Practice Lesson of the Week

Slow ventricular tachycardia

BMJ 2008; 337 doi: (Published 03 July 2008) Cite this as: BMJ 2008;337:a424
  1. Nicolas Leitz, training post in dermatology1,
  2. Zarqa Khawaja, foundation year 2, anaesthetics2,
  3. Martin Been, consultant cardiologist3
  1. 1Praxis Leitz, Stuttgart, Germany
  2. 2Royal-Berkshire Hospital, Reading
  3. 3Department of Cardiology, University Hospitals Coventry and Warwickshire, Coventry CV2 2DX
  1. Correspondence to: M Been martin.been{at}
  • Accepted 11 September 2007

A high index of suspicion for “slow ventricular tachycardia” is required in patients taking antiarrhythmic drugs

Ventricular tachycardias are commonly mistaken for supraventricular tachycardia with aberrant conduction. An incorrect diagnosis occurs in as many as 30% of cases.1 2 For patients prone to serious ventricular arrhythmias, antiarrhythmic drugs are frequently used, even in patients with devices such as an implantable cardioverter defibrillator, in whom slow ventricular tachycardia is more common than in the rest of the population.3 Such drug regimens commonly include amiodarone and β blockers, which may modulate the rate of any breakthrough ventricular rhythms to as low as 100-120 beats/min. Failure to recognise that patients have a persistent ventricular rhythm may have a deleterious effect on their haemodynamic status, with potential aggravation of symptoms of heart failure and further impairment of ventricular function. Such patients often have poor cardiac reserve, and minor deterioration in cardiac function can have serious consequences such as ventricular fibrillation, cardiac arrest, and sudden cardiac death.4 We report two cases where the diagnosis was missed, mainly because the heart rate was relatively slow.

Case reports

Case 1

An 87 year old man was admitted because of a sudden onset of shortness of breath and slurred speech. His medical history included an inferior myocardial infarction 27 years previously and left ventricular failure diagnosed about 10 years ago. He had been prescribed amiodarone eight years previously, after the start of atrial fibrillation, and had taken it continuously since then.

On examination his pulse was 108 beats/min, heart sounds were normal with no murmurs, and …

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