Materiały źródłowe

• #1 Sustained monomorphic ventricular tachycardia: Clinical manifestations, diagnosis, and evaluation – UpToDate

  https://www.uptodate.com/contents/sustained-monomorphic-ventricular-tachycardia-clinical-manifestations-diagnosis-and-evaluation

  Sustained monomorphic ventricular tachycardia (SMVT) is defined by the following characteristics: A regular (<50 msec beat-to-beat cycle length variation) wide QRS complex (≥120 milliseconds) tachycardia at a rate greater than 100 beats per minute [...] The arrhythmia lasts ≥30 seconds or causes hemodynamic collapse in <30 seconds. In patients with coronary heart disease (CHD) or other structural heart disease, a wide QRS complex tachycardia (WCT) should be considered to be ventricular tachycardia until proven otherwise.

• #1 Ventricular tachycardia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ventricular-tachycardia/diagnosis-treatment/drc-20355144

  Ventricular tachycardia consultation at Mayo Clinic […] A thorough physical exam, medical history and testing are required to diagnose ventricular tachycardia. […] Ventricular tachycardia sometimes requires emergency medical care and may be diagnosed at a hospital. […] Tests are done to check the heart and confirm a diagnosis of ventricular tachycardia, also called V-tach or VT. […] Electrocardiogram (ECG or EKG). This is the most common test to diagnose tachycardia. […] A Holter monitor is a small ECG device. It is worn for a day or more to record the heart’s activity during daily activities. […] A wearable cardiac event monitor may be used to diagnose tachycardia. […] Imaging tests can help your care team check the structure of your heart. […] An EP study is a series of tests that help create a very detailed map of how signals move between each heartbeat. […] A tilt table test may be done to better understand how tachycardia leads to fainting.

• #1 Ventricular Tachycardia – Monomorphic VT • LITFL • ECG Library

  https://litfl.com/ventricular-tachycardia-monomorphic-ecg-library/

  Ventricular Tachycardia (VT) is a broad complex tachycardia originating from the ventricles. There are several different forms of VT the most common is monomorphic VT, which originates from a single focus within the ventricles. Monomorphic VT can be difficult to differentiate from other causes of broad complex tachycardia. Other ECG features suggestive of VT include: Very broad complexes (160ms), Absence of typical RBBB or LBBB morphology, Extreme axis deviation (northwest axis), AV dissociation (P and QRS complexes at different rates), Capture beats occur when the sinoatrial node transiently captures the ventricles, in the midst of AV dissociation, to produce a QRS complex of normal duration, Fusion beats occur when a sinus and ventricular beat coincide to produce a hybrid complex of intermediate morphology, Positive or negative concordance throughout the chest leads, i.e. leads V1-6 show entirely positive (R) or entirely negative (QS) complexes, with no RS complexes seen, Josephsons sign Notching near the nadir of the S-wave, Brugadas sign The distance from the onset of the QRS complex to the nadir of the S-wave is 100ms, RSR complexes with a taller left rabbit ear. This is the most specific finding in favour of VT. This is in contrast to RBBB, where the right rabbit ear is taller. VT may impair cardiac output with consequent hypotension, collapse, and acute cardiac failure. This is due to extreme heart rates and loss of coordinated atrial contraction (atrial kick). The presence of pre-existing poor ventricular function is strongly associated with cardiovascular compromise. Decreased cardiac output may result in decreased myocardial perfusion with degeneration into VF. Prompt recognition and initiation of treatment (e.g. electrical cardioversion) is required in all cases of VT. A number of diagnostic algorithms exist to help aid in the diagnosis of VT. No algorithm is 100% accurate in predicating VT. Algorithms can be complex and require specific and unfamiliar measurements to be calculated. If in doubt, treat as VT!

• #1 Ventricular Tachycardias: Symptoms and Treatment | Doctor

  https://patient.info/doctor/ventricular-tachycardias

  Ventricular tachycardia (VT) is a broad complex tachycardia originating from a ventricular ectopic focus. It is defined as three or more ventricular extrasystoles in succession at a rate of more than 120 beats per minute (bpm). […] No absolute ECG criteria exist for establishing the presence of VT. However, several factors suggest VT, including the following: Rate greater than 100 bpm (usually 150-200). […] If treated rapidly, VT generally has a favourable short-term outcome. Long-term prognosis depends upon the underlying cardiac disease.

• #1 Diagnosis and management of ventricular tachycardia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10541285/

  It is generally accepted that the default diagnosis of a WCT on ECG should be considered VT until proven otherwise, particularly in urgent situations. This consideration is based on the importance of avoiding administration to patients with VT of medication commonly reserved for the treatment of SVT, which can commonly be associated with haemodynamic deterioration when administered during VT. […] A definitive diagnosis of VT requires the demonstration of ventriculoatrial dissociation (ie ventricular activation that is independent of atrial activity). With extremely rare exceptions, this can be considered the case when the number of spontaneous ventricular activations exceeds the number of atrial activations. […] Proof of atrioventricular dissociation is sometimes not possible based on available data when a patient is being assessed and, therefore, a judgement about the likely origin of an arrhythmia must be made instead. Such a judgement can be based on the clinical context in which the arrhythmia occurs, the myocardial substrate that an arrhythmia occurs in and electrocardiographic evidence that might be suggestive, even if not diagnostic, of a ventricular origin for the rhythm. […] The diagnosis of VT is made primarily using the 12-lead ECG. Diagnostic algorithms exist to differentiate VT from other WCTs, but uncertainty often persists despite appropriate application of these algorithms. In this scenario, a WCT should be treated as VT until proven otherwise.

• #1 Diagnosis and management of ventricular tachycardia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10541285/

  Ventricular tachycardia (VT) describes rapid heart rhythms originating from the ventricles. Accurate diagnosis of VT is important to allow prompt referral to specialist services for ongoing management. The diagnosis of VT is usually made based on electrocardiographic data, most commonly 12-lead echocardiography (ECG), as well as supportive cardiac telemetric monitoring. Distinguishing between VT and supraventricular arrhythmias on ECG can be difficult. However, the VT diagnosis frequently needs to be made rapidly in the acute setting. […] VT forms an important differential diagnosis for any patient presenting with a regular wide complex tachycardia (WCT), which is a regular heart rhythm demonstrating at least three consecutive beats with a ventricular rate 100 bpm and a prolonged QRS duration (120 ms) on 12-lead electrocardiogram (ECG). In addition, VT can present as an irregular rhythm, although irregularity does not exclude VT as a diagnosis.

• #1 Ventricular Tachycardia: Symptoms, Causes, Diagnosis, Treatment

  https://www.webmd.com/heart-disease/atrial-fibrillation/what-is-ventricular-tachycardia

  Ventricular tachycardia happens when theres a glitch in your hearts electrical system. These abnormal signals trigger the fast rhythm in your ventricles that revs up your heart rate. […] Your doctor will review your medical history and ask about your symptoms. Theyll also run some tests on your heart, which usually includes an electrocardiogram (EKG or ECG). An EKG records your hearts electrical activity. […] Other tests used to diagnose ventricular tachycardia include: […] Holter monitor. This is a portable device you wear outside of the doctors office. It can check your hearts electrical activity off and on throughout the day. Your doctor might suggest this if they think you have ventricular tachycardia but your EKG is normal. […] Event monitor. This is another portable EKG you use outside of the doctors office. Your doctor may have you wear one for up to 30 days or until you have an irregular heart rhythm.

• #1 Ventricular Tachycardia (VT) | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/v/ventricular-tachycardia-1.html

  How is VT diagnosed? To find out if you have VT, you may need an electrocardiogram (ECG). This test records your heart rate and rhythm. Your doctor may want to watch your hearts activity for a longer time. This is done using a Holter monitor or event recorder. VT may be diagnosed in the hospital with heart monitoring called telemetry. It may also be seen and diagnosed from a stress test. Some smartphones along with a recording device can record VT when you’re having symptoms. […] In some cases, your doctor may think you have VT, but they have not been able to record it. Implantable loop recorders can be used to record your heart rhythm for up to 5 years. These are electronic devices that are about the size of a pinky finger. They’re put into the skin near the heart. […] In some cases, an electrophysiology study is done to see if VT can be induced. This is done by placing wires in the heart via a vein in your leg.

• #1 Ventricular Tachycardia (V-tach): Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/heart/arrhythmias/ventricular-tachycardia-v-tach/treatment

  How is Ventricular Tachycardia (V-tach) Diagnosed? Diagnosis To find out if you have ventricular tachycardia, your doctor will examine you and may recommend other tests. First, your doctor will ask about your symptoms and personal and family medical history. They may also perform a physical examination. Diagnostic tests can also be done to help evaluate the hearts function. Tests may include: Electrocardiogram (ECG or EKG) measures your heart’s electrical activity, rate, and rhythm […] Electrophysiological (EP) test and cardiac mapping is a test to confirm that you have V-tach and to find the location of the abnormal heartbeat. […] What is the best treatment for ventricular tachycardia? Your doctor will decide the best treatment for you after examining you and considering your health history. Treatment options may include medications and procedures to treat your arrhythmia.

• #1 Ventricular Tachycardia | Conditions | UCSF Benioff Children’s Hospitals

  https://www.ucsfbenioffchildrens.org/conditions/ventricular-tachycardia

  Ventricular tachycardia often occurs spontaneously with unpredictable timing, and specialized tests are needed to make an accurate diagnosis. If your doctor suspects that your child has an arrhythmia such as ventricular tachycardia, he or she will order one or more of the following diagnostic tests to determine the source of your child’s symptoms: […] An ECG records the heart’s electrical activity. Small patches called electrodes are placed on your child’s chest, arms and legs, and are connected by wires to the ECG machine. The electrical impulses of your child’s heart are translated into a graph or chart, enabling doctors to determine the pattern of electrical current flow in the heart and to diagnose arrhythmias. […] In an EP study, doctors insert special electrode catheters long, flexible wires into veins and guide them into the heart. These catheters sense electrical impulses and also may be used to stimulate different areas of the heart. Doctors can then locate the sites that are causing arrhythmias. The EP study allows doctors to examine an arrhythmia under controlled conditions and acquire more accurate, detailed information than with any other diagnostic test.

• #1 Ventricular Tachycardia | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/ventricular-tachycardia

  Tilt table testing is used to diagnose fainting or black-out spells (vasovagal syncope) by trying to reproduce the black-out episodes. […] The EP study allows doctors to acquire more accurate, detailed information and, in many cases, provide treatment (i.e. catheter ablation) during the same session.

• #1 Ventricular Tachycardia: Symptoms, Causes, Diagnosis, Treatment

  https://www.webmd.com/heart-disease/atrial-fibrillation/what-is-ventricular-tachycardia

  Implantable loop recorder. Your doctor may put a small device under your skin. This can monitor your heartbeat on a regular basis for up to 3 years. […] Imaging tests (X-ray, MRI, CT, echocardiogram). These tests take a closer look at your heart to show how well it works or if you have structural problems. […] Coronary angiogram. This can check for blocked arteries that may cause blood flow problems. […] Stress test. Your doctor may give you medicine or have you exercise (ride a bike, walk on a treadmill) to see if physical activity affects your hearts electrical activity. […] Tilt table test. If you faint a lot, your doctor may have you lie on a special table. Theyll move you from flat to upright to see how your heart and blood pressure react to certain situations (like when you go from sitting to standing).

• #1 Ventricular Tachycardia (VT) | Frankel Cardiovascular Center | Michigan Medicine

  https://www.umcvc.org/conditions-treatments/ventricular-tachycardia-vt

  Ventricular tachycardia (VT) is a rapid heart rate that originates in the lower chambers of the heart, or ventricles, due to a malfunction of the heart’s electrical system. VT is defined by a pulse of more than 100 beats per minute with at least three irregular heartbeats in a row. […] Your doctor can diagnose VT by physical exam and certain tests: An electrocardiogram (ECG), which will highlight any abnormalities. […] A transesophageal echocardiograph, in which a ultrasound probe is inserted in the esophagus to provide images as well as better sound. […] Cardiac magnetic resonance imaging (CMRI), which is an MRI scan of the heart.

• #1 Ventricular Tachycardia | Diagnosis | UK Healthcare

  https://ukhealthcare.uky.edu/gill-heart-vascular-institute/conditions/arrhythmias/ventricular-tachycardia/diagnosis

  If your doctor suspects you may have ventricular tachycardia, there will be several steps to confirm your diagnosis. […] During your initial office visit, your healthcare provider will spend time with you and learn more about your symptoms and overall health. […] These tests can help detect the cause of arrhythmia, such as chronic kidney disease or a thyroid issue. […] This imaging test takes pictures of the heart, lungs and nearby blood vessels. […] Using cardiac CT, doctors can evaluate the heart valves structure and locate blockages that prevent the valves from opening or closing correctly. […] An electrocardiogram (ECG or EKG) records the electrical activity in your heart through electrodes attached to the body and connected to a machine with wires. […] A patch monitor is a battery-operated ECG that sticks to your chest. […] Using cardiac MRI, your physician can diagnose heart valve disease by evaluating leaky or narrowed valves.

• #1 Ventricular Tachycardia: Symptoms, Causes, Diagnosis, Treatment

  https://www.webmd.com/heart-disease/atrial-fibrillation/what-is-ventricular-tachycardia

  Electrophysiological test. Your doctor may thread small wires and sensors through a big blood vessel into your heart. This can pinpoint problem areas that cause your irregular heartbeat. […] Transesophageal echocardiography. This can check the size and shape of your heart and look for other problems, including certain blood flow issues. […] Blood tests. These can check for other health problems that may affect your heart, including an electrolyte imbalance or problem with your thyroid hormone.

• #1 Diagnosing Ventricular Arrhythmias | NYU Langone Health

  https://nyulangone.org/conditions/ventricular-arrhythmias/diagnosis

  Doctors at NYU Langones Heart Rhythm Center are experts in the diagnosis of all types of ventricular arrhythmias, potentially life-threatening heart rhythm disorders that originate in the hearts lower chambers, or ventricles. […] To diagnose ventricular arrhythmia, our heart specialists first perform a physical exam. […] Your doctor may order the following tests to help diagnose a ventricular arrhythmia. […] Because each type of arrhythmia produces unique EKG results, this test is essential for correctly identifying the type of arrhythmia. Our electrophysiologists are highly skilled in interpreting EKG results to pinpoint an exact diagnosis. […] If your arrhythmia occurs sporadically, your doctor may recommend surveillance monitoring using a Holter monitor or ambulatory telemetry device that records your heart rhythm for 24 hours or up to 2 weeks. […] Because some ventricular arrhythmias are caused by genetic heart rhythm disorders, your NYU Langone doctor may recommend genetic testing through our Inherited Arrhythmia Program.

• #1 Ventricular Tachycardia Differential Diagnoses

  https://emedicine.medscape.com/article/159075-differential

  In addition to the conditions listed in the differential diagnosis (see below), other problems to consider in the differential diagnosis of ventricular tachycardia (VT) include the following: […] VF is a disorganized, rapid ventricular rhythm that varies in interval and waveform. It may be difficult to distinguish from rapid, polymorphic VT. Sudden death accounts for approximately half of all deaths from cardiovascular disease and is generally caused by VT and VF. […] Accelerated idioventricular rhythm is defined as an enhanced ectopic ventricular rhythm with at least three consecutive ventricular beats that is faster than the normal intrinsic ventricular escape rhythm (40 beats/min) but slower than VT. However, there is a potential definitional overlap with accelerated idioventricular rhythm and an automatic VT of 100-120 beats/min.

• #1 Ventricular tachycardia differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Ventricular_tachycardia_differential_diagnosis

  Wide complex tachycardia will be due to VT in 98% of cases if there’s a history of structural heart disease. […] Hemodynamic stability does not reliably differentiate VT from SVT. […] Patients with ventricular tachycardia can often be hemodynamically stable, and stable vital signs do not rule out ventricular tachycardia. […] Although AV dissociation is highly suggestive of VT, it may also be seen in junctional tachycardias with retrograde block. […] A wide complex tachycardia with a RBBB morphology and a QRS 0.14, or a LBBB morphology with a QRS 0.16 suggests VT. […] The finding of a positive or negative QRS complex in all precordial leads is in favor of ventricular tachycardia. […] If premature ventricular contractions (PVCs) are present on a prior tracing, and if the morphology of the wide complex tachycardia is the same, then it is likely to be ventricular tachycardia.

• #1 VT versus SVT • LITFL Medical Blog • ECG Library Basics

  https://litfl.com/vt-versus-svt-ecg-library/

  RSR complexes with a taller left rabbit ear: […] This is the most specific finding in favour of VT […] The likelihood of VT is increased with: […] Age 35 (positive predictive value of 85%) […] Structural heart disease […] Ischaemic heart disease […] Previous MI […] Family history of sudden cardiac death […] For difficult cases, the Brugada algorithm can be used to distinguish between VT and SVT with aberrancy. […] If the RS interval is 100 ms […] VT is diagnosed. […] AV dissociation is present and VT is diagnosed. […] Leads V1-2 and V6 are assessed for characteristic features of VT. […] With a positive R wave in V1/V2, three patterns are indicative of VT: […] Notching or slurring of the S wave (Josephson sign) […] QS waves in V6 (as with RBBB-like patterns) […] Very specific for VT.

• #1 VT versus SVT • LITFL Medical Blog • ECG Library Basics

  https://litfl.com/vt-versus-svt-ecg-library/

  Regular broad complex tachycardias can be ventricular (VT) or supraventricular (SVT with aberrancy) in origin, and differentiation between the two will significantly influence management of your patients. […] Unfortunately, the electrocardiographic differentiation of VT from SVT with aberrancy is not always possible. […] Electrocardiographic features that increase the likelihood of VT include: […] Absence of typical RBBB or LBBB morphology […] Very broad complexes 160ms […] AV dissociation: […] P and QRS complexes at different rates […] Capture beats: Occur when the sinoatrial node transiently captures the ventricles in the midst of AV dissociation, producing a QRS complex of normal duration […] Positive concordance throughout the precordial leads: […] Negative concordance throughout the precordial leads:

• #1 Diagnosing Ventricular Tachycardia in 5 easy steps | Resus

  https://resus.com.au/diagnosing-ventricular-tachycardia-5-easy-steps/

  Here is a simple case of potential ventricular tachycardia(VT) How do you manage this? […] The problem with these rules is that they are not sensitive enough and they lack consistency across observers. If you sit a group of cardiologists down and ask them to apply them, they will disagree. […] For monomorphic VT, the rate must be greater than 120 beats per minute in order for the diagnosis of VT to be made. […] This is based on the Brugada algorithm which confirms VT if RS 100ms. […] This really asks if all the precordial leads have either a monophonic R or S wave […] Capture Beats are narrow beats, that represent normal complexes. They confirm VT […] Fusion Beats occur when the beat from the AV Node fuses with the beat from the ventricles, resulting in an intermediate-looking beat […] Look for the notching of the S wave, also known as Josephsons Sign. It confirms VT […] The distance from the QRS onset to the nadir of the S wave being 100ms. It confirms VT.

• #1 Ventricular tachycardia diagnosis – wikidoc

  https://wikidoc.org/index.php/Ventricular_tachycardia_diagnosis

  The proper diagnosis is important, as the misdiagnosis of supraventricular tachycardia when ventricular tachycardia is present is associated with worse prognosis. This is particularly true if calcium channel blockers, such as verapamil are used to attempt to terminate a presumed supraventricular tachycardia. It is therefore wisest to assume that all wide complex tachycardia is VT until proven otherwise.

• #1 Ventricular Tachycardia Differential Diagnoses

  https://emedicine.medscape.com/article/159075-differential

  Permanent pacemakers occasionally generate rapid rhythms. The most common cause is tracking of atrial tachyarrhythmias, such as atrial flutter or atrial fibrillation (AF). The pacemaker typically paces around the programmed maximum tracking limit, which is often set at 120-140 beats/min in older patients. […] Wide-complex conduction during SVT can mimic VT. The two most common forms are atrioventricular (AV) reentrant tachycardia (AVRT) and AV nodal reentrant tachycardia (AVNRT) with aberrant conduction. […] Historically, the use of adenosine to distinguish VT from regular wide QRS complex SVT has been discouraged because, in theory, it could precipitate VF. Wide QRS complex tachycardia should be presumed to be VT if the diagnosis is unclear. […] However, a retrospective observational study in 197 consecutive patients with regular wide QRS complex tachycardia found that adenosine was useful and safe as a diagnostic agent for making this differentiation.

• #1 Ventricular Tachycardia Workup: Approach Considerations, Laboratory Studies, Electrocardiography

  https://emedicine.medscape.com/article/159075-workup

  Genetic testing is now feasible for a variety of inherited disorders that may cause long QT syndrome, arrhythmogenic right ventricular dysplasia, or dilated or hypertrophic cardiomyopathy. However, the absence of a defined genomic mutation does not exclude these abnormalities, and interpretation of mutations, especially those resulting in a noncoding alteration is presently difficult. […] The presence of a dual-chamber pacemaker or implantable cardioverter-defibrillator (ICD) can occasionally simplify the diagnosis. Most contemporary devices are capable of recording and logging tachyarrhythmias for subsequent analysis during interrogation of the implanted device, as well as providing real-time telemetry of intracardiac signals.

• #1 Ventricular Tachycardia (VT) ECG Review

  https://www.healio.com/cardiology/learn-the-heart/ecg-review/ecg-topic-reviews-and-criteria/ventricular-tachycardia-review

  Ventricular tachycardia refers to a wide QRS complex heart rhythm that is, a QRS duration beyond 120 milliseconds originating in the ventricles at a rate of greater than 100 beats per minute. […] Ventricular tachycardia can occur with many variations of the QRS morphology, depending on where the arrhythmia originates, which sometimes makes diagnosis on ECG challenging. […] Ventricular tachycardia should be described by type (monomorphic or polymorphic), duration (sustained or non-sustained) and heart rate i.e. monomorphic VT non-sustained at a heart rate of 220 bpm or sustained polymorphic VT at a heart rate of 250 bpm. […] Electrophysiologists may also describe the location within the ventricles from where the VT is originating. This can be determined by the morphology of the QRS complex.

• #1 Sustained ventricular tachycardias – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/537

  Sustained VT is a ventricular rhythm faster than 100 bpm typically lasting at least 30 seconds or requiring termination earlier due to haemodynamic instability. […] VT is defined as a wide complex tachycardia (QRS 120 milliseconds or greater) that originates from one of the ventricles, and is not due to aberrant conduction (e.g., from bundle branch block), at a rate of 100 bpm or greater. […] Torsades de pointes is a polymorphic VT with a characteristic twisting morphology occurring in the setting of QT interval prolongation. […] Sustained VT often results in hypotension and symptoms of weakness, syncope, or palpitations; however, the arrhythmia may be present in patients who are asymptomatic and normotensive. […] Key diagnostic factors include coronary artery disease, presence of other risk factors, tachycardia, and hypotension. […] 1st investigations to order include ECG, transthoracic echocardiogram, electrolytes, and troponin I. […] Investigations to consider include cardiac catheterisation, cardiac MRI, electrophysiological (EP) study, and genetic testing.

• #1 Nonsustained ventricular tachycardia: Clinical manifestations, evaluation, and management – UpToDate

  https://www.uptodate.com/contents/nonsustained-ventricular-tachycardia-clinical-manifestations-evaluation-and-management

  Nonsustained ventricular tachycardia (NSVT) is a common arrhythmia. It is usually asymptomatic and is typically diagnosed during external cardiac monitoring (eg, continuous ambulatory electrocardiography or inpatient telemetry), pacemaker interrogation, or exercise testing. […] The presence of NSVT has long been recognized as a potential marker for developing sustained ventricular arrhythmias. NSVT in the presence of structural heart disease carries a more serious prognosis than NSVT in the absence of a cardiac abnormality. While NSVT in patients with structural heart disease predicts overall mortality, it does not predict sudden cardiac death. […] There are two general goals in the management of NSVT: Identification of patients at risk for sustained arrhythmias and sudden cardiac death; Treatment to suppress symptoms caused by NSVT (when present).

• #1 How to recognise and manage idiopathic ventricular tachycardia

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-8/How-to-recognise-and-manage-idiopathic-ventricular-tachycardia

  Recognition of this type of tachycardia has important practical value: we must know how to distinguish idiopathic ventricular tachycardia from supraventricular tachycardia with aberration since treatment will be very different. […] Idiopathic ventricular tachycardia in patients with an anatomically normal heart is a distinct entity whose management and prognosis differs from ventricular tachycardia associated with structural heart disease. […] Treatment options include pharmacotherapy or catheter ablation. […] A characteristic common to most cases of idiopathic ventricular tachycardia is good prognosis, although patients should continue to have periodic cardiac follow-ups to rule out latent progressive heart disease such as arrhythmogenic right ventricular dysplasia or other forms of cardiomyopathies.

• #1 Sustained ventricular tachycardias – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/537

  ECG findings for sustained ventricular tachycardia (VT) include wide QRS complex (duration 120 milliseconds) at a rate greater than 100 bpm. […] Patients may have a normal cardiac output or may be haemodynamically compromised during episodes of VT. […] Presence or absence of symptoms does not reliably differentiate VT from supraventricular tachycardia. […] Sustained VT is usually observed in ischaemic and non-ischaemic cardiomyopathy, but idiopathic VT may also be observed in patients without structural heart disease. […] Among patients with prior myocardial infarction or non-ischaemic cardiomyopathy, VT is usually due to re-entry involving regions of slowed conduction adjacent to scar. […] Due to the unpredictable and life-threatening nature of most aetiologies of sustained VT, prophylactic implantable cardioverter defibrillator implantation is recommended in high-risk patients.

• #1 Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT): What It Is, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/23006-catecholaminergic-polymorphic-ventricular-tachycardia

  Ventricular tachycardia is an abnormally fast heartbeat in your hearts lower chambers (ventricles). When you have CPVT, you may experience ventricular tachycardia at certain times, such as after exercise. […] To diagnose CPVT, your healthcare provider uses tests that check your heart health, including: […] If your heart is in ventricular tachycardia, you may need an electrical shock (cardioversion) to restore typical rhythm. Electrical cardioversion in this case is usually an emergency treatment. […] Without treatment, CPVT can lead to health complications. Some of these complications, such as sudden cardiac arrest, can affect life expectancy. Treatment can help keep your heart in typical rhythm and lower your risk of these complications.

• #1 Ventricular tachycardia (VT): ECG criteria, causes, classification, treatment – The Cardiovascular

  https://ecgwaves.com/topic/ventricular-tachycardia-vt-ecg-treatment-causes-management/

  The ECG provides valuable information regarding the location of the ectopic foci causing the tachycardia. This is done by classifying ventricular tachycardias broadly as either left bundle branch appearance or right bundle branch appearance. Ventricular tachycardias with ECG waveforms reminding of a left bundle branch block (dominant S-wave in V1) originate in the right ventricle. The opposite is also true, namely that ventricular tachycardias reminding of right bundle branch block (dominant R-wave in V1) originates in the left ventricle. This might be useful in trying to decipher what the cause of the ventricular tachycardia may be. […] It is fundamental to be able to differentiate supraventricular tachycardias with wide QRS from VT and the reason for this is simple: VT is potentially life-threatening, whereas supraventricular arrhythmias rarely are. Hence, wide QRS complexes do not guarantee that the rhythm is ventricular in origin.

• #1 Ventricular Tachycardia (VT) – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/specific-cardiac-arrhythmias/ventricular-tachycardia-vt

  Ventricular tachycardia is 3 consecutive ventricular beats at a rate 120 beats/minute. […] Diagnosis is by electrocardiography. […] Diagnosis of ventricular tachycardia is by ECG (see figure Broad QRS Ventricular Tachycardia). Any wide QRS complex tachycardia (QRS 0.12 second) should be considered VT until proved otherwise. […] Diagnosis is supported by ECG findings of […] Differential diagnosis includes fast supraventricular rhythms conducted with bundle branch block or via an accessory pathway. […] Because some patients tolerate VT surprisingly well, concluding that a well-tolerated wide QRS complex tachycardia must be of supraventricular origin is a mistake. […] The primary goal is preventing sudden death, rather than simply suppressing the arrhythmia. It is best accomplished by use of an implantable cardioverter-defibrillator (ICD). […] Patients who had an episode of sustained VT without a transient or reversible cause typically require an implantable cardioverter-defibrillator (ICD).

• #1 How to recognise and manage idiopathic ventricular tachycardia

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-8/How-to-recognise-and-manage-idiopathic-ventricular-tachycardia

  The decision to treat patients with OT VT depends on frequency and severity of symptoms. Treatment options include medical therapy vs. catheter ablation. […] Acute termination of RVOT VT can be achieved by vagal maneuver or adenosine (6 mg up to 24 mg). […] Chronic management: long-term treatment options include medical therapy and catheter ablation. […] Radiofrequency ablation has cure rates of 90% with a recurrence rate of 5% (mainly in the first year). […] The long-term prognosis of patients with fascicular VT without structural heart disease is very good. […] Radiofrequency catheter ablation is an appropriate management strategy for patients with severe symptoms or those intolerant or resistant to antiarrythmic therapy. […] Depending on tachycardia mechanism, idiopathic VT may respond to Beta-blockers, Ca2+ channel blockers or to vagal maneuvers, although radiofrequency ablation is curative in most patients.

• #1 Ventricular Tachycardia: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/ventricular-tachycardia

  The goal of treatment is to correct the heart rhythm immediately and to prevent future episodes. In an emergency, treatment for ventricular tachycardia may include: CPR, electrical defibrillation, antiarrhythmic medication. […] The outlook for people with ventricular tachycardia is usually good if treatment is received quickly. When the disorder goes untreated, however, people are at a greater risk for sudden cardiac arrest and other serious conditions.

• #1 Diagnosis and management of supraventricular and ventricular tachyarrhythmias: Narrow complex tachycardia & wide complex tachycardia – The Cardiovascular

  https://ecgwaves.com/topic/diagnosis-management-tachycardia-tachyarrhythmia-wide-narrow/

  The vast majority of WCTs originate from impulses generated in the ventricles (ventricular tachycardia being the most common arrhythmia). […] Narrow complex tachycardias generally do not cause circulatory compromise and are therefore easier to manage than wide complex tachycardias. […] The latter (WCT) is in the vast majority of cases caused by ventricular tachycardia (or other ventricular arrhythmias) and may be potentially life-threatening. […] For this reason, management of tachycardias actually does not start with judging the ECG, it starts with judging the patients symptoms and hemodynamic status. […] If the patient displays one or more of the first three symptoms (palpitations, dyspnea, chest discomfort) it is considered safe to take time to judge the ECG and additional information.

• #1 Ventricular Tachycardia (VT) ECG Review

  https://www.healio.com/cardiology/learn-the-heart/ecg-review/ecg-topic-reviews-and-criteria/ventricular-tachycardia-review

  Ventricular tachycardia can be difficult to distinguish from supraventricular tachycardia, or SVT, with aberrancy. […] If present, fusion beats and capture beats can also be helpful to diagnose VT. […] A few general rules apply to diagnosing ventricular tachycardia: If there is any question regarding diagnosis, treat the patient as if the rhythm is VT. […] The rhythm is much more likely to be VT in patients with ischemic heart disease or systolic congestive heart failure. […] VT is more likely with advancing age. […] If AV dissociation is present, the diagnosis is VT. […] Examine the morphology of the QRS complex to see if it meets the specific criteria for VT. […] VT is frequently either in a right bundle branch block (upright in V1) or a left bundle branch block pattern (downward in V1). […] Note that rhythms can, at times, originate in the ventricles but have a heart rate less than 100 bpm.

• #1 A Retrospective Diagnosis of Ventricular Tachycardia

  https://www.patientcareonline.com/view/retrospective-diagnosis-ventricular-tachycardia

  When in doubt, treat for ventricular tachycardia. […] Amiodarone is a safe choice when the diagnosis is unclear. […] In the stable patient, when the diagnosis is uncertain, it is essential to obtain a 12-lead ECG to assess for ventricular tachycardia versus supraventricular tachycardia with aberrancy and then to compare it with a baseline ECG.

• #1 Diagnosis and management of supraventricular and ventricular tachyarrhythmias: Narrow complex tachycardia & wide complex tachycardia – The Cardiovascular

  https://ecgwaves.com/topic/diagnosis-management-tachycardia-tachyarrhythmia-wide-narrow/

  All other symptoms listed above (highlighted in red) are signs of instability and thus indications for treatment. […] A wide complex tachycardia is considered as a ventricular tachycardia until proven otherwise, and in the case of affected circulation it is highly likely that the arrhythmia is ventricular tachycardia. […] Roughly 80% of all wide complex tachycardias are caused by ventricular tachycardia, and this figure rises to 90% among patients with ischemic heart disease (coronary artery disease). […] Nevertheless, the majority of wide complex tachycardias are ventricular tachycardias, which also means that the majority of patients presenting with wide complex tachycardias are at risk of developing unstable hemodynamics and even more malignant arrhythmias (ventricular fibrillation and asystole).

• #2 Ventricular Tachycardia (VT) | Frankel Cardiovascular Center | Michigan Medicine

  https://www.umcvc.org/conditions-treatments/ventricular-tachycardia-vt

  Ventricular tachycardia (VT) is a rapid heart rate that originates in the lower chambers of the heart, or ventricles, due to a malfunction of the heart’s electrical system. VT is defined by a pulse of more than 100 beats per minute with at least three irregular heartbeats in a row. […] Your doctor can diagnose VT by physical exam and certain tests: An electrocardiogram (ECG), which will highlight any abnormalities. […] A transesophageal echocardiograph, in which a ultrasound probe is inserted in the esophagus to provide images as well as better sound. […] Cardiac magnetic resonance imaging (CMRI), which is an MRI scan of the heart.

• #2 Diagnosis and management of ventricular tachycardia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10541285/

  It is generally accepted that the default diagnosis of a WCT on ECG should be considered VT until proven otherwise, particularly in urgent situations. This consideration is based on the importance of avoiding administration to patients with VT of medication commonly reserved for the treatment of SVT, which can commonly be associated with haemodynamic deterioration when administered during VT. […] A definitive diagnosis of VT requires the demonstration of ventriculoatrial dissociation (ie ventricular activation that is independent of atrial activity). With extremely rare exceptions, this can be considered the case when the number of spontaneous ventricular activations exceeds the number of atrial activations. […] Proof of atrioventricular dissociation is sometimes not possible based on available data when a patient is being assessed and, therefore, a judgement about the likely origin of an arrhythmia must be made instead. Such a judgement can be based on the clinical context in which the arrhythmia occurs, the myocardial substrate that an arrhythmia occurs in and electrocardiographic evidence that might be suggestive, even if not diagnostic, of a ventricular origin for the rhythm. […] The diagnosis of VT is made primarily using the 12-lead ECG. Diagnostic algorithms exist to differentiate VT from other WCTs, but uncertainty often persists despite appropriate application of these algorithms. In this scenario, a WCT should be treated as VT until proven otherwise.

• #2 Ventricular tachycardia differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Ventricular_tachycardia_differential_diagnosis

  Wide complex tachycardia will be due to VT in 98% of cases if there’s a history of structural heart disease. […] Hemodynamic stability does not reliably differentiate VT from SVT. […] Patients with ventricular tachycardia can often be hemodynamically stable, and stable vital signs do not rule out ventricular tachycardia. […] Although AV dissociation is highly suggestive of VT, it may also be seen in junctional tachycardias with retrograde block. […] A wide complex tachycardia with a RBBB morphology and a QRS 0.14, or a LBBB morphology with a QRS 0.16 suggests VT. […] The finding of a positive or negative QRS complex in all precordial leads is in favor of ventricular tachycardia. […] If premature ventricular contractions (PVCs) are present on a prior tracing, and if the morphology of the wide complex tachycardia is the same, then it is likely to be ventricular tachycardia.

• #2 Diagnosis and management of ventricular tachycardia – PubMed

  https://pubmed.ncbi.nlm.nih.gov/37775174/

  Atrioventricular (AV) dissociation is diagnostic of VT. Morphological criteria can be applied depending on the overall similarity of the QRS complex in lead V1 to a typical left bundle branch block or right bundle branch block morphology. Having differentiated between these, further criteria can be applied. As per the image, QRS duration, precordial lead concordance, and QRS axis all suggest VT.

• #2 VT versus SVT • LITFL Medical Blog • ECG Library Basics

  https://litfl.com/vt-versus-svt-ecg-library/

  Regular broad complex tachycardias can be ventricular (VT) or supraventricular (SVT with aberrancy) in origin, and differentiation between the two will significantly influence management of your patients. […] Unfortunately, the electrocardiographic differentiation of VT from SVT with aberrancy is not always possible. […] Electrocardiographic features that increase the likelihood of VT include: […] Absence of typical RBBB or LBBB morphology […] Very broad complexes 160ms […] AV dissociation: […] P and QRS complexes at different rates […] Capture beats: Occur when the sinoatrial node transiently captures the ventricles in the midst of AV dissociation, producing a QRS complex of normal duration […] Positive concordance throughout the precordial leads: […] Negative concordance throughout the precordial leads:

• #2 VT versus SVT • LITFL Medical Blog • ECG Library Basics

  https://litfl.com/vt-versus-svt-ecg-library/

  RSR complexes with a taller left rabbit ear: […] This is the most specific finding in favour of VT […] The likelihood of VT is increased with: […] Age 35 (positive predictive value of 85%) […] Structural heart disease […] Ischaemic heart disease […] Previous MI […] Family history of sudden cardiac death […] For difficult cases, the Brugada algorithm can be used to distinguish between VT and SVT with aberrancy. […] If the RS interval is 100 ms […] VT is diagnosed. […] AV dissociation is present and VT is diagnosed. […] Leads V1-2 and V6 are assessed for characteristic features of VT. […] With a positive R wave in V1/V2, three patterns are indicative of VT: […] Notching or slurring of the S wave (Josephson sign) […] QS waves in V6 (as with RBBB-like patterns) […] Very specific for VT.

• #2 Ventricular tachycardia (VT): ECG criteria, causes, classification, treatment – The Cardiovascular

  https://ecgwaves.com/topic/ventricular-tachycardia-vt-ecg-treatment-causes-management/

  If AV dissociation can be verified, VT is very likely to be the cause of the arrhythmia. […] If the start of the tachycardia is recorded it is valuable to assess the initial beats. If the R-R intervals during the start of the tachycardia were irregular, it suggests ventricular tachycardia. This is called warm-up phenomenon and is characteristic of ventricular tachycardia. […] If a ventricular impulse is discharged simultaneously as the atrial impulse enters the His-Purkinje system, the ventricles will be depolarized by both. The resulting QRS complex will have an appearance resembling both a normal QRS and a wide QRS. Such beats are called fusion beats, and such beats are diagnostic of ventricular tachycardia. […] If there is no QRS complex from lead V1 to lead V6 which is an RS complex (i.e consists of an R wave and an S wave), then ventricular tachycardia is very likely.

• #2 Ventricular Tachycardia (VT) | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/v/ventricular-tachycardia-1.html

  How is VT diagnosed? To find out if you have VT, you may need an electrocardiogram (ECG). This test records your heart rate and rhythm. Your doctor may want to watch your hearts activity for a longer time. This is done using a Holter monitor or event recorder. VT may be diagnosed in the hospital with heart monitoring called telemetry. It may also be seen and diagnosed from a stress test. Some smartphones along with a recording device can record VT when you’re having symptoms. […] In some cases, your doctor may think you have VT, but they have not been able to record it. Implantable loop recorders can be used to record your heart rhythm for up to 5 years. These are electronic devices that are about the size of a pinky finger. They’re put into the skin near the heart. […] In some cases, an electrophysiology study is done to see if VT can be induced. This is done by placing wires in the heart via a vein in your leg.

• #2 Tachycardia: Symptoms, Causes, Diagnosis, Treatment

  https://www.webmd.com/heart-disease/atrial-fibrillation/what-are-the-types-of-tachycardia

  Ventricular tachycardia. The ventricular type is associated with abnormal electrical pathways that are present at birth (long QT), structural problems of the heart (such as cardiomyopathy or coronary disease), medications, or electrolyte imbalance. Sometimes, the reason is unclear. […] Ventricular tachycardia treatment. Medicine, cardioversion, and ablation also are used to treat this type of tachycardia. Your doctor could recommend implanting a device to monitor your heart rhythm and administer electrical shocks to correct it when needed. It’s called an implantable cardioverter defibrillator, or ICD. It’s inserted under the skin of your chest and attached to your heart by small wires. […] Ventricular fibrillation can cause the heart to stop altogether. Breathing may also stop. This is cardiac arrest.

• #2 Ventricular Tachycardia: Symptoms, Causes, Diagnosis, Treatment

  https://www.webmd.com/heart-disease/atrial-fibrillation/what-is-ventricular-tachycardia

  Implantable loop recorder. Your doctor may put a small device under your skin. This can monitor your heartbeat on a regular basis for up to 3 years. […] Imaging tests (X-ray, MRI, CT, echocardiogram). These tests take a closer look at your heart to show how well it works or if you have structural problems. […] Coronary angiogram. This can check for blocked arteries that may cause blood flow problems. […] Stress test. Your doctor may give you medicine or have you exercise (ride a bike, walk on a treadmill) to see if physical activity affects your hearts electrical activity. […] Tilt table test. If you faint a lot, your doctor may have you lie on a special table. Theyll move you from flat to upright to see how your heart and blood pressure react to certain situations (like when you go from sitting to standing).

• #2 Ventricular Tachycardia (V-tach): Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/heart/arrhythmias/ventricular-tachycardia-v-tach/treatment

  How is Ventricular Tachycardia (V-tach) Diagnosed? Diagnosis To find out if you have ventricular tachycardia, your doctor will examine you and may recommend other tests. First, your doctor will ask about your symptoms and personal and family medical history. They may also perform a physical examination. Diagnostic tests can also be done to help evaluate the hearts function. Tests may include: Electrocardiogram (ECG or EKG) measures your heart’s electrical activity, rate, and rhythm […] Electrophysiological (EP) test and cardiac mapping is a test to confirm that you have V-tach and to find the location of the abnormal heartbeat. […] What is the best treatment for ventricular tachycardia? Your doctor will decide the best treatment for you after examining you and considering your health history. Treatment options may include medications and procedures to treat your arrhythmia.

• #2 Sustained ventricular tachycardias – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/537

  Sustained VT is a ventricular rhythm faster than 100 bpm typically lasting at least 30 seconds or requiring termination earlier due to haemodynamic instability. […] VT is defined as a wide complex tachycardia (QRS 120 milliseconds or greater) that originates from one of the ventricles, and is not due to aberrant conduction (e.g., from bundle branch block), at a rate of 100 bpm or greater. […] Torsades de pointes is a polymorphic VT with a characteristic twisting morphology occurring in the setting of QT interval prolongation. […] Sustained VT often results in hypotension and symptoms of weakness, syncope, or palpitations; however, the arrhythmia may be present in patients who are asymptomatic and normotensive. […] Key diagnostic factors include coronary artery disease, presence of other risk factors, tachycardia, and hypotension. […] 1st investigations to order include ECG, transthoracic echocardiogram, electrolytes, and troponin I. […] Investigations to consider include cardiac catheterisation, cardiac MRI, electrophysiological (EP) study, and genetic testing.

• #2 Ventricular Tachycardia: Symptoms, Causes, Diagnosis, Treatment

  https://www.webmd.com/heart-disease/atrial-fibrillation/what-is-ventricular-tachycardia

  Electrophysiological test. Your doctor may thread small wires and sensors through a big blood vessel into your heart. This can pinpoint problem areas that cause your irregular heartbeat. […] Transesophageal echocardiography. This can check the size and shape of your heart and look for other problems, including certain blood flow issues. […] Blood tests. These can check for other health problems that may affect your heart, including an electrolyte imbalance or problem with your thyroid hormone.

• #2 Ventricular Tachycardia | Conditions | UCSF Benioff Children’s Hospitals

  https://www.ucsfbenioffchildrens.org/conditions/ventricular-tachycardia

  An exercise stress or treadmill test records the electrical activity of your child’s heart during exercise, which differs from the heart’s electrical activity at rest. […] This is a small monitor about the size of a pager that your child can have for up to a month. Since the arrhythmia may occur at unpredictable times, this will help to record the abnormal rhythm when your child is experiencing symptoms. […] A Holter monitor is a small, portable machine that your child wears for 24 hours. It is about the size of a portable tape player and provides a continuous 24-hour recording of your child’s heartbeat onto a tape. You will be asked to keep a diary of your child’s activities and symptoms. This monitor may detect arrhythmias that might not show up on a resting electrocardiogram, which only records a heartbeat for a few seconds at rest.

• #2 Ventricular Tachycardia | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/ventricular-tachycardia

  Tilt table testing is used to diagnose fainting or black-out spells (vasovagal syncope) by trying to reproduce the black-out episodes. […] The EP study allows doctors to acquire more accurate, detailed information and, in many cases, provide treatment (i.e. catheter ablation) during the same session.

• #2 Ventricular Tachycardia

  https://mydoctor.kaiserpermanente.org/mas/structured-content/Condition_Ventricular_Tachycardia_-_Cardiology.xml?co=/regions/mas

  If you have symptoms that may be due to ventricular tachycardia, your doctor will first check for other heart problems. Your doctor may advise you to have one or more of these tests: […] Electrocardiogram (EKG, ECG), to measure the heart’s electrical activity […] Chest X-ray, to produce images of the heart and lungs […] Echocardiogram, to produce detailed images of the heart as it beats […] Blood tests, to check for chemical imbalances […] Imaging tests, to produce detailed images of the heart […] Exercise stress test, to measure changes in heart activity during exercise. […] You may also need to wear a portable heart monitor for a day or up to a month. The device records your heart’s activity during usual daily activities. The results help your doctor assess your heart condition and recommend treatment.

• #2 Ventricular Tachycardia Workup: Approach Considerations, Laboratory Studies, Electrocardiography

  https://emedicine.medscape.com/article/159075-workup

  Genetic testing is now feasible for a variety of inherited disorders that may cause long QT syndrome, arrhythmogenic right ventricular dysplasia, or dilated or hypertrophic cardiomyopathy. However, the absence of a defined genomic mutation does not exclude these abnormalities, and interpretation of mutations, especially those resulting in a noncoding alteration is presently difficult. […] The presence of a dual-chamber pacemaker or implantable cardioverter-defibrillator (ICD) can occasionally simplify the diagnosis. Most contemporary devices are capable of recording and logging tachyarrhythmias for subsequent analysis during interrogation of the implanted device, as well as providing real-time telemetry of intracardiac signals.

• #2 Ventricular tachycardia differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Ventricular_tachycardia_differential_diagnosis

  When wide QRS tachycardia is present on the ECG, it is necessary to rapidly differentiate whether it is caused by ventricular tachycardia (VT) or a supraventricular tachycardia (SVT) with aberrant conduction. […] The primary tool to differentiate VT from SVT with aberrant conduction is the ECG. […] The diagnosis of VT is more likely if: There is a history of myocardial infarction or structural heart disease, the electrical axis is -90 to -180 degrees (a northwest or superior axis), the QRS is 140 msec, there is AV dissociation, there are positive or negative QRS complexes in all the precordial leads, and the morphology of the QRS complexes resembles that of a previous premature ventricular contraction (PVC). […] Risk factors for the ventricular tachycardia as a cause of wide complex tachycardia include a history of prior myocardial infarction, a history of congestive heart failure, and a history of recent angina pectoris.

• #2 Ventricular Tachycardia (VT) ECG Review

  https://www.healio.com/cardiology/learn-the-heart/ecg-review/ecg-topic-reviews-and-criteria/ventricular-tachycardia-review

  Ventricular tachycardia can be difficult to distinguish from supraventricular tachycardia, or SVT, with aberrancy. […] If present, fusion beats and capture beats can also be helpful to diagnose VT. […] A few general rules apply to diagnosing ventricular tachycardia: If there is any question regarding diagnosis, treat the patient as if the rhythm is VT. […] The rhythm is much more likely to be VT in patients with ischemic heart disease or systolic congestive heart failure. […] VT is more likely with advancing age. […] If AV dissociation is present, the diagnosis is VT. […] Examine the morphology of the QRS complex to see if it meets the specific criteria for VT. […] VT is frequently either in a right bundle branch block (upright in V1) or a left bundle branch block pattern (downward in V1). […] Note that rhythms can, at times, originate in the ventricles but have a heart rate less than 100 bpm.

• #2 Ventricular tachycardia – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/ventricular-tachycardia/

  Ventricular tachycardia (VT) is a potentially life-threatening arrhythmia originating in the cardiac ventricles. […] The characteristic ECG findings of VT are wide QRS complexes ( 120 ms), tachycardia ( 100/minute), and signs of AV dissociation. […] If sustained VT is suspected, immediately obtain an ECG to confirm the diagnosis and initiate treatment as it can rapidly progress to ventricular fibrillation and cause sudden cardiac death. […] Obtain an ECG in all patients with suspected VT (ongoing or resolved). A narrow-complex tachycardia on ECG or rhythm strip excludes VT. […] 3 consecutive wide QRS complexes at a frequency 100/minute and signs of AV dissociation confirm a diagnosis of VT. […] In wide-complex tachycardia (WCT), signs of AV dissociation help distinguish between VT (AV dissociation present) from SVT with aberrancy (AV dissociation absent).

• #2 Wide QRS Tachycardias: Differential Diagnosis (VT or SVT)

  https://www.aerjournal.com/articles/differential-diagnosis-wide-qrs-tachycardias?language_content_entity=en

  A QRS duration 140 ms with RBBB or 160 ms with left bundle branch block (LBBB) pattern suggests VT. […] The presence of negative chest lead concordance (i.e. when all QRS complexes in leads V1V6 are negative) is almost diagnostic of VT, with a specificity of 90%, but is only present in 20% of VTs. […] The absence of RS complex in the precordial leads, i.e. only R and S complexes are seen on ECG, is only found in VTs. […] On certain occasions, such as tachycardias with borderline QRS duration and/or in the absence of atrioventricular dissociation, an electrophysiology study is necessary for diagnosis.

• #2 Sustained ventricular tachycardias – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/537

  ECG findings for sustained ventricular tachycardia (VT) include wide QRS complex (duration 120 milliseconds) at a rate greater than 100 bpm. […] Patients may have a normal cardiac output or may be haemodynamically compromised during episodes of VT. […] Presence or absence of symptoms does not reliably differentiate VT from supraventricular tachycardia. […] Sustained VT is usually observed in ischaemic and non-ischaemic cardiomyopathy, but idiopathic VT may also be observed in patients without structural heart disease. […] Among patients with prior myocardial infarction or non-ischaemic cardiomyopathy, VT is usually due to re-entry involving regions of slowed conduction adjacent to scar. […] Due to the unpredictable and life-threatening nature of most aetiologies of sustained VT, prophylactic implantable cardioverter defibrillator implantation is recommended in high-risk patients.

• #2 Ventricular Tachycardia – Core EM

  https://coreem.net/core/ventricular-tachycardia/

  Definition: A wide-complex (QRS complex 120 msec) tachydysrhythmia that originates within or below the bundle of His. […] Diagnosis There are a number of algorithms that can be used to diagnose VT with the Brugada criteria being the most widely used. The derivation study of this algorithm found a sensitivity of 98.7% and specificity of 96.5%. (Brugada 1991). However, the study was not performed under ED circumstances (patients were taken off cardiac meds prior to EKG, not acute presentations etc). There is no algorithm that has 100% sensitivity or specificity. […] Critical Point: It is safer to assume all wide-complex, regular tachydysrhtyhmias as VT, because the treatment of SVT with aberrancy (the most common alternate diagnosis) as if it is VT is safe but misdiagnosing VT as SVT with aberrancy is potentially life-threatening.

• #2 Diagnosing Ventricular Tachycardia in 5 easy steps | Resus

  https://resus.com.au/diagnosing-ventricular-tachycardia-5-easy-steps/

  Here is a simple case of potential ventricular tachycardia(VT) How do you manage this? […] The problem with these rules is that they are not sensitive enough and they lack consistency across observers. If you sit a group of cardiologists down and ask them to apply them, they will disagree. […] For monomorphic VT, the rate must be greater than 120 beats per minute in order for the diagnosis of VT to be made. […] This is based on the Brugada algorithm which confirms VT if RS 100ms. […] This really asks if all the precordial leads have either a monophonic R or S wave […] Capture Beats are narrow beats, that represent normal complexes. They confirm VT […] Fusion Beats occur when the beat from the AV Node fuses with the beat from the ventricles, resulting in an intermediate-looking beat […] Look for the notching of the S wave, also known as Josephsons Sign. It confirms VT […] The distance from the QRS onset to the nadir of the S wave being 100ms. It confirms VT.

• #2 Ventricular Tachycardia Differential Diagnoses

  https://emedicine.medscape.com/article/159075-differential

  Permanent pacemakers occasionally generate rapid rhythms. The most common cause is tracking of atrial tachyarrhythmias, such as atrial flutter or atrial fibrillation (AF). The pacemaker typically paces around the programmed maximum tracking limit, which is often set at 120-140 beats/min in older patients. […] Wide-complex conduction during SVT can mimic VT. The two most common forms are atrioventricular (AV) reentrant tachycardia (AVRT) and AV nodal reentrant tachycardia (AVNRT) with aberrant conduction. […] Historically, the use of adenosine to distinguish VT from regular wide QRS complex SVT has been discouraged because, in theory, it could precipitate VF. Wide QRS complex tachycardia should be presumed to be VT if the diagnosis is unclear. […] However, a retrospective observational study in 197 consecutive patients with regular wide QRS complex tachycardia found that adenosine was useful and safe as a diagnostic agent for making this differentiation.

• #2 Polymorphic Ventricular Tachycardia: Symptoms, Causes, and Treatments

  https://www.healthline.com/health/polymorphic-ventricular-tachycardia

  Polymorphic ventricular tachycardia is an abnormal heart rhythm where the bottom chambers of your heart beat too quickly. […] Ventricular tachycardia can be monomorphic or polymorphic, based on the results of a test called an electrocardiogram (ECG or EKG). […] Doctors primarily diagnose ventricular tachycardia with an ECG. This test involves placing adhesive electrodes on the chest to measure the hearts electrical activity. […] People with polymorphic ventricular tachycardia have beat-to-beat variation in the QRS complex. […] You may also receive other tests to support your diagnosis or rule out ischemic disease, such as: a heart MRI, a Holter monitor, blood tests, a treadmill stress test, heart catheterization. […] If you do have symptoms, you may require: an implantable cardioverter defibrillator (ICD), beta-blockers, antiarrhythmic medications, radiofrequency ablation. […] Polymorphic ventricular tachycardia is an abnormal heart rhythm where the bottom chambers of your heart beat too quickly and in a varying pattern. Doctors can observe these patterns on an ECG.

• #2 Sustained ventricular tachycardias – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-us/537

  Sustained VT is a ventricular rhythm faster than 100 bpm typically lasting at least 30 seconds or requiring termination earlier due to haemodynamic instability. […] VT is defined as a wide complex tachycardia (QRS 120 milliseconds or greater) that originates from one of the ventricles, and is not due to aberrant conduction (e.g., from bundle branch block), at a rate of 100 bpm or greater. […] 'Idiopathic’ VT occurs in the absence of apparent structural heart disease (e.g., prior myocardial infarction, active ischaemia, cardiomyopathy, valvular disease, arrhythmogenic right ventricular cardiomyopathy, cardiac sarcoid, left ventricular non-compaction, or other disorders of the myocardium), known channelopathy (e.g., long QT syndrome, Brugada syndrome, catecholaminergic polymorphic VT, short QT syndrome), drug toxicity, or electrolyte imbalance.

• #2 Ventricular Tachycardia: Signs, Causes, Diagnosis, Treatment

  https://resources.healthgrades.com/right-care/heart-health/ventricular-tachycardia

  Ventricular tachycardia is when the bottom part of the heart beats too fast. The heart beats over 100 times per minute. This can be fatal because this arrhythmia is not stable. This condition is also known as V-tach or VT. […] It is important that doctors diagnose the cause of ventricular tachycardia and treat the cause of the condition. […] If ventricular tachycardia worsens or becomes destabilized, it can lead to ventricular fibrillation. It is important to recognize the symptoms and triggers of ventricular tachycardia to reduce the risk of it developing into ventricular fibrillation. […] Both types of ventricular tachycardia require a medical workup to determine their causes. […] Symptoms of ventricular tachycardia occur as a result of the heart’s ventricles, or lower chamber, not being able to pump oxygen-rich blood through the body. It is important to recognize the symptoms of ventricular tachycardia so that you can seek treatment as soon as possible and prevent the condition from worsening.

• #2 Tachycardia Causes, Symptoms, and Treatments

  https://www.upmc.com/services/heart-vascular/conditions/tachycardia

  How Do You Diagnose Tachycardia? Our experts use leading-edge technology and techniques to diagnose hundreds of cases of cardiac arrhythmias each year, including tachycardia. […] Following your exam, your doctor may order additional tests and procedures to confirm a diagnosis of tachycardia. […] We offer a full range of tests for tachycardia, including: […] Electrocardiogram (ECG) This noninvasive test measures the electrical activity in your heart. […] Electrophysiology (EP) study This test uses a special catheter that is threaded through your blood vessels and into your heart to map electrical impulses. […] Tachycardia is a common, treatable condition. With proper treatment, most people with tachycardia are able to control symptoms and live a normal, active life. […] Rapid heart rates can originate from either the atria or the ventricles of the heart. The treatment for your tachycardia may vary depending on where the abnormal heart rhythm starts and the severity of your condition. Rhythms from the ventricle are more often considered life-threatening.

• #2 Diagnosis and management of supraventricular and ventricular tachyarrhythmias: Narrow complex tachycardia & wide complex tachycardia – The Cardiovascular

  https://ecgwaves.com/topic/diagnosis-management-tachycardia-tachyarrhythmia-wide-narrow/

  If earlier ECG reveals intraventricular conduction defects (left bundle branch block, right bundle branch block, or any other unspecified conduction defect that prolongs the QRS duration), one must compare the waveforms with those seen during tachycardia. […] Pacemaker-mediated tachycardia must always be suspected in patients with artificial pacemakers. […] If the patient is hemodynamically stable, one may study the ECG carefully and attempt treating the arrhythmia pharmacologically. […] The greater the cardiac function, the less pronounced the symptoms. […] Vagal stimulation rarely terminates ventricular tachycardia. […] Verapamil, adenosine and beta-blockers are all hazardous in case of ventricular tachycardia (risk of developing hypotension and cardiac arrest). […] Termination by means of lidocaine suggests ventricular tachycardia, although AVRT may also be terminated by lidocaine.

• #2 Tachycardia: Fast Heart Rate | American Heart Association

  https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia/tachycardia–fast-heart-rate

  Ventricular tachycardia (VT) is a fast heart rate that starts in the heart’s lower chambers (ventricles). Electrical signals in the heart’s lower chambers fire abnormally fast. This interferes with electrical impulses coming from the sinus node, the heart’s natural pacemaker. […] VT may be either well-tolerated or life-threatening, requiring immediate diagnosis and treatment. The severity of VT depends largely on whether you have other heart conditions and the type of VT you have. […] Symptoms for VT vary. Common symptoms include: Dizziness, Palpitations, Shortness of breath, Nausea, Lightheadedness, Fainting (syncope), Cardiac arrest, in extreme cases, Chest pain. […] Treatment will depend on your symptoms and the cause of your VT. Possible treatments include: Medication that helps prevent arrhythmias, Radiofrequency ablation, a procedure that destroys the cells causing the VT, Surgery to implant a cardioverter defibrillator (ICD), which delivers an electrical pulse to the heart to reset a dangerously irregular heartbeat, Immediate electrical defibrillation, in extreme cases.

• #2 Ventricular Tachycardia: Signs, Causes, Diagnosis, Treatment

  https://resources.healthgrades.com/right-care/heart-health/ventricular-tachycardia

  Ventricular tachycardia typically occurs as a result of conditions affecting the heart. […] A doctor may perform a series of tests in order to diagnose ventricular tachycardia. Examples of tests used to diagnose VT include: Electrocardiogram tracing, Wearing a portable ECG, An echocardiogram, Coronary angiogram procedure, Electrophysiology study, Cardiac MRI, Stress testing. […] Following a ventricular tachycardia diagnosis, your doctor will explain the available treatment options to help you to manage the condition and prevent it from worsening. […] If you are at risk of ventricular tachycardia, your doctor may suggest one of the following: antiarrhythmic medicines or beta blockers, an implantable cardioverter defibrillator (ICD), catheter ablation. […] It is important that you contact your doctor as soon as you notice any symptoms relating to your heart or your breathing. They will be able to carry out tests and advise on whether a referral to a specialist is needed. […] Ventricular tachycardia typically happens due to other conditions affecting the heart. Your doctor will be able to carry out tests to diagnose ventricular tachycardia.

• #2 Tachycardia Causes, Symptoms, and Treatments

  https://www.upmc.com/services/heart-vascular/conditions/tachycardia

  Stereotactic body radiation therapy (SBRT) SBRT is an experimental treatment for ventricular tachycardia (V-Tach) that has not responded to treatment. […] At UPMC, our cardiologists are experts at managing and treating arrhythmia, including tachycardia. Your doctors will recommend the treatment that is most likely to be effective for your heart rhythm disorder while considering your lifestyle, preferences, and overall health.

• #2 Diagnosis and management of supraventricular and ventricular tachyarrhythmias: Narrow complex tachycardia & wide complex tachycardia – The Cardiovascular

  https://ecgwaves.com/topic/diagnosis-management-tachycardia-tachyarrhythmia-wide-narrow/

  All other symptoms listed above (highlighted in red) are signs of instability and thus indications for treatment. […] A wide complex tachycardia is considered as a ventricular tachycardia until proven otherwise, and in the case of affected circulation it is highly likely that the arrhythmia is ventricular tachycardia. […] Roughly 80% of all wide complex tachycardias are caused by ventricular tachycardia, and this figure rises to 90% among patients with ischemic heart disease (coronary artery disease). […] Nevertheless, the majority of wide complex tachycardias are ventricular tachycardias, which also means that the majority of patients presenting with wide complex tachycardias are at risk of developing unstable hemodynamics and even more malignant arrhythmias (ventricular fibrillation and asystole).

• #2 Ventricular Tachycardia – Monomorphic VT • LITFL • ECG Library

  https://litfl.com/ventricular-tachycardia-monomorphic-ecg-library/

  Ventricular Tachycardia (VT) is a broad complex tachycardia originating from the ventricles. There are several different forms of VT the most common is monomorphic VT, which originates from a single focus within the ventricles. Monomorphic VT can be difficult to differentiate from other causes of broad complex tachycardia. Other ECG features suggestive of VT include: Very broad complexes (160ms), Absence of typical RBBB or LBBB morphology, Extreme axis deviation (northwest axis), AV dissociation (P and QRS complexes at different rates), Capture beats occur when the sinoatrial node transiently captures the ventricles, in the midst of AV dissociation, to produce a QRS complex of normal duration, Fusion beats occur when a sinus and ventricular beat coincide to produce a hybrid complex of intermediate morphology, Positive or negative concordance throughout the chest leads, i.e. leads V1-6 show entirely positive (R) or entirely negative (QS) complexes, with no RS complexes seen, Josephsons sign Notching near the nadir of the S-wave, Brugadas sign The distance from the onset of the QRS complex to the nadir of the S-wave is 100ms, RSR complexes with a taller left rabbit ear. This is the most specific finding in favour of VT. This is in contrast to RBBB, where the right rabbit ear is taller. VT may impair cardiac output with consequent hypotension, collapse, and acute cardiac failure. This is due to extreme heart rates and loss of coordinated atrial contraction (atrial kick). The presence of pre-existing poor ventricular function is strongly associated with cardiovascular compromise. Decreased cardiac output may result in decreased myocardial perfusion with degeneration into VF. Prompt recognition and initiation of treatment (e.g. electrical cardioversion) is required in all cases of VT. A number of diagnostic algorithms exist to help aid in the diagnosis of VT. No algorithm is 100% accurate in predicating VT. Algorithms can be complex and require specific and unfamiliar measurements to be calculated. If in doubt, treat as VT!

• #3 Ventricular Tachycardia | Conditions | UCSF Benioff Children’s Hospitals

  https://www.ucsfbenioffchildrens.org/conditions/ventricular-tachycardia

  Ventricular tachycardia often occurs spontaneously with unpredictable timing, and specialized tests are needed to make an accurate diagnosis. If your doctor suspects that your child has an arrhythmia such as ventricular tachycardia, he or she will order one or more of the following diagnostic tests to determine the source of your child’s symptoms: […] An ECG records the heart’s electrical activity. Small patches called electrodes are placed on your child’s chest, arms and legs, and are connected by wires to the ECG machine. The electrical impulses of your child’s heart are translated into a graph or chart, enabling doctors to determine the pattern of electrical current flow in the heart and to diagnose arrhythmias. […] In an EP study, doctors insert special electrode catheters long, flexible wires into veins and guide them into the heart. These catheters sense electrical impulses and also may be used to stimulate different areas of the heart. Doctors can then locate the sites that are causing arrhythmias. The EP study allows doctors to examine an arrhythmia under controlled conditions and acquire more accurate, detailed information than with any other diagnostic test.

• #3 Diagnosing Ventricular Tachycardia in 5 easy steps | Resus

  https://resus.com.au/diagnosing-ventricular-tachycardia-5-easy-steps/

  Here is a simple case of potential ventricular tachycardia(VT) How do you manage this? […] The problem with these rules is that they are not sensitive enough and they lack consistency across observers. If you sit a group of cardiologists down and ask them to apply them, they will disagree. […] For monomorphic VT, the rate must be greater than 120 beats per minute in order for the diagnosis of VT to be made. […] This is based on the Brugada algorithm which confirms VT if RS 100ms. […] This really asks if all the precordial leads have either a monophonic R or S wave […] Capture Beats are narrow beats, that represent normal complexes. They confirm VT […] Fusion Beats occur when the beat from the AV Node fuses with the beat from the ventricles, resulting in an intermediate-looking beat […] Look for the notching of the S wave, also known as Josephsons Sign. It confirms VT […] The distance from the QRS onset to the nadir of the S wave being 100ms. It confirms VT.

• #3 A Retrospective Diagnosis of Ventricular Tachycardia

  https://www.patientcareonline.com/view/retrospective-diagnosis-ventricular-tachycardia

  When in doubt, treat for ventricular tachycardia. […] Amiodarone is a safe choice when the diagnosis is unclear. […] In the stable patient, when the diagnosis is uncertain, it is essential to obtain a 12-lead ECG to assess for ventricular tachycardia versus supraventricular tachycardia with aberrancy and then to compare it with a baseline ECG.

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