SYMPOSIUM ON CARDIOVASCULAR DISEASESVentricular Tachycardia and Sudden Cardiac Death
Section snippets
Ventricular Tachycardia With Structural Heart Disease
Although usually associated with structural heart disease, VT can occur in its absence. Ischemic heart disease is the most common cause of sustained ventricular arrhythmias. Acute coronary ischemia is a cause of polymorphic VT or ventricular fibrillation (VF) and is probably the most common cause of out-of-hospital sudden death. During acute ischemia, the leakage of potassium leads to increased extracellular potassium that depolarizes myocytes in the ischemic border zone.1, 2 This
Emergent Management and Initial Evaluation
Regardless of the etiology, emergent cardioversion is warranted for sustained VT that is causing symptomatic hypotension, pulmonary edema, or myocardial ischemia. An algorithm for the emergent resuscitation of ventricular arrhythmias (adapted from The American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care) is shown in Figure 2.24 Reversible causes, such as acute ischemia, electrolyte abnormalities, or drug toxicities, should be corrected.
CONCLUSION
Ventricular tachycardia is an important cause of sudden death. The risk and consequently the therapeutic approach are determined by the underlying heart disease. Ventricular tachycardia is most commonly associated with ischemic heart disease or other forms of structural heart disease that are associated with a risk of sudden death. Several groups of patients who are at increased risk of sudden death from VT have been identified and benefit from ICDs. It is important to distinguish high-risk
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