Development factors signs and methods of treatment of paroxysmal tachycardia

Paroxysmal tachycardia is a violation of the heart rhythm with a frequency of 150-300 beats per minute. The focus of excitation occurs in any part of the conducting system of the heart and causes high-frequency electrical impulses.

The reasons for the appearance of such foci have not yet been fully studied. This form of tachycardia is characterized by a sudden onset and end of the attack, which lasts from several minutes to several days.

With paroxysmal tachycardia, diastolic pauses are shortened as much as possible, therefore, the time to recovery processes is reduced to a minimum, which causes changes.

Also, there is a violation of the function of the heart, due to the “blockage of the atria” of Wenckebach. Then the blood accumulated in the atria is thrown back into the hollow and pulmonary veins, as a result of which pulse waves form in the jugular veins. Blockage makes filling the ventricles with blood even more difficult and provokes stagnation in a large circle.

The suddenness of the attack and the fact that the focus does not occur in the sinus node, the normal source of impulses, are distinguished from the sinus paroxysmal form.

Paroxysmal tachycardia is usually accompanied by mitral stenosis and coronary atherosclerosis.

Causes of appearance

The causes of paroxysmal tachycardia are divided into organic and functional. In the first case, the causes are structural changes in the heart, in the second – dysfunctions of various organs and systems, as well as the pathological effect on them.

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Functional

Functional causes of the development of tachycardia are diagnosed, as a rule, in young people with short paroxysms and a poor clinical picture. In this case, paroxysmal tachycardia occurs due to such factors:

  • The use of a large number of alcoholic and caffeinated drinks;
  • Smoking;
  • Unbalanced diet;
  • Psychological trauma, chronic stress;
  • Disorder of the autonomic nervous system – in this case, tachycardia develops with VVD (vegetative-vascular dystonia) neurosis, neurasthenia;
  • Intoxication with chemical compounds;
  • An overdose of antidepressants, antiarrhythmic drugs;
  • Electrolyte imbalance.

Also, among the causes of tachycardia at a young age, there are diseases of the endocrine system, accompanied by increased production of thyroid hormones or adrenal glands (hyperthyroidism, pheochromocytoma).

Organic

Organic causes are understood as diseases that lead to a structural change in the heart muscle. Such pathologies are most often found in old age, but congenital anomalies can serve as the reasons.

Among the organic causes are:

  • Congenital canalopathy – the presence of additional ways of conducting electrical pulses in the heart (such a pathology accompanies the syndrome of an extended QT interval, Brugada syndrome);
  • Congenital and acquired heart defects (tetralogy of Fallot, open ductus arteriosus, stenosis or valve insufficiency due to rheumatism, atherosclerosis, etc.);
  • Coronary heart disease (CHD) in the form of progressive angina pectoris, myocardial infarction, post-infarction cardiosclerosis;
  • Dilated or hypertrophic forms of cardiomyopathy;
  • Myocardial dystrophy – dysfunction of the heart muscle due to metabolic disorders;
  • Myocarditis – an inflammatory lesion of the heart muscle;
  • Hypertrophy of the left or right ventricle;
  • Acute or chronic heart failure.

Sometimes paroxysmal tachycardia occurs due to post-infarction aneurysm, reperfusion disorders that lead to impaired blood circulation.

In addition to the reasons, there are triggering factors that provoke the occurrence of paroxysmal seizures. These include:

  1. Excessive physical exertion;
  2. Sudden movements;
  3. Exposure to the body of low or high temperatures;
  4. Sharp inhalation of cold air;
  5. Unbalanced diet;
  6. Emotional overload;
  7. Great fear.

How does the disease develop

The rhythm is broken due to the fact that the electric signal, following the heart, meets obstacles or finds additional paths. As a result, the sections above the obstacle are reduced, and then the impulse returns again, forming an ectopic focus of excitation.

Plots that receive momentum from additional beams are stimulated with greater frequency. As a result, the recovery period of the heart muscle is reduced, the mechanism of ejection of blood into the aorta is disrupted.

This leads to disruption of other internal organs, and especially the brain.

According to the development mechanism, three types of paroxysmal tachycardia are distinguished – reciprocal, as well as focal and multifocal, or ectopic and multifocal.

The reciprocal mechanism is the most frequent when an impulse is re-formed in the sinus node under the influence of some reasons or a circulation of excitation is observed. Less commonly, paroxysm gives rise to an ectopic focus of abnormal automatism or post-depolarization trigger activity.

No matter what mechanism is used, extrasystole is always observed before an attack. So called the phenomenon of untimely depolarization and contraction of the heart or its individual chambers.

Classification of paroxysmal tachycardia

Supraventricular tachycardia, which has the following forms:

Ventricular tachycardia, having the following forms:

  • The duration of paroxysm is unstable (less than 30 seconds) and stable (more than half a minute);
  • By the number of ectopic foci – monomorphic and polymorphic.

In addition, supraventricular tachycardia, depending on the development mechanism, has the following forms:

  1. Reciprocal form, where the re entry mechanism is the basis of development – re-entry of the excitation wave, where it returns, passing in a closed circle;
  2. Ectopic form, where the onset of tachycardia is one or more pathological foci of generating electrical pulses.

With the course, acute, chronic and continuously recurring types of paroxysmal tachycardia are distinguished.

Depending on the course, acute, constant recurrent (chronic) and continuously recurring forms are distinguished. The last type of course is especially dangerous, since it causes circulatory failure and arrhythmogenic dilated cardiomyopathy.

There are such forms of paroxysmal tachycardia:

  • ventricular – persistent (from 30 seconds), unstable (up to 30 seconds);
  • supraventricular (supraventricular) – atrial, atrioventricular.

Supraventricular

The atrial form is the most common. The source of increased impulse production is the atrioventricular node. Short-term attacks are often not diagnosed on an electrocardiogram.

The antioventricular form is characterized by what occurs in the atrioventricular junction.

For this form, heart rate reaches 250 beats per minute, the relief of paroxysmal tachycardia is performed by the vagus method.

Ventricular

The center of excitation in the ventricular form is in the ventricles – the bundle of His, its legs, in Purkin’s fibers. The ventricular form often develops against the background of cardiac glycoside poisoning (approximately 2% of cases). This is a dangerous condition that sometimes develops into ventricular fibrillation.

Heart rate does not typically “accelerate” more than 180 beats per minute. Samples with the awakening of the vagus nerve show a negative result.

clinical picture

The initial symptom of paroxysmal rhythm disturbance is a strong impulse in the heart area with its subsequent “fading” – a sign of extrasystole. Then the heartbeat becomes much faster, but the rhythm remains correct.

The following symptoms accompany paroxysm:

  • Dizziness;
  • Difficulty breathing;
  • Noise in ears;
  • Feeling of fear;
  • Discomfort in the heart;
  • General weakness;
  • Decreased urine output.

Often an attack of paroxysmal tachycardia is accompanied by autonomic disorders, the severity of which depends on the emotional state of the person. The following symptoms are usually observed:

  • Hot flashes;
  • Increased sweating;
  • Hand tremor;
  • Nausea;
  • Flatulence.

If paroxysm develops against a background of heart disease, pain occurs behind the sternum of varying intensity, shortness of breath, hypertension (increased blood pressure), and swelling of the lower extremities.

Paroxysm of tachycardia can lead to the development of a syncopal state, the forerunners of which are darkening in the eyes, severe weakness and dizziness; cramps are sometimes observed.

In rare cases, focal neurological symptoms occur – aphasia (speech impairment), impaired consciousness, asymmetry of the face, hemiparesis. Such symptoms occur when cerebrovascular accident.

Objectively, pallor of the skin, tachypnea (rapid breathing), pulsation of the carotid arteries are noted. When measuring blood pressure, a decrease in systolic rate is often observed, diastolic numbers remain normal.

Causes and risk factors

The supraventricular form causes a high activity of the sympathetic nervous system.

An important cause of the atrioventricular form is the presence of additional pathways that are congenital abnormalities. Such deviations include the Kent bundle, located between the atria and ventricles, the Maheim fibers between the atrioventricular node and the ventricles.

Similar deviations appear as a result of cardiac pathologies –

Damage to the heart muscle is characteristic of the gastric form – necrotic, dystrophic, sclerotic, inflammatory abnormalities. This form often affects older men. They are diagnosed with hypertension, coronary heart disease, myocardial infarction, malformations.

Children are characterized by idiopathic paroxysmal tachycardia, or essential. Its causes are not reliably established.

There are extracardial (extracardiac) and intracardial (cardiac) risk factors.

Extracardiac

So, in people with a healthy heart, an attack of paroxysmal tachycardia develops after stress, a heavy load – physical or mental, as a result of smoking, drinking.

Spicy food, coffee and tea also provoke an attack.

This also includes diseases:

  • thyroid gland;
  • kidney;
  • light;
  • gastrointestinal system.

Intracardial

Cardiac pathologies are directly understood as intracardiac factors – myocarditis, malformations, mitral valve prolapse.

Paroxysmal tachycardia: diagnosis and treatment

When conducting diagnostic measures, the doctor conducts a survey of the patient about the nature of the sensations and the circumstances in which the attack began, and clarifies the medical history.

The main hardware research method is an electrocardiogram. But at rest, deviations are not always recorded. Then studies with loads are shown to provoke an attack.

An ECG allows you to distinguish between forms of paroxysmal tachycardia. So, with the atrial location of the lesion, the P wave is located in front of the QRS complex. When the atrioventricular junction, the P wave takes a negative value, and merges or is located behind the QRS.

The ventricular shape is determined by the deformed and expanded QRS, while the P wave is unchanged.

If paroxysm is not fixed, daily ECG monitoring is prescribed, showing short episodes of paroxysm not noticed by the patient.

In some cases, to clarify the diagnosis, an endocardial ECG is recorded with intracardiac injection of electrodes.

An ultrasound scan, MRI or MSCT of the organ is also performed.

With a meager clinical picture, an attack of paroxysmal tachycardia can be suspected by a feeling of weakness, some difficulty in breathing, which are accompanied by increased heart rate. The final diagnosis is made after a comprehensive diagnosis, which consists of clinical and additional methods.

Clinical

A survey is a conversation between a doctor and a patient, during which the following information is collected:

  1. Complaints – most often, patients are disturbed by a feeling of palpitations, a frequent pulse, dizziness and shortness of breath;
  2. Anamnesis of the disease – the nature and duration of paroxysm, its time period and provoking factors are specified;
  3. Anamnesis of life – risk factors are diagnosed, the burden of heredity is assessed, the nature of nutrition and lifestyle, the presence of addictions and occupational hazards are determined.

Inspection – assessment of objective data using the following methods:

  • Physical examination – assesses the general condition, consciousness, color of the skin;
  • Evaluation of body systems – diagnostically important is the calculation of the number of heart contractions and respiratory movements, blood pressure measurement, pulse oximetry;
  • Auscultation of the heart – the clarity of the first and the deafness of the subsequent heart tone, increased heart rate are noted.

Additional diagnostics includes a number of analyzes and instrumental studies. Among them:

  • General and biochemical blood tests – associated pathologies are diagnosed (inflammatory processes, anemia, renal or liver failure, etc.);
  • Hormonal blood test – determination of the level of thyroid hormones and adrenal hormones to detect thyrotoxicosis or pheochromocytoma;
  • Ultrasound of the heart and thyroid gland – possible structural changes are diagnosed;
  • Electrocardiogram (ECG) – an assessment of the electrical activity of the heart, which is carried out to identify pathologies from the conductive system, as well as the diagnosis of hypertrophy, post-infarction cardiosclerosis and various rhythm disturbances;
  • Daily ECG monitoring is the removal of a cardiogram during the day to determine the triggering factors of paroxysm and its characteristics, since it is not always possible to catch an attack during a regular ECG;
  • Electrophysiological study – assessment of the response of the heart in response to its stimulation with physiological doses of current; assigned to detect hidden heart disease.

ECG is the main diagnostic method of paroxysmal tachycardia, as well as other rhythm disturbances. Depending on the location of the ectopic focus, the ECG signs will be different.

All forms of paroxysmal tachycardia have the same symptom on the ECG – a suddenly registered attack with an increase in rhythm within 150-250 beats / min, while the rhythm remains correct.

Other ECG signs depend on the form of tachycardia. So, when the ectopic focus is in the atria, the following changes will be noted on the cardiogram:

  1. P wave negative, reduced, deformed or biphasic;
  2. The P wave always precedes the ventricular complex;
  3. The distance RR is the same;
  4. The QRS complex is not changed and is no different from the complex registered outside the attack;
  5. In some cases, there is an elongation of the PQ interval (a sign of AV blockade of I degree).

The atrioventricular form of tachycardia has the following symptoms:

  1. P wave negative in leads II, III and aVF;
  2. P waves are located after the ventricular complexes and merge with them (a sign of AB dissociation);
  3. The distance RR is the same;
  4. QRS complexes are not changed.
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Paroxysm of ventricular tachycardia on an ECG can be diagnosed by the following symptoms:

  • QRS complexes follow each other, merge, are deformed and objectively similar to the blockade of the right bundle branch block;
  • ST segment depression in leads V5, V6;
  • The P wave is not determined, since it completely merges with the ventricular complex;
  • The distance RR is slightly different.

Differential diagnosis is a comparative method that allows you to distinguish from each other forms of paroxysmal tachycardia.

Sign
Supraventricular form Ventricular form
Age Develops at a young age It develops in adulthood and old age.
Heart rate Within 200-250 bpm Within 180-200 bpm
Rhythm Maintaining a regular rhythm Some irregular rhythm
Course of paroxysm More often light More often heavy
I tone over the top Normal, rarely – enhanced Periodic occurrence of “cannon” tone
Intestinal peristalsis Amplifies Fine
The effect of vagal samples There is No
The effect of verapamil There is No
ATP effect There is No
Effect of Novocainamide No There is

The basic method for determining paroxysmal tachycardia is a cardiogram. Since the deviation can only be recorded during an attack, Holter monitoring is used.

Depending on the localization of the ectopic focus, the ECG picture will be as follows:

  • The atrial form of the disorder is accompanied by unchanged ventricular complexes, and the P wave is in front of them, but at the same time it is reduced or deformed.
  • At the rhythm from the AV connection, the atrial tooth may be behind the QRS or superimposed on it.
  • Ventricular paroxysmal tachycardia on the ECG is manifested by a significant deformation of the main complexes.

In all cases, the RR intervals are the same. But with ventricular tachycardia, heart rate does not exceed 180 bpm. And the supraventricular form proceeds with a pulse rate of up to 220 / min. and even more.

Paroxysmal tachycardia is a violation of the heart rhythm (arrhythmia), expressed in heart palpitations (140-250 beats / min) caused by the replacement of the normal sinus rhythm under the influence of pathological ectopic impulses.

The functioning of the heart is affected by the state of the autonomic nervous system, the anatomical and physiological characteristics of the heart muscle and the level of catecholamines. With the disease, the innervation of the muscles of the atria and ventricles is disrupted.

Paroxysm (attack) of arrhythmia occurs suddenly and just as suddenly stops. The duration of the attack is different – from short (several seconds) to long (several hours).

In exceptional cases, there is an attack of tachycardia lasting several days.

Blockage or the formation of a new pathway (nerve bundle) can cause a violation of the movement of the nerve impulse. With the formation of the blockade, the nerve impulse returns back, stimulating muscle contraction over the obstacle – an ectopic focus of excitation is formed.

With the formation of new pathways, impulses along the nerve fibers stimulate contraction of the myocardium in addition to the main pathways, so the muscles contract with a greater frequency, provoking tachycardia.

In case of a disease, the “contraction-relaxation” mechanism is violated, the relaxation phase of the muscle drag is practically absent, which leads to a violation of hemodynamics. As a result of insufficient blood flow to the organs, their functions and condition are violated.

First of all, brain tissue is affected.

Paroxysmal tachycardia in children, as a rule, appears due to impaired signaling, such as the formation of a circular wave (re-entry) or the formation of an ectopic focus. The cause of the occurrence is most often a condition similar to a panic attack. Paroxysmal tachycardia is observed in children of any age (from infants to adolescents).

The classification of the types of paroxysmal tachycardia varies depending on the localization of the focus of the pathology:

  • supraventricular (supraventricular) tachycardia, which is divided into atrial and atrioventricular;
  • ventricular tachycardia, which according to the duration of paroxysm is divided into: unstable (less than 30 seconds) and persistent (more than 30 seconds).

Supraventricular or paroxysmal supraventricular tachycardia occurs as a result of the formation of a pathological focus of automatism located above the ventricles of the heart. Located in the atrioventricular zone, an abnormal focus of excitation causes an atrioventricular form of the disease. If in the atria – then the atrial.

Supraventricular tachycardia is rarely caused by pathology of the heart structure. However, pathology is accompanied by severe symptoms and dangerous clinical manifestations. They allow us to conclude that paroxysmal atrial tachycardia is a pathology that threatens the patient’s life.

The ventricular form is the leader among life-threatening pathologies associated with heart rhythm disturbances, since there is a risk of tachycardia transitioning to trembling and ventricular fibrillation.

With unstable ventricular tachycardia, at least 3 consecutive atypical QRS complexes appear on the electrocardiogram (characterizing the state of excitation and relaxation of the ventricles). This condition occurs for a short time – no more than 30 seconds. In this condition, blood circulation is not impaired, but there is a risk of ventricular fibrillation and sudden cardiac death.

symptomatology

The clinical picture of paroxysmal angina pectoris is so expressive that a conversation with the patient is enough for the doctor. The ailment is distinguished by such symptoms:

  • a sudden push in the heart and a subsequent increase in heart rate;
  • possible pulmonary edema in patients with heart failure;
  • weakness, general malaise, chills, trembling in the body (tremor);
  • headache;
  • feeling of coma in the throat;
  • change in blood pressure indicators;
  • in severe cases – loss of consciousness.

With organic heart lesions, an attack of paroxysmal therapy is accompanied by chest pain similar to

If paroxysmal tachycardia does not cause heart failure, then a frequent attack is a sharp polyuria – copious excretion of light urine with a low specific gravity.

Symptoms are also supplemented by manifestations characteristic of the disease that provoked tachycardia. For example, if the thyroid gland is dysfunctional, the patient loses weight, his hair condition worsens, with diseases of the gastrointestinal tract, his stomach hurts, he suffers from nausea, heartburn, etc.

Between attacks, the patient may not complain about well-being.

Paroxysmal tachycardia: diagnosis and treatment

Each person throughout his life experienced a feeling of rapid heartbeat. This also happens in healthy people during physical activity, with emotional stress, and an increase in body temperature. Such tachycardia is always sinus and stops on its own.

The etiological factors of pathological paroxysmal tachycardia are similar to the causes of the development of extrasystole, while its supraventricular form, or sinus tachycardia of the heart. usually caused by increased activation of the sympathetic nervous system, and the ventricular develops as a result of inflammatory, necrotic, dystrophic, or sclerotic lesions of the heart muscle. The focus of ectopic excitement in the ventricular form is located either in the bundle of His or its legs, or in Purkinje fibers.

For the development of paroxysmal tachycardia, an important prerequisite is the presence in the myocardium of congenital additional ways of conducting an impulse, such as:

  • Kent’s bundle between the atria and ventricles, bypassing the atrioventricular node;
  • Maheim fibers between the ventricles and the atrioventricular node.

In some cases, additional pathways for conducting pulses are the result of myocardial damage due to myocarditis, heart attack, or cardiomyopathy.

As a result of the presence of additional ways of conducting an impulse, a pathological circulation of excitation along the myocardium appears.

Sometimes in the atrioventricular node, longitudinal dissociation can develop, which leads to the uncoordinated functioning of its fibers. At the same time, some of the fibers function normally, and the other conducts excitation in a retrograde (reverse) direction, which leads to a circular circulation of pulses between the atria and ventricles.

In some cases, tachycardia is caused by the arrhythmogenic effect of drugs. Usually this happens against the background of various electrolyte disturbances.

The ventricular form of tachycardia in only 2% of cases is recorded in patients who do not have reliable signs of organic myocardial damage, clinically or using instrumental examination methods.

Sinus tachycardia in children is sometimes idiopathic (or essential), that is, one whose cause cannot be reliably established.

In childhood, paroxysmal tachycardia is a fairly common type of arrhythmia, occurring at a frequency of 1: 25000, which in childhood is 10,2% of all heart rhythm disturbances.

A clinical attack of paroxysmal tachycardia is manifested by a sensation of a sudden rapid heartbeat. In this case, dizziness, trembling in the body, a feeling of lack of air, and general weakness often appear. With a prolonged attack, pain in the heart, headaches, and loss of consciousness may appear. For diagnosis, ECG is used primarily, including the Holter monitoring method, which makes it possible to track the heart rhythm at rest and during exercise, as well as to establish the frequency of seizures per day.

In addition, ultrasound scanning of the heart, computed tomography and radionuclide examination are used to clarify the diagnosis. A comprehensive examination of the body, especially the nervous and endocrine systems, is also carried out. Be sure to determine the level of potassium in the blood, the lack of which is often the cause of various violations of the heart rhythm.

Electrocardiographic signs of tachycardia also depend on its shape.

In the classical form of atrioventricular paroxysmal tachycardia, only QRS complexes are recorded electrocardiographically with a frequency of excitation of the atria and ventricles of 140 – 220 per minute, ST segment shift down, flattening of tooth T.

When salvo (return, reciprocal) form on the ECG recorded 3-7, and sometimes 10 or more, short repeated paroxysms, which are separated by single sinus strokes; with a heart rate of 90-150 per minute. P wave in the case of simultaneous excitation of the atria and ventricles is absent, and in the case of previous excitation of the ventricles is located behind the QRS complex.

If the QRS complexes are not changed during a tachycardia attack, then this is supraventricular tachycardia.

Among all cases of paroxysmal supraventricular tachycardia, about 90% are recurrent (reciprocal) atrioventricular tachycardia. Reciprocal, or recurrent, is such a tachycardia, the development of which is due to the mechanism of re-entry of excitation.

There are two options for reciprocal atrioventricular tachycardia:

  1. Reciprocal nodal tachycardia, in which re-entry, that is, circulation of an excitation pulse, occurs within the atrioventricular node.
  2. Reciprocal tachycardia with the presence of an additional pathway, when anterograde (reverse) impulse conduction occurs through the atrioventricular node, while retrograde conduction occurs through the pathological additional pathway.

Much less often, in about 10% of cases, paroxysmal atrial tachycardia occurs when the source is in the cardiac muscle of the atria.

To date, attacks of paroxysmal tachycardia in most cases are stopped by drugs that reduce the excitability of the adrenergic system. In the future, such tachycardia – treatment requires a comprehensive and continuous.

In the period outside the attack, it is necessary to strive to identify the cause that causes paroxysmal tachycardia. Further treatment should be directed primarily at her, with small doses of digitalis drugs, it is possible to directly reduce myocardial excitability.

In some cases, a reflex effect on the vagus nerve is enough to stop the attack. A very effective way of such an impact is straining at the height of a deep breath. You can also act on the sinocarotid zone with massage, pressing on the right carotid artery or pressing on the eyeballs.

If there is no effect from the use of these mechanical techniques, drugs are used, the most effective of which is verapamil (isoptin, finoptin). Enter it in an amount of 10 mg (4 ml of a 0,25% solution) intravenously.

Intravenous jet administration of 10% adenosine triphosphate (ATP) solution in an amount of 10 ml with 10 ml of physiological saline or 5% glucose solution is also quite effective. However, this drug can lower blood pressure, so if a tachycardia attack is accompanied by arterial hypotension, it is better to use novocainamide in combination with 0,3 ml of a 1% solution of adrenaline or mesatone.

You can stop attacks of supraventricular tachycardia with other drugs, such as amiodarone (cordarone) – 6 ml of a 5% solution, aymalin (giluritmal) – 4 ml of a 2,5% solution, propranolol (inderal, obzidan) – 5 ml of 0,1% solution, disopyramids (rhythmylene, rhythmodan) – 10 ml of 1% solution, digoxin – 2 ml of 0,025% solution.

Of course, all these drugs must be used, taking into account contraindications and possible side effects.

In the case of ineffective drug therapy, an attack of paroxysmal tachycardia is stopped using electro-pulse therapy (cardioversion), as well as electrical stimulation of the heart using the esophagus or endocardial electrode.

When choosing treatment tactics, it is necessary to take into account the results of the examination, namely the exact determination of the type of tachycardia. With atrial tachycardia, which is associated with the impact on the body of neuropsychic factors, conservative treatment is required.

A good effect in such cases is given by combination therapy combining sedative and antiarrhythmic drugs, as well as improving blood circulation and, as a result, myocardial nutrition. Often in such cases, it is enough to undergo treatment in a sanatorium or rehabilitation center with a cardiological profile.

Treatment of ventricular forms of paroxysmal tachycardia also begins with conservative methods, and in case of their ineffectiveness, the ablation method is used. This method consists in removing the focus of pathological excitation of the myocardium using low temperatures, cauterization or laser exposure. The radio frequency ablation method is also effective.

Most often, the ventricular form of the disease develops against the background of severe heart defects. Gender dependence is noted – in men, ventricular tachycardia is recorded more often than in women.

And only in rare cases (less than 2%), this disease is not accompanied by confirmed clinical studies, organic heart disorders.

In this case, the ideopathic form of ventricular tachycardia is diagnosed.

With the flow, pathology can be divided into the following types:

  • sharp;
  • chronic, characterized by a regular return of paroxysms;
  • continuously recurring.

Also, tachycardia is classified as follows:

  • reciprocal;
  • focal (ectopic);
  • multifocal (multifocal).

The reciprocal mechanism is to return the impulse.

As a result of the study, it was found that only in small in diameter (no more than 6-8 mm) loops with characteristic electrophysiological properties, a paroxysmal form of the disease is formed.

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The attack begins suddenly immediately after ventricular (less often atrial) extrasystole and breaks off just as sharply. With the ectopic mechanism, the frequency of the focal impulses is higher than the sinus nerve node.

Ectopic tachycardia is caused by the formation of a focus of automatism or after depolarized induced (trigger) activity. Often the focus is the result of increased levels of hormones (catecholamines). Paroxysmal tachycardia is always preceded by extrasystole.

Risk Factors

The causes of pathology can be associated with the following problems:

  • pathogenesis – a violation of the condition and functions of the heart;
  • functional changes (for example, increased levels of stress hormones);
  • reflex mechanism – friendly irritation of nerve fibers as a result of pathology of organs and systems (stomach, diaphragm, kidneys, etc.);
  • heart diseases (IHD, GB, myocardial infarction, etc.);
  • drugs, intake and overdose (Digoxin, Novokainamid, Quinidine, etc.);
  • endocrine dysfunctions (thyrotoxicosis, pheochromocytoma, etc.);
  • medical manipulations (installation of a pacemaker, coronary angiography, ventriculography, etc.).

Folk methods

Traditional methods are aimed at calming the nervous system and normalizing blood pressure.

The following recipes have a sedative effect:

  • Infusion of flowers of wild rose and hawthorn. Take 10 g of dried flowers of each plant and pour 1,5 liters of hot water. Let it brew for 30 minutes, then strain and consume 100 ml before meals.
  • Infusion of mint, fireweed and St. John’s wort. Take 1 tsp. each plant, pour 1 liter of boiling water and let it brew until completely cooled. Then add 15 ml of honey to the infusion and drink throughout the day.
  • Infusion of chamomile, mint and lemon balm. Take 5 g of each plant, pour 300 ml of hot water and insist for 2 hours. Then strain and drink 50 ml several times a day before meals.
    The following recipes will help normalize blood pressure:
  • Infusion of calendula, linden and oregano. Take 15 g of each plant and pour 0,5 l of boiling water. Leave the infusion for 3 hours, then strain and drink 100 ml 3 times a day.
  • Tincture of garlic. Clean 4 heads of the plant and pour 0,5 l of 40% alcohol or vodka. Remove tincture in a dark place for a week and a half. Then take a teaspoon before meals.
  • A decoction of lemongrass berries. Take 50 g of berries, pour 1 liter of water and boil for a quarter of an hour. Then cool and take 50 ml 3 r / day.

It is recommended to take alternative medicines in conjunction with drug therapy and in consultation with the attending physician.

Emergency care and treatment tactics

First aid for paroxysmal tachycardia is as follows:

  1. They soothe the patient, with dizziness and severe weakness – they plant or lay.
  2. Provide airflow, free from tight clothing, unfasten collars.
  3. Carry out vagal tests.
  4. With a sharp deterioration in condition, an ambulance is called.

The tactics of treatment depend on the form of the disease and complications.

With ventricular paroxysmal tachycardia, in most cases they are hospitalized, with the exception of idiopathies with a benign course. The patient is immediately injected with a universal antiarrhythmic drug – novokainamide, isoptin, quinidine, etc. If the drug effect does not bring any result, they resort to the electric pulse method.

If attacks of ventricular tachycardia are more often 2 times a month, planned hospitalization is indicated. Patients with a diagnosis of paroxysmal tachycardia are observed on an outpatient basis by a cardiologist.

Drugs for treatment are taken under ECG control. To prevent the transition of the ventricular form to ventricular fibrillation, β-adrenergic blockers are prescribed, which are most effective in combination with antiarrhythmic drugs.

How to treat paroxysmal tachycardia in severe cases? Doctors resort to surgical treatment. It consists in the destruction of additional ways of conducting an impulse or foci of automatism, radiofrequency ablation, the implantation of stimulants or defibrillators.

Treatment of paroxysmal tachycardia should be carried out taking into account its variety, the cause of the occurrence, the likelihood of complications and the degree of impaired cardiac activity. In my practice, idiopathic options, regardless of location, have a favorable course and prognosis. Such forms are well stopped by antiarrhythmic drugs.

Elimination of an attack

The treatment protocol for paroxysmal tachycardia includes:

  • antiarrhythmic drugs;
  • glycosides;
  • beta-blockers;
  • Lidocaine
  • adrenomimetics;
  • potassium salts (with supraventricular disorders);
  • magnesium salts (with ventricular).

Since paroxysmal tachycardia in most cases is a sign of another disease, relief should be carried out simultaneously with the elimination of the underlying problem.

In severe cases, electropulse therapy or surgery is used (radiofrequency ablation, mechanical excision of additional pathways, cryogenic or laser exposure of the excitation sites).

According to recent studies, it is recommended not to use antiarrhythmics of the XNUMXst generation due to many side effects. Better to block beta-blockers for an attack. “Sotalol” has a good effect on this pathology, as it combines inhibition of b-receptors and the basic properties of “Amiodarone”.

All actions aimed at restoring the rhythm, regardless of its origin, in a newborn should be carried out in a hospital. Relieve the attack and an older child should be as follows:

  • vagal stimulation (flipping the head down, pressing for 30 seconds on the epigastric region, inducing vomiting), paroxysmal atrial tachycardia is best eliminated in this way;
  • the introduction of “ATP” intravenously;
  • use of “Cordarone” and “Digoxin” with supraventricular form;
  • ventricular paroxysm is stopped by Lidocaine.

Folk treatment

All methods offered by traditional medicine can only act as additional along with the implementation of other recommendations. They use herbs and collections of them, which cause a sedative effect (chamomile, mint, St. John’s wort, motherwort), beekeeping products (bee bread, honey, death) and homeopathy.

Advice from a specialist

I want to recommend those who suffer from paroxysmal tachycardia to take all possible measures to increase the vagal effect and reduce the activation of the sympathetic nervous system. To do this:

  • practice meditation, do yoga;
  • develop stress resistance;
  • reduce the consumption of coffee, strong tea, energy drinks;
  • reduce the use of hot spices;
  • to engage in physical therapy;
  • with the development of an attack, press on the eyeballs, strain, close the nose and mouth and at the same time try to inhale.

Mechanically acting on the vagus independently is possible only under the condition of the appearance of supraventricular tachycardia.

Case study

A young man of 30 years old came to see me with complaints of heart attacks, which are accompanied by dizziness, shortness of breath and pain in the chest. He goes in for sports, but there is no increase in paroxysms with an increase in physical activity. No abnormalities were detected on the ECG, echocardiography showed a normal myocardial state. After Holter monitoring, a clinical diagnosis of atrial tachycardia with a heart rate of 130-140 beats / min was made.

He was treated with Verapamil (intravenous administration for a prolonged attack) and the technique of massage of the carotid artery was shown. After 5 months, paroxysms were practically not observed, and isolated cases were quickly eliminated by vagal stimulation.

The article describes the causes of paroxysmal tachycardia. Diagnostic and treatment methods are described.

Paroxysmal tachycardia is called a sudden attack of a rapid heartbeat. The rhythm of the heart remains correct. This is a common heart pathology that is observed in children and adults. In most cases, it does not pose a threat to life.

Heart palpitations occur in almost every cardiac patient

The essence of pathology

Paroxysmal tachycardia is a form of cardiac arrhythmia. It is characterized by sudden attacks of frequent heartbeats, in which the ventricles or atria are reduced to 200 times per minute.

Such attacks, or paroxysms, occur under the influence of ectopic impulses. Ectopic impulses are those that occur out of turn, or are generated not by the main pacemaker – the atrioventricular node (photo).

Paroxysm occurs and stops suddenly, can last up to several hours. The rhythm of the heartbeat is correct. Pathology is detected in 20-30% of cardiac patients. During an attack, the heart spends a large amount of blood, which leads to the formation of heart failure. The more often attacks occur, the faster it develops. According to ICD 10, the disease has code I47.

It looks like a normal conduction system of the heart It looks like an ectopic focus of excitation

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Paroxysmal tachycardia occurs in several versions, depending on the place of production of ectopic impulses, the nature of the course.

At the place of formation of the pulses emit:

  • supraventricular – atrial and atrioventricular;
  • ventricular.

By the nature of the current, they distinguish:

  • acute (actually an attack);
  • chronic, lasting for years;
  • constantly recurring, leading to the development of cardiomyopathy.

The mechanism for the development of an attack of paroxysmal tachycardia is the principle of re-entry (literally “re-entry”). Paroxysmal AV-nodal reciprocal tachycardia occurs when an impulse is generated by the ectopic focus, which passes around the heart and falls back into this focus. This is how a “vicious circle” is formed.

Causes

The causes of PT are the same as with extrasystole. The supraventricular form is caused by dysfunction of the sympathetic division. Ventricular tachycardia occurs against the background of inflammatory or dystrophic heart diseases.

They predispose to the development of the disease the presence of extra paths for conducting impulses – the Kent bundle, the Maheim fiber. In newborns and adolescents, an idiopathic form of the disease occurs.

As manifested

A characteristic feature of paroxysmal tachycardia is the sudden onset and end of an attack. It can occur both under load and in a state of complete rest.

The attack has the following symptoms:

  • the patient feels the onset of an attack as a push in the heart;
  • then a heart palpitations proper develops, on the background of which a person feels weakness, dizziness, tinnitus;
  • rarely, neurological symptoms can be observed – blurred consciousness, impaired speech and motor function;
  • with VSD, sweating, nausea, and redness of the skin will be observed.

The attack lasts from several minutes to several hours. A prolonged course leads to hypotension, fainting.

Attack occurs suddenly

Complications

More common with ventricular form:

  • ventricular fibrillation or flutter;
  • fibrillation;
  • pulmonary edema;
  • myocardial infarction.

With long-term paroxysmal tachycardia, chronic heart failure develops.

How to diagnose

The diagnosis is not difficult. The characteristic symptoms, objective examination data (heart rate) are taken into account. The diagnosis is confirmed by ECG. It is necessary to remove it at the time of the attack, so a person is monitored daily.

With paroxysmal atrial tachycardia on an ECG, the P wave is in front of the QRS complex, it can be positive or negative. If the ectopic impulse comes from the AV node, the tooth is located behind the ventricular complex. Signs of an ECG of the ventricular form are a deformed QRS complex with a normal R wave.

Atrial tachycardia on a cardiogram

How to treat

How to treat paroxysmal tachycardia depends on the nature of the disease, the frequency and duration of the onset of attacks, the underlying heart disease. The supraventricular form is usually treated on an outpatient basis. An attack of ventricular tachycardia requires hospitalization in the cardiology department.

Emergency care for paroxysmal tachycardia is to conduct vagal receptions:

  • straining;
  • exhale through a closed mouth;
  • careful squeezing of the eyes;
  • pressure on the region of the carotid artery.

Such tests can only help with supraventricular forms. First aid for paroxysmal tachycardia with ventricular damage – the introduction of antiarrhythmic drugs.

The following tools are used:

If treatment with tablets does not bring effect, electro-pulse therapy is required. Patients with a chronic form require ongoing anti-relapse treatment.

Complications and prognosis

The most formidable complications develop with ventricular paroxysms. However, the lack of treatment can lead to undesirable consequences, regardless of the form of tachycardia.

Paroxysmal tachycardia can lead to the following complications:

  1. Arrhythmogenic shock is a sharp deterioration in blood circulation, which is manifested by a decrease in blood pressure, an increase in heart rate, pallor of the skin, sweating, and depression of consciousness.
  2. Thromboembolic complications – myocardial or cerebral infarction, pulmonary thromboembolism (pulmonary embolism) are emergency conditions that can be fatal.
  3. Ventricular fibrillation is a complication resulting from severe ventricular paroxysm; characterized by discoordinated contraction of the ventricles, often leading to cardiac arrest.

The supraventricular form of rhythm disturbance has the most favorable prognosis. Often, it proceeds chronically, is not accompanied by a bright clinic, and does not lead to a deterioration of the condition.

Sustained attacks of ventricular tachycardia occur with a vivid clinical picture and a worsening of the general condition. This form of arrhythmia has an unfavorable prognosis, as it often leads to ventricular fibrillation, which is dangerous for the development of a fatal outcome.

Whether paroxysmal tachycardia leads to heart failure depends largely on the state of the heart muscle and the presence of other changes in the circulatory system.

Seizures lasting from 6-8 days are dangerous.

The first sign of developing heart failure is neck tension, which occurs due to overflow of veins with blood, shortness of breath, fatigue, heaviness and pain in the liver.

Prevention

The main goal of prevention is to prevent further paroxysms and reduce the risk of complications. To do this, you must:

  • Exclude the use of alcohol, coffee and cigarettes;
  • Normalize the diet;
  • Prevent excessive exercise;
  • Avoid stressful situations;
  • To go in for sports, if there are contraindications – other types of vigorous activity (to carry out cardio training, to engage in Nordic walking);
  • With increased emotional lability, do meditation or yoga.

Also, prevention consists of periodic examinations, regular visits to the attending physician and strict adherence to drug therapy.

The main preventive measure is a healthy lifestyle, which involves:

  • a healthy diet, with enough vitamins, minerals, a reduction in the diet of fatty, sweet, spicy foods;
  • exclusion from the diet of alcoholic beverages, caffeinated drinks, especially instant coffee;
  • to give up smoking.

With emotional excitability, sedatives are prescribed.

To prevent attacks, the patient may be prescribed drug therapy:

  • with ventricular paroxysms – anaprilin, diphenin, novokainamid, isoptin preventive courses;
  • with supraventricular paroxysms – digoxin, quinidine, merkazolil.

Medications are prescribed if seizures are observed more than twice a month and require the help of a doctor.

Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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