Paroxysmal tachycardia - Causes, Symptoms and Treatment .MF .
Symptoms and Diagnosis
forecast Due to the fact that the heart is influenced by different factors in the human body, it can respond to the slightest deviation in the internal organs of violations of their functions.This is especially true function of conductivity and contractility.For example, a regular rhythm of heart muscle contractions (myocardium) depends on the balance of the autonomic nervous system influence on the level of adrenal hormones (adrenaline) and thyroid blood and on the state of the heart muscle itself.Therefore, the conditions and diseases that change the internal consistency of the body or causing damage to the myocardium, may develop cardiac arrhythmias.This change in heart rate and / or conducting an electrical pulse on the atria and ventricles.One of these disorders is tachycardia - rapid heartbeat.But if some types of tachycardia develops as a reaction to stress, muscle strain, fever and, in principle, are not dangerous t
Paroxysm - an attack of cardiac arrhythmias, lasting from a few seconds to hours, sometimes up to several days, which suddenly appears and suddenly ends.Paroxysmal tachycardia is not only, but also atrial fibrillation.Paroxysmal tachycardia - a type of heart rhythm disorder characterized by the occurrence of attacks palpitations with a heart rate of 140 - 250 per minute with a regular sinus rhythm.
rhythm disturbance in the form of paroxysms developed due to the fact that the path of the electrical signal to the heart there are obstacles, or, conversely, further ways of pulse (bundles of Kent, James).This leads to the fact that the muscles begin to shrink portions of the obstacle, as it returns to the pulse repeatedly back and formed ectopic excitation focus (not located at the location).In addition, portions of the myocardium receiving pulse with additional beams are stimulated more often than necessary.The result is frequent ventricular contraction to lack of sufficient time for relaxation of the heart muscle, and, as a consequence, with impaired ejection of blood into the aorta.It affects the internal organs, and primarily the brain.Therein lies the danger of paroxysmal tachycardia.
The figure shows schematically the pulse circulation for atrial and ventricular myocardium.
Depending on the area of the cardiac conduction system, where there was a "failure", the following types of paroxysmal tachycardia:
1. Supraventricular (supraventricular) tachycardia
- atrial tachycardia - localization occurs when the ectopic focus in the atria
- atrioventricular - at the locationin atrioventricular connection
2. ventricular tachycardia - the localization of the tissues
ventricular - unstable - recorded on an electrocardiogram of less than 30 seconds
- resistant - for 30 seconds or more
adrift distinguish acute paroxysmal tachycardia, and constantly returncontinuously relapsing form.
most dangerous is ventricular tachycardia, as it most often leads to heart failure.Returnable and recurrent forms, and even dangerous in that, often arising lead to wear of the heart muscle and to the rapid development of heart failure.
reasons paroxysmal tachycardia
Even though that supraventricular tachycardia not always evidence of organic heart disease, it is still with ventricular tachycardia is not the norm for this.That is, in any case, you must look for the cause, which has involved over a data breach rhythm.
supraventricular tachycardia often does not develop with the direct damage to the heart tissue, and as a result of violations of neurohumoral influence or the toxic effect of certain substances on the heart.
reasons for its development are the following diseases:
- there are additional ways of pulse.It is an innate characteristic, and can occur at any age.Particularly significant bundle of Kent (between the atrium and ventricle) and a bunch of James (connecting the sinoatrial and atrioventricular nodes).If there are additional beams it is as if "reset" before the electric signal than it should be OK.The result is a premature ventricular excitation, but in most cases this signal comes back, circulates between the primary and secondary beam.This will cause supraventricular tachycardia.In general, a condition called ventricular pre-excitation syndrome.There are two syndromes - Wolff - Parkinson - White and Clerk - Levi - Cristescu (syndrome shortened PQ).Thus, these two syndromes can lead to the development of supraventricular tachycardia
- toxic effects of cardiac glycosides (strofantin, digoxin, Korglikon) when they overdose, and arrhythmogenic effects of certain anti-arrhythmic drugs (propafenone, quinidine)
- disease neurogenic nature (neurosis, neurasthenia), constant stress
- alcohol, drugs
- excess kardiotropnyh hormones in the body - with hyperthyroidism (hyperthyroidism) increased triiodothyronine levels in the blood, while an adrenal gland tumor (pheochromocytoma) - adrenaline and noradrenaline
- diseases of other organs (peptic ulcer, gastritis, cholecystitis, renal and hepatic failure)
Ventricular tachycardia in most cases is caused by organic heart disease.Causes of ventricular tachycardia:
- the most common cause - ischemic heart disease, particularly myocardial infarction with the formation of myocardial infarction (rumen replacement of muscle tissue)
- myocarditis, also having in its outcome cardio
- cardiomyopathy and myocardial dystrophy - metabolic disorders in the cells of the heartmuscle development and structural changes in it
- congenital heart
- Brugada syndrome - clinical and electrocardiographic syndrome caused by a genetic mutation of proteins responsible for transport of sodium into and out of the cells of the myocardium, resulting in impaired contractility and conduction of impulses by the heart cells.Syndrome dangerous sudden development of life-threatening arrhythmias and sudden cardiac death.
Factors that provoke hysteria are:
- emotional stress or a significant physical activity
alcohol - smoking a cigarette
- hypertensive crisis
- receiving regular doses of the drug (cardiac glycoside or antiarrhythmics)
Symptoms of paroxysmal tachycardia
between paroxysms of tachycardia, the patient may feel satisfactory.In the case of chronic disease patient complains depending on the nature of the disease.For example, in hyperthyroidism concerned trembling in the limbs, marked weight loss, irritability, hair loss, with heart defects and chronic heart failure - shortness of breath, fatigue, dizziness, pain in the heart, in case of problems with the gastrointestinal tract - abdominal pain, nausea, heartburnetc.
Paroxysm tachycardia is accompanied by a sense of shock in the heart, and following this subjective feeling of the heartbeat.Patients literally feel that the heart is beating very often.In addition, there may be general weakness, dyspnea, chest pain, dizziness, impaired speech and vision, loss of sensation and movement in the arms or legs.Unstable ventricular tachycardia may not manifest itself.Persistent ventricular tachycardia may be accompanied by loss of consciousness and lead to ventricular fibrillation, which is manifested clinical picture of death - the lack of consciousness, pulse, spontaneous breathing, the reaction of pupils to light.
diagnosis of paroxysmal tachycardia
diagnosis of paroxysmal tachycardia, as a rule, does not cause difficulties and confirmed during the ECG during the attack.ECG - signs:
- paroxysmal atrial tachycardia - sinus rhythm, right, with a heart rate of 140 - 250 per minute.P wave (pulse indicates holding sinoatrial node of the atria) before each ventricular complex, but its amplitude is reduced, it can be deformed, biphasic or negative (positive tooth portion, a part of the negative).Ventricular QRS complex is not extended and not deformed.
- paroxysmal tachycardia of the atrio-ventricular node - negative P wave, the QRS is after, or at all.QRS complex is normal.
Paroxysm of supraventricular tachycardia
- paroxysm of ventricular tachycardia - developing atrioventricular dissociation - the atria and ventricles separately, each at their own pace (ventricles with a frequency of 140 - 220 ppm).Barb P is, but it is difficult to detect.QRS complex is extended (more than 0.12 seconds), deformed.
Paroxysm ventricular tachycardia
addition to the standard ECG, can be assigned:
- ECG monitoring,
- ultrasound of the heart,
- chrezpischevodnoye electrophysiological study (with supraventricular tachycardia),
- exercise test (treadmill,veloergometry),
- cardiac MRI,
- coronary angiography.
survey plan prescribed by a doctor in the clinic or in a hospital.
treatment of paroxysmal tachycardia
paroxysmal tachycardia therapy is aimed at preventing the development of attack and treatment of the underlying disease in the interictal period, as well as relief of the attack palpitations.Warning frequent occurrence of episodes of ventricular tachycardia using the continuous use of drugs pursues the aim of preventing complications and sudden cardiac death.
asymptomatic supraventricular tachycardia cardiac continuous use of drugs does not.With frequent paroxysms, causing a subjective discomfort and hemodynamic instability, in addition to the treatment of diseases of the digestive, nervous and endocrine systems, alcoholism, drug addiction and other diseases, leading to the development of supraventricular tachycardia, patients received beta - blockers (carvedilol, bisoprolol), calcium channel antagonists (verapamil), antiarrhythmics (aymalin, VFS, Cordarone, etc.).
Ventricular tachycardia is more dangerous to health and life, the more so as it is often caused by serious heart disease.Therefore, even if the patient only in a paroxysm of life, should be carefully examined in the cardiology department or arrhythmology, and should take some time after the attack, beta-blockers and / or antiarrhythmics.
first emergency aid for relief of paroxysmal tachycardia:
- lay patient
- to measure blood pressure and pulse at the wrist
- call an ambulance on the phone "03»
- apply vagal tests - askpatient breathe deeply and tighter, click the closed eyeball, cough.Samples can be effective only with supraventricular tachycardia.
- when the development of clinical death - resuscitation (chest compressions and artificial respiration by the scheme 15: 2 - 15 taps on the sternum in two blowing air into the patient's lungs)
2. Brigade ambulance:
- in paroxysmal supraventriculartachycardia - ECG after intravenous bolus adenosine triphosphate (ATP), digoxin, procainamide + mezaton with initially low blood pressure, and the ineffectiveness of the development of clinical death - cardioversion (with the help of a defibrillator).
hospitalization is indicated for severe general condition of the patient, high risk of developing complications, pain in the heart, shortness of breath, pulmonary edema.In the case of the stable condition of the patient may be left under the supervision of the local doctor.
- with paroxysmal ventricular tachycardia - after ECG - cardioversion, in the absence of sinus rhythm - intravenous bolus lidocaine, procainamide + phenylephrine, Cordarone, with no effect - cardioversion.Hospitalization is required.
3. The hospital conducted intravenous infusion antiarrhythmics (lidocaine, Cordarone, procainamide), a complete examination.The issue of the need for cardiac surgery treatment.
cardiac surgical treatment is indicated in cases of frequent bouts of ventricular tachycardia, high risk of death and is the implantation of an artificial pacemaker (cardioverter - defibrillator).For supraventricular tachycardia indication for surgery is the continued existence of the disease with frequent attacks, leading to heart failure, responds poorly to medical treatment.Operation is radiofrequency ablation - "cauterization" additional radio pulse beams by introducing electrodes into the heart cavity through the blood vessels.
In order to avoid triggers of paroxysmal tachycardia, should stop drinking coffee in large quantities to reduce the number of cigarettes smoked.Significant physical exertion and stress is also recommended to reduce.For the health of the heart and blood vessels, and it is important to eat rationally, eliminate fatty foods, fried foods, consume more vegetables, fruits, natural juices, milk products, products made from cereals and grains, limiting consumption of confectionery.
To prevent the development of cardiovascular disease, particularly atherosclerosis and coronary heart disease have to struggle with excess weight, get rid of bad habits, monitor the level of blood pressure and control cholesterol levels, taking lipid-lowering drugs prescribed by the doctor if necessary.
Patients with bouts of ventricular tachycardia and high risk of mortality regularly, perhaps even for life, take prescribed medications, especially beta - blockers, and antiarrhythmics antiplatelet agents (aspirin, tromboAss, aspikor etc.).
Complications paroxysmal tachycardia
most threatening complication paroxysm of ventricular tachycardia is ventricular fibrillation and death.Besides, can develop severe heart failure, pulmonary edema, myocardial infarction.Not excluded thromboembolic complications - pulmonary embolism, ischemic stroke, acute thrombosis of the renal arteries, the arteries of the lower extremities, etc. Prevention of complications is a regular intake of drugs and the timely identification of indications for pacemaker implantation..Complications in a paroxysm of supraventricular tachycardia are extremely rare.
Weather Forecast for supraventricular tachycardia in the absence of an organic lesion of the heart-friendly, especially if the original has been eliminated (adjusted dose of cardiac glycosides, normalized levels of hormones in the body, etc.) for ventricular tachycardia less favorable prognosis, especially iftachycardia koronarogennoy nature, that is originated due to ischemia or myocardial infarction.Mortality in the case of ventricular tachycardia with acute myocardial high and is in the first month of 36% in the first year - 55%.Nevertheless, when taken regularly or drugs after implantation of the pacemaker relatively favorable prognosis.
therapists Sazykina OJ