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Polymorphic ventricular Tachycardia
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Polymorphic ventricular Tachycardia


Was on a holter monitor for palpitations, episodes of heart racing and previous syncope. A couplet PVC followed by a 6 second run of unsustained Polymorphic Ventricular Tacycardia was captured. I am currently wearing a defribilater vest until all tests (MRI, EPS, Angio, genetic blood work etc) can be run. How serious is this?
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251395_tn?1395961265
Hello...

Ventricular tachyarrhythmias include a number of different rhythms, which arise in a number of different clinical situations. The ventricular tachyarrhythmias are fast heart rhythms that arise entirely within the lower chambers of the heart (the ventricles). They are faster than 100 beats per minute by definition. Generally, the tachyarrhythmias can be characterized as either monomorphic ventricular tachycardia or polymorphic ventricular tachycardia. Monomorphic ventricular tachycardia would appear on an ECG record with a regular rate and rhythm and fixed shape or morphology of the ECG trace. Each beat of the tachycardia would look the same, hence the designation monomorphic. Polymorphic ventricular tachycardia typically is irregular in rate and rhythm and has varying shapes or morphologies on the ECG.

The good news is that it was caught and that you are wearing a Defib vest. If you should go into this rhythm again, the vest will give your heart a shock to being it back to NSR (Normal Sinus Rhythm) How soon will you be having these tests? Other than the captured VT, do you have any other heart related problems?
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995271_tn?1312416925
Hi, you had a duplicate post, I deleted the repeat and left this latest post up.

You could have the type of vtach that can degrade into something that requires a shock to get the heart back to beating normally.

There's a couple of types of VTACH that you should research more and learn as much as possible so you can make decisions.  Polymorphic means the ventricular beats are coming from various sources.  If it were monomorphic it would mean that the extra beats are coming from just one source.  Ventricular beats means that the ventricles are firing beats on its own, from its backup pacer cells when it's not supposed to.  The signal to beat should be coming from the upper part of the heart.

Why they are doing this needs further study.  Without knowing the extra detail it's impossible to guess on how serious the issue is.   The condition can usually be managed with medications and/or ablation + getting an implantable defib as a backup.
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1124887_tn?1313758491
There are some conditions creating polymorphic VT. It is really important your doctors find the cause. When you have a defibrillator, it will terminate the tachycardia and return your heart rate to sinus rhythm.

An important question: When do you experience syncope, and in what setting did the VT occur?

There are some conditions possibly causing this, but I'm not sure if you want to read more about them, it's a bit up to you. Maybe it's best to let your doctors investigate this.

Good luck.
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Avatar_f_tn
Thank you for deleting the sesond post. I am new to this!
How soon tests? Already had the MRI and started the genetic testing. I have an appointment tomorrow to schedule the EPS and Angio (I beleive they are doing at the same time).
Previous heart issues? None, except the palpitations and every morning heart racing to the point I gag and throw up about 50% of the time.
What was I doing? The syncope episode I was at the dentist office with my husband (he was sedated and I was his ride, lol) and when they were telling me what they did I turned to my husband and got out "I don't feel..." and down I went. I had a stress test and echo later that week and all was fine. That was about a year ago.
When the Polymorphic VT episode was caught on the holter was just about 2 weeks ago and at that time I was just on the computer puttering around. Nothing strenuous. I got a call from the monitoring company and they asked me a bunch of questions and I got a call from my dr the next day wanting me in right away. That is when they put me in the vest and started all this testing.

I should point out that I am still working at this piont, which is tough because I work in a high stress environment and that I do not work at ONE location. I have to drive sometimes 200 miles a day and wearing this vest, it is giving me back pain, lol. In addition I have to alert the locations I am visiting about the vest so they know not to touch me should it go "off" I also am having issues with having to take the time off of work for the testing. I am going to ask my doctor tomorrow if he will put me out until the testing is completed and the dignosis/determination of treatment is decided.
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995271_tn?1312416925
one of the things I remember reading about polymorphic vtach is they like to find out if you also have "prolonged resting QT interval".  The "QT" interval is an EKG term.  The electrical waves created by the heart are labled P-Q-R-S-T.  sometimes there's also a U wave.

P - atriums firings
Q - Ventricles firing
R -  Ventricles firing
S - Ventricles firing
T - Ventricles recovring

The electrical waves created by the ventricles firing are called the "QRS".  There's a lot going on when the ventricles fire, that's why 3 waves can be seen.  The T wave is also related to the ventricles, it's a wave seen as the ventricles recover.  

So a prolonged QT interval means that it takes longer than usual for the ventricles to fire and recover.

I think they'll be looking for this,because if you have that as-well you might have something called torsades de pointes.  Hang in there, hope everything checks out OK.
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1331422_tn?1326570197
Can QT range being prolonged show as a pause of 1.9 seconds?  I am on a arrhythmic drug that will prolong a QT range.  I have been told I have a 1.9 second pause.  Is this serious?  Is a pacemaker called for?

Where is the pause and the QT range shown on an EKG?  Are they related?
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1124887_tn?1313758491
No, it cannot. Prolonged QT show as a longer interval between the "spike" on EKG and the last wave. Or the last wave can be enlarged.

A 1,9 second pause is normal. Pauses up to 2,7 sec at daytime and 3 sec at night is considered normal.
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Avatar_m_tn
I'm a 24 yr old male. Echo, stress test, stress echo, holter, and event monitors have all been normal besides "PVC's and a 26 beat run of ventricular tachycardia at 127bpms that self terminated". I seen an EP today and he said that he thought it to be benign and called it Idiopathic Ventricular Tachycardia and I started asking questions and he said that just to be safe he wants to do an EP study next week. Can you explain an EP study? How safe are they to do? If he triggers a deadly arrythmia can they easily terminate it and keep me safe? What if he has to do an ablation, how safe is that? Just how benign is "Idiopathic Ventricular Tachycardia"? Can it develop into V-Fib? How bad is it to have a 26 beat run of v-tach?? Can you share your personal experiences and opinions? I also have been experiencing what feels like angina for about 2 yrs now and thats why I had the whole work up but all the test for that came back negative. ??

also found on my copy of the cardionet report it says sinus rhythm with IVCD (Intraventricular Conduction Delay) and on the Diagnosis part it says (ICD-9): 426.9 conduction disorder, unspecified. sinus rhythm with IVCD shows like 3 different times on the report. and 3 different times had ventricular tachycardia 25 beats, rate 124BPM, all the v-tach reports had 25 beat runs with the highest rate 125BPM. does any of this offer any additional info for this v-tach maybe not being benign? does the IVCD pose more risk to SCD or v-fib with since i had documented v-tach?"

does that long of a run (25beats) make it dangerous? will drinking alot of alcohol make my Idiopathic v-tach dangerous? i've been feeling ALOT of pvc's today, and alot of long runs of them that make me extremely scared, is this common?? what could that be?

thank you SOOO much and appreciate your help and opinions.

if they induce V-Fib during EP study can it easily be terminated and brought back to normal or is there a good chance that you could die from it?

could it be Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy? how would that be diagnosed? would that fit my symptoms of left side chest pain, left arm pain, angina and the PVC's and VT and other symptoms that I feel? I have on one of my EKG's it says "T Wave Inversion now evident in Inferior Leads", what does that mean? ARVD?

I also have came across some information about "Idiopathic Ventricular Fibrillation", and "Primary Ventricular Fibrillation" where it has occured in people with normal hearts, structural and electrical, with normal echos, holters, stress test, ep studies, cardiac mri's, so my question is how can one say that PVC's, and NSVT are benign in NORMAL hearts but they still have these cases of sudden death "v-fib" in people with NORMAL hearts???

Dr. also said that it was "monomorphic non sustained ventricular tachycardia"!!
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Avatar_f_tn
Hi, I am new here and I see this is an old post, but I am hoping one of you will check back here and reply to my question. Looking over my old papers I found the following
"a possible 3 beat run of multifocal pvcs" My EP said he didnt see this. I called the tech and she said a tech as well as a doctor viewed it and are fairly sure but not 100% sure that I had this. They cant tell for sure due to the 2nd beat. When the report says 3 beat run multifocal, does this mean polymorphic vt?
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967168_tn?1343732745
Here is an excellent answer to your question from one of the MH dr's - http://www.medhelp.org/posts/Heart-Disease/Signaficance-of-unifocal-vs-multifocal-PVCs-in-a-normal-heart-structure/show/253854

"The good news is it doesn't matter if they are unifocal or multifocal PVCs--if you have a structurally normal heart, there is no need to worry about them.  I understand they make you feel uncofortable, but it is not harmful."

If you're worried about P-VT then it's best to get another full cardiac workup just to be safe and make sure your heart is structurally "normal".

I went undiagnosed and almost died, I had both unifocal and multifocal pvc's off & on since 2004 that showed up on ekg's and dr's said it was nothing to worry about.  I had an EPS where the EP triggered long runs of P-VT and went into V-Fib 3 times so I had to have a pacemaker/defibrillator implanted.  No known cause was found, so I'm still trying to find the cause but haven't yet.
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Avatar_f_tn
Thank you so much for taking the time to provide all that information. I will look it over and decide from there. Again, thank you!
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