bubble_chart Overview

Most cases are seen in organic heart diseases, particularly coronary heart disease, acute myocardial infarction, and cardiomyopathy. A few cases occur in individuals without obvious organic heart disease or those with drug poisoning disease and hypokalemia. Since ventricular tachycardia can lead to severe clinical outcomes, outpatient management should be handled with caution, and hospitalization is generally recommended.

bubble_chart Diagnosis

(1) Medical history and symptoms: Ventricular tachycardia (VT) often occurs suddenly, with patients experiencing noticeable flusteredness and chest tightness. It may develop on the basis of ventricular premature beats. When the heart rate exceeds 200 beats per minute or there is significant organic heart disease, symptoms such as colicky pain, acute left heart failure, Adams-Stokes syndrome, or even sudden death may occur. A history of heart disease or previous episodes of VT can aid in diagnosis. Understanding the timing and frequency of episodes, as well as recent medication use—particularly antiarrhythmic drugs, cardiotonics, and diuretics—can sometimes help identify the cause of VT.

(2) Physical examination findings: In cases of short bursts of VT or sustained VT without hemodynamic compromise, vital signs are generally stable. Cardiac auscultation reveals a rapid and roughly regular heart rate, with premature beats audible during intermittent episodes. Patients with underlying heart disease or a heart rate exceeding 200 beats per minute may exhibit signs of hemodynamic instability, such as decreased blood pressure, dyspnea, profuse sweating, and cold extremities, indicating a critical condition requiring urgent intervention.

(3) Auxiliary examinations: An electrocardiogram (ECG) can confirm the diagnosis by recording three or more consecutive rapid, wide, and bizarre QRS complexes unrelated to P waves. Ventricular captures or fusion beats may sometimes be observed. For infrequent or brief episodes, 24-hour Holter monitoring can assist in diagnosis. Cardiac ultrasound can identify underlying heart diseases.

(4) Differential diagnosis: VT should be distinguished from supraventricular tachycardia (SVT) with pre-excitation syndrome via accessory pathway anterograde conduction or bundle branch block.

bubble_chart Treatment Measures

(1) Management of acute episodes; Ventricular tachycardia can cause hemodynamic disturbances and must be promptly corrected, with most cases requiring hospitalization. The drug of choice is lidocaine, administered as a slow intravenous push of 50–100 mg diluted solution, which can be repeated if ineffective. After achieving effect, maintenance is continued with an intravenous drip at 1–4 mg/min. Alternatively, propafenone 75 mg or amiodarone 150 mg diluted solution can be slowly pushed intravenously, followed by intravenous drip maintenance. In cases of significant hemodynamic instability, synchronized direct current cardioversion is the preferred method, with an optimal energy level of 300 joules. Concurrently, active treatment of the underlying heart disease and potassium supplementation should be pursued.

(2) Prevention of episodes; For prevention, intravenous lidocaine drip can be used, along with oral mexiletine 450–800 mg/d, propafenone 450–800 mg/d, or amiodarone 200–600 mg/d. Effective treatment of the primary disease and long-term potassium supplementation are helpful in preventing ventricular tachycardia episodes.