Overview

Ventricular tachycardia is a type of irregular heartbeat, called an arrhythmia. It starts in the lower chambers of the heart, called the ventricles. This condition also may be called V-tach or VT.

A healthy heart typically beats about 60 to 100 times a minute at rest. In ventricular tachycardia, the heart beats faster, usually 100 or more beats a minute.

Sometimes the rapid heartbeat stops the heart chambers from properly filling with blood. The heart may not be able to pump enough blood to the body. If this happens, you may feel short of breath or lightheaded. Some people lose consciousness.

Ventricular tachycardia episodes may be brief and last only a few seconds without causing harm. But episodes lasting more than a few seconds, called sustained V-tach, can be life-threatening. Sometimes ventricular tachycardia can cause all heart activity to stop. This complication is called sudden cardiac arrest.

Treatments for ventricular tachycardia include medicines, a shock to the heart, a heart device, and a procedure or surgery.

What is ventricular tachycardia?

Mayo Clinic cardiologist Suraj Kapa, M.D., discusses common misconceptions about ventricular tachycardia.

I'm Dr. Suraj Kapa, a Mayo Clinic cardiologist specializing in heart rhythm disorders. Today, I'm going to talk about the condition known as ventricular tachycardia. Now, if you go on the internet and you look up ventricular tachycardia, you might find yourself concerned because people tell you, oh, this is associated with sudden death, or, oh, you might have to seek urgent medical attention. But I'm going to try and clarify things for you a little bit, both about what this might be and how we might go about treating it.

Ventricular arrhythmias can occur in both structurally normal and structurally abnormal hearts. What we mean by this is that there are some patients out there who really have no other underlying heart disease except some abnormality in their electrical system of the bottom chambers of their heart, or the ventricles, that can cause the heart to go out of rhythm. These can appear as occasional extra beats that one might experience as skipped beats, or as a rapid array of beats that are occurring all in a row, termed ventricular tachycardia. In rare cases, if the heart is structurally normal, this can actually result in a dangerous rhythm, though again that's relatively rare if there's not some other underlying heart disease that might be contributing.

Now, in some patients, however, they can have an abnormal heart for other reasons. There are a variety of reasons that the heart can become structurally abnormal, such as if you've had a heart attack in the past, if you have some sort of genetic abnormality that you might have inherited from your mother or your father. You might have some inflammatory disorder of your heart, such as sarcoidosis or myocarditis. All of these different syndromes can contribute to electrical abnormalities in the bottom chamber of the heart as well, but sometimes, when people have what we call substrate, or abnormalities of the normal heart architecture, this can lead to ventricular arrhythmias. And in these patients, these ventricular arrhythmias can potentially be life-threatening.

When we look at these arrhythmias happening, however, we have to take a systematic approach to their evaluation and to their treatment. So what do I mean by this? When we talk about evaluation, we're looking to see, Is there another reason they happened? Was there a medication you were placed on, was there some abnormality in your electrolytes, or what you were taking for other reasons, such as over-the counter herbal remedies, that might have contributed to why you might have those arrhythmias, and in fact they might go away if we do nothing else?

We're also trying to figure out how significant the arrhythmia is. Is it something that is life-threatening, or is not, because not all of them are. And then when we talk about treatment, we're looking really at two large areas. In those patients who don't have dangerous ventricular arrhythmias, we're looking to treat to improve quality of life, or symptoms, because some patients can have a variety of symptoms attributable to these arrhythmias, including feelings of skipped beats or rapid heart beats, or even dizziness. But some might just feel tired.

But then, the other group we worry about is the ones in whom these arrhythmias can potentially be mortal. In other words, they can lead to sudden death. In those patients, we like to risk stratify to figure out are these arrhythmias dangerous, and how do we protect those patients from dying suddenly.

The mainstay of treatments you might see if you go online is something called a defibrillator. You might have seen this on commercials or on TV shows where people are running about with these pads, drop them on a patient, and then provide an electric shock. This is what a defibrillator does for those patients who have the more risky ventricular arrhythmias. It sits in your body all the time, and then basically gives a jolt of electricity if your heart goes out of rhythm in order to restore it to normal rhythm. But the defibrillator doesn't prevent the arrhythmias from happening, it just is there to save your life in case they do.

In order to prevent the arrhythmias from actually happening, there are two mainstays of therapy. If we cannot find another reversible cause, we can either provide you with medications, and there are a variety of medications we can use. These medications are termed anti-arrhythmic drugs, and tend to be successful in as many as 50% to 60% of patients. However, they can have side effects, and in some patients they can actually cause more arrhythmias, and sometimes dangerous arrhythmias that could lead to sudden death, as well. As long as patients are properly monitored and the initiation of the drugs is properly done, however, the likelihood of this is very low.

Thank you for joining me today to learn more about ventricular tachycardia. In the next video, I will go into more detail in what an ablation procedure involves.

Symptoms

When the heart beats too fast, it may not send enough blood to the rest of the body. So the organs and tissues may not get enough oxygen. Symptoms of ventricular tachycardia are due to a lack of oxygen. They may include:

  • Chest pain, called angina.
  • Dizziness.
  • Pounding heartbeat, called palpitations.
  • Lightheadedness.
  • Shortness of breath.

Ventricular tachycardia can be a medical emergency even if your symptoms are minor.

Ventricular tachycardia, sometimes called V-tach or VT, is grouped according to how long an episode lasts.

  • Nonsustained V-tach stops on its own within 30 seconds. Brief episodes may not cause any symptoms.
  • Sustained V-tach lasts more than 30 seconds. This type of ventricular tachycardia can cause serious health problems.

Symptoms of sustained V-tach may include:

  • Fainting.
  • Loss of consciousness.
  • Cardiac arrest or sudden death.

When to see a doctor

Many different things can cause ventricular tachycardia, sometimes called V-tach or VT. It's important to get a fast, accurate diagnosis and appropriate care. Even if you have a healthy heart, you should get prompt medical help if you have symptoms of V-tach.

Make an appointment for a health checkup if you think you have an irregular heartbeat. Sometimes, urgent or emergency care is needed.

Call 911 or your local emergency number for these symptoms:

  • Chest pain that lasts more than a few minutes.
  • Difficulty breathing.
  • Fainting.
  • Shortness of breath.

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Causes

Ventricular tachycardia is caused by faulty heart signaling that makes the heart beat too fast in the lower heart chambers. The lower heart chambers are called the ventricles. The fast heart rate doesn't allow the ventricles to fill and squeeze to pump enough blood to the body.

Many things can cause or lead to problems with heart signaling and trigger ventricular tachycardia. These include:

  • Prior heart attack.
  • Any heart condition that caused scarring of heart tissue, called structural heart disease.
  • Poor blood flow to the heart muscle due to coronary artery disease.
  • Heart problems present at birth, including long QT syndrome.
  • Changes in levels of body minerals called electrolytes. These include potassium, sodium, calcium and magnesium.
  • Side effects of medicines.
  • Use of stimulants such as cocaine or methamphetamine.

Sometimes, the exact cause of ventricular tachycardia can't be determined. This is called idiopathic ventricular tachycardia.

How does the heart beat?

To better understand the cause of ventricular tachycardia, it may help to know how the heart works.

The typical heart has four chambers.

  • The two upper chambers are called the atria.
  • The two lower chambers are called the ventricles.

The heart's electrical system controls the heartbeat. The heart's electrical signals start in a group of cells at the top of the heart called the sinus node. They pass through a pathway between the upper and lower heart chambers called the atrioventricular (AV) node. The movement of the signals causes the heart to squeeze and pump blood.

In a healthy heart, this heart signaling process usually goes smoothly, resulting in a resting heart rate of 60 to 100 beats a minute.

But some things can change how electrical signals travel through the heart. In ventricular tachycardia, faulty electrical signaling in the heart's lower chambers make the heart beat100 or more times a minute.

Risk factors

Any condition that puts a strain on the heart or damages heart tissue can increase the risk of ventricular tachycardia. Lifestyle changes such as eating healthy and not smoking may lower the risk. It's also important to get proper medical treatment if you have any of the following conditions and events:

  • Heart disease.
  • Side effects of medicines.
  • Severe changes in the level of body minerals, called electrolyte imbalances.
  • A history of using stimulant drugs such as cocaine or methamphetamine.

A family history of tachycardia or other heart rhythm disorders also makes a person more likely to get ventricular tachycardia.

Complications

Complications of ventricular tachycardia depend on:

  • How fast the heart is beating.
  • How long the rapid heart rate lasts.
  • Whether there are other heart conditions.

A life-threatening complication of V-tach is ventricular fibrillation, also called V-fib. V-fib can cause all heart activity to suddenly stop, called sudden cardiac arrest. Emergency treatment is needed to prevent death. V-fib happens most often in people with heart disease or a prior heart attack. Sometimes it occurs in those who have high or low potassium levels or other changes in body mineral levels.

Other possible complications of ventricular tachycardia include:

  • Frequent fainting spells or unconsciousness.
  • Heart failure.
  • Sudden death caused by cardiac arrest.

Prevention

Preventing ventricular tachycardia starts with keeping the heart in good shape. If you have heart disease, get regular health checkups and follow your treatment plan. Take all medicines as directed.

Take the following steps to keep the heart healthy. The American Heart Association recommends these eight steps:

  • Eat a balanced, nutritious diet. Eat a healthy diet that's low in salt and solid fats and rich in fruits, vegetables and whole grains.
  • Get regular exercise. Try to exercise for at least 30 minutes on most days. Ask your healthcare team which exercises are safest for you.
  • Maintain a healthy weight. Being overweight increases the risk of heart disease. Talk with your care team to set realistic goals for body mass index (BMI) and weight.
  • Control blood pressure and cholesterol. High blood pressure and high cholesterol increase the risk of heart disease. Make lifestyle changes and take medicines as directed to manage high blood pressure or high cholesterol.
  • Manage stress. Stress can make the heart beat faster. Getting more exercise, practicing mindfulness and connecting with others in support groups are some ways to reduce and manage stress.
  • Limit alcohol. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.
  • Stop smoking. If you smoke and can't quit on your own, talk to a healthcare professional about strategies to help you stop.
  • Practice good sleep habits. Poor sleep may increase the risk of heart disease and other long-term health conditions. Adults should aim to get 7 to 9 hours of sleep daily. Go to bed and wake at the same time every day, including on weekends. If you have trouble sleeping, talk to a healthcare professional about strategies that might help.

Other lifestyle changes also can help protect heart health and may prevent irregular heartbeats:

  • Limit caffeine. Caffeine is a stimulant. It can make the heart beat faster.
  • Don't use illegal drugs. Stimulants such as cocaine and methamphetamine can increase the heart rate. If you need help stopping, talk to your healthcare team about an appropriate program for you.
  • Check medicine ingredients. Some cold and cough medicines bought without a prescription contain stimulants that may increase the heart rate. Always tell your healthcare team about all the medicines you take.
  • Go to scheduled health checkups. Have regular physical exams and report any new symptoms to your healthcare team.

March 06, 2024
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