Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Approach to investigating a first episode of ventricular tachycardia (VT) in a patient with underlying heart disease:
- Urgent specialist cardiovascular assessment: Refer the patient urgently for specialist cardiovascular assessment, ideally within 24 hours, due to the high risk associated with VT and underlying structural heart disease NICE CG109.
- Detailed clinical history and examination: Reassess the patient’s detailed history including any previous syncopal or arrhythmic events, family history of sudden cardiac death or inherited cardiac conditions, current medications, and perform a full cardiovascular examination including vital signs and lying/standing blood pressure if appropriate NICE CG109.
- 12-lead ECG: Record and carefully interpret a 12-lead ECG to identify conduction abnormalities, QT interval abnormalities, ventricular arrhythmias, or other relevant changes NICE CG109.
- Cardiac imaging: Perform cardiac imaging (e.g., echocardiography) to assess the extent and nature of structural heart disease, as this will guide further management and risk stratification NICE CG109.
- Ambulatory ECG monitoring: Consider ambulatory ECG monitoring (Holter or event recorder) to detect arrhythmias and correlate symptoms, especially if VT is suspected to be intermittent NICE CG109.
- Exclude other causes: Investigate for other potential causes or contributors such as electrolyte imbalances, ischemia, or drug effects NICE CG109.
This structured approach ensures timely diagnosis and management of VT in the context of underlying heart disease, reducing the risk of sudden cardiac death and guiding appropriate treatment.