Summary
Definition
History and exam
Key diagnostic factors
- coronary artery disease
- presence of other risk factors
- tachycardia
- hypotension
Other diagnostic factors
- weak pulse
- syncope
- presyncope
- airway compromise
- impaired consciousness
- light-headedness
- dizziness
- diminished responsiveness
- chest discomfort
- dyspnoea
- asymptomatic
Risk factors
- coronary artery disease
- acute myocardial infarction
- left ventricular systolic dysfunction
- hypertrophic cardiomyopathy
- long QT syndrome
- short QT syndrome
- Brugada syndrome
- Family history of sudden death
- mental or physical stress
- ventricular pre-excitation
- arrhythmogenic right ventricular cardiomyopathy
- electrolyte imbalance
- drug toxicity
- Chagas disease, and other cardiomyopathies
Diagnostic investigations
1st investigations to order
- ECG
- electrolytes
- troponin I
- creatine kinase-MB
Investigations to consider
- transthoracic echocardiogram
- cardiac catheterisation
- cardiac MRI
- electrophysiological study
- genetic screening
Treatment algorithm
haemodynamically unstable ventricular tachycardia with a pulse
torsades de pointes
catecholaminergic polymorphic ventricular tachycardia
haemodynamically stable non-idiopathic sustained ventricular tachycardia
haemodynamically stable idiopathic sustained ventricular tachycardia
non-idiopathic: at high risk for ventricular tachycardia or history of sustained ventricular tachycardia/cardiac arrest without identifiable reversible cause
idiopathic ventricular tachycardia
Contributors
Authors
Sei Iwai, MD, FACC, FHRS
Professor of Clinical Medicine
New York Medical College
Director, Cardiac Electrophysiology
Westchester Medical Center Health Network
Valhalla
NY
Disclosures
SI is on the Biosense-Webster speakers' bureau. He receives honoraria from Biotronik, Boston Scientific, and Medtronic for lectures, and research grant support from Boston Scientific.
Acknowledgements
Prof Sei Iwai would like to gratefully acknowledge Dr Kenneth Stein and Dr Richard Keating, previous contributors to this topic.
Disclosures
KS declares he is an employee of and shareholder in Boston Scientific, a manufacturer of implantable cardioverter defibrillators and ablation catheters. RK declares that he has no competing interests.
Peer reviewers
Suneet Mittal, MD
Director
Electrophysiology Laboratory
The St. Luke's-Roosevelt Hospital Center
New York
NY
Disclosures
SM declares that he has no competing interests.
Kenneth A. Ellenbogen, MD
Kontos Professor of Cardiology
Medical College of Virginia
Richmond
VA
Disclosures
KAE declares that he has no competing interests.
Kim Rajappan, MA, MD, MRCP
Consultant Cardiologist and Electrophysiologist
Cardiac Department
John Radcliffe Hospital
Oxford
UK
Disclosures
KR declares that she has no competing interests.
Differentials
- Supraventricular tachycardia with aberrancy
- Supraventricular tachycardia with pre-excitation
- Electrical artefact
More DifferentialsGuidelines
- Adult advanced life support
- European resuscitation council guidelines 2021
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