Synchronized electrical shock to restore rhythm.

Long-Term Management

• Medications – Beta-blockers and antiarrhythmic drugs to control rhythm.
• Implantable Cardioverter-Defibrillator (ICD) – A small device to detect and stop dangerous arrhythmias.
• Catheter Ablation – Destruction of abnormal electrical pathways causing VT.
• Lifestyle modifications – Avoidance of stimulants, control of blood pressure, and regular exercise under guidance.

Prognosis

The outlook for VT depends on its underlying cause and how soon treatment is started. Patients with structural heart disease and frequent VT episodes are at higher risk and require continuous monitoring.

Conclusion

VT is a serious and potentially life-threatening condition that requires prompt recognition and appropriate treatment. Anyone experiencing symptoms of VT should seek immediate medical attention to prevent severe complications such as sudden cardiac arrest.

Source recommendations

1. 2022 AHA/ACC/HRS Guideline for the Management of Patients With Ventricular Arrhythmias

1. https://pubmed.ncbi.nlm.nih.gov/29084733/
2. https://www.sciencedirect.com/science/article/pii/S2405500X22010945
3. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000548
4. https://www.heartrhythmjournal.com/article/S1547-5271(17)31250-X/fulltext
5. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193

2. 2022 ESC Guidelines for the Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

1. https://academic.oup.com/eurheartj/article/43/40/3997/6675633
2. https://pubmed.ncbi.nlm.nih.gov/36017572/
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