What happens in ventricular tachycardia?
Your heartbeat is controlled by electrical signals (impulses) that travel through your heart and make it contract.
Ventricular tachycardia is when your heart beats faster than normal because of faulty electrical signals in your ventricles (the lower chambers of your heart).
Normally, at rest, your heart will beat between 60 and 100 times a minute. If you have ventricular tachycardia, it may beat over 100 beats per minute. As a result, your ventricles pump out blood too quickly and they might not have enough time to fill up properly with blood between beats. Your heart cannot then pump enough blood out of your heart and to the rest of your body.
Watch our animation to see how your heart beats normally and what happens in ventricular tachycardia.
Ventricular tachycardia can develop into ventricular fibrillation which happens when electrical signals fire off in different areas of your ventricles at the same time. The signals are erratic and uncoordinated. It’s an extremely fast, life-threatening heart rhythm that results in your heart being unable to beat properly; so little (or no) blood is pumped out of your heart. It doesn’t have time to fill up properly between beats, so the volume of blood pumped out to your body may fall.
If you have ventricular fibrillation, you’ll quickly lose consciousness and you may have a cardiac arrest. It can be fatal unless you get treatment immediately.
Watch our animation to see what happens in ventricular fibrillation:
Symptoms of ventricular tachycardia
Some people with ventricular tachycardia don’t get any symptoms if they have what’s called non-sustained ventricular tachycardia. But others do and symptoms can range from being mild that are little more than an occasional nuisance, to being serious or even life-threatening.
Symptoms of ventricular tachycardia can include:
- palpitations (a steady, regular thumping in your chest)
- chest pain or discomfort
- difficulty breathing
- feeling sick
- sweating a lot
- feeling light headed or blacking out
- feeling anxious
If you get any of these symptoms, go and see your GP. If you feel very unwell or you blackout, go to the accident and emergency department at your nearest hospital.
Diagnosis of ventricular tachycardia
Your GP will ask about your symptoms and examine you, and also about your medical history. They’ll check your pulse and blood pressure too, and may do an electrocardiogram (ECG). Your GP may refer you to see a cardiologist (heart specialist).
If you have symptoms that suggest you may have ventricular tachycardia, your GP, emergency doctor or cardiologist will do an ECG first. This will record the electrical activity of your heart to see how well it's working.
You may need to have an ambulatory ECG. This records your heartbeat while you go about your normal daily activities, over 24 hours or longer if necessary. Or you might need to have an implantable loop recorder. This is a small device (about the size of a computer memory stick), which is implanted under the skin. You activate the device when you feel an abnormal rhythm.
If your ECG test shows you have ventricular tachycardia, you’ll need to have further tests at hospital, which may include the following.
- Blood tests. These will check for substances that may be causing ventricular tachycardia, or other conditions that may be causing your symptoms.
- Echocardiogram. This test uses ultrasound (sound waves) to produce a clear image of your heart muscles and valves to see how well it’s working.
- Chest X-ray. This will enable your doctor to look for any changes in your heart or lungs that might be causing the problem.
- An exercise ECG (cardiac stress test). This is when you have an ECG while you exercise to see how your heart works under pressure. It may trigger abnormal heart rhythms, but you're in the best place for this to happen as you'll be surrounded by a medical team.
- Coronary angiography. This is a type of X-ray that uses a dye to show your coronary arteries. It can show if they’re narrowed or blocked.
- An MRI scan of your heart. This will check if you have any problem with your heart muscle.
Treatment of ventricular tachycardia
Treatment for ventricular tachycardia aims to stop the attack and get your heart back to a normal rhythm. There are also treatments to help prevent you getting further attacks. Sometimes episodes of ventricular tachycardia stop on their own.
The type of treatment you have will depend on how serious your ventricular tachycardia is, and what’s causing it. If it’s caused by an underlying health condition, your doctor will also treat that. If exercise triggers your ventricular tachycardia, you’ll need to stop, and talk to your doctor about the next steps.
If your heart has stopped and you’ve had what’s called a cardiac arrest, you may lose consciousness. If this happens, you’ll have immediate defibrillation. This delivers an electric shock to your heart to re-start it.
If your ventricular tachycardia has been going on for some time, or looks like it’s getting worse, you’ll need an emergency procedure called electrical cardioversion. This uses an electric shock to restore your rapid heartbeat back to normal. It’s similar to defibrillation, but the electrical burst is timed rather than given right away. For more information about this, see our separate topic on Cardioversion.
If this doesn’t work, you may need to have another type of antiarrhythmic medicine, such as amiodarone. In this situation, you may be given it through a drip in your arm. Your doctor will then try cardioversion again.
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.
Once your heart rate is under control there are different types of medicine that can help control your heart rate and rhythm. Your doctor may prescribe one or more of these:
- calcium-channel blockers
- other antiarrhythmic medicines, such as amiodarone and lidocaine
You may need to take tablets 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.
You might need to have a procedure called catheter ablation to stop you having future attacks of ventricular tachycardia. In this procedure, your doctor will pass a thin tube called an electrode catheter into the vein in your groin. They’ll pass it up to your heart and destroy any tissue that's disrupting or causing abnormal electrical signals.
You might need to have a procedure called epicardial ablation as well as catheter ablation. In an epicardial ablation, your doctor will pierce the skin in your chest and pass a thin tube through to the outer layer of your heart wall. This is called the epicardium. They’ll then destroy any tissue that's disrupting or causing abnormal electrical signals.
Implantable cardioverter defibrillator (ICD)
You might need to have an 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 powered by a battery and is put under your skin or muscle, usually near your collarbone, and has leads into your heart. It can’t stop you having ventricular tachycardia, but an ICD can correct it when it occurs. So, your doctor may suggest you take medicine too, to reduce the chance of an attack in the first place.
Your ICD monitors your heart, but doesn't control it most of the time. It will send electrical signals to your heart only if you start having an episode of 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 your ventricular tachycardia. It will also deliver a more powerful shock (a defibrillation) if it detects that your heartrate has gone outside pre-programmed settings, or has stopped beating. This will be very painful so it’s important to lie down if possible and prepare yourself.
You’ll usually have check-ups about every three months to a year to check how well your ICD is working. Some types of ICD allow your clinic to monitor its effect remotely using software installed in your home.
If an ICD or ablation isn’t a good option for you, you may need to have an operation on your heart, although this is rare. This will treat or remove the tissue that’s causing your abnormal heart beat.
Causes of ventricular tachycardia
Ventricular tachycardia is often caused by damage to the muscle in your heart. This might have happened from:
- having a heart attack
- heart muscle disease (cardiomyopathy)
- if you’ve had heart problems since birth (congenital heart disease) – these can include conditions called long QT syndrome and Brugada syndrome
- if you have coronary heart disease
Although some people who don’t have any problems with their heart can get ventricular tachycardia.
Things that can trigger ventricular tachycardia include:
- some types of medicines
- physical or mental stress
- having too much caffeine
- illegal drugs, such as cocaine
- imbalances of chemicals in your blood (such as too low a level of sodium, potassium, or calcium)
Complications of ventricular tachycardia
Ventricular tachycardia can sometimes cause your heart to stop beating, which is called a cardiac arrest. This will be fatal unless you have treatment to re-start your heart.
You can reduce the chance of this happening by having the treatment we describe above. If you have an implantable cardioverter defibrillator (ICD) fitted, this can correct any dangerous changes in your heart rhythm and prevent a cardiac arrest.
FAQ: Can I drive if I have ventricular tachycardia?
The rules depend on the type of arrhythmia you have, how well it’s controlled and the type of vehicle you want to drive. It’s essential that you don’t drive until your arrhythmia is under control so you don’t put yourself or others in danger.
As long as you don’t have any symptoms that could distract you when driving, you’ll probably be able to drive a car or motorcycle. But the cause of your arrhythmia must have been identified and your condition controlled for at least four weeks. Ask your doctor if they agree that your condition is controlled.
If you have symptoms, such as dizziness or breathlessness, you shouldn’t drive, and you must let the Driver and Vehicle Licensing Agency (DVLA) know. See your doctor for advice as you might be able to try another treatment to control your symptoms.
If you’ve had a procedure to treat your arrhythmia, you won’t be able to drive for longer. This can range from a couple of days to several months depending on the treatment you have. If you have catheter ablation, for example, you mustn't drive a car or motorbike for at least two days after your procedure.
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 afterwards. If you have a severe attack of ventricular tachycardia and your ICD shocks you, you shouldn't drive for six months. And you’ll need to let the DVLA know about it. But if your ICD fired because of a programming issue, you’ll be able to drive after one month – check with your doctor first though.
The rules about driving are different if you have an arrhythmia and drive a lorry, or are responsible for passengers. Always follow your doctor’s advice and check the DVLA website before you drive.
FAQ: Why do I need an Implantable cardioverter defibrillators (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 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 will be fatal unless you get treatment. If your doctor thinks you’re at risk of ventricular tachycardia, they may suggest you have an ICD. 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)
- have ventricular tachycardia but doctors can’t find a reason why
Not everyone who has one of these conditions will need an ICD. Your doctor will explain the risks, benefits and possible alternatives to an ICD.
FAQ: What do I need to tell family and friends?
If your ICD delivers a shock to treat you, it will be painful so it’s understandable to feel worried about this. It’s a good idea to know what to expect so you can prepare yourself, and plan what to do in advance. You may want to talk to your family and friends about this so they know what could happen.
If your ICD detects your heart has stopped beating, or your heartrate is above or below a pre-programmed setting, it will deliver an electrical shock. This is likely to cause you a lot of 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, they might feel a tingling sensation, but don’t worry – it won’t harm them.
You may feel some things before the ICD shocks you; for example, you may feel dizzy or have palpitations (a thumping in your chest). If so, sit or lie down so that you don’t hurt yourself in case you collapse. It's possible you’ll have blacked out 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 in your hospital. 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.
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Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, June 2017
Expert reviewed by Dr Matthew Wright, Consultant Cardiologist and Electrophysiologist
Next review due June 2020
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