Emergency care for supraventricular paroxysmal tachycardia. Complications of paroxysmal tachycardia

Paroxysmal appearance tachycardia refers to one of the types of arrhythmic condition, which is characterized by heart contraction with a frequency of 140 beats per minute. Paroxysms occur against the background of impulses of an ectopic nature, as a result of which the normal sinus rhythm is disrupted.

General characteristics, classification

According to etiological and pathogenetic indicators, paroxysmal tachycardia is similar to extrasystoles, as a result of which extrasystoles following each other can be regarded as a short-term paroxysm of tachycardia. If the cause of the pathology is related to cardiac diseases, then the disease is accompanied by circulatory failure, which leads to uneconomical functioning of the heart. In one third of all cases, paroxysmal tachycardia is detected after ECG monitoring.

A feature of the pathology is the sudden onset and end of the attack. Locations of impulses: atria, ventricles or atrioventricular junction.

The basis of the mechanism of occurrence of pathology is considered to be the re-entry of impulses, the circular circulation of excitation. Sometimes you can find paroxysmal tachycardia, which occurs due to ectopic foci with abnormal automaticity or triggered activity of a post-depolarization nature.

Classification paroxysmal tachycardia, based on the course of the disease:

sharp look(paroxysmal);
chronic form(often returnable);
recurrent type (continuous), which lasts for many years.

Forms of paroxysmal tachycardia depending on the mechanism of development:

reciprocal (develops in the sinus node);
focal (ectopic);
multifocal (multifocal).

Types of disease based on location:

Atrial. It is considered the most common, localized in the atrium on the left or right, and performs the function sinus node. It has the highest contraction frequency, but the rhythm of the impulses is the same. Impulses are sent to the ventricles.
Nodular (atrioventricular). Location: atrioventricular reciprocal node. The number of beats per minute ranges from 150 to 200. The impulses are sent to the ventricles, after which they return to the atria.
Ventricular is the most rare form. There is no strict rhythmicity in contractions, but sinus impulses affect the atria, as a result of which the latter have a frequency 2 times less than in the ventricles, and in the ventricles contractions are 200 beats. Most often, this form develops against the background of atherosclerosis, ischemia, myocarditis of diphtheria etiology, after taking certain groups of medications. It is considered dangerous, since this condition refers to the dissociation of work between the ventricles and atria.

Atrial and nodal paroxysmal tachycardia belong to the group with supraventricular and supraventricular disorders, because they are localized higher than the level of the ventricles, where the pathways pass.

Causes

The main factors in the development of paroxysmal tachycardia:

Congenital form pathologies in which new pathways for impulse conduction are formed. Manifests in any age category. These are Clerk-Levy-Christesco and Wolff-Parkinson-White syndrome. In this case, the electrical signal is reset much earlier, which leads to premature arousal ventricular sections. Most often, the electric pulse returns back, passes between the main beam and the additional one. In short, this is a syndrome of pre-excitation in the cardiac ventricles.
Taking medications from the group of cardiac glycosides and some antiarrhythmic drugs. Basically, pathology occurs against the background of an overdose. This can happen after using drugs such as Digoxin, Strophanthin, Korglykon, Quinidine, Propaferon, etc.
Neurasthenia and. The main reason is neurogenic disorders.
Hyperthyroidism, in which thyroid creates excessive amounts of the hormone triiodothyronine.
Pheochromocytoma (newly formed growths in the adrenal glands), in which great amount norepinephrine and adrenaline.
Ulcerative lesions gastrointestinal organs.
Gastritis and cholecystitis.
Renal failure.
Liver failure.

Causes ventricular tachycardia paroxysmal manifestation:

cardiac ischemia and myocardial infarction, after which cardiogenic sclerosis develops;
with cardiosclerosis;
congenital heart defect;
cardiomyopathy, myocardial dystrophy, in which metabolism in the heart muscles is disrupted;
clinical electrocardiographic syndrome (Brugada).

If we talk about Brugada syndrome, it is life-threatening, since a violation of the heart rhythm occurs suddenly, which leads to death (cardiac arrest). This happens because in this disease there is a mutation in the proteins that are responsible for the distribution of sodium inside myocardial cells.

Provoking factors:

smoking and abuse alcoholic drinks;
frequent stress and emotional outbursts;
excessive physical exercise;
development .

Main sign consists of an abnormal heart rhythm. Features of this symptom:

the attack occurs unexpectedly and abruptly and ends in the same way;
the very first sign is a push in the heart area, after which the rhythm quickens;
rhythmicity of rapid heartbeat;
the number of blows can be from 100 to 250;
immediately before the end of the paroxysmal attack, the patient notes that the heart stops for a moment, it is after this heartbeat is being restored.

In addition to the main symptom, the following may be observed:

violations in nervous system which are manifested by excitability, anxiety, fear;
severe dizziness, up to darkening in the eyes, while the hands begin to tremble;
neurological signs: high level sweating, nausea and vomiting, flatulence, increased peristalsis;
the skin becomes pale and becomes very noticeable through it jugular vessels;
the patient constantly feels the need to urinate, this lasts a maximum of one and a half to two hours, and if you pay attention to the shade of the urine, you can notice the saturation of the color;
the patient feels weakened; if you measure your blood pressure, it will be low, so you may faint.

If paroxysmal tachycardia occurs due to diseases of cardio-vascular system, then the attack is much more difficult to bear.

Diagnostics

To diagnose paroxysmal tachycardia, it is used comprehensive examination:

The doctor collects anamnesis: questions the patient about the symptoms that appear, the frequency of attacks, studies the history of all the diseases that the patient has suffered and has.
The patient is sent for an electrocardiogram, which records heartbeats. Additionally, Holter monitoring is used. Sensors are attached to the chest area, which record indicators for 1-2 days.
Echocardiography is required, with the help of which the atrium and heart valve are examined.
To assess disturbances in the circulatory system, an ultrasound is performed.
The cardiologist will perform auscultation of the heart (listening to vibrations using stethophonendoscopes and stethoscopes).
IN in rare cases Magnetic resonance imaging may be prescribed.

Treatment of paroxysmal tachycardia

Therapeutic measures are aimed at normalizing heart rhythm, eliminating symptoms and preventing the development of complications. The patient is sent to the hospital.

First aid for an attack

If the attack is severe, the person needs to receive proper first aid. Initially called ambulance. Next you need to give comfortable position to the patient. It is advisable to measure blood pressure. If it is significantly lowered, then the legs should be placed above the level of the head. If a person is sitting, then the head drops down to normalize blood circulation in the brain. If the pressure is high, the head should be on top. The victim himself must take a deep breath of air with his mouth closed. It is recommended to rub the chest with a cold and wet cloth. To normalize the pressure, you need to induce vomiting.

The doctor will tell you in our video how to quickly relieve an attack of paroxysmal tachycardia:

Therapy with traditional methods

If the patient is admitted to the hospital during an attack, the doctor administers intravenously the drug "Warfarin". Next is assigned drug treatment, consisting of the following drugs:

to normalize heart rate and stabilize blood pressure, Cordarone, Novocainamide, and Digoxin are prescribed;
antagonists calcium channels(“Verapamil”);
beta blockers: "", "Carvedilol";
antiarrhythmic drugs: “Allapinin”, “Isotroin”, “Aymalin”, “Cordarone”;
diuretics and drugs that stabilize functionality circulatory system(the drug is selected based on pathological changes).

Electropulse treatment

Exposure to electrical impulses is prescribed when drug therapy does not provide positive result. The technique is based on restarting the heart through an electrical discharge. To carry out this procedure, the patient is given anesthesia, and two devices are placed on the heart and right collarbone. Next, the synchronization mode and the amount of current supply are set. At the very end, a discharge is carried out. The procedure is considered highly effective.

Surgical intervention

Surgery is only used when frequent relapses. The most commonly used is radiofrequency ablation, during which the lesions are cauterized with a laser. The operation is safe.

The patient must maintain the functioning of the heart and circulatory system. There are special therapeutic exercises for this purpose.

First of all, this is breathing exercises, which significantly accelerates blood circulation, preventing the formation of blood clots. When a person inhales and exhales correctly, the muscles of his heart are trained, which helps accelerate gas exchange, oxygen saturation and stabilize pulsation. The simplest exercise is long and deep breaths, lasting 8-10 minutes.

Physical exercise are selected on an individual level exclusively by doctors. On initial stages You should exercise under the supervision of a doctor, then continue medical complex possible at home.

Nutrition

The patient is prescribed diet No. 10. It is based on fractional meals, excluding fatty, spicy, salty and smoked foods from the diet. Limit fluid intake to 1 liter per day. It is advisable to consume light soups based on mushrooms and vegetables. You can cook boiled meat low-fat variety. Cereal porridge will be useful. You will have to abstain from sweets and baked goods. You can eat rye and whole grain bread. Dairy products- low fat.

Folk remedies

ethnoscience offers universal remedies:

Brew herbal teas from lemon balm, mint, yarrow, motherwort and valerian. A decoction can be made from individual herbs or combined with each other.
Take 4 lemons, wash them and remove the seeds. Pass through a meat grinder along with the zest. Add walnuts and almonds, honey Leave for 2-3 days. Take 1 tablespoon 3 times daily.
Boil rose hips or in the usual way. Drink as a compote.

Forecast, prevention

If you do not seek medical help in a timely manner, the following complications may develop:

ventricular fibrillation;
heart failure;
ischemia and heart attack;
swelling of the lungs;
death.

In such cases, the prognosis is considered unfavorable. If assistance was provided in a timely manner and was carried out adequate therapy, the prognosis for recovery is positive.

Preventive actions:

lead healthy image life: do not drink alcohol, stop smoking and drinking large quantities coffee;
go in for sports, but physical activity should not be strong;
treat chronic and other diseases;
eat right;
protect yourself from stress;
take medications with magnesium and potassium;
Contact a specialist at the first manifestations of paroxysmal tachycardia.

Paroxysmal tachycardia is a disease that can subsequently lead to death. It is important to follow recommendations to prevent the development of this disease and monitor your heart rate - then you can detect violations in a timely manner.

Supraventricular tachycardia is a regular, fast rhythm, the occurrence of which is due to either a reentry mechanism or an ectopic pacemaker in areas located above the bifurcation of the His bundle. The most commonly observed variants in the clinic are reentry. These patients often experience acute symptomatic episodes called paroxysmal supraventricular tachycardia (PSVT).

Ectopic SVT usually occurs in the atrium at rates between 100 and 250 beats/min (most commonly 140–200). Regular P waves can be mistaken for atrial flutter or (with 2:1 AV conduction block) for sinus rhythm.

The vast majority of patients with SVT have the reentry variant: in almost 2/3 of them, reentry is localized in the AV node, and in the rest - in additional bypass tracts. Only in a small number of patients reentry is localized in other places. At healthy heart reentrant SVT with a contraction frequency of 160 to 200 beats/min is often tolerated by patients for several hours or days. However, it is always reduced cardiac output regardless blood pressure, and a high heart rate can lead to heart failure.

Reentrant SVT occurs in the AV node when an ectopic atrial impulse arrives at the first node during its partial refractory period.” In this case, in the AV node there are two functionally different parallel conducting segments, which connect above at the atrial end and below at the ventricular end of the node. With appropriate stimulation, this circuit is capable of maintaining reentry. In AV nodal reentry, the P waves are usually overlapped by the QRS complexes and are therefore not visible; in this case, 1:1 conduction and normal QRS complexes are observed.

In patients with additional bypass tracts, two parallel reentry circuits, respectively located in the AV node and in the bypass tract, are interconnected at the atrial and ventricular ends by myocardial cells. With the reentrant mechanism, impulses can rush in either direction, but usually they travel down the AV node and up the bypass tract, which causes the appearance of narrow QRS complexes. In Wolff-Parkinson-White syndrome (WWS), approximately 85% of reentrant SVTs have narrow QRS complexes.

Clinical significance

Ectopic SVT may occur in patients with acute heart attack myocardium, chronic disease lungs, pneumonia, alcohol intoxication and with digitalis intoxication (in the latter case it is often combined with atrioventricular block and is called paroxysmal atrial tachycardia with block). It is often believed that the high percentage of SVT with block (approximately 75%) is due to digitalis intoxication. However, this is not found in all studies. The most common arrhythmias associated with digitalis intoxication are listed in Table. 1.

Table 1. Common arrhythmias in digitalis intoxication (approximate frequency)

Reentrant SVT can occur in normal heart or in combination with rheumatic disease heart disease, acute pericarditis, myocardial infarction, prolapse mitral valve or with one of the previous syndromes. SVT often causes a sensation of palpitation and “lightness” in the head. Patients with coronary artery disease may experience anginal chest pain and shortness of breath, which is associated with a high heart rate. In patients with impaired left ventricular function, overt heart failure and pulmonary edema may occur. Patients with left ventricular failure usually do not tolerate loss of atrial contractions due to decreased cardiac output.

Ectopic SVT caused by digitalis intoxication is treated as follows.

Stop taking digitalis medications.
If there is no high degree atrioventricular block, then any existing hypokalemia is corrected to bring the serum potassium concentration to upper limit norms, which helps to reduce atrial ectopia.
Atrial ectopy can be reduced by intravenous phenytoin, lidocaine, or magnesium. Based on published reports, it is quite difficult to determine the degree of effectiveness, risk and benefit of each of the named drugs, so the choice here depends on personal preference (the doctor). Historically, the most commonly used drug is phenytoin, but the percentage of its beneficial effect is not impressive; besides, when using full loading dose(15-18 mg/kg IV) toxic effects are often observed side effects. Lidocaine has not been considered beneficial for this arrhythmia, but recent evidence suggests some effectiveness. Recent studies have shown that 1 g IV magnesium sulfate significantly reduces atrial ectopia caused by digitalis toxicity, so it may be more effective than phenytoin or lidocaine.
Cardioversion for this arrhythmia is ineffective and risky.

Ectopic SVT not associated with digitalis intoxication is treated as follows.

Digoxin or verapamil is prescribed to slow the ventricular rate.
Antiarrhythmic therapy is carried out with quinidine, procainamide or magnesium sulfate.

SVT arising through the reentry mechanism can be converted by delaying conduction along one of the segments of the closed circuit; in this case, self-maintenance of reentry becomes impossible and it fades, and sinus rhythm resumes ventricular stimulation.

Techniques are used to increase tone vagus nerve, which slows down conduction and increases the refractory period in the AV node. These techniques can be performed either independently or after the administration of antiarrhythmic drugs.

When massaging the carotid sinus, the sinus and its baroreceptors in the area of the transverse process are massaged. The massage is performed once for 10 s, primarily on the side of the non-dominant hemisphere; it should never be done on both sides at the same time. In persons with pathologically altered AV node or in patients receiving digitalis, prolonged AV block may occur during such massage. When excessive strong massage carotid sinus in patients with stenosis carotid artery Cerebral ischemia or infarction may develop.
Sometimes it helps to immerse your face with your nostrils pinched cold water for 6-7 s. This technique is especially effective in infants.
Inducing a gag reflex.
The use of pneumatic anti-shock clothing increases blood pressure, thereby stimulating the carotid sinus. Published reports regarding the effectiveness of such clothing in SVT are rather conflicting.

The drug of choice is verapamil, administered intravenously at a dose of 0.075-0.15 mg/kg (3-10 mg) over 15-60 s; if necessary, repeat the dose after 30 minutes. As observations show, more than 90% of adults with reentrant SVT respond positively to the administration of the drug within 1-2 minutes. Intravenous administration of verapamil is almost always accompanied by a drop in blood pressure, even after successful conversion of SVT. The decrease in systolic and mean arterial pressure is approximately 20 and 10 mmHg. respectively.

It has been documented that the fall in blood pressure caused by verapamil can be prevented (or reversed) by intravenous calcium without reducing antiarrhythmic action verapamil; the most commonly used was calcium chloride at a dose of 1 g (iv administration over several minutes); The effectiveness of such a small dose of calcium gluconate as 90 mg has also been reported. In any case, when administering verapamil intravenously, calcium should be available.

The tone of the vagus nerve can be increased with the help of edrophonium: first, a test dose of 1 mg is administered intravenously and wait 3-5 minutes, after which 5-10 mg is administered (iv) over 60 s. The response rate to edrophonium, unfortunately, does not reach the 90% observed with verapamil.

Vagal tone can be increased by pharmacologically increasing blood pressure with a purely peripheral vasoconstrictor; However, drugs with beta-adrenergic activity should not be used. This method combined with carotid sinus massage. In this case, blood pressure is often measured; diastolic pressure should not exceed 130 mm Hg. The method should not be used in patients with hypertension.

Metaraminol (200 mg in 500 mL DSW) or norepinephrine (4 mg in 500 mL D5W) can be administered at a rate of 1-2 mL/min and titrated until rhythm conversion occurs.
Methoxamine or phenylephrine (0.5-1.0 mg IV) is administered over 2-3 minutes; if necessary, doses are repeated.

Propranolol in a dose of 0.5-1.0 mg is administered intravenously over 60 s; repeat every 5 minutes until heart rate converts or total dose reaches 0.1 mg/kg. According to the literature, propranolol successfully converts reentrant SVT in approximately 50% of patients.

Digoxin - 0.5 mg IV with repeated doses of 0.25 mg every 30-60 minutes is administered until a positive effect is obtained or a total dose of 0.02 mg/kg is achieved. Negative point in the use of digoxin are a slow onset of action and a potential risk in patients with additional bypass tracts.

In all unstable patients with hypotension, pulmonary edema or severe chest pain, synchronized cardioversion is performed. The discharge force required for this is usually low (less than 50 J).

Paroxysmal tachycardia is an attack of extremely sharp tachycardia (up to 200-300 contractions per minute), associated with contractions of the heart under the influence of heterotopic impulses emanating from the atria, atrioventricular node or from the ventricles. The causes may be: myocardial infarction (often), rheumatic and infectious-allergic myocarditis, thyrotoxicosis, various emotions, neuropsychic factors, physical stress.

Symptoms

The onset of an attack is noted when good condition patient, sometimes at night, or after warning signs in the form of dizziness, chest tightness, discomfort in the epigastric region.

The face and mucous membranes are pale during an attack. Possible cyanosis, swelling of veins, congestion in small and big circle blood circulation

The pulse is frequent (often the number of pulse waves cannot be counted), decreased filling; may be thread-like, sometimes alternating. Arterial pressure decreases. Pulse pressure downgraded

When auscultating the heart, there is a very high heart rate (up to 200-300 per minute); embryocardia occurs.

ECG: high frequency of ventricular complexes. With supraventricular paroxysmal tachycardia, the shape of the C?/?5 ventricular complexes is not changed, their frequency exceeds 160 per minute, and the rhythm of contractions is preserved. The localization of P waves reflects the source of the heterotopic impulse.

With ventricular paroxysmal tachycardia, the complexes are deformed (idioventricular rhythm), and it is not always possible to identify P waves.

After the attack ends, they appear general weakness, drowsiness, excessive urination.

Emergency care for supraventricular paroxysmal tachycardia

Arsenal antiarrhythmic drugs presented above. Emergency measures must be carried out consistently. The cessation of tachycardia paroxysm serves as a signal to stop emergency procedures and switch to maintenance therapy.

1. Complete rest. Immediate radical assistance to interrupt the attack. At the same time, begin treatment of the underlying disease.

2. For the atrial form of paroxysmal tachycardia in relatively young people, you can use various ways increasing the tone of the vagus nerve: pressure on eyeballs; pressure on the area of the internal carotid artery, at the horns hyoid bone; cold on the heart area; Valsalva experience with straining; quick change of position of the patient from lying to sitting; deep breaths with breath holding; forcible induction of vomiting (contraindicated in case of myocardial infarction!)

3. Strophanthin - 0.3-0.5 ml of 0.05% solution intravenously, slowly in 10-15 ml of isotonic sodium chloride solution. If a paroxysm of tachycardia developed against the background of previous use of digitalis drugs, then intravenous administration cardiac glycosides are contraindicated.

4. Potassium chloride intravenously, drip, as part of a polarizing mixture (100-150 ml of 1% sterile solution of potassium chloride mixed with 100-150 ml of 10% sterile glucose solution and add 6-8 units of insulin) In the absence of potassium chloride, inject intravenously 30- 40 ml of panangin in 150 ml of 5% glucose solution.

5. Novocainamide - 10 ml of a 10% solution intravenously in 10-15 ml of isotonic sodium chloride solution. If symptoms of collapse appear during the administration of novocainamide, then administer 0.75-1 ml of a 1% solution of mezatone intramuscularly or 0.5 ml of a 1% solution of mezatone in 20 ml of a 40% glucose solution intravenously, slowly!

6. Isoptin (finoptin) - 4-5 ml of 0.25% solution in 15-20 ml of isotonic sodium chloride solution or 5% glucose solution intravenously, slowly.

7. Ethmozin - 3-4 ml of a 2.5% solution intramuscularly or intravenously in 10 ml of isotonic sodium chloride solution.

8. Aymalin - 2 ml of a 2.5% solution in 10-15 ml of isotonic sodium chloride solution intravenously, slowly.

9. Anaprilin (Inderal, Obzidan) -5 ml of 0.1% solution in 10-15 ml of isotonic sodium chloride solution intravenously, slowly. In case of hypotension, the administration of beta-blockers is strictly contraindicated. Background administration of 0.5 ml of 1% mesatone solution intramuscularly prevents the development of hypotension and collapse.

10. Electrical defibrillation of the heart during a prolonged and persistent attack of paroxysmal tachycardia (not performed if it occurs due to intoxication with digitalis drugs) High-frequency stimulation, programmed stimulation. Transvenous endocardial electrical stimulation of the heart.

Emergency care for ventricular form of paroxysmal tachycardia

Medicines from the arsenal of antiarrhythmic drugs are consistently used

1. Complete rest. Attempts to apply mechanical techniques to increase the tone of the vagus nerve in the ventricular form of paroxysmal tachycardia are ineffective and in some cases dangerous (myocardial infarction, acute disorder cerebral circulation), especially in elderly patients. Catheterize the ulnar or subclavian vein

2. Remove pain syndrome by inhalation of a mixture of nitrous oxide and oxygen. Neuroleptanalgesia: 1 ml of 0.005% fentanyl solution along with 2-3 ml of 0.25% droperidol solution in 20 ml of isotonic sodium chloride solution or 5% glucose solution is administered intravenously, slowly.

Seduxen - 0.5% solution 2 ml intramuscularly or intravenously (in 10 ml of isotonic sodium chloride solution)

3. Lidocaine - 4 ml of a 2% solution intravenously without dilution, then 6 ml in 50 ml of isotonic sodium chloride solution by drip, intravenously. After 15-20 minutes, the administration of lidocaine can be repeated.

4. Novocainamide - 10 ml of a 10% solution in 100 ml of isotonic sodium chloride solution or 5% glucose solution intravenously, drip. Then inject 5 ml of a 10% solution of procainamide intramuscularly. As a collapse protector, inject 1 ml of a 1% mesatone solution subcutaneously.

5. Aymalin - 2 ml of a 2.5% solution in 15 ml of isotonic sodium chloride solution intravenously, slowly.

6. Potassium chloride - 150 ml of 1% solution with glucose (150 ml of 10% solution) intravenously, drip, mixed with 6 units of insulin. In the absence of potassium chloride, inject intravenously 30-40 ml of ampouled panangin into 100 ml of 5% glucose solution. Magnesium sulfate - 10-15 ml of 25% solution intramuscularly.

7. Isoptin - up to 5 ml of 0.25% solution intravenously in 15-20 ml of 5% glucose solution or isotonic sodium chloride solution.

8. Cordarone - 6 ml of ampoule solution (300 mg) in 150 ml of isotonic sodium chloride solution mixed with 150 ml of 5% glucose solution intravenously, slowly (over 20 minutes)

9. Korglykon - 1 ml of 0.06% solution in 20 ml of isotonic sodium chloride solution intravenously, very slowly, during development acute failure blood circulation

10. Electrical defibrillation of the heart during a prolonged and persistent attack of paroxysmal tachycardia. Programmed cardiac stimulation. Transvenous endocardial electrical stimulation of the heart.

11. Urgent hospitalization to the ward intensive care cardiology department.

V.F.Bogoyavlensky, I.F.Bogoyavlensky

Very rapid heartbeat characteristic of an arrhythmia called paroxysmal tachycardia. The attacks begin unexpectedly and also end abruptly. She is accompanied by shortness of breath, weakness, fear, painful sensations in the chest, decreased pressure. This disease affects both young people and old people. The disease is also diagnosed in young children.

Types of paroxysmal tachycardia

Classification of paroxysmal tachycardia:

Depending on the location of concentration of unnatural impulses, they are distinguished:
- ventricular;
- supraventricular (includes atrial and atrioventricular);
Depending on the nature of the flow, it happens:
- acute (paroxysmal) form;
- chronic (returns regularly);
- constantly recurrent (lasts for years and causes arrhythmogenic cardiomyopathy);
Depending on the development it develops:
- reciprocal (repeatedly returns to the same node);
- ectopic (focal);
- multifocal (multifocal).

Causes

Stress is considered one of the main provocateurs of the appearance of paroxysmal tachycardia. In this way the body reacts to a surge of adrenaline in stressful situations. Gallbladder diseases, gastric tract, problems with the kidneys and diaphragm can serve as an impetus for the development of tachycardia.

Not so often, such irritation is associated with diseases of the pancreas, lungs, spine and other organs. Ventricular tachycardia is typical for patients with severe cardiac damage. This arrhythmia develops as a result of various heart defects, blood pressure-related diseases, complex infections And suffered a heart attack. One of the leading factors in the occurrence of this disease is the use of drugs. Medicines Digitalis provokes severe paroxysmal tachycardia with high probability fatal outcome. To one more dangerous drugs include "Quinidine" and "Novocainamide"

Attacks of paroxysmal tachycardia in children occur due to emotional or physical stress.

Paroxysmal tachycardia is the most common form of arrhythmia in children. The occurrence of the disease is caused by overstrain of a psycho-emotional nature and various lesions of the heart muscle. Pathology often develops as a result panic attack or increased load mental or physical.

Symptoms of pathology

The paroxysm suddenly appears and disappears unexpectedly, and the duration is measured in several minutes, and at most lasts several days. It starts with a push in chest, turning into an increased heart rate. You may experience dizziness, noise in the head, pressing pain in heart. This kind of arrhythmia may be accompanied by bloating, nausea, increased sweating. Its long duration can provoke loss of consciousness, loss of strength, hypotension and fever.

Giving help

The Aschner test is used to independently eliminate the symptoms of tachycardia.

First urgent Care for paroxysmal tachycardia consists of simple manipulations that will help improve the patient’s well-being. First of all, you need to ensure peace and get rid of tight clothes, which will provide the opportunity to breathe freely. It is necessary to offer the victim to do lung breathing gymnastics - slow inhalation and exhalation. How mechanical method To stop an attack, you can use the Aschner test. Its essence is that you need the tips thumbs apply light pressure under the upper eye arches with the eyes closed. The patient must lie down. The duration of pressure should not exceed 30 seconds. However, it should not be used by people with ophthalmological problems and children. There are other non-drug methods for paroxysm, although they are less effective. These include:

pressing on the upper abdomen;
specially induced vomiting;
bending your knees and pressing them to your chest.

Emergency medical care for paroxysmal tachycardia

When all mechanical methods did not give results, the victim is administered “Verapamil” intravenously. If the attack does not go away after 5 minutes, the injection is repeated. Before administering this medicine, it is necessary to avoid taking adrenergic blockers for 24 hours, otherwise this will lead to cessation of blood circulation. Like an ambulance health care A number of antiarrhythmetics are used that are effective for any form of paroxysm. These include “Cordarone”, “Aymalin”, “Isoptin”, “Ethmozin”, “Quinidine”, “Ritmodan”. If positive effect does not occur from medications; for prolonged attacks, electrical pulse therapy is used. Defibrillation is safer and effective method stopping an attack of ventricular and supraventricular tachycardia. It is effective in 90% of cases. That is why when severe attacks paroxysm, you should use it and not waste time on medications.

Diagnosis and treatment methods

Using an electrocardiograph, the doctor determines the final diagnosis and prescribes treatment for the patient.

During the first attack of tachycardia in the patient’s life, it is necessary to urgently hospitalize and conduct an extensive examination. It includes: ultrasound of the heart, CT scan and radionuclide scanning. Additionally, the patient is connected to a portable electrocardiograph for a day, which monitors the heart rhythm during rest and during exercise.

Treatment of tachycardia is prescribed after all tests have been completed, full implementation examination and determination of the type of disease. If the atrial form is diagnosed and a connection with neuropsychic factors is established, then a treatment regimen is prescribed in the form of medication and lifestyle changes. Good effect observed when combining antiarrhythmic and sedative medications.

For the treatment of the ventricular form of paroxysmal tachycardia, it is initially used conservative methods, and only if there is no result they resort to the ablation method. Treatment consists of eliminating the source of excitation using a laser, cryogenic, chemical or electrical methods. There is also a non-surgical ablation method - the popular radiofrequency ablation. This method eliminates hospitalization. All you need is constant examination by a cardiologist and taking medications. The effectiveness of the method is almost 100%, and patients forget about their illness forever.

Depending on location ectopic focus automaticity is distinguished between supraventricular (atrial, atrioventricular) and ventricular forms.

Symptoms

With supraventricular tachycardia: the onset is sudden, “unexpected” for the patient. There is palpitation and interruptions in heart function. Consciousness is preserved. Heart sounds are frequent and rhythmic. Blood pressure is not changed or there is a tendency to decrease. The pulse is frequent up to 160 beats/min, with weakened filling. On ECG signs supraventricular tachycardia.

With ventricular tachycardia: the subjective sensations are the same. Pain in the chest region, shortness of breath, confusion, and even complete loss of consciousness may occur. Arterial hypotension. The pulse is weak, often rhythmic. Skin pale, damp. The ECG shows signs of ventricular tachycardia.

First aid

Invite the patient to take a deep breath, and then, with his mouth closed and nose pinched, strain hard. Inhalation of humidified oxygen. Orally phenazepam 0.0005 g (1 tablet).

Medical emergency care

Medical Center

Repeat the test with straining at height deep breath. Massage of the right carotid sinus with the patient lying on his back (under ECG control). Orally 4-6 g potassium chloride in 100-200 ml of water. For supraventricular tachycardia, intravenous injection of 2 ml of 0.25% anaprilin solution (contraindicated in arterial hypotension), 1 ml of 0.06% solution of korglykon or 0.5-1 ml of 0.05% solution of strophanthin in 10 ml of 0.9% sodium chloride solution or 10 ml of 5% glucose solution. In case of ventricular tachycardia or in case of previous ineffective treatment of supraventricular tachycardia - slowly intravenous 5-10 ml of 10% solution of novocainamide under blood pressure control, if necessary after 15-20 minutes reintroduction 5-10 ml of a 10% solution of novocainamide in combination with 0.3-0.5 ml of a 1% solution of mezatone to prevent arterial hypotension. To relieve fear, 1 ml of a 3% solution of phenazepam is administered intramuscularly.

After restoration of normal sinus rhythm or achieved reduction in heart rate, stabilization of blood pressure, evacuation to the hospital (omedb) by ambulance, lying on a stretcher, accompanied by a doctor.

Omedb, hospital

In case of supraventricular tachycardia, repeat the measures of the previous stage, which can be supplemented with optional intravenous jet injection 3-6 ml of a 5% solution of cordarone, 1-2 ml of a 1% solution of ATP, 5-10 ml of a 1% solution of disopyramide (rhythmylene) or 2-4 ml of a 2.5% solution of ajmaline. If there is no effect - electrical pulse therapy (cardioversion), transesophageal cardiac stimulation. To stop ventricular tachycardia - 4-8 ml of 2% lidocaine solution (80-160 mg) intravenously, then 5-10 ml of 2% lidocaine solution in 200-400 ml of 5% glucose solution intravenously. In the absence of lidocaine, ethmozin - 2-6 ml of a 2% solution (50-150 mg) or etacizin - 2-4 mg of a 2.5% solution (50-100 mg) can be used intravenously slowly in 10 ml of 0.9% sodium solution chloride or 5% glucose solution. If ineffective drug therapy- electropulse therapy.