Ventricular Tachycardia

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Topic Overview

If you want to learn about supraventricular tachycardia (SVT), go to the topic Supraventricular Tachycardia.

What is ventricular tachycardia?

Ventricular tachycardia is a fast heart rhythm that starts in the lower part of the heart (ventricles). If left untreated, some forms of ventricular tachycardia may get worse and lead to ventricular fibrillation, which can be life-threatening.

Ventricular tachycardia is a fast but regular rhythm. It can lead to ventricular fibrillation, which is fast and irregular. With ventricular fibrillation, the heartbeats are so fast and irregular that the heart stops pumping blood. Ventricular fibrillation is a leading cause of sudden cardiac death.

What causes ventricular tachycardia?

Sometimes it is not known what causes ventricular tachycardia, especially when it occurs in young people. But in most cases ventricular tachycardia is caused by heart disease, such as a previous heart attack, a congenital heart defect, hypertrophic or dilated cardiomyopathy, or myocarditis. Sometimes ventricular tachycardia occurs after heart surgery. Inherited heart rhythm problems, such as long QT syndrome or Brugada syndrome, are rare causes of ventricular tachycardia.

Some medicines-including antiarrhythmic medicines, which are used to treat other types of abnormal heart rhythms-can cause ventricular tachycardia. Less common causes include blood imbalances, such as low potassium levels and other electrolyte imbalances.

Nonprescription decongestants, herbal remedies (especially those that contain ma huang or ephedra), diet pills, and "pep" pills often contain stimulants that can trigger episodes of ventricular tachycardia. Illegal drugs (such as stimulants, like cocaine) also may cause ventricular tachycardia. It is important to be aware of which substances have an effect on you and how to avoid them.

What are the symptoms?

In ventricular tachycardia, the heart beats too rapidly and the ventricles cannot effectively pump oxygen-rich blood to the rest of the body. Ventricular tachycardia can be life-threatening.

Symptoms include:

  • Palpitations, an uncomfortable awareness of the heart beating rapidly or irregularly.
  • Dizziness or lightheadedness.
  • Shortness of breath.
  • Chest pain or pressure.
  • Near-fainting or fainting (syncope).
  • Weak pulse or no pulse.

This heart rhythm is dangerous for most people. If it lasts more than just a few seconds, it can turn into ventricular fibrillation, which causes sudden death.

How is ventricular tachycardia diagnosed?

If an electrocardiogram (EKG, ECG) can be done while ventricular tachycardia is occurring, it often provides the most useful information. An electrocardiogram is a tracing of the electrical activity of your heart. It is usually done along with a history and physical exam, lab tests, and a chest X-ray.

Because ventricular tachycardia can occur intermittently and may not always be captured by an EKG at the doctor's office, you may be asked to use a portable EKG to record your heart rhythm on a continuous basis, usually over a 24-hour period. This is referred to by several names, including ambulatory electrocardiography, ambulatory EKG, Holter monitoring, 24-hour EKG, or cardiac event monitoring.

Your doctor may recommend further tests, including an echocardiogram, to evaluate your heart's function, a stress test or coronary angiogram to determine whether a part of the heart is not getting enough blood, and/or an electrophysiology (EP) study. An EP study can locate specific areas of heart tissue that give rise to abnormal electrical impulses, which may be causing the ventricular tachycardia. This information is used to determine the best treatment.

How is it treated?

If you are having symptoms and are in a sustained tachycardia, it is a medical emergency. You will need immediate treatment. You may need CPR or a shock from an automatic defibrillator (also known as an AED). Paramedics or your doctor may try intravenous medicines or electrical cardioversion to return your heart to a normal rhythm.

To prevent the arrhythmia from recurring, you may need to take antiarrhythmic medicines.

Your doctor might recommend an implanted device, called an implantable cardioverter defibrillator (ICD). An ICD can detect an abnormal heart rhythm and restore a normal rhythm.

Heart Rhythm Problems: Should I Get an ICD?

In some cases a procedure called catheter ablation is used to destroy small areas of heart tissue responsible for the arrhythmia. Catheter ablation might make the arrhythmia happen less often or stop the arrhythmia from happening again.footnote 1

It is very important that any causes of ventricular tachycardia be identified and treated, if possible. For example, if the ventricular tachycardia results from a medicine, the medicine needs to be stopped.

What precautions should you take?

Call 911 or other emergency services immediately if you have palpitations, dizziness, near-fainting, or chest pain.

Talk with your doctor before changing your diet. If you want to lose weight, do not use diets that rely on a liquid-based program or a high-protein regimen. These types of diets can affect the concentrations of electrolytes in your blood. This can, in turn, cause problems with your heart.

Ask your doctor when you can drive again. If you have had an episode of ventricular tachycardia or ventricular fibrillation, your doctor may recommend that you don't drive a car for a few months. This precaution is to make sure you don't have any other episodes that could make driving unsafe. Right after you get an ICD implanted, you will not drive for at least a few days.

Travel safely. It is safe for most people with arrhythmias to travel. Plan ahead to travel safely. For example, plan to wear a medical alert bracelet and to bring enough medicine for the length of your trip.

Know how to live well with an ICD. This includes getting your device checked regularly, avoiding strong electric or magnetic fields, exercising safely, and knowing what to do if you get a shock.

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Other Places To Get Help

Organizations

American Heart Association
www.heart.org
National Heart, Lung, and Blood Institute (U.S.)
www.nhlbi.nih.gov

References

Citations

  1. Aliot EM, et al. (2009). EHRA/HRS expert consensus on catheter ablation of ventricular arrhythmias. Heart Rhythm, 6(6): 886-933.

Other Works Consulted

  • Epstein AE, et al. (1996). Personal and public safety issues related to arrhythmias that may affect consciousness: Implications for regulation and physician recommendations. A medical/scientific statement from the American Heart Association and the North American Society of Pacing and Electrophysiology. Circulation, 94(5): 1147-1166.
  • Epstein AE, et al. (2007). Addendum to Personal and public safety issues related to arrhythmias that may affect consciousness: Implications for regulation and physician recommendations: A medical/scientific statement from the American Heart Association and the North American Society of Pacing and Electrophysiology. Public safety issues in patients with implantable defibrillators. A scientific statement from the American Heart Association and the Heart Rhythm Society. Circulation, 115(9): 1170-1176.
  • Epstein AE, et al. (2008). ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation, 117(21): e350-e408. [Correction in Circulation, 120(5): e34-e35.]
  • Miller JM, Zipes DP (2015). Therapy for cardiac arrhythmias. In DL Mann et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 10th ed., vol. 1, pp. 685-720. Philadelphia: Saunders.
  • Olgin JE, Zipes DP (2015). Specific arrhythmias: Diagnosis and treatment. In DL Mann et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 10th ed., vol. 1, pp. 748-797. Philadelphia: Saunders.
  • Reynolds MR, et al. (2011). Sudden cardiac death. In V Fuster et al., eds., Hurst's the Heart, 13th ed., vol. 1, pp. 1139-1162. New York: McGraw-Hill.
  • Tung R, et al. (2011). Catheter ablation of ventricular tachycardia. Circulation, 123(20): 2284-2288.
  • Zipes DP, et al. (2006). ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). Circulation, 114(10): 1088-1032.

Credits

ByHealthwise Staff

Primary Medical ReviewerRakesh K. Pai, MD, FACC - Cardiology, Electrophysiology

Martin J. Gabica, MD - Family Medicine

E. Gregory Thompson, MD - Internal Medicine

Specialist Medical ReviewerJohn M. Miller, MD, FACC - Cardiology, Electrophysiology

Current as ofSeptember 21, 2016

Current as of: September 21, 2016

Author: Healthwise Staff

Medical Review: Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology & Martin J. Gabica, MD - Family Medicine & E. Gregory Thompson, MD - Internal Medicine & John M. Miller, MD, FACC - Cardiology, Electrophysiology