Nonsustained ventricular tachycardia on ambulatory electrocardiographic monitoring: should it be treated?

Nonsustained ventricular tachycardia (NSVT) is defined as a sequence of consecutive ventricular ectopic beats lasting <30 s. As it tends to occur in the presence of underlying heart disease, it is fairly common in heart failure. It is detected on standard or Holter electrocardiographic (ECG) monitoring, both of which are performed routinely in an ambulatory setting. NSVT is not necessarily symptomatic and its prognostic significance is unclear, other than that it may vary with the underlying heart disease. Its management in heart failure depends on a number of factors: Presence of a reversible cause. Underlying cardiac disease. Ongoing medical therapy. Presence of an automatic implantable cardioverter defibrillator (AICD). Reversible causes Reversible triggers of NSVT in the presence of underlying heart disease include: Electrolyte imbalance (hypokalemia, hypomagnesemia). Ischemic stress with increased sympathetic tone. Antiarrhythmic drugs. Electrolyte imbalance is common in heart failure patients on chronic loop diuretic therapy. Concomitant gastroenteritis or malabsorption may compound the hypokalemia. Acute myocardial ischemia is a known trigger of NSVT, while various classes of antiarrhythmic drugs have paradoxical proarrhythmic effects. Underlying heart disease According to the most recent guidelines, NSVT in the presence of ischemic heart failure is an indication for AICD implantation, regardless of the electrophysio-logical data. In dilated cardiomyopathy, NSVT is an indication to screen for reentry tachycardia and treat with transcatheter ablation as appropriate. Medical therapy NSVT in a patient with heart failure is an indication for P-blocker therapy, if not already in place. The routine use of amiodarone is not justified. Depending on the electrophysiological data, AICD implantation or ablation should be considered as additional protection. Keywords management; arrhythmia; ambulatory ECG monitoring; nonsustained ventricular tachycardia; medical treatment [gallery ids=""]We have already mentioned reflexology, foot massage that also focuses on the relief of stress through the release of energy. Many people also find that massage can address particular issues, and pregnancy massage and sports massage two examples that are being increasingly used to treat beauty spa clients. Finally, back massages are often requested by clients who have chronic back pain or other problems that massage can alleviate. There are several good glossaries of the terminology used to distinguish various types of massage and their purposes. You can find examples of the many lists of massage terminology available online at: http://www.holisticonline.com/massage/mas_types.htm and http://www.thebodyworker.com/typesofmassage.htmlTom had posted a duty roster on the wall; I was cleaning the lower stairs, which sounded easy. I went to the communal bathroom and lined up for a sink. It was freezing cold. People were scratching and farting. No one spoke much. I had a wash in tepid water, cleaned my teeth and then set off to clean the stairs. Cleaning the stairs turned out to be a ghastly and soul-destroying job. They were edged in white rubber and the job was to clean all the black shoe marks off with white dubbing polish. Every step was scarred almost black by the end of each day and had to be coated and scrubbed, coated and scrubbed, each morning. Whenever I turned my back, someone would walk down and leave fresh black smears.

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