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Ventricular tachycardia is a potentially life threatening cardiac arrhythmia. Monomorphic ventricular tachycardia in the setting of acute myocardial ischemia can also be treated by intravenous lignocaine bolus followed by infusion. If the rate is very fast, hemodynamic deterioration can occur rapidly.
Pediatric exercise testing may be used for evaluation of various disorders of cardiac rhythm rather than for inducible ischemia as in adults. QT prolongation and the occurrence of ventricular arrhythmias with exercise are another important aspect of exercise testing in children. Discussion on pediatric exercise testing.
Mechanism is thought to be due to sustained sympathetic stimulation, probably caused by dysfunction of insular cortex resulting in reversible neurogenic damage to the myocardium which could include contraction bands and subendocardial ischemia [2]. Risk is thought to be higher with damage to right hemisphere than left hemisphere.
ECG is recorded periodically during the test in addition to documenting any specific events like arrhythmias. The recording in early phase of recovery at 1 minute, shows very little ST segment depression, making us suspect further whether the earlier recording was really due to myocardial ischemia.
This is the proposed mechanism of precipitation of arrhythmias in Brugada syndrome during febrile episodes. There is a potential risk for drug challenge in that life threatening ventricular arrhythmias could be precipitated. This leads to shortening of action potential duration. With proper precautions, risk can be reduced.
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