Ventricular Tachycardia: Symptoms, Causes, and Treatment

When your heart’s electrical system becomes disrupted, ventricular tachycardia (VT) can develop. This arrhythmia can cause your heart to beat very rapidly and be unable to pump blood effectively. Normally, your heart beats 60-100 times per minute, but during VT this rate can rise above 100, sometimes even up to 250. This condition can lead to serious symptoms such as dizziness, fainting, chest pain, shortness of breath, and sudden cardiac arrest. VT is usually a sign of underlying heart disease.

What Is Ventricular Tachycardia?

Ventricular tachycardia (VT) is a rapid heart rhythm caused by abnormal electrical signals originating from the lower chambers of your heart (ventricles). This condition prevents your heart from contracting effectively and pumping blood. This arrhythmia, which begins when heart rate rises above 100 per minute, can be short-term (a few seconds) or long-term (longer than 30 seconds). VT can be life-threatening because your heart cannot send enough blood to the brain and other organs.

What Are the Types of Ventricular Tachycardia?

Ventricular tachycardia is classified in different ways according to its duration, shape, and underlying heart disease. This classification helps your doctor determine the severity of the disease and treatment approach.

The main types of ventricular tachycardia are:

• Non-sustained VT: In this type, the VT episode lasts less than 30 seconds and ends spontaneously. It usually causes no symptoms or creates a mild palpitation sensation. This condition may be a harbinger of heart disease but usually does not carry risk of sudden death.
• Sustained VT: The VT episode lasts longer than 30 seconds or needs to be terminated due to serious symptoms. Sustained VT is a serious condition because it prevents the heart from pumping blood effectively and requires emergency medical intervention.
• Monomorphic VT: This is the type of VT where all heartbeats have the same shape (morphology) on ECG. It usually originates from a single damaged area in the heart and is seen in those with stable heart disease.
• Polymorphic VT: This is the type of VT where heartbeats have different shapes on ECG. It can originate from multiple damaged areas and can transform into a dangerous arrhythmia called Torsades de Pointes. This condition increases the risk of sudden cardiac arrest.

What Causes Ventricular Tachycardia?

Ventricular tachycardia is usually a result of underlying heart disease. Heart attack or other conditions that cause damage to the heart muscle create scar tissue or damaged areas in the ventricles that initiate abnormal electrical signals. Rarely, VT can occur without structural heart disease.

The main causes of ventricular tachycardia are:

• Coronary Artery Disease and Heart Attack: In patients who have had a heart attack, scar tissue formed in the heart muscle is the most common cause of VT.
• Cardiomyopathies: These are structural diseases of the heart muscle. Conditions such as hypertrophic cardiomyopathy and dilated cardiomyopathy increase VT risk.
• Heart Failure: In patients with heart failure, weakening and enlargement of the heart muscle can prepare the ground for VT.
• Congenital Heart Diseases: Some congenital heart diseases (such as Brugada syndrome or long QT syndrome) increase VT risk.
• Electrolyte Imbalances: Abnormal levels of electrolytes such as potassium, magnesium, or calcium can trigger VT by disrupting the heart’s electrical activity.
• Medications: Some medications, especially anti-arrhythmic drugs or some antidepressants, can increase VT risk.

What Are the Symptoms of Ventricular Tachycardia?

Ventricular tachycardia symptoms vary depending on the duration of the VT episode and how much your heart’s pumping function is affected. Short-duration VT episodes usually cause no symptoms, while long-duration episodes can lead to serious symptoms.

The most common symptoms of ventricular tachycardia are:

• Rapid Heartbeat (Palpitations)
• Dizziness and Lightheadedness
• Fainting (Syncope)
• Chest Pain or Pressure Sensation
• Shortness of Breath
• Fatigue and Weakness

If this arrhythmia lasts long, loss of consciousness and sudden cardiac arrest can develop.

Who Gets Ventricular Tachycardia?

Ventricular tachycardia is most commonly seen in people with underlying heart disease. VT risk is especially high in individuals who have previously had a heart attack, heart failure, or conditions such as cardiomyopathy. Besides this, VT can also occur in young people with a family history of sudden cardiac death or those with certain congenital syndromes.

The main groups at risk for ventricular tachycardia are:

• Those Who Have Had Heart Attacks: Scar tissue formed after heart attack is the most common cause of VT.
• Those with Heart Failure: Decreased pumping power of the heart can cause electrical problems in the ventricles.
• Cardiomyopathy Patients: Diseases such as hypertrophic or dilated cardiomyopathy disrupt the heart’s structure and prepare the ground for VT.
• Those with Congenital Electrical Diseases: Individuals with genetic diseases such as Brugada syndrome and long QT syndrome can experience VT even at a young age.
• Those with Family History of Sudden Cardiac Death: VT risk increases in families with a history of sudden cardiac death due to genetic predisposition.

How Is Ventricular Tachycardia Diagnosed?

An important diagnostic tool for ventricular tachycardia diagnosis is electrocardiography (ECG), which records your heart’s electrical activity. However, since VT episodes occur intermittently, a single ECG recording may not be sufficient. Therefore, tests that monitor your heart for long periods and advanced imaging methods are also used.

The main methods used in ventricular tachycardia diagnosis are:

• Electrocardiography (ECG): ECG taken during a VT episode shows that the source of the arrhythmia is from the ventricles.
• Holter Monitoring: This is a portable device that continuously records your heart’s rhythm for 24 or 48 hours. This way, short-term and intermittent VT episodes can be detected.
• Electrophysiologic Study (EPstudy): Your heart’s electrical activity is examined by entering the heart through catheters, and the area causing VT is found by triggering it. This test is used for both diagnosis and treatment.
• Echocardiography: Evaluates your heart’s structure and pumping function to detect structural heart diseases that may cause VT.
• Cardiac MRI (Magnetic Resonance Imaging): Used to image scar tissue or abnormalities in the heart muscle in more detail.

How Is Ventricular Tachycardia Treated?

Treatment of ventricular tachycardia is determined according to the type of VT episode, underlying causes, and the patient’s general health condition. In emergency situations, medications or electrical shock (cardioversion) are used to return your heart’s rhythm to normal. In long-term treatment, the goal is to prevent VT episodes and reduce the risk of sudden death.

Methods applied in ventricular tachycardia treatment are:

• Emergency Intervention: In sustained and life-threatening VT, heart rhythm is returned to normal with intravenous medications or externally applied electrical shock (cardioversion).
• Medication Treatment: Anti-arrhythmic drugs are used to prevent ventricular tachycardia episodes. These drugs try to prevent VT formation by regulating the heart’s electrical activity.
• Cardiac Ablation: With catheters placed inside your heart, the abnormal electrical focus causing VT is found and burned or frozen. This is a permanent treatment option for some VT types.
• Implantable Cardioverter-Defibrillator (ICD): For patients at high risk of sudden death, a device is implanted that detects VT episodes and returns heart rhythm to normal by giving electrical shock. This device is a life-saving preventive tool.

What Are the Risks and Complications of Ventricular Tachycardia?

Ventricular tachycardia carries serious risks and complications when not treated or cannot be controlled. The most important and feared complication is ventricular fibrillation (VFib) and related sudden cardiac arrest. When VT transforms into VFib, the heart completely loses its blood pumping ability and is fatal if emergency intervention is not performed.

The main complications that ventricular tachycardia can cause are:

• Ventricular Fibrillation (VFib): VT can cause the lower chambers of the heart (ventricles) to tremble rapidly and chaotically. This condition stops the heart’s blood pumping function and causes sudden cardiac arrest.
• Sudden Cardiac Arrest and Death: VFib is a condition requiring emergency intervention (defibrillation). When this intervention is not performed, death occurs within minutes.
• Heart Failure: Continuous or recurrent VT episodes can weaken the heart’s pumping power over time, leading to heart failure.
• Fainting (Syncope): Decreased blood flow to the brain can cause fainting and related injuries.

What Are the Prevention Methods for Ventricular Tachycardia?

Since ventricular tachycardia is usually related to underlying heart disease, controlling conditions that increase risk is more important than preventing the disease itself. Lifestyle changes and effective management of your existing heart disease help reduce your VT risk.

What you can do to reduce VT risk:

• Manage Your Heart Disease: Continue treatment of existing heart diseases such as coronary artery disease, heart failure, or cardiomyopathy regularly.
• Healthy Lifestyle: Quit smoking, eat healthily, and exercise regularly with your doctor’s approval.
• Avoid Triggers: Stay away from factors that may trigger VT episodes such as caffeine, alcohol, or excessive stress.
• Be Careful with Your Medications: Use medications prescribed by your doctor regularly and be careful about side effects.

How Should Nutrition and Exercise Be?

For ventricular tachycardia patients, nutrition and exercise are of great importance for managing underlying heart disease. However, you should definitely follow your doctor’s recommendations on these matters.

Nutrition:

• Limit Salt Consumption: Salt restriction is vital especially for patients with heart failure.
• Electrolyte Balance: Adopt a healthy diet containing electrolytes such as potassium and magnesium.
• Avoid Fatty Foods: Prefer a diet low in saturated fat to reduce coronary artery disease risk.

Exercise:

• Get Doctor Approval: Definitely consult your doctor before starting your exercise program and ask them to create a personalized exercise plan for you.
• Avoid Heavy Exercise: You should avoid heavy physical activities especially because they may trigger VT episodes.
• Regular and Light Exercise: Moderate-intensity exercises such as brisk walking or cycling are usually safe.

When Should You Consult a Doctor?

If you feel your heart beating rapidly and irregularly and this condition is accompanied by symptoms such as dizziness, chest pain, and feeling of fainting, you should consult a doctor without delay. Especially if you experience a VT episode lasting longer than 30 seconds or causing fainting, immediately call emergency services or go to the nearest emergency room.

Emergency intervention may be needed in the following situations:

• If your rapid heartbeat starts suddenly and does not pass with rest
• If you faint when your heartbeat accelerates
• If there is chest pain and shortness of breath accompanying palpitations
• If you have previously had a heart attack and experience palpitations

Reference: Ventricular Tachycardia