Your heartbeat is controlled by electrical signals (impulses) from a part of your heart called the sinus node. These impulses travel through your heart, making it beat. They travel from your atria (the upper chambers of your heart) to your ventricles (the lower chambers of your heart) through the atrioventricular (AV) node. The AV node helps to time the pumping action of your heart.
Ventricular tachycardia happens when the electrical signals in your ventricles get disorganised, overriding your heart's normal rate and rhythm. This most often happens because an area of your heart has been damaged (from a previous heart attack for example).
The abnormal rhythm causes your ventricles to contract faster than normal. Your heart then pumps out blood too quickly. Your ventricles may not have enough time to fill up properly with blood between beats.
Some people have no symptoms with ventricular tachycardia, but others do. When you have an attack of ventricular tachycardia, you may have the following symptoms:
- palpitations (when you're aware of your heart beating faster or more forcefully than usual)
- chest pain
- feeling light headed
You may also feel anxious. These symptoms may be caused by problems other than ventricular tachycardia. But if you have them, get medical advice urgently.
If you have symptoms that suggest you may have ventricular tachycardia, your GP, emergency doctor or cardiologist will suggest an electrocardiogram (ECG) at first. A cardiologist is a doctor who specialises in heart conditions. An ECG is a test that records the electrical activity of your heart. If your doctor thinks you may have an arrhythmia such as ventricular tachycardia, they may suggest you have a further test called an ambulatory ECG. This records your heartbeat while you go about your normal daily activities, over 24 hours or longer.
If either of these ECG tests shows you have ventricular tachycardia, you’ll need to have further tests at the hospital. Tests you might have are described below.
- Blood tests.
- A chest X-ray can look for any changes in your heart or lungs that might be causing the problem.
- An echocardiogram is an ultrasound scan of your heart. It gives a clear image of your heart muscles and valves and shows how well your heart is working.
- An electrophysiological study uses a special catheter (a flexible tube) with an electrical tip that stimulates and records your heart. Using this, your doctor can check your heart’s electrical activity in great detail.
- An angiogram uses dye visible on X-rays that is injected into your heart’s arteries to show up any narrowing or blockages.
Treatment of ventricular tachycardia during an attack aims to stop the attack and treat your symptoms. There are also treatments to help prevent future attacks.
There are several different types of medicine that can help control your heart rate and rhythm. Your doctor may prescribe one or more of these medicines:
- calcium-channel blockers
- antiarrhythmic medicines
You may take them for a short period of time until you have an emergency procedure to restore your heart rhythm, such as electrical cardioversion. In this situation, you may be given these medicines through a drip in your arm. Alternatively, you may be given tablets to take every day, to help prevent further episodes of ventricular tachycardia. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.
If your ventricular tachycardia has been going on for some time or your condition could get worse, you’ll need an emergency procedure. This is called an electrical cardioversion. A short burst of electrical current is applied to your chest via a machine called a defibrillator. This shock is timed to coincide with your heart’s normal rhythm. It stops your heart’s disorganised beats, so that your heart can pick up a normal rhythm again.
If having a cardioversion doesn't help, you may be given an antiarrhythmic medicine, such as amiodarone through a drip in your arm.
If your heart has stopped (cardiac arrest), you may lose consciousness. If this happens, you’ll have immediate defibrillation. This is similar to cardioversion, but the electrical burst isn't timed, it’s just given right away. You might also need to have a procedure called temporary pacing. This is where a thin tube is placed on your skin or gently guided through a vein to your heart. It gives electrical impulses to control your heart beat.
Types of surgery you may have to reduce the chance you’ll have ventricular tachycardia in the future include:
- having an implantable cardioverter defibrillator (ICD) fitted
- catheter ablation (radiofrequency ablation)
- heart surgery
We've described each of these procedures below.
Having an implantable cardioverter defibrillator (ICD) fitted
An ICD is a device that can detect your heart starting to have an attack of ventricular tachycardia and restore your heart beat to normal.
An ICD is put under your skin, usually near your collarbone on your right or left side. The operation is quick and isn't very risky. ICDs can’t stop you having ventricular tachycardia, but they can correct it when it occurs. So, your doctor may suggest you take medication too, to reduce the chance you’ll have an attack in the first place.
Your ICD monitors your heart, but doesn't control it most the time. It will send electrical signals to your heart only if you start having ventricular tachycardia. It might give regular pulses that override the disorganised signals in your heart. Or if these pulses don’t help, it may give you a small electric shock to stop you having ventricular tachycardia. It will also deliver a shock if it detects that your heart has stopped beating.
Catheter ablation can be used to stop you having future attacks of ventricular tachycardia. In this procedure, heat is used to damage the muscles in the area of your heart that is giving incorrect electrical signals.
You may be awake for the procedure, but you’ll be given a sedative medicine so you’re calm. Alternatively, you may be given a general anaesthetic and so you’ll be asleep. A thin, long tube (a catheter) will be put into a vein in your neck or groin. This will be threaded through to your heart. Here, it will deliver the heat to precisely the right piece of abnormal tissue in your heart. Catheter ablation can prevent ventricular tachycardia from happening again.
If other techniques aren’t suitable, you may have an operation on your heart to treat or remove the tissue causing your abnormal heart beat. You might have a procedure to widen any narrowed blood vessels. This may help to prevent your heart from beating abnormally, by making sure your heart muscles get enough blood and oxygen.
Ventricular tachycardia is often caused by damage to the muscles in your heart. This could have developed as a result of a having a heart attack, or having had a heart attack in the past, for example.
Heart muscle disease (cardiomyopathy) and heart problems since birth (congenital heart disease) can also lead to ventricular tachycardia.
Other factors that can trigger ventricular tachycardia include:
- certain medicines or illegal drugs
- imbalances of chemicals in your blood (such as too low a level of potassium, calcium or magnesium)
Ventricular tachycardia can sometimes cause your heart to stop beating (cardiac arrest). A cardiac arrest is life-threatening and can be fatal. Your risk of having a cardiac arrest can be reduced by taking medicines (such as beta-blockers) or having surgery. If you have an implantable cardioverter defibrillator (ICD) fitted, this can correct any dangerous changes in your heart rhythm.
Can I drive if I have ventricular tachycardia?
Whether or not you’ll be able to drive depends on your individual circumstances. You must follow your doctor’s advice and check with the Driver and Vehicle Licensing Agency (DVLA) before driving.
The DVLA states that you must not drive if you have an arrhythmia (an abnormal heartbeat) that has caused, or is likely to cause, you to be unable to control your car. You can drive if the cause of your arrhythmia has been identified and controlled for at least four weeks. You need to let the DVLA know if your condition may distract or disable you.
If you have catheter ablation, you mustn't drive a small vehicle (car or motorbike) for at least two days after your procedure. Follow your doctor’s advice about when to drive again. If you hold a licence for large goods vehicles (LGVs) or passenger-carrying vehicles (PCVs), you mustn't drive these for at least two weeks. You may need to wait up to six weeks before driving again.
If you have an implantable cardioverter defibrillator (ICD) fitted, you might need to tell the DVLA. You may not be allowed to drive for six months after having your ICD fitted. If you have a severe attack of ventricular tachycardia and your ICD shocks you, you shouldn't drive for six months. You’ll be able to drive after one month if your ICD successfully corrected your heart beat though.
Have your regular check-ups after the ICD is fitted and discuss with your doctor when you can drive again. If you hold a driving licence that allows you to drive LGVs or PCVs, you won’t be allowed this after you have an ICD fitted.
If you don’t follow the medical advice of the DVLA, your insurance might not cover you if you’re involved in an accident. Always follow your doctor’s advice and check with the Driver and Vehicle Licensing Agency (DVLA) before driving.
Why do I need an implantable cardioverter defibrillator (ICD)?
Your doctor might suggest you have an implantable cardioverter defibrillator (ICD) to treat ventricular tachycardia. This way, you’ll be treated by the device immediately should you ever need treatment.
An ICD is a device that can monitor your heart rhythm and restore your heartbeat to a normal rate if you have an episode of ventricular tachycardia.
An ICD is a device that can monitor your heart rhythm and get your heartbeat back to normal if it goes wrong. When you have an episode of ventricular tachycardia, it’s important you get treatment quickly. Without treatment, your heart may stop beating (cardiac arrest), which can be life threatening. If your doctor thinks you’re at risk of ventricular tachycardia or fibrillation, they may suggest you have an ICD. Ventricular fibrillation is a condition where your heart stops beating, and only quivers. If your heart beat goes wrong, the device can provide electric pulses or a shock to correct it.
Reasons you might be at risk of having ventricular tachycardia and need an ICD are if you:
- previously had a heart attack
- have diseased heart muscle
- were born with a heart condition (congenital heart disease)
Not everyone who has one of these conditions will need an ICD. Talk to your doctor before you have the procedure. They can explain the risks, benefits and possible alternatives.
What do I need to tell my family and friends about having an implantable cardioverter defibrillator (ICD)?
If you ever need your ICD to treat you, it might cause some discomfort. You may want to talk to your family and friends about this so they know what could happen.
If you ever need your ICD to treat you, it might deliver an electrical shock to your heart. This may cause you some discomfort. If you explain about your ICD to people who know you, they can help and reassure you if this ever happens. If someone is touching you when your ICD delivers a shock, don’t worry – it won’t harm them.
You may feel ventricular tachycardia coming on; for example you may feel dizzy or have palpitations. If so, sit or lie down so that you don’t hurt yourself in case you collapse. It's possible you will have fainted or collapsed due to your ventricular tachycardia before your ICD shocks you. In this case, you won’t be aware of the shock. Ask your family and friends to stay calm and to stay with you.
If you continue to feel unwell after an ICD shock, have someone call an ambulance or take you straight to an accident and emergency department.
If you get a single shock, contact your ICD Centre. If you have multiple shocks, go to an accident and emergency department. A doctor will check your device to find out why it shocked you.
If you or your family and friends have any concerns about your ICD, speak to your doctor. There may also be support groups in your area that you can contact. Find out what’s available to you.
What is torsades de pointes?
Torsades de pointes is an uncommon type of ventricular tachycardia. It’s different to other types of ventricular tachycardia and may need different treatments.
Torsades de pointes is an uncommon type of ventricular tachycardia which can happen in people with ‘long QT syndrome’. Your heartbeat is controlled by electrical signals (impulses). In long QT syndrome, the time it takes for your heart to recharge after each heartbeat is longer than normal. This can sometimes lead to your heart beating too quickly (ventricular tachycardia).
Torsades de pointes can run in families, but you can still get it even if no one in your family is affected. It can be triggered by certain medicines, such as antiarrhythmic medicines (used to treat heart rhythm problems). It can also be triggered by low levels of calcium or magnesium.
Torsades de points often corrects itself, but can sometimes lead to cardiac arrest. Treatments can help to prevent your heart from beating abnormally.
Certain types of antiarrhythmic medicines can make torsades de pointes worse, so other treatments are used. Medicines that can stop an attack include beta-blockers, magnesium and a certain antiarrhythmic medicine called mexiletine. Treatments to stop future attacks include drugs used to treat high blood pressure (e.g. propranolol) and beta-blockers. You may also need to have a procedure called temporary pacing or have an implantable cardioverter defibrillator (ICD) or pacemaker fitted. These can regulate your heartbeat.
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