Ventricular Tachycardia (VT)

WHAT IS IT?

Ventricular tachycardia (VT) refers to an increased heart rate (often above 120 ppm) that originates from the ventricles of the heart themselves (distal to the bundle of His)

WHAT CAUSES IT?

This condition is caused by an abnormality in the patient’s ventricles. Patients will have some cardiac pathology that allows for abnormal heart conduction (mainly a reentry circuit int he ventricle that leads to a rhotic depolarization of the ventricles). This cardiac pathology can be caused by:

  • Old scars from a previous myocardial infarction
WHY IS IT CONCERNING MEDICALLY?

If ventricular tachycardia is left untreated, it can progress to ventricular fibrillation (which can be fatal). 

WHAT IS THE INTIAL PRESENTATION?

Patient Chief Complaints:

  • Asymptomatic if non-sustained in nature. 
  • Symptoms in sustained VT: 

Detected Medical Problems:

  • Tachycardia 
  • Wide QRS complex (EKG)
  • PVC (EKG)
WHAT ARE IMPORTANT ELEMENTS OF THE MEDICAL HISTORY?

Risk Factors:

  • Coronary artery disease
  • Past myocardial infarction 
  • Structural heart disease 

Medical History:

 

WHAT ARE IMPORTANT FEATURES OF THE PHYSICAL EXAM?

Vital Signs:

 

Other:

 

CLINICAL WORKUP: SERUM STUDIES

 

CLINICAL WORKUP: IMAGING

 

CLINICAL WORKUP: ELECTROCARDIOGRAM

The following can be appreciated on an EKG in patients with VT:

Wide QRS complexes:

AV disassociation:

Premature Ventricular Contractions:

HOW DO WE NARROW THE DIFFERENTIAL?

Conditions that present similarly and how to exclude them:

 

WHAT IS OUR THRESHOLD FOR DIAGNOSING THIS CONDITION?

 

PATIENT MANAGMENT: SYMPTOM RELEIF

 

PATIENT MANAGEMENT: DISEASE TREATMENT

Cardiac Defibrillation: this intervention will depolarize the entire heart at once in order to reset any abnormal circuits. 

Antiarrhythmics:

  • Amiodarone
  • Lidocaine
  • Procainamide
PATIENT MANAGEMENT: PROPHYLACTIC MEASURES

 

COULD THIS HAVE BEEN PREVENTED?

 

ARCHIVE OF STANDARDIZED EXAM QUESTIONS 

This archive compiles standardized exam questions that relate to this topic.

 

Page Updated: 02.18.2017