Ventricular tachycardia diagnostic study of choice: Difference between revisions

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{{Ventricular tachycardia}}
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== Overview ==
== Overview ==
Simple [[ECG]] is the first initiative study of choice for diagnosing a ventricular tachycardia rhythm. Further investigations are necessary afterwards to confirm the cause of abnormal ventricular rhythm. Cardiac magnetic resonance is the gold standard test for the diagnosis of structural VT substrate. Cardiac magnetic resonance provides detailed assessment of cardiac morphology and function.
[[ECG]] is the first diagnostic test that should be obtained in hemodynamically stable [[Ventricular tachycardia]]. For detection of [[tachyarrhythmia]] [[symptoms]] related exercise such as [[cathecolaminergic polymorphic VT]], [[Exercise stress test]] is recommended. Findings on resting [[ECG]] associated with diagnosis of [[VT]] include evidence of  [[structural hear disease]] such as prior [[MI]] or [[chamber enlargement]], evidence of [[inherited arrhythmia disorders]] such as [[long QT syndrome]], [[Brugada syndrome]], [[arrhythmogenic right ventricular cardiomyopathy]]. [[QRS]] duration and [[conduction abnormality]] may have prognostic value in [[structural heart disease]].


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
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| Colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| Colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| Bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1'''In [[patients]] with sustained, hemodynamically stable, [[wide QRStachycardia]], 12 leads [[ECG]] should be obtained '' ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence B]])<nowiki>"</nowiki>''
| Bgcolor="LemonChiffon"|<nowiki>"</nowiki>In [[patients]] with sustained, hemodynamically stable, [[wide QRS tachycardia ]], 12 leads [[ECG]] should be obtained '' ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence B]])<nowiki>"</nowiki>''
|-
|-
| Bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2'''In [[patients]] with exercise induced [[ventricular tachyarrhythmia]] such as [[IHD] or [[cathecolaminergic polymorphic VT]] exercise treadmill test is recommended'' ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence B]])<nowiki>"</nowiki>''
| Bgcolor="LemonChiffon"|<nowiki>"</nowiki>In [[patients]] with exercise induced [[ventricular tachyarrhythmia]] such as [[IHD]] or [[cathecolaminergic polymorphic VT]], exercise treadmill test is recommended'' ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence B]])<nowiki>"</nowiki>''
|-
|-
| Bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3'''In [[patients]] with suspected or documented [[VT]], 12 leads [[ECG]] during sinuse rhythm should be obtained for detecting [[structural heart disease]]'' ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence B]])<nowiki>"</nowiki>''
| Bgcolor="LemonChiffon"|<nowiki>"</nowiki>In [[patients]] with suspected or documented [[VT]], 12 leads [[ECG]] during [[sinus rhythm]] should be obtained for detecting [[structural heart disease]]'' ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence B]])<nowiki>"</nowiki>''
|-
| Bgcolor="LemonChiffon"|<nowiki>"</nowiki> [[Ambulatory electrocardiogram monitoring]] is recommended for [[patients]] presented  with [[palpitation]], [[syncope]], [[presyncope]] suspected [[ventricular arrhythmia]]'' ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence B]])<nowiki>"</nowiki>''
|}
|}


 
* 12-lead [[ECG]] is the first diagnostic test that should be obtained in hemodynamically stable [[Ventricular tachycardia]].
 
* For detection of [[tachyarrhythmia]] [[symptoms]] related exercise such as [[cathecolaminergic polymorphic VT]], [[Exercise stress test]] is recommended.
 
*Findings on [[ECG]] associated with [[VT]] include:
 
# Evidence of  [[structural hear disease]] such as prior [[MI]] or [[chamber enlargement]]
 
# Evidence of [[inherited arrhythmia disorders]] such as [[long QT syndrome]], [[Brugada syndrome]], [[arrhythmogenic right ventricular cardiomyopathy]]
 
*: [[QRS]] duration and [[conduction abnormality]] may have prognostic value in [[structural heart disease]].<ref name="BaldasseroniOpasich2002">{{cite journal|last1=Baldasseroni|first1=Samuele|last2=Opasich|first2=Cristina|last3=Gorini|first3=Marco|last4=Lucci|first4=Donata|last5=Marchionni|first5=Niccolò|last6=Marini|first6=Maurizio|last7=Campana|first7=Carlo|last8=Perini|first8=Giampaolo|last9=Deorsola|first9=Antonella|last10=Masotti|first10=Giulio|last11=Tavazzi|first11=Luigi|last12=Maggioni|first12=Aldo P.|title=Left bundle-branch block is associated with increased 1-year sudden and total mortality rate in 5517 outpatients with congestive heart failure: A report from the Italian network on congestive heart failure|journal=American Heart Journal|volume=143|issue=3|year=2002|pages=398–405|issn=00028703|doi=10.1067/mhj.2002.121264}}</ref>
 
 
 
 
Simple [[ECG]] is the first initiative study of choice for diagnosing a ventricular tachycardia rhythm. Further investigations are necessary afterwards to confirm the cause of abnormal ventricular rhythm.
 
=== Study of choice ===
Cardiac magnetic resonance is the gold standard test for the diagnosis of structural VT substrate.
 
Cardiac magnetic resonance provides:
 
* Excellent [[soft tissue]] image resolution
* Detailed assessment of cardiac morphology and function
* Let myocardial scar to be visualized precisely
** late gadolinium enhancement (LGE) is being considered as the most widely used technique for evaluating myocardial scar tissue by CMR. It is based on measurement of the signal intensity of LGE of scarred tissue which help defining the scar.


==References==
==References==

Latest revision as of 05:31, 27 May 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Mahshid Mir, M.D. [3]

Overview

ECG is the first diagnostic test that should be obtained in hemodynamically stable Ventricular tachycardia. For detection of tachyarrhythmia symptoms related exercise such as cathecolaminergic polymorphic VT, Exercise stress test is recommended. Findings on resting ECG associated with diagnosis of VT include evidence of structural hear disease such as prior MI or chamber enlargement, evidence of inherited arrhythmia disorders such as long QT syndrome, Brugada syndrome, arrhythmogenic right ventricular cardiomyopathy. QRS duration and conduction abnormality may have prognostic value in structural heart disease.

Diagnostic Study of Choice

2017 AHA/ACC/HRS Guidelines for Management of Patients With Ventricular Arrhythmias

Class I
"In patients with sustained, hemodynamically stable, wide QRS tachycardia , 12 leads ECG should be obtained (Level of Evidence B)"
"In patients with exercise induced ventricular tachyarrhythmia such as IHD or cathecolaminergic polymorphic VT, exercise treadmill test is recommended (Level of Evidence B)"
"In patients with suspected or documented VT, 12 leads ECG during sinus rhythm should be obtained for detecting structural heart disease (Level of Evidence B)"
" Ambulatory electrocardiogram monitoring is recommended for patients presented with palpitation, syncope, presyncope suspected ventricular arrhythmia (Level of Evidence B)"
  1. Evidence of structural hear disease such as prior MI or chamber enlargement
  2. Evidence of inherited arrhythmia disorders such as long QT syndrome, Brugada syndrome, arrhythmogenic right ventricular cardiomyopathy

References

  1. Baldasseroni, Samuele; Opasich, Cristina; Gorini, Marco; Lucci, Donata; Marchionni, Niccolò; Marini, Maurizio; Campana, Carlo; Perini, Giampaolo; Deorsola, Antonella; Masotti, Giulio; Tavazzi, Luigi; Maggioni, Aldo P. (2002). "Left bundle-branch block is associated with increased 1-year sudden and total mortality rate in 5517 outpatients with congestive heart failure: A report from the Italian network on congestive heart failure". American Heart Journal. 143 (3): 398–405. doi:10.1067/mhj.2002.121264. ISSN 0002-8703.

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