Ventricular tachycardia laboratory findings: Difference between revisions

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{{Ventricular tachycardia}}
{{Ventricular tachycardia}}
{{CMG}}
{{CMG}} {{AE}} {{Sara.Zand}}
==Overview==
==Overview==
Serial [[cardiac enzymes]], [[serum electrolytes]] as well as [[calcium]], [[magnesium]] and [[phosphate]] levels, should be obtained. A toxicology screen should also be obtained to assess for illicit drugs as the cause of the VT, as well as levels of  medications that may have caused the VT.
Laboratory findings predicting [[sudden cardiac arrest]] and [[ventricular tachycardia]] include elevated level of [[Natriuretic peptides—B-type]] ([[BNP]]) or  N-terminal pro-[[BNP]] as the marker of [[myocardial stress]] and [[fibrosis]] in [[heart failure]] disease, highly sensitive [[troponin]] T indicating [[cardiomyocyte]] injury, screening about [[hypokalemia]], [[hypomagnesemia]] and also toxic level of [[digoxin]], [[cocaine]], [[tricyclic antidepressant]].
 
==Laboratory Findings==
==Laboratory Findings==
Common laboratory findings predicting [[sudden cardiac arrest]] and [[ventricular tachycardia]] include:
Common laboratory findings predicting [[sudden cardiac arrest]] and [[ventricular tachycardia]] include:
* Elevated level of [[Natriuretic peptides—B-type]] ([[BNP]]) or  N-terminal pro-[[BNP]] as the marker of [[myocardial stress]] and [[fibrosis]] in [[heart failure]] disease<ref name="AhmadFiuzat2014">{{cite journal|last1=Ahmad|first1=Tariq|last2=Fiuzat|first2=Mona|last3=Neely|first3=Benjamin|last4=Neely|first4=Megan L.|last5=Pencina|first5=Michael J.|last6=Kraus|first6=William E.|last7=Zannad|first7=Faiez|last8=Whellan|first8=David J.|last9=Donahue|first9=Mark P.|last10=Piña|first10=Ileana L.|last11=Adams|first11=Kirkwood F.|last12=Kitzman|first12=Dalane W.|last13=O'Connor|first13=Christopher M.|last14=Felker|first14=G. Michael|title=Biomarkers of Myocardial Stress and Fibrosis as Predictors of Mode of Death in Patients With Chronic Heart Failure|journal=JACC: Heart Failure|volume=2|issue=3|year=2014|pages=260–268|issn=22131779|doi=10.1016/j.jchf.2013.12.004}}</ref>
* Elevated level of [[Natriuretic peptides—B-type]] ([[BNP]]) or  N-terminal pro-[[BNP]] as the marker of [[myocardial stress]] and [[fibrosis]] in [[heart failure]] disease predicting [[SCD]]<ref name="AhmadFiuzat2014">{{cite journal|last1=Ahmad|first1=Tariq|last2=Fiuzat|first2=Mona|last3=Neely|first3=Benjamin|last4=Neely|first4=Megan L.|last5=Pencina|first5=Michael J.|last6=Kraus|first6=William E.|last7=Zannad|first7=Faiez|last8=Whellan|first8=David J.|last9=Donahue|first9=Mark P.|last10=Piña|first10=Ileana L.|last11=Adams|first11=Kirkwood F.|last12=Kitzman|first12=Dalane W.|last13=O'Connor|first13=Christopher M.|last14=Felker|first14=G. Michael|title=Biomarkers of Myocardial Stress and Fibrosis as Predictors of Mode of Death in Patients With Chronic Heart Failure|journal=JACC: Heart Failure|volume=2|issue=3|year=2014|pages=260–268|issn=22131779|doi=10.1016/j.jchf.2013.12.004}}</ref>
* Highly sensitive [[troponin]] T indicating [[cardiomyocyte]] injury<ref name="HusseinGottdiener2013">{{cite journal|last1=Hussein|first1=Ayman A.|last2=Gottdiener|first2=John S.|last3=Bartz|first3=Traci M.|last4=Sotoodehnia|first4=Nona|last5=deFilippi|first5=Christopher|last6=Dickfeld|first6=Timm|last7=Deo|first7=Rajat|last8=Siscovick|first8=David|last9=Stein|first9=Phyllis K.|last10=Lloyd-Jones|first10=Donald|title=Cardiomyocyte Injury Assessed by a Highly Sensitive Troponin Assay and Sudden Cardiac Death in the Community|journal=Journal of the American College of Cardiology|volume=62|issue=22|year=2013|pages=2112–2120|issn=07351097|doi=10.1016/j.jacc.2013.07.049}}</ref>
* Highly sensitive [[troponin]] T indicating [[cardiomyocyte]] injury<ref name="HusseinGottdiener2013">{{cite journal|last1=Hussein|first1=Ayman A.|last2=Gottdiener|first2=John S.|last3=Bartz|first3=Traci M.|last4=Sotoodehnia|first4=Nona|last5=deFilippi|first5=Christopher|last6=Dickfeld|first6=Timm|last7=Deo|first7=Rajat|last8=Siscovick|first8=David|last9=Stein|first9=Phyllis K.|last10=Lloyd-Jones|first10=Donald|title=Cardiomyocyte Injury Assessed by a Highly Sensitive Troponin Assay and Sudden Cardiac Death in the Community|journal=Journal of the American College of Cardiology|volume=62|issue=22|year=2013|pages=2112–2120|issn=07351097|doi=10.1016/j.jacc.2013.07.049}}</ref>
* [[Electrolytes]] abnormality such as [[hypokalemia]], [[hypomagnesemia]] relation [[QT prolongation]] and [[torsades de pointes]]<ref name="LaslettCooper2020">{{cite journal|last1=Laslett|first1=David B.|last2=Cooper|first2=Joshua M.|last3=Greenberg|first3=Richard M.|last4=Yesenosky|first4=George A.|last5=Basil|first5=Anuj|last6=Gangireddy|first6=Chethan|last7=Whitman|first7=Isaac R.|title=Electrolyte Abnormalities in Patients Presenting With Ventricular Arrhythmia (from the LYTE-VT Study)|journal=The American Journal of Cardiology|volume=129|year=2020|pages=36–41|issn=00029149|doi=10.1016/j.amjcard.2020.04.051}}</ref>
* [[Electrolytes]] abnormality such as [[hypokalemia]], [[hypomagnesemia]] relation [[QT prolongation]] and [[torsades de pointes]]<ref name="LaslettCooper2020">{{cite journal|last1=Laslett|first1=David B.|last2=Cooper|first2=Joshua M.|last3=Greenberg|first3=Richard M.|last4=Yesenosky|first4=George A.|last5=Basil|first5=Anuj|last6=Gangireddy|first6=Chethan|last7=Whitman|first7=Isaac R.|title=Electrolyte Abnormalities in Patients Presenting With Ventricular Arrhythmia (from the LYTE-VT Study)|journal=The American Journal of Cardiology|volume=129|year=2020|pages=36–41|issn=00029149|doi=10.1016/j.amjcard.2020.04.051}}</ref>


* [[Digoxin]] intoxication associated bidirectional [[VT]]  
* [[Digoxin]] intoxication associated bidirectional [[VT]]<ref name="MenduiñaCandel2005">{{cite journal|last1=Menduiña|first1=Manuel J.|last2=Candel|first2=José M.|last3=Alaminos|first3=Pilar|last4=Gómez|first4=Francisco J.|last5=Vilchez|first5=José|title=Bidirectional Ventricular Tachycardia Due to Digitalis Poisoning|journal=Revista Española de Cardiología (English Edition)|volume=58|issue=8|year=2005|pages=991–993|issn=18855857|doi=10.1016/S1885-5857(06)60385-X}}</ref>
* [[Tricyclic antidepressant]] overdose associated with [[ QT prolongation ]]
*  [[Cocaine]] toxicology screening
* [[Tricyclic antidepressant]] poisoning associated with [[ QT prolongation ]]<ref name="pmid28709467">{{cite journal |vauthors=Sabah KMN, Chowdhury AW, Islam MS, Saha BP, Kabir SR, Kawser S |title=Amitriptyline-induced ventricular tachycardia: a case report |journal=BMC Res Notes |volume=10 |issue=1 |pages=286 |date=July 2017 |pmid=28709467 |pmc=5513042 |doi=10.1186/s13104-017-2615-8 |url=}}</ref>
 
*  [[Cocaine]] toxicology screening<ref name="Hoffman2010">{{cite journal|last1=Hoffman|first1=Robert S.|title=Treatment of patients with cocaine-induced arrhythmias: bringing the bench to the bedside|journal=British Journal of Clinical Pharmacology|volume=69|issue=5|year=2010|pages=448–457|issn=03065251|doi=10.1111/j.1365-2125.2010.03632.x}}</ref>
 
 
* Elevated levels of [[natriuretic peptides—B-type]] (BNP) or N-terminal pro-[[BNP]] are associated with increased risk of [[sudden cardiac death]] and [[ventricular tachycardia]], particularly in high risk [[ischemic heart disease]] and [[heart failure]] [[patients]].<ref name="AhmadFiuzat2014">{{cite journal|last1=Ahmad|first1=Tariq|last2=Fiuzat|first2=Mona|last3=Neely|first3=Benjamin|last4=Neely|first4=Megan L.|last5=Pencina|first5=Michael J.|last6=Kraus|first6=William E.|last7=Zannad|first7=Faiez|last8=Whellan|first8=David J.|last9=Donahue|first9=Mark P.|last10=Piña|first10=Ileana L.|last11=Adams|first11=Kirkwood F.|last12=Kitzman|first12=Dalane W.|last13=O'Connor|first13=Christopher M.|last14=Felker|first14=G. Michael|title=Biomarkers of Myocardial Stress and Fibrosis as Predictors of Mode of Death in Patients With Chronic Heart Failure|journal=JACC: Heart Failure|volume=2|issue=3|year=2014|pages=260–268|issn=22131779|doi=10.1016/j.jchf.2013.12.004}}</ref>


* Ionized [[calcium]] levels along with [[magnesium]] and [[phosphate]] levels should be obtained.<ref name="pmid3337132">{{cite journal |vauthors=Tchou P, Young P, Mahmud R, Denker S, Jazayeri M, Akhtar M |title=Useful clinical criteria for the diagnosis of ventricular tachycardia |journal=Am. J. Med. |volume=84 |issue=1 |pages=53–6 |date=January 1988 |pmid=3337132 |doi=10.1016/0002-9343(88)90008-3 |url=}}</ref><ref name="pmid4709549">{{cite journal |vauthors=Lown B, Temte JV, Arter WJ |title=Cardiac arrhythmias. 6. Ventricular tachyarrhythmias. Clinical aspects |journal=Circulation |volume=47 |issue=6 |pages=1364–81 |date=June 1973 |pmid=4709549 |doi=10.1161/01.cir.47.6.1364 |url=}}</ref>


* [[Hypocalcemia]], [[hypokalemia]], and [[hypomagnesemia]] make patients vulnerable to monomorphic VT or [[torsade de pointes]].
* Diuretic usage can lead to hypokalemia which can provoke ventricular tachycardia.


* Cardiac [[troponin I]] and cardiac [[troponin T]] levels along with [[CK-MB]] and [[LDH]] can help access [[myocardial ischemia]] or [[MI|infarction]].


* [[Digoxin]] and [[tricyclic antidepressant]] blood levels should be ordered.


* Sometimes [[recreational drugs]] like [[cocaine]], can result in ventricular tachycardia so a [[toxicology screen]] should also be obtained.


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Latest revision as of 05:13, 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]

Overview

Laboratory findings predicting sudden cardiac arrest and ventricular tachycardia include elevated level of Natriuretic peptides—B-type (BNP) or N-terminal pro-BNP as the marker of myocardial stress and fibrosis in heart failure disease, highly sensitive troponin T indicating cardiomyocyte injury, screening about hypokalemia, hypomagnesemia and also toxic level of digoxin, cocaine, tricyclic antidepressant.

Laboratory Findings

Common laboratory findings predicting sudden cardiac arrest and ventricular tachycardia include:





Laboratory Pearls for Ventricular Tachycardia
Electrolytes Hypokalemia and hypomagnesemia frequently associated with torsades de pointes
Troponin I Elevated in myocardial infarction
Creatine-kinase MB Elevated in myocardial infarction

References

  1. Ahmad, Tariq; Fiuzat, Mona; Neely, Benjamin; Neely, Megan L.; Pencina, Michael J.; Kraus, William E.; Zannad, Faiez; Whellan, David J.; Donahue, Mark P.; Piña, Ileana L.; Adams, Kirkwood F.; Kitzman, Dalane W.; O'Connor, Christopher M.; Felker, G. Michael (2014). "Biomarkers of Myocardial Stress and Fibrosis as Predictors of Mode of Death in Patients With Chronic Heart Failure". JACC: Heart Failure. 2 (3): 260–268. doi:10.1016/j.jchf.2013.12.004. ISSN 2213-1779.
  2. Hussein, Ayman A.; Gottdiener, John S.; Bartz, Traci M.; Sotoodehnia, Nona; deFilippi, Christopher; Dickfeld, Timm; Deo, Rajat; Siscovick, David; Stein, Phyllis K.; Lloyd-Jones, Donald (2013). "Cardiomyocyte Injury Assessed by a Highly Sensitive Troponin Assay and Sudden Cardiac Death in the Community". Journal of the American College of Cardiology. 62 (22): 2112–2120. doi:10.1016/j.jacc.2013.07.049. ISSN 0735-1097.
  3. Laslett, David B.; Cooper, Joshua M.; Greenberg, Richard M.; Yesenosky, George A.; Basil, Anuj; Gangireddy, Chethan; Whitman, Isaac R. (2020). "Electrolyte Abnormalities in Patients Presenting With Ventricular Arrhythmia (from the LYTE-VT Study)". The American Journal of Cardiology. 129: 36–41. doi:10.1016/j.amjcard.2020.04.051. ISSN 0002-9149.
  4. Menduiña, Manuel J.; Candel, José M.; Alaminos, Pilar; Gómez, Francisco J.; Vilchez, José (2005). "Bidirectional Ventricular Tachycardia Due to Digitalis Poisoning". Revista Española de Cardiología (English Edition). 58 (8): 991–993. doi:10.1016/S1885-5857(06)60385-X. ISSN 1885-5857.
  5. Sabah K, Chowdhury AW, Islam MS, Saha BP, Kabir SR, Kawser S (July 2017). "Amitriptyline-induced ventricular tachycardia: a case report". BMC Res Notes. 10 (1): 286. doi:10.1186/s13104-017-2615-8. PMC 5513042. PMID 28709467. Vancouver style error: initials (help)
  6. Hoffman, Robert S. (2010). "Treatment of patients with cocaine-induced arrhythmias: bringing the bench to the bedside". British Journal of Clinical Pharmacology. 69 (5): 448–457. doi:10.1111/j.1365-2125.2010.03632.x. ISSN 0306-5251.