Ventricular Tachycardia Clinical Presentation

Updated: Dec 31, 2015
  • Author: Steven J Compton, MD, FACC, FACP, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
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Presentation

History

Ventricular tachycardia (VT) can be symptomatic. Symptomatic patients typically present with palpitation, lightheadedness, and syncope from diminished cerebral perfusion. Chest pain may result from ischemia or from the rhythm itself. Understandably, patients often experience anxiety. Syncope is more common when VT occurs in the setting of structural heart disease.

Some patients describe a sensation of neck fullness, which may be related to increased central venous pressure and occasional cannon a waves. Dyspnea may be related to increased pulmonary venous pressures and occasional left atrial contraction against a closed mitral valve.

Eliciting a history of risk factors for VT is important. These include prior myocardial infarction, other known structural heart disease, or a family history of premature sudden death. VT must be strongly considered in any syncopal patient with such a history.

For athletes, determination of the risk for VT should be part of the preparticipation history and physical examination. Guidelines from the American College of Cardiology (ACC), the American Heart Association (AHA), and the European Society of Cardiology (ESC) recommend assessment for a family history of premature or sudden cardiac death, as well as for specific evidence of cardiovascular diseases such as cardiomyopathies and ion channel disorders. [25]

Any patient with a strong family history of premature (ie, before 40 years of age) sudden death should be evaluated for inherited arrhythmia syndromes, including the following:

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Physical Examination

Besides tachycardia, findings in patients with VT generally reflect the degree of hemodynamic instability. Episodes of VT are often associated with hypotension and tachypnea. Signs of diminished perfusion may be present, including a diminished level of consciousness, pallor, and diaphoresis. Jugular venous pressure may be high, and cannon a waves may be observed if the atria are in sinus rhythm. The first heart sound may vary in intensity as a result of loss of atrioventricular (AV) synchrony.

In patients who have converted to sinus rhythm (whether spontaneously or after cardioversion), relevant physical findings would be related to any underlying structural heart disease. These may include displacement of the point of maximal impulse (PMI), murmurs related to valvular heart disease or hypertrophic cardiomyopathy, and an S3 gallop. Rales may be present during sinus rhythm if uncompensated heart failure is present. Sinus rhythm is often interrupted by ventricular extrasystole.

The following changes may be seen in the patient’s mental status:

  • Anxiety
  • Agitation
  • Lethargy
  • Coma
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