Ventricular tachycardia is a medical condition characterised by faster heart rhythm (arrhythmia) due to irregular electrical conduction in the ventricles of the heart (lower chambers). Typically, the heart beats 60 to 100 times per minute. However, the heart beats 100 or more times per minute in ventricular tachycardia.
Ventricular tachycardia is due to faulty conduction of the electrical signals. The following conditions can affect the electrical signal conduction:
- Structural heart disease: Scarring of the cardiac tissue caused by a previous heart attack or other cardiac conditions.
- Poor blood flow: Reduced supply of the blood to the cardiac tissue, as in case of coronary artery disease.
- Electrolyte imbalance: Dehydration or other conditions leading to an imbalance of electrolytes, such as potassium, magnesium, calcium, sodium, etc.
- Congenital: Presence of heart diseases at birth, such as QT prolongation
- Medication side effects: Medication can cause ventricular tachycardia as an adverse reaction. It can also be caused due to an overuse of cocaine or other habit-forming substances.
Signs or Symptoms
Signs and symptoms of ventricular tachycardia include the following:
- Chest pain radiating to arm (angina)
- Dyspnea (difficulty in breathing)
- Palpitations (pounding heart)
- Rapid pulse
Ventricular tachycardia symptoms should go away within 30 seconds. If not, it could lead to severe symptoms such as:
- Loss of consciousness
- Cardiac arrest
- Sudden death
Treatment approaches for ventricular tachycardia include the following:
- Medications: Certain anti-arrhythmia medications, such as amiodarone, lidocaine, sotalol, etc., can be used to slow the heart rhythm.
- Cardioversion: Electrical shock is given to bring the heart rhythm to normal.
- Cardiac resynchronisation therapy: This technique involves placing a pacemaker to regulate the synchronisation of both ventricles to send regulated signals.
- Cardiac ablation: Heat waves are used to destroy the damaged heart tissues to cure ventricular tachycardia.
- Implantable cardioverter-defibrillator (ICD): A device is placed under your skin below the collarbone to adjust the heartbeat by giving shocks whenever the heartbeat becomes abnormal.
Risk factors that increase the chances of developing ventricular tachycardia include the following:
- Heart conditions: Any pre-existing heart diseases, such as a history of heart attack, structural heart changes, etc., increase the risk of developing ventricular tachycardia.
- Substance overuse: Misuse of stimulating substances such as cocaine or methamphetamine increases the risk of developing ventricular tachycardia.
- Electrolyte disturbances: Severe electrolyte disturbances, such as acute serious dehydration, make you more prone to develop ventricular tachycardia.
- Side effects of medications: Various medications, such as antibiotics, antifungals, antipsychotic drugs, etc., can cause ventricular tachycardia.
There is typically no staging system for ventricular tachycardia. However, based on the lasting duration of the arrhythmia, it can be categorised as follows:
- Non-sustained VT (NSVT): Having a heartbeat of more than 100 that lasts for less than 30 seconds for consecutive three or more times.
- Sustained VT (SVT): Having a heartbeat of more than 100 that lasts for more than 30 seconds for consecutive three or more times.
Typical diagnosis includes a physical examination and monitoring of vitals, such as blood pressure, heart rhythm, respiration rate, and pulse. Your doctor will also run a certain blood test to examine various parameters, such as troponin levels, electrolytes, etc. In addition, you will undergo an electrocardiogram (ECG) that measures the electrical conduction in your heart. You might also be required to undergo a CT scan or cardiac magnetic resonance imaging (MRI), or transesophageal echocardiography (esophageal ultrasound) to confirm the diagnosis.
The risk of developing ventricular tachycardia can be reduced or prevented by the following:
- Eating a healthy diet: Eating a diet with a good balance of protein, carbs, and fats is essential for heart and overall health. Adding fruits, nuts, and leafy vegetables has great effects on heart health.
- Exercise: You should exercise for at least 30 minutes a day or 150 minutes a week to maintain a healthy heart.
- Regular health check-ups: Regular monitoring of blood pressure, cholesterol levels, and getting regular health check-ups are crucial to keep your heart healthy and reduce the risk of ventricular tachycardia.
- Avoid the use of certain drugs: You should avoid the use of drugs and stimulating substances that are known to cause ventricular tachycardia.
- Managing stress: Reduce stress levels in your life and practice yoga, mindfulness, etc.
Secondary prevention aims to reduce the risk of recurrences or avoid complications post-treatment.
- Symptom watch-out: Always look out for any signs or symptoms of ventricular tachycardia and seek immediate medical care if required.
- Lifestyle modifications: Eating a balanced diet, exercising regularly, and getting physically active are crucial for heart health and reducing recurrences.
- Regular health check-up: Regular monitoring of your vitals and visiting the doctor on scheduled follow-ups is crucial for an event-free recovery.
V-tach or VT
Presentation of ventricular tachycardia might mimic other heart disorders or cardiac conditions, such as ventricular fibrillation, atrial tachycardia, supraventricular tachycardia, premature ventricular contraction, accelerated idioventricular rhythm, pacemaker failure, ECG lead motion artifact, Wolff-Parkinson-White syndrome, multifocal atrial tachycardia, pacemaker syndrome, etc. Hence, a differential diagnosis is required to rule out other possibilities.
- Ventricular tachycardia is more prevalent in men compared to women, as men are more prone to ischemic heart disease.
- The prevalence of ventricular tachycardia increases with age and the maximum prevalence is observed in the middle years.
- Ventricular tachycardia is more common in developed countries compared to developing countries.
Prognosis in patients with ventricular tachycardia usually depends on age, gender, cardiac condition, and the overall health condition. People with ventricular tachycardia develop hemodynamic instability, leading to heart failures and associated co-morbidities.
The progression of ventricular tachycardia depends on how fast the heart is beating. If the heart is beating very fast, it will progress to episodes of fainting and consciousness loss. Eventually, it will cause a heart attack and can cause sudden death.
Ventricular tachycardia is the result of the electrical signal abnormalities in the ventricles, at the cellular level. Damaged heart tissue or scarring of heart tissue, as in previous myocardial episodes, leads to electrical reentry and enhanced automaticity, causing the triggered activity in the electrical conduction. This leads to fast heart rhythm and reduced cardiac output.
Ventricular tachycardia requires emergency treatment. If left untreated, it causes the following complications:
- Ventricular tachycardia storm: One of the common complications is experiencing three or more episodes of ventricular tachycardia and associated fainting.
- Heart failure: Untreated ventricular tachycardia can lead to failure of the heart to pump the blood and stop functioning.
- Sudden death: Sudden unexplained death is associated with uncontrolled ventricular tachycardia.
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