Ventricular Tachycardia

Ventricular tachycardia is a fast, abnormal heart rhythm that starts in the lower chambers of the heart and can become life-threatening if not properly managed, but with the right medical care and lifestyle adjustments, many people can live active, fulfilling lives.

Table of contents

• What Is Ventricular Tachycardia?
• What Causes This Condition?
• Who Is at Risk?
• Signs and Symptoms
• Different Types of Ventricular Tachycardia
• How Doctors Diagnose It
• Treatment Options
• Possible Complications
• Living With Ventricular Tachycardia
• How to Lower Your Risk

What Is Ventricular Tachycardia?

Ventricular tachycardia (VT or V-tach) is a type of abnormal heart rhythm, called an arrhythmia (a heart rhythm that is not regular). It starts in the lower chambers of the heart, called the ventricles, which are the main pumping chambers that push blood out to your body^[1].

In this condition, the heart beats very fast, usually more than 100 beats per minute. A healthy heart typically beats about 60 to 100 times per minute when you are resting^[1][3]. When your heart beats this rapidly, it doesn’t have enough time to fill with blood between beats. This means your heart can’t pump enough blood and oxygen to your body^[3].

Doctors define ventricular tachycardia as three or more rapid heartbeats in a row coming from the ventricles^[2][5]. Some episodes may last only a few seconds and cause no harm. However, episodes lasting more than 30 seconds are considered serious and require emergency treatment, as they can lead to sudden cardiac death^[1][3].

Think of your heart like a bus at a bus stop. When ventricular tachycardia happens, the bus stops so briefly that people can’t board because there isn’t enough time. Similarly, your heart chambers don’t have time to fill with blood before the next beat^[3].

What Causes This Condition?

Ventricular tachycardia develops when abnormal electrical signals in the heart cause it to beat faster than normal. The most common cause is ischemic heart disease, also known as coronary artery disease. This happens when your heart muscle can’t get enough blood and oxygen because of blockages in the coronary arteries, usually due to atherosclerosis (a buildup of fatty deposits in the arteries)^[2][3].

Scar tissue may form in the muscle of the ventricles days, months, or even years after a heart attack. This scarring can lead to ventricular tachycardia because damaged heart muscles can cause abnormal electrical circuits^[4][5].

Other causes of ventricular tachycardia include^[3][4]:

• Heart failure
• Heart muscle problems, such as cardiomyopathy (weakened heart muscle) or myocarditis (inflammation of the heart muscle)
• Heart valve disease
• Previous heart surgery
• Sarcoidosis (a disease that causes inflammation in body tissues)
• Certain inherited conditions, such as long QT syndrome or Brugada syndrome
• Medications, including some drugs used to treat abnormal heart rhythms
• Imbalance in electrolytes (minerals in your blood like potassium or magnesium)
• Changes in blood pH (the acid-base balance in your blood)
• Lack of oxygen
• Certain stimulants like methamphetamine or cocaine

Sometimes, ventricular tachycardia can occur in people with structurally normal hearts, and the cause may be unknown. This is called idiopathic ventricular tachycardia^[5][6].

Who Is at Risk?

You are more likely to develop ventricular tachycardia if you have a history of heart disease or certain heart conditions. The condition is more common among older people^[8].

Risk factors include^[3][4][5]:

• A previous heart attack
• Heart failure
• Abnormal heart valves
• Cardiomyopathy
• Coronary artery disease
• Previous heart surgery
• A family history of certain heart rhythm problems
• Severe electrolyte abnormalities
• Use of stimulant drugs like cocaine
• Certain inherited disorders, such as long QT syndrome or Brugada syndrome

In some cases, ventricular tachycardia can develop in young people who do not have structural heart disease, particularly those with inherited heart rhythm disorders^[8].

Signs and Symptoms

Ventricular tachycardia makes it hard for your heart to send blood to your body. Your tissues and cells need oxygen from your blood. Without enough oxygen, you may start to experience symptoms^[3].

Some people with ventricular tachycardia may not have any symptoms at all, especially if episodes are very brief. However, when symptoms do occur, they may include^[1][3][5]:

• Feeling your heart beat (palpitations) or a fluttering sensation in your chest
• Chest pain or discomfort
• Shortness of breath
• Dizziness
• Lightheadedness
• Fainting or passing out
• Weakness or feeling very tired
• Neck tightness
• Anxiety
• Blurry vision
• Sweating

One of the most concerning symptoms is fainting, as it may mean that your heart isn’t pumping enough blood to your brain. If you ever feel lightheaded or pass out unexpectedly, you should seek medical attention immediately^[18].

In severe cases, ventricular tachycardia can lead to cardiac arrest (when the heart stops beating effectively)^[4][5].

Different Types of Ventricular Tachycardia

Ventricular tachycardia is classified in different ways based on how long it lasts and what the heartbeat pattern looks like.

Based on duration:

Non-sustained ventricular tachycardia lasts less than 30 seconds and does not cause problems with blood flow or make you feel unstable^[2][5].

Sustained ventricular tachycardia lasts more than 30 seconds or causes blood flow problems within 30 seconds and requires immediate treatment^[2][5].

Based on heartbeat pattern:

Monomorphic ventricular tachycardia has a single, stable pattern with no changes from beat to beat. It is the most common type and is often associated with heart attacks^[2][14].

Polymorphic ventricular tachycardia has a changing pattern from beat to beat, with the heartbeat appearing to twist or change shape. The heart rate is usually 200 beats per minute or more^[2][14].

A specific form of polymorphic ventricular tachycardia is called Torsades de Pointes, which means “twisting of the points” in French. This type happens when you have a prolonged QT interval (a measurement on an electrocardiogram) and shows a characteristic waxing and waning pattern^[2].

Another form is bidirectional ventricular tachycardia, which has a beat-to-beat change in the electrical axis of the heart. This is commonly seen with digitalis toxicity (too much of a heart medication called digitalis) or in patients with a rare inherited condition^[2].

How Doctors Diagnose It

Ventricular tachycardia sometimes requires emergency medical care and may be diagnosed at a hospital. When possible, a healthcare professional will ask you or your family questions about your symptoms, lifestyle habits, and medical history^[9].

The most common test to diagnose ventricular tachycardia is an electrocardiogram, also called an ECG, EKG, or EKG test. This test records the electrical signals in your heart and shows how the heart is beating. Small sensors called electrodes are placed on your chest and sometimes on your arms or legs. Wires connect these patches to a computer, which prints or displays the results^[3][5][9].

Because ventricular tachycardia can come and go, it may be hard to capture it during a brief office visit. Your doctor may want you to wear a heart monitor that records your heart rhythm over a longer period. Types of monitors include^[5][9]:

• A Holter monitor, which you wear for a day or more and continuously records your heart’s rhythm
• An event recorder or cardiac event monitor, which records heart activity only during episodes of irregular heartbeats
• Telemetry, which is heart monitoring done in the hospital

Other tests your doctor may recommend include^[5][9]:

• Blood tests to check for electrolyte imbalances or other problems
• Echocardiogram (an ultrasound test that creates pictures of your heart’s structure)
• Chest X-ray
• Stress test to see if your heart muscle is getting enough blood
• Electrophysiology (EP) study, which can find specific areas of your heart that may be causing the ventricular tachycardia
• Cardiac imaging tests such as CT or MRI scans

The results of these tests help your doctor decide what treatment options are best for you^[5].

Treatment Options

Treatment for ventricular tachycardia depends on whether you are stable or unstable, how severe your condition is, and what is causing it^[4][12].

Emergency treatment:

If someone with ventricular tachycardia is in distress or unstable (showing signs like very low blood pressure, loss of consciousness, or difficulty breathing), they need immediate treatment. This may include^[4][12]:

• Cardioversion — an electrical shock delivered to the heart to convert it back to a normal rhythm. This is done with sedation to prevent discomfort^[8][12]
• Cardiopulmonary resuscitation (CPR) if needed
• Medications given through a vein, such as lidocaine, procainamide, sotalol, or amiodarone^[4]

People who have no symptoms but have had ventricular tachycardia for more than 30 seconds should be treated with either cardioversion or medications^[8].

Medications:

To prevent ventricular tachycardia and relieve symptoms, you may need to take heart rhythm medicines. These help control your heart rate and prevent episodes. However, these medicines may have serious side effects, and they are being used less often as other treatments are developed^[4][5].

Procedures:

Catheter ablation is a procedure that destroys small areas of heart tissue causing the abnormal heartbeat. During this procedure, thin tubes called catheters are inserted through blood vessels and guided to your heart. Energy is delivered through the catheter tip to destroy the tissue. This may make ventricular tachycardia happen less often or stop it from happening again^[4][5].

Devices:

An implantable cardioverter-defibrillator (ICD) is a small device placed under the skin, usually near the collarbone. It continuously monitors your heart rhythm. If it detects a life-threatening abnormal rhythm, it quickly sends an electrical shock to change the rhythm back to normal. This device is often recommended to prevent sudden death^[4][5][8].

Some people may wear a wearable cardioverter-defibrillator as a vest. This device can also detect dangerous heart rhythms and help restore a normal rhythm^[5].

A pacemaker may be used in some cases, particularly if the ventricular tachycardia doesn’t respond to other treatments. Overdrive pacing may be considered^[4][14].

Treating underlying causes:

It’s important to address any underlying heart problems or other conditions that may be causing ventricular tachycardia. This might involve treating coronary artery disease, managing heart failure, correcting electrolyte imbalances, or stopping medications that may be triggering the condition^[4].

Possible Complications

Ventricular tachycardia can be dangerous, especially if it lasts for a long time or leads to other life-threatening heart rhythms. The most serious complication is when ventricular tachycardia causes the heart to stop pumping blood effectively, leading to sudden cardiac arrest (when all heart activity stops)^[1][8].

Sometimes, ventricular tachycardia can change into another dangerous abnormal rhythm called ventricular fibrillation, in which the heart quivers instead of beating properly. This is a form of cardiac arrest and requires immediate treatment^[1][3].

Because the rapid heartbeat doesn’t allow the heart chambers to fill adequately or pump blood normally, blood pressure tends to fall, and heart failure can develop^[8].

Ventricular tachycardia is responsible for the majority of sudden cardiac deaths in the United States^[2]. That’s why it’s so important to diagnose and treat it early^[18].

Living With Ventricular Tachycardia

Living a full and normal life with ventricular tachycardia is possible with the right approach, understanding, and support. By embracing healthy habits, seeking appropriate medical care, and staying informed, people with ventricular tachycardia can manage their condition effectively while maintaining a high quality of life^[15].

Heart-healthy lifestyle:

A heart-healthy lifestyle is important for managing ventricular tachycardia and maintaining overall well-being. Diet, exercise, stress management, and avoiding triggers all play a key role^[15].

A balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats supports heart health and may reduce the likelihood of ventricular tachycardia episodes. Limiting salt intake helps prevent high blood pressure, while reducing excessive caffeine and alcohol consumption can decrease the risk of abnormal heart rhythms. Staying hydrated is also important^[15].

Physical activity:

Regular physical activity benefits heart health, but it’s important to approach exercise with caution. You should consult your healthcare provider before starting any new exercise program to make sure activities are safe and appropriate for you. Gentle aerobic exercises, such as walking, swimming, or cycling, are generally recommended^[15].

Medical management:

Establishing a strong partnership with your healthcare provider is essential. This typically involves a combination of lifestyle changes, medications, and sometimes medical procedures or devices. Regular follow-up appointments are important for adjusting treatment plans as needed and for monitoring your condition. You should report any changes in symptoms, such as increased frequency or severity of palpitations, to your healthcare provider promptly^[15].

If you have been prescribed medications, take them exactly as directed. If you have an implantable cardioverter-defibrillator or pacemaker, follow your doctor’s instructions for device monitoring and care.

How to Lower Your Risk

Avoiding the heart problems that cause ventricular tachycardia may lower your risk of developing it. You can protect yourself from coronary artery disease, the most common cause of ventricular tachycardia, in these ways^[3]:

• Eat low-fat, low-salt foods
• Get frequent physical activity
• Stay at a weight that’s healthy for you
• Stop using all tobacco products
• Take medicines your healthcare provider prescribes for high blood pressure and high cholesterol

Other steps to reduce your risk include managing stress, avoiding excessive alcohol and caffeine, not using stimulant drugs like cocaine, and getting treatment for any underlying heart conditions^[3][4].

If you have inherited conditions that can cause ventricular tachycardia, genetic counseling and regular monitoring by a heart specialist may help prevent complications.

• Heart (ventricles)
• Coronary arteries

V-tach, VT