Textbook of Cardiology

Tachycardia: Difference between revisions

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===History===
===History===
Symptoms can arise in every ventricular tachycardia, depending on the heart rate, the presence of underlying heart disease and the degree of systolic and diastolic heart failure.  
Symptoms can arise in every ventricular tachycardia, depending on the heart rate, the presence of underlying heart disease and the degree of systolic and diastolic heart failure.  
[[Image:Vent1.jpg|thumb|right|400px]]


Various symptoms are:  
Various symptoms are:  
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==Overview of ventricular tachycardias==
==Overview of ventricular tachycardias==
 
[[Image:TableVent.jpg]]
{| class="wikitable" font-size="90%"
|- style="text-align:center;background-color:#6EB4EB;"
|+'''An overview of ventricular tachycardias''', follow the Approach to the Wide Complex Tachycardia
|-
!
!example
!regularity
!atrial frequency
!ventricular frequency
!origin (SVT/VT)
!p-wave
!effect of adenosine
|-
| colspan="8" style="text-align:left;background-color:#cfefcf;" | '''Wide complex (QRS>0.12)'''
|-
! Ventricular Tachycardia
| [[Image:vt_small.svg|200px]]
| regular (mostly)
| 60-100 bpm
| 110-250 bpm
| ventricle (VT)
| AV-dissociation
| no rate reduction (sometimes accelerates)
|-
! Ventricular Fibrillation
| [[Image:vf_small.svg|200px]]
| irregular
| 60-100 bpm
| 400-600 bpm
| ventricle (VT)
| AV-dissociation
| none
|-
! Ventricular Flutter
| [[Image:vflutt_small.svg|200px]]
| regular
| 60-100 bpm
| 150-300 bpm
| ventricle (VT)
| AV-dissociation
| none
|-
! Accelerated Idioventricular Rhythm
| [[Image:aivr_small.svg|200px]]
| regular (mostly)
| 60-100 bpm
| 50-110 bpm
| ventricle (VT)
| AV-dissociation
| no rate reduction (sometimes accelerates)
|-
! Torsade de Pointes
| [[Image:tdp_small.svg|200px]]
| regular
|
| 150-300 bpm
| ventricle (VT)
| AV-dissociation
| no rate reduction (sometimes accelerates)
|-
! Bundle-branch re-entrant tachycardia*
| [[Image:Bb reentry small.svg|200px]]
| regular
| 60-100 bpm
| 150-300 bpm
| ventricles (VT)
| AV-dissociation
| no rate reduction
|-
|colspan="8"|'''*Bundle-branch re-entrant tachycardia is extremely rare'''
|}


==Ventricular tachycardia==
==Ventricular tachycardia==
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==Torsades de Pointes==
==Torsades de Pointes==
[[Image:VentDrg.jpg|thumb|right|400px]]
Torsades de pointes (TdP) is a ventricular tachycardia associated with a prolonged QTc interval on the resting ECG. It is on the ECG characterized by twisting of the peaks of the QRS complexes around the isoelectric line during the arrhythmia (changing axis). Torsade de pointes is typically initiated by a short-long-short interval. A ventricle extrasystole (first beat: short) is followed by a compensatory pause. The following beat (second beat: long) has a longer QT interval. If the next beat follows shortly thereafter, there is a good chance that this third beat falls within the QT interval, resulting in the R on T phenomenon and subsequent Torsades de pointes.  
Torsades de pointes (TdP) is a ventricular tachycardia associated with a prolonged QTc interval on the resting ECG. It is on the ECG characterized by twisting of the peaks of the QRS complexes around the isoelectric line during the arrhythmia (changing axis). Torsade de pointes is typically initiated by a short-long-short interval. A ventricle extrasystole (first beat: short) is followed by a compensatory pause. The following beat (second beat: long) has a longer QT interval. If the next beat follows shortly thereafter, there is a good chance that this third beat falls within the QT interval, resulting in the R on T phenomenon and subsequent Torsades de pointes.  


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