Ventricular tachycardia laboratory findings: Difference between revisions

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{{Ventricular tachycardia}}
{{Ventricular tachycardia}}
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{{CMG}} {{AE}} {{Sara.Zand}}
==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==
==Laboratory Findings==
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 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>
* [[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>


* Ionized [[calcium]] levels along with [[magnesium]] and [[phosphate]] levels should be obtained.
* [[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]] 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>


* [[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.
 
 
<br />
{| class="wikitable"
|+
! colspan="2" |Laboratory Pearls for Ventricular Tachycardia
|-
!Electrolytes
|[[Hypokalemia]] and [[hypomagnesemia]] frequently associated with [[Torsade de pointes|torsades de pointes]]
|-
!Troponin I
|Elevated in [[myocardial infarction]]
|-
!Creatine-kinase MB
|Elevated in [[myocardial infarction]]
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
 
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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.