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 a contraction of the heart with a frequency of 140 beats per minute. There are paroxysms against the background of impulses of an ectopic nature, as a result of which the normal sinus rhythm is disturbed.

General characteristics, classification

According to the etiological and pathogenetic indicators, paroxysmal tachycardia is similar to extrasystole, as a result of which extrasystoles following one after another can be regarded as a short paroxysm of tachycardia. If the cause of the pathology refers to cardio diseases, then the disease is accompanied by circulatory failure, which leads to uneconomical work of the heart. In one third of all cases, after ECG monitoring, paroxysmal tachycardia is detected.

A feature of the pathology is the sudden onset and end of the attack. Places of localization of impulses: atria, ventricles or atrioventricular connection.

The basis of the mechanism for the 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 automatism or with trigger activity of a post-depolarization nature.

Classification paroxysmal tachycardia based on the course of the disease:

sharp look(paroxysmal);
chronic view(often reversible);
recurrent type (continuous) that 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, performs the function sinus node. It has the highest contraction rate, but the pulse rhythm is the same. The impulses are sent to the ventricles.
Nodular (atrioventricular). Location: atrioventricular reciprocal node. The number of beats per minute is from 150 to 200. The impulses are sent to the ventricles, after which they return to the atria.
Ventricular - the most rare form. There is no strict rhythm 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 the 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 are formed for impulse conduction. It appears in any age category. This is the 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 electrical impulse 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, Korglikon, Quinidine, Propaferon, etc.
Neurasthenia and. The main reason is neurological disorders.
Hyperthyroidism, in which thyroid creates an excessive amount of the hormone triiodothyronine.
Pheochromocytoma (newly formed growths in the adrenal glands), which produces great amount norepinephrine and epinephrine.
Ulcerative lesions organs of the gastrointestinal tract.
Gastritis and cholecystitis.
Renal insufficiency.
Liver failure.

Causes ventricular tachycardia paroxysmal manifestation:

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

If we talk about the Brugada syndrome, then it is life-threatening, since the heart rhythm disturbance occurs suddenly, which leads to death (cardiac arrest). This happens because in this disease there is a mutation of 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 feature is the disturbed rhythm of heart contractions. Features of this symptom:

the attack occurs unexpectedly and abruptly, ends in the same way;
the very first sign is a push in the region of the heart, after which the rhythm quickens;
rhythmic palpitations;
the number of strokes can be from 100 to 250;
just 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, there may be:

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

If paroxysmal tachycardia occurs against the background of diseases of cardio-vascular system, then the attack is much more difficult.

Diagnostics

used to diagnose paroxysmal tachycardia comprehensive examination:

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

Treatment of paroxysmal tachycardia

Therapeutic activities aimed at normalizing the 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 properly provide first aid. Initially called ambulance. Next, you need to give comfortable position sick. 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 goes 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.

How to quickly relieve an attack of paroxysmal tachycardia, the doctor will tell in our video:

Therapy with traditional methods

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

to normalize the heart rhythm and stabilize the pressure, Cordaron, Novocainamide, Digoxin are prescribed;
antagonists calcium channels("Verapamil");
beta-blockers: "", "Carvedilol";
antiarrhythmic drugs: "Allapinin", "Isotroin", "Aimalin", "Kordaron";
diuretics and drugs that stabilize functionality circulatory system(the drug is selected based on pathological changes).

Electropulse treatment

The impact of electrical impulses is prescribed in the case when drug therapy does not give positive result. The technique is based on restarting the work of the heart through an electrical discharge. To carry out such a procedure, the patient is anesthetized, 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, the discharge is carried out. The procedure is considered highly effective.

Surgical intervention

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

The patient must support the work of the heart and circulatory system. For this, there are special therapeutic complexes of exercises.

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 to accelerate gas exchange, oxygen saturation and stabilize the pulsation. The simplest exercise is long and deep breaths, lasting 8-10 minutes.

Physical exercise selected at the individual level exclusively by physicians. On early stages should be done under the supervision of a doctor, then continue medical complex you can at home.

Nutrition

The patient is prescribed diet number 10. It is based on fractional nutrition, exclusion from the diet of fatty, spicy, salty and smoked. Fluid intake is limited to 1 liter per day. It is advisable to consume light soups based on mushrooms and vegetables. You can cook boiled meat low-fat grade. Cereal cereals will be useful. You will have to refrain from sweets and rich pastries. Bread can be eaten with rye and whole grains. Dairy products- defatted.

Folk remedies

ethnoscience offers universal means:

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 pits. Together with the zest, pass through a meat grinder. Add walnuts and almond nuts, honey. Insist 2-3 days. Take daily 3 times 1 tablespoon.
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 infarction;
swelling of the lungs;
death.

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

Preventive actions:

lead healthy lifestyle life: do not drink alcohol, stop smoking and drinking in 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 the death of a person. It is important to follow the recommendations for the prevention of development this disease and monitor your heart rate - then you can detect violations in a timely manner.

Supraventricular tachycardia is a regular, fast rhythm that occurs either by a reentry mechanism or by an ectopic pacemaker in areas above the bifurcation of the His bundle. In the clinic, reentry variants are most often observed. These patients often present with acute symptomatic episodes called paroxysmal supraventricular tachycardia (PSVT).

Ectopic SVT usually occurs in the atrium at a rate of 100 to 250 bpm (140 to 200 is most common). Regular P waves may be mistaken for atrial flutter or (with 2:1 AV block) for sinus rhythm.

The vast majority of patients with SVT have a reentry variant: in almost 2/3 of them, reentry is localized in the AV node, and the rest - in additional detours. Only in a small number of patients reentry is localized in other places. At healthy heart reentrant SVT with a frequency of contractions from 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 at the AV node when an ectopic atrial impulse arrives at the I node during its partial refractory period." At the same time, there are two functionally different parallel conducting segments in the AV node, which are connected at the top at the atrial end and at the bottom at the ventricular end of the node. With appropriate stimulation, this circuit is able to maintain reentry. In AV nodal reentry, P waves usually overlap with QRS complexes and are therefore not visible; while 1:1 conduction and normal QRS complexes are observed.

In patients with accessory 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 reentry 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 (WPW), approximately 85% of reentrant SVTs have narrow QRS complexes.

Clinical Significance

Ectopic SVT may occur in patients with acute infarction 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 a high percentage of SVT with block (approximately 75%) is due to digitalis toxicity. 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 may occur in normal heart or in combination with rheumatic disease heart, acute pericarditis, myocardial infarction, prolapse mitral valve or with one of the previous syndromes. SVT often causes a feeling 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. Patients with impaired left ventricular function may present with overt heart failure and pulmonary edema. Patients with left ventricular failure usually do not tolerate the loss of atrial contractions due to a decrease in cardiac output.

Ectopic SVT due to digitalis intoxication are treated as follows.

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

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

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

SVT, which occurred by the reentry mechanism, can be converted by a delay in conduction along one of the segments of the closed loop; at the same time, self-maintenance of reentry becomes impossible and it fades, and sinus rhythm resumes ventricular stimulation.

Tune-up techniques are used vagus nerve, which slows down conduction and increases the refractory period in the AV node. These techniques can be performed both independently and after the administration of antiarrhythmic drugs.

When massaging the carotid sinus, the sinus and its baroreceptors in the region of the transverse process are massaged. Massage is performed once for 10 s, primarily on the side of the non-dominant hemisphere; it should never be done simultaneously on both sides. In individuals with a pathologically altered AV node or in patients receiving digitalis, prolonged AV blockade may occur during such massage. When excessive strong massage carotid sinus in patients with stenosis carotid artery cerebral ischemia or myocardial infarction may develop.
Sometimes it helps to immerse the face with pinched nostrils in 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 inconsistent.

The drug of choice is verapamil administered intravenously at a dose of 0.075-0.15 mg/kg (3-10 mg) for 15-60 seconds; 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 after 1-2 minutes. Intravenous administration of verapamil is almost always accompanied by a fall in blood pressure, even after successful SVT conversion. The decrease in systolic and mean arterial pressure is approximately 20 and 10 mm Hg. respectively.

It has been documented that the fall in blood pressure due to verapamil can be prevented (or reversed) by intravenous calcium without reducing antiarrhythmic action verapamil; the most commonly used calcium chloride at a dose of 1 g (in / in the introduction within a few minutes); also reported the effectiveness of such a small dose of calcium gluconate as 90 mg. In any case, with intravenous administration of verapamil, calcium should be at the ready.

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

Vagus 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 given 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, repeat the dose.

Propranolol at a dose of 0.5-1.0 mg is administered intravenously over 60 seconds; repeat every 5 minutes until heart rate has converted or total dose reaches 0.1 mg/kg. According to the literature, propranolol successfully converts SVT reentrant 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 reached. negative moment in the use of digoxin are a slow onset of action and a potential risk in patients with accessory bypass tracts.

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

Paroxysmal tachycardia is called an attack of the sharpest tachycardia (up to 200-300 contractions per 1 min), associated with contractions of the heart under the influence of heterotopic impulses emanating from the atria, atrioventricular node or from the ventricles. The reasons may be: myocardial infarction (often), rheumatic and infectious-allergic myocarditis, thyrotoxicosis, various emotions, neuropsychic factors, physical overstrain.

Symptoms

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

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

The pulse is frequent (often the number of pulse waves cannot be counted), low filling; may be filiform, sometimes alternating. Arterial pressure decreases. Pulse pressure lowered.

With auscultation of the heart - a very high heart rate (up to 200-300 per 1 min); embryocardia occurs.

ECG: high frequency of ventricular complexes. With supraventricular paroxysmal tachycardia, the shape of the ventricular C? /? 5 complexes is not changed, their frequency exceeds 160 per 1 min, the rhythm of contractions is preserved. The localization of the P waves reflects the source of the heterotopic impulse.

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

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

Emergency care for supraventricular paroxysmal tachycardia

Arsenal antiarrhythmic drugs presented above. Emergency care activities should be carried out sequentially. Termination of paroxysmal tachycardia serves as a signal to terminate emergency procedures and transition to maintenance therapy.

1. Complete rest. Immediate radical assistance to interrupt the attack. Simultaneously begin treatment of the underlying disease.

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

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

4. Potassium chloride intravenously, drip, as part of a polarizing mixture (100-150 ml of 1% sterile potassium chloride solution mixed with 100-150 ml of 10% sterile glucose solution and add 6-8 IU of insulin) In the absence of potassium chloride, enter 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 with the introduction of novocainamide symptoms of collapse appear, then administer 0.75-1 ml of 1% mezaton solution intramuscularly or 0.5 ml of 1% mezaton solution in 20 ml of 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. Etmozin - 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. With hypotension, the introduction of β-blockers is categorically contraindicated. The background introduction of 0.5 ml of a 1% solution of mezaton intramuscularly prevents the development of hypotension and collapse.

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

Emergency care for ventricular form of paroxysmal tachycardia

Consistently used drugs from the arsenal of antiarrhythmic drugs

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 an antecubital or subclavian vein

2. Remove pain syndrome by inhalation of a mixture of nitrous oxide and oxygen. Neuroleptanalgesia: 1 ml of a 0.005% solution of fentanyl, together with 2-3 ml of a 0.25% solution of droperidol 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 drip, intravenously. After 15-20 minutes, the introduction 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 novocainamide intramuscularly. As a collapse protector, inject 1 ml of a 1% mezaton 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 a 1% solution with glucose (150 ml of a 10% solution) intravenously, drip, mixed with 6 units of insulin. In the absence of potassium chloride, intravenously inject 30-40 ml of ampouled panangin into 100 ml of 5% glucose solution. Magnesium sulfate - 10-15 ml of a 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. Kordaron - 6 ml of an ampouled 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. Korglikon - 1 ml of 0.06% solution in 20 ml of isotonic sodium chloride solution intravenously, very slowly, with development acute insufficiency circulation.

10. Electrical defibrillation of the heart with 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. Attacks suddenly begin and also end abruptly. It is accompanied by shortness of breath, weakness, fear, pain in the chest, decreased pressure. This disease affects both young people and old people. The disease is also diagnosed in young children.

Varieties of paroxysmal tachycardia

Classification of paroxysmal tachycardia:

Depending on the place of concentration of unnatural impulses, there are:
- ventricular;
- supraventricular (includes atrial and atrioventricular);
Depending on the nature of the flow, it happens:
- acute (paroxysmal) form;
- chronic (regularly returns);
- constantly recurring (lasts for years and causes arrhythmogenic cardiomyopathy);
Depending on the development 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 disease, 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 lesions. Such an arrhythmia develops as a result of various heart defects, diseases associated with pressure, complex infections And myocardial infarction. One of the leading factors in the occurrence of this disease is the use of drugs. Medicines foxglove provoke severe paroxysmal tachycardia with highly likely lethal 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. Often the pathology develops as a result panic attack or increased load mental or physical nature.

Symptoms of pathology

Paroxysm suddenly appears and suddenly disappears, and the duration is measured in several minutes, and lasts a maximum of several days. It starts with a push chest, turning into a rapid 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

Ashner's test is used to self-eliminate the symptoms of tachycardia.

First urgent Care with paroxysmal tachycardia, it consists in 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 allow you to breathe freely. The victim should be asked to do easy respiratory gymnastics - slow inhalation and exhalation. How mechanical way to stop an attack, you can use the Ashner test. Its essence lies in the fact that you need tips thumbs gently press under the upper eye arches with the eyes closed. The patient must lie down. The duration of pressing should not exceed 30 seconds. However, it should not be used by people with ophthalmic problems and children. There are other non-drug methods for paroxysm, although they are less effective. These include:

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

Emergency medical care for paroxysmal tachycardia

When all mechanical methods did not give results, the victim is administered "Verapamil" intravenously. If the attack has not passed after 5 minutes, the injection is repeated. Before you enter this medicine, you must exclude the use of adrenergic blockers throughout the day, otherwise it will lead to circulatory arrest. Like an ambulance health care a number of antiarrhythmetics are used, which are effective in any form of paroxysm. These include Kordaron, Aimalin, Isoptin, Etmozin, Quinidin, Ritmodan. If positive effect from medicines does not occur, with prolonged attacks, electropulse 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.

Diagnostics and methods of treatment

With the help of an electrocardiograph, the doctor determines the final diagnosis and prescribes the treatment of the patient.

During the first attack of tachycardia in the life of the patient, 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 passing all the tests, full implementation examination and determination of the type of disease. If an 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 drugs.

For the treatment of the ventricular form of paroxysmal tachycardia, initially used conservative methods, and only in the absence of a result resort to the ablation method. Treatment consists in the elimination of the focus of excitation with a laser, cryogenic, chemical or electrical methods. There is also a non-surgical method of ablation - a popular radiofrequency ablation. This method excludes hospitalization. All that is needed is a constant examination by a cardiologist and medication. The effectiveness of the method is almost 100%, and patients forget about their illness forever.

Depending on the location ectopic focus automatism distinguish supraventricular (atrial, atrioventricular) and ventricular form.

Symptoms

With supraventricular tachycardia: the onset is sudden, "unexpected" for the patient. There is a heartbeat, interruptions in the work of the heart. Consciousness is preserved. Heart sounds are frequent, rhythmic. BP is not changed or there is a tendency to decrease it. The pulse is frequent up to 160 beats/min, weakened filling. On ECG signs supraventricular tachycardia.

With ventricular tachycardia: subjective sensations are the same. There may be pain in the retrosternal region, shortness of breath, clouding of consciousness up to its complete loss. Arterial hypotension. Pulse weak filling, often rhythmic. Skin pale, wet. The ECG shows signs of ventricular tachycardia.

First aid

Invite the patient to take a deep breath, and then, with the mouth closed and the nose pinched, strain hard. Humidified oxygen inhalation. Inside phenazepam 0.0005 g (1 tab.).

Medical emergency

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). Inside 4-6 g potassium chloride in 100-200 ml of water. With supraventricular tachycardia, intravenous bolus 2 ml of a 0.25% solution of anaprilin (contraindicated in case of arterial hypotension), 1 ml of 0.06% solution of corglicon 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. With ventricular tachycardia or in the case of previous ineffective therapy for supraventricular tachycardia - intravenously slowly 5-10 ml of a 10% solution of procainamide under the control of blood pressure, if necessary, after 15-20 minutes reintroduction 5-10 ml of 10% novocainamide solution in combination with 0.3-0.5 ml of 1% mezaton solution for the prevention of arterial hypotension. For the relief of fear intramuscularly 1 ml of a 3% solution of phenazepam.

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

Omedb, hospital

With supraventricular tachycardia, the repetition of the activities of the previous stage, which can be supplemented by choice with 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 (ritmilen) or 2-4 ml of a 2.5% solution of aymaline. In the absence of effect - electrical impulse therapy (cardioversion), transesophageal pacing. For the relief of ventricular tachycardia - intravenously bolus 4-8 ml of 2% lidocaine solution (80-160 mg), then intravenously drip 5-10 ml of 2% lidocaine solution in 200-400 ml of 5% glucose solution. In the absence of lidocaine, etmozine can be used - 2-6 ml of a 2% solution (50-150 mg) or etacizin - 2-4 mg of a 2.5% solution (50-100 mg) slowly intravenously in 10 ml of a 0.9% sodium solution chloride or 5% glucose solution. With inefficiency drug therapy- electropulse therapy.