Ventricular tachycardia consultation at Mayo Clinic
A thorough physical exam, medical history and testing are required to diagnose ventricular tachycardia.
Your doctor will evaluate your symptoms, perform a physical examination, and ask you about your health habits and medical history. In some cases, ventricular tachycardia may be a medical emergency that requires urgent diagnosis and treatment.
Several tests may be done to diagnose ventricular tachycardia.
An electrocardiogram (ECG or EKG) records the electrical signal from your heart to check for different heart conditions. Electrodes are placed on your chest to record your heart's electrical signals, which cause your heart to beat. The signals are shown as waves on an attached computer monitor or printer.
A Holter monitor uses electrodes and a recording device to track your heart's rhythm for 24 to 72 hours. Your doctor can print an electrocardiogram strip using the data on the recording device to see your heart's rhythm during the period you wore the monitor.
Cardiac event monitor
A wearable cardiac event monitor may be used to diagnose tachycardia. This type of portable ECG device records heart activity only during episodes of abnormal heartbeat.
An electrocardiogram (ECG or EKG) is the most common tool used to diagnose tachycardia. The painless test detects and records your heart's electrical activity using small sensors (electrodes) attached to your chest and arms.
An ECG records the timing and strength of electrical signals as they travel through your heart. Your doctor can look for patterns among the signals to determine what kind of tachycardia you have and how problems in the heart may be causing a fast heart rate.
Your doctor may also ask you to use a portable ECG device at home to obtain more information about your heart rate. These devices include:
- Holter monitor. You carry this portable ECG device in your pocket or wear it on a belt or shoulder strap. It records your heart's activity for an entire 24-hour period, which gives your doctor a prolonged look at your heart rhythms. Your doctor will likely ask you to keep a diary during the same 24 hours. You'll describe any symptoms you have and record the time they occur.
- Event monitor. This portable ECG device is intended to monitor your heart activity over a week to a few months. You wear it all day, but it records only at certain times for a few minutes at a time. You typically activate the monitor by pushing a button when you have symptoms of a fast heart rate. However, some monitors automatically sense abnormal heart rhythms and then start recording.
- Other monitors. Some personal devices, such as smart watches, offer electrocardiogram monitoring. Ask your doctor if this is an option for you.
- Transtelephonic monitor. This device provides continuous heart rhythm monitoring but must be worn continuously. It may or may not include wires.
- Implantable loop recorder. This is an implantable device that has no wires and can sit underneath your skin for up to three years to continuously monitor your heart rhythm.
Your doctor may recommend an electrophysiological test to confirm the diagnosis or to pinpoint the location of problems in your heart.
During this test, a doctor inserts thin, flexible tubes (catheters) tipped with electrodes into your groin, arm or neck and guides them through your blood vessels to various spots in your heart. Once in place, the electrodes can precisely map the spread of electrical impulses during each beat and identify abnormalities in your circuitry.
Your doctor may get images of your heart to determine if structural problems are affecting blood flow and causing your ventricular tachycardia.
Cardiac imaging tests used to diagnose ventricular tachycardia include:
- Echocardiogram. An echocardiogram creates a moving picture of your heart using sound waves. It can identify areas of poor blood flow, abnormal heart valves and heart muscle that are not working normally.
- Magnetic resonance imaging (MRI). A cardiac MRI can provide still or moving pictures of how the blood is flowing through the heart and detect irregularities.
- Computerized tomography (CT). CT scans combine several X-ray images to provide a more detailed cross-sectional view of the heart.
- Coronary angiogram. To study the flow of blood through your heart and blood vessels, your doctor may use a coronary angiogram to reveal potential blockages or abnormalities. It uses a dye and special X-rays to show the inside of your coronary arteries.
- Chest X-ray. This test is used to take still pictures of your heart and lungs and can detect if your heart is enlarged.
Seeing inside the heart with MRI
Cardiac MRI provides still or moving pictures of how the blood is flowing through the heart and detects irregularities. It is often used to diagnose ventricular tachycardia.
Exercise stress test
In an exercise stress test, electrodes are taped to your chest to detect your heart's rhythm. A nurse or technician will watch your heartbeat on a monitor while you exercise. If your doctor orders a nuclear stress test, you'll also receive an injection of radioactive dye that shows the blood flow to your heart muscle.
Your doctor may recommend a stress test to see how your heart works when you are active or when medication is given to make the heart beat faster.
In an exercise stress test, electrodes are placed on your chest to monitor heart function while you exercise, usually by walking on a treadmill. Other heart tests may be done along with a stress test.
Tilt table test
This test is sometimes used to help your doctor better understand how your tachycardia contributes to fainting spells. Under careful monitoring, you'll receive a medication that causes a tachycardia episode. You lie flat on a special table, and then the table is tilted as if you were standing up. Your doctor notes how your heart and nervous system respond to these changes in position.
Your doctor may order additional tests as needed to diagnose an underlying condition that is contributing to ventricular tachycardia and judge the condition of your heart.
Ventricular tachycardia treatment at Mayo Clinic
Mayo Clinic doctors deliver specialized care to treat ventricular tachycardia using advanced treatment technologies.
The goals of ventricular tachycardia treatment are:
- Restore a normal heart rhythm
- Control the fast heart rate when it occurs
- Prevent future episodes of tachycardia
The specific treatment you receive depends on what is causing the arrhythmia and the type or severity of your ventricular tachycardia.
Ventricular tachycardia may go away on its own within 30 seconds (nonsustained V-tach) or last more than 30 seconds (sustained V-tach or VT ). Sustained VT can disrupt normal blood flow and requires immediate medical treatment.
Treatment for sustained ventricular tachycardia
Sustained ventricular tachycardia often requires urgent medical treatment, as this condition may sometimes lead to sudden cardiac death.
Treatment involves restoring a normal heart rate by delivering a jolt of electricity to the heart. This may be done using a defibrillator or with a treatment called cardioversion.
Defibrillation can be done using an automated external defibrillator (AED) by a bystander who recognizes the signs of cardiac arrest.
Cardioversion is done in a hospital setting using a machine that monitors your heart rhythm before and after shocks are delivered. In this procedure, medical professionals shock your heart using paddles, an automated external defibrillator (AED) or patches on your chest.
You may also be given medications by mouth or by IV (intravenously).
Preventing episodes of a fast heart rate
An ICD works to regulate your heartbeat by delivering shocks to your heart when it detects an abnormal heartbeat.
Subcutaneous implantable cardioverter-defibrillator (S-ICD)
A subcutaneous implantable cardioverter-defibrillator (S-ICD) is a less invasive alternative to a traditional ICD. Using a special insertion tool, your doctor implants the S-ICD device under the skin at the side of the chest below the armpit and connects it to an electrode that runs along the breastbone.
With treatment, it may be possible to prevent or manage episodes of ventricular tachycardia.
Catheter ablation. This procedure is often used when a discrete electrical pathway is responsible for an increased heart rate.
In this procedure, a doctor inserts catheters into your heart through the veins in your groin, arm or neck. Electrodes at the catheter tips can use extreme cold or radiofrequency energy to damage (ablate) the extra electrical pathway and prevent it from sending electrical signals.
- Medications. Anti-arrhythmic medications may prevent a fast heart rate when taken regularly. Other heart medications, such as calcium channel blockers and beta blockers, may be prescribed with anti-arrhythmic drugs.
- Implantable cardioverter-defibrillator. If you're at risk of having a life-threatening tachycardia episode, your doctor may recommend an implantable cardioverter-defibrillator (ICD). The pager-sized device is surgically implanted in your chest. The ICD continuously monitors your heartbeat, detects an increase in heart rate and delivers precisely calibrated electrical shocks, if needed, to restore a normal heart rhythm.
Surgery. Open-heart surgery may be needed in some cases to treat a process contributing to ventricular tachycardia (for example, if there are blockages in blood vessels).
Tachycardia may also be treated with a maze procedure. During this procedure, a surgeon makes small incisions in heart tissue to create a pattern or maze of scar tissue. Because scar tissue doesn't conduct electricity, it interferes with stray electrical impulses that cause some types of tachycardia.
Surgery is usually used only when other treatment options don't work or when surgery is needed to treat another heart disorder.
Monitor and treat existing disease
If another medical condition is contributing to ventricular tachycardia, such as heart disease, treating the underlying problem may prevent or reduce ventricular tachycardia episodes.
Following your treatment plan is important. It can help lower your risk of future heart rhythm problems. If your symptoms change or get worse or you develop new symptoms, tell your doctor immediately.
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.
Coping and support
If you have a plan in place to deal with an episode of a fast heartbeat, you may feel calmer and more in control when one occurs. Talk to your doctor about:
- How to take your pulse and what a normal pulse rate is for you
- When and how to use a variety of maneuvers or take additional medications if they are appropriate for you
- When to call your doctor
- When to seek emergency care
Preparing for your appointment
Whether you first see your family doctor or get emergency care, you'll likely be referred to a doctor trained in heart conditions (cardiologist) for one or more appointments for a complete evaluation.
If possible, bring along a family member or friend who can give some moral support and help you keep track of new information. Because there may be a lot to discuss, it will be helpful to prepare a list of questions ahead of time.
Your list should include:
- Symptoms you've experienced, including any that may seem unrelated to your heart
- Key personal information, including any major stresses or recent life changes
- Medications, including vitamins or supplements
- Questions to ask your doctor
List your questions from most important to least important in case time runs out. Basic questions to ask your doctor include:
- What is likely causing my fast heart rate?
- What kinds of tests do I need?
- What's the most appropriate treatment?
- What kind of risks does my heart condition create?
- How will we monitor my heart?
- How often will I need follow-up appointments?
- How will other conditions I have or medications I take affect my heart problem?
- Do I need to restrict my activities?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did you first begin experiencing symptoms?
- How often have you had episodes of a fast heartbeat?
- How long have the episodes lasted?
- Does anything, such as exercise, stress or caffeine, seem to trigger or worsen episodes?
- Does anyone in your family have heart disease or a history of arrhythmias?
- Has anyone in your family experienced cardiac arrest or died suddenly?
- Do you smoke?
- How much alcohol or caffeine do you use?
- Do you use recreational drugs?
- Are you being treated for high blood pressure, high cholesterol or other conditions that may affect your circulatory system?
- What medications do you take for these conditions, and do you take them as prescribed?
Oct. 30, 2020