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Exercise induced Ventricular Tachycardia

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I am a 40 years old male. Very active in sports.
I have been experiencing ventrikel tachycardie during exercise for the last weeks.
VT was seen on ECG during exercise test.
I have had an elektrofysical exam of my heart, where they also tried to provoke the tachycardie.
(also 2 different substances , one was adrenaline, were submitted during the examination)
Everything was normal, no tachycardie could be provoked.
Also had an catherisation of the vanes on my heart. Everything normal.
Still planned is an MRI of my heart and a 'late potentials' ECG.
Am I at great risk for developing ventrikel fibrilation ? What if the MRI and 'late potentials' ECG also turn out ok ? What could be a treatment ?

Thanks,
Bart

Category: Cardiologist

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Category: Cardiologist
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Hello,
Thank you for your query at DoctorSpring.com.

You are a young male with exercise induced vt.
Do you have a history of young sudden cardiac deaths in family?
Do your symptoms progressively increase as you exercise or is there a sudden blackout?
Do you have an echo report?

Your history maybe like a CPVT or catecholaminergic polymorphic vt. What is the rate of the vt?

MRI is useful to rule out ARVC or arrhytmogenic Right ventricular cardiomyopathy. If that is absent in MRI you should be happy because it is a bad condition.

Late depolarisation indicates brugada. You should be happy if not there. No tachycardia induced on an ep study could mean you don't have an Inducible vt like rvot or lvot vt or ilvt
CPVT is very good condition to have. It can be treated with beta blockers. You need to undergo a tmt to prove that its CPVT.

Hope this helps, please feel free to discuss further.
Regards
Dr Vivek Mahajan
DM Cardiology


Patient replied :

-no sudden deaths in the family
-no progressive increase, more like sudden feeling
-lasts for few seconds
-echo report : my personal doctor has it
-rate of the vt : I will ask my doctor
-what do you mean with "tmt" to prove CPVT ?
-what if it is not CPVT, MRI is ok, no brugada ? And still I experience the VT's ?
-Note : I am taking bisoprolol on advice of my doctor, awaiting the further examinations

Thanks a lot for your advice !


Hello,

Thanks for the follow-up.

TMT means treadmill test. CPVT can be seen when you perform tmt.
Your rate of VT is important because if it is around 160 then its a slow VT, faster than 180 means a fast VT. If it's a slow VT then it is less likely to be hemodynamically significant and benign.

Since your ecg and family history are normal the likelihood of long QT syndrome is low.

Your echo if normal rules out structural abnormality like HCM.

So possibly you have some benign condition like ILVT or RVOT VT provided your heart rate during VT is not very high.
MRI is for ARVC. If it is normal there is less chance, but a still possibility of ARVC (despite normal echo).

At present the best treatment for you is bisoprolol and if it is still uncontrolled you may be started on amiodarone.

Because you have no structural heart disease and have normal echo you won't benefit much from an implantable cardioverter defibrillator.

Hope this helps, please feel free to discuss further.
Regards
Dr Vivek Mahajan


Patient replied :

Hello Doctor,

First of all many thanks for your analysis done so far !
After your next reply I will close this consultation.

I have had almost all possible tests. These are the results :
- Elektrofysical tests : tachycardia could not be reproduced during these tests (also adrenaline test was done)
- catherisation of the heart veins : normal
- MRI of my heart : normal, no abnormalities, no indication for ARVC or other form of cardiomiopathie
- late potentials ECG : normal
- no indications for long QT

The rate of the VT was around 180, monomorphic VT

I have had a new TMT today... the VT was not there (I am taking 1.25 mg of bisoprolol daily).

I have only a few questions for you :
- do you think I have something like RVOT VT ?
- my doctor proposed to keep taking the bisoprolol, the dosis is not that high he said, so keep taking it, do you agree ;-)
- I have also been taking extra magnesium the last month , could it be that I had a shortage on magnesium and maybe that triggered the episodes ?

Already many thanks for your answer.

Greetings,
Bart.


Hello,
Nice to hear back from you.

It is good that most of your investigations have turned to be negative.
Also it is good that the rate of vt is 180 per min. It could be idiopathic left ventricular vt or rvot vt. But that should have been diagnosed on eps rfa session.
Still its better to have rvot vt or ilvt than other forms.

Continue on your beta blockers. In fact you could increase it from the current dose if you don't have bradycardia rate below 60.

If you still have vt on bisoprolol you may try verapamil which is better option for rvot vt n ilvt.

Regards
Dr Vivek Mahajan
DM Cardiology


Dr. Vivek Mahajan
Category: Cardiologist
Experience: 
Fellowship: DM, Cardiology, PGIMER, 2013
Residency: MD, Internal Medicine, AIIMS, 2007
Internship: King Edward Memorial (KEM) Hospital, 2003 
Medical School: MBBS, Seth G.S. Medical College, 2002
Dr. Vivek Mahajan and 4 other Medical Specialists are ready to help you

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