Ventricular Tachycardia Clinical Presentation

Updated: Dec 05, 2017
  • 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. Symptoms of VT are often a function of the associated heart rate, or the causal process, such as an acute myocardial infarction (MI). 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.

VT may also be asymptomatic, or the symptoms may be those of the associated triggered therapy (eg, an implantable cardioverter-defibrillator [ICD] shock).

Eliciting a history of risk factors for VT is important. These include prior MI, 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. 

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

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Physical Examination

Aside from tachycardia, findings in patients with ventricular tachycardia (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 (S1) 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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