What is arrhythmia or ventricular tachycardia such as pirouette

Ventricular tachycardia of the pirouette type is manifested by lengthening the QT interval and polymorphism (different shape and orientation of the teeth). With this pathology, frequent, uneven rhythm failures are recorded on the electrocardiogram (ECG).

Features of the occurrence of symptoms of arrhythmias such as pirouette:

  • seizures begin and stop suddenly;
  • have a tendency to fibrillation, which often ends fatally;
  • as a result of disruption of the left ventricular system, atrium, there is a malfunction in hemodynamics, and the heartbeat can increase to 350 beats per minute;
  • the cause of “cardiac ballet” is an imbalance of potassium and magnesium.

The heart muscle in a normal state conducts electrical impulses regularly and orderly, with a frequency of 60-90 times per minute. In this case, the atria are first reduced, and then the impulse enters the ventricles through the atrioventricular node, which are also reduced several milliseconds later. This process runs so fast that it is almost not felt by a person, and in medicine it is defined as a sinus rhythm.

With ventricular tachycardia, the sinus node is not the main pacemaker, since it is not able to control the contractility of the heart.

Ventricular tachycardia (VT) is a violation of the normal (sinus) rhythm of the heart, characterized by an increase in the number of contractions of the ventricles. This occurs due to a disturbed myocardial structure, as a result of which an electrical impulse cannot normally be transmitted through the fibers. If in the atria and through the AV node it passes normally, then in the ventricles it begins to interrupt and circulate in a closed circle.

udlinenie intervala qt na ekg - What is arrhythmia or ventricular tachycardia such as pirouette

With VT, hemodynamics are impaired. This is due to the influence of two factors:

  • with an increase in the frequency of ventricular contractions, the release of blood into the small and large circle of blood circulation decreases, which negatively affects the general condition of the patient.
  • discoordination of the heart reduces its functionality, which also affects hemodynamics.

Causes of ventricular tachycardia

Most often, the pathology occurs due to regular stress, abuse of strong coffee, alcohol. Often fixed in drug addicts, in some cases it has a genetic predetermination. A special role in the occurrence of this type of arrhythmia belongs to a long intoxication with drugs. Among them are the following drugs:

  • antiarrhythmic (Amiodarone);
  • diuretics (Furosemide, Torasemide);
  • anti-allergic (antihistamines);
  • antibiotics (penicillins, aminoglycosides);
  • beta-blockers (Labetalol, Carvedilol);
  • antidepressants (amitriptyline);
  • antihypertensives;
  • antimycotic (clotrimazole).

A special role in psychotropic drugs: according to studies, haloperidol and thioridazine increase mortality in patients who have started taking drugs within 1-3 months. It is necessary to check the duration of QT by fixing the initial ECG (before starting therapy) and after a few days. Monitoring is carried out during the entire treatment period with an interval of 1 month.

The possibility of pirouette type tachycardia increases with a combination of drugs. For example, erythromycin metabolism occurs in the liver when exposed to cytochrome P450 3A4. And the commonly used drugs – Diltiazem and Verapamil, as well as a number of antimycotic drugs – reduce the effect of this enzyme system while being used with Erythromycin, Clarithromycin.

Also, a pathological rhythm can occur with a number of diseases and conditions:

  • congenital elongated QT interval;
  • bradycardia due to sinus node dysfunction, AV block;
  • endocrine disharmonization;
  • central nervous system problems;
  • cardiovascular disease (CVD);
  • neurogenic anorexia;
  • vagotomy.

This type of disorder has another name – ventricular tachycardia or tachycardia type pirouette, as this is one of the types of disease. The reasons that provoke the disease are many. Pirouette arrhythmia develops under the influence of stress, with alcohol abuse, frequent use of coffee and energy drinks, smoking, severe intoxication of the body.

  • antihypertensive drugs – Triplex and Normopres;
  • antifungal drugs – “Fluconazole” and “Fluzamed”;
  • diuretics – “Furosemide” and “Indapramide”;
  • beta-adrenostimulants – “Fenoterol”;
  • macrolide antibiotics – “Erythromycin”;
  • antidepressant – “Frenolon”;
  • antihistamines;
  • antiarrhythmic drugs, for example, Nerviplex-N.

VT is directly related to cardiac pathology, but practical experience shows that the risk of pathology increases in patients with the following diseases:

  • Coronary heart disease leads to the development of VT in 90-95% of cases. Basically, the pathology is associated with heart attacks, which lead to tachycardia in 1-2% of cases and developing in the first hours after organic damage. It was noted that post-infarction VT does not last long and passes on its own. Myocarditis, which significantly changes the structure of the heart muscle, can also play a negative role in the appearance of VT.
  • Heart defects caused by congenital and rheumatic factors. Violation of the structure of the valves does not allow blood to be ejected from the heart properly. Seizures are especially difficult against the background of long-untreated stenosis and valve insufficiency, which caused decompensation of the left ventricle.
  • Drug exposure can adversely affect the activity of the heart. In 20% of cases, cardiac glycosides cause ventricular tachycardia. VT can be a complication of treatment with drugs such as isadrine, quinidine, adrenaline. psychotropic drugs, some anesthetics.

In the etiopathogenesis of the disease, provoking factors are noted that contribute to the development of VT. This can be frequent stressful and psychoemotional stresses, increased physical activity, surgical interventions on the heart and hormonal imbalance in the body that occurs with pheochromocytoma.

Doctors distinguish a wide range of causes that cause cardiac arrhythmias. Moreover, this condition can be caused by both excessive loads when playing sports, and serious heart problems.

StressThis reaction can be caused by both physical and mental factors. Arrhythmia develops due to the release of adrenaline, causing an increase in heart rate.
Alcohol, energy drinks, and caffeinated foodsThe result is an increase in heart rate.
DehydrationIt provokes arrhythmia to compensate for beneficial substances and oxygen in the tissues of organs.
Binge eatingIncreased heart rate occurs due to increased blood flow to the digestive tract.
Physical exerciseArrhythmia occurs due to increased metabolism in muscles that require a significant amount of nutrients and oxygen.

The elimination of these causes is the basis for the cessation of cardiac arrhythmia. This is the state of affairs for healthy people.

There are several types of arrhythmias. Their occurrence is associated with different reasons. Above were considered the most common.

Pirouette-type arrhythmia develops when there is a deficiency in the body and blood plasma of the necessary elements, magnesium and potassium. It is detected in the form of a heartbeat, in which the heart muscle touches the myocardium of the left ventricle and dysfunction of oxygen supply to the atrium. The contraction occurs at the same time, but incorrectly due to the increased heart rate (up to 350 beats per minute).

Pirouette-type arrhythmias are triggered by mental disorders, such as vagotonia. Pathology can occur due to constant stress, lack of sleep, smoking, alcohol and coffee abuse.

Arrhythmia can develop with the use of certain drugs, for example, cardiac glycosides, tranquilizers and antidepressants.

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This type of disease can be hereditary.

What is pirouette type arrhythmia and what is the mechanism of its occurrence?

Due to various factors, VT can occur in several forms: unstable and stable. Potentially dangerous ventricular tachycardia types are also distinguished because of the high risk of ventricular fibrillation.

In a small amount, about 2%, ventricular tachycardia develops in young people. Moreover, in their health there are no special violations. In such cases, they speak of idiopathic VT.

An unstable type of VT is characterized by an unstable course. On the ECG, paroxysms are recorded with a frequency of half a minute. Their number is more than three for a certain period. Hemodynamic disturbances occur, but the prognosis of a fatal outcome is insignificant. Unstable ventricular tachycardia is a frequent complication of ventricular extrasystole, therefore, when combined, they are diagnosed with “extrasystole with jogging of ventricular tachycardia”.

A stable type of VT is no longer prognostically prognostic. The resulting paroxysm lasts at least 30 seconds, determined by ECG. Ventricular complexes in this case are greatly altered. Due to the increased risk of sudden cardiac death amid developed fibrillation, this type of tachycardia is considered life-threatening.

According to this division, types of VT are identified that are potentially dangerous due to the possible development of fibrillation.

  • Monomorphic VT, which often arise as a result of organic damage to the heart.
  • Polymorphic, or multiform, VT are ventricular complexes of various amplitudes and directions., Resulting from the action of two or more ectopic foci. They occur mainly without structural changes in the heart, although in some cases organic changes are determined. There are bidirectional, spindle-shaped polymorphic VTs and polytopic, or multifocal.

Sometimes pirouette type tachycardia occurs when the QRS complexes progressively change and repeat against the background of an extended QT interval.

Clinical signs and symptoms

The initial stage of paroxysmal tachycardia is characterized by a latent course. With progress, hypoxia increases (oxygen starvation), symptoms of arrhythmias such as pirouette arise:

  • dizziness;
  • fainting;
  • weakness;
  • cardiopalmus;
  • alarm conditions;
  • feeling short of breath;
  • a rare sign is chest pain.

Zhelud tahikard 2 - What is arrhythmia or ventricular tachycardia such as pirouette

With a sharp increase in heart rate, loss of consciousness is possible. The development of symptoms is associated with the inefficiency of myocardial contraction due to the high frequency of impulses.

Symptoms of arrhythmias such as “pirouette”

  • dizziness;
  • weakness and fatigue;
  • anxiety;
  • interruptions in the work of the heart;
  • shortness of breath in a calm state;
  • chest pain on the left side.

The clinical picture directly depends on the complexity of hemodynamic disorders. As a rule, the symptoms of the disease are added to the main manifestations of arrhythmia, against which VT has developed.

Symptoms characteristic of all paroxysmal tachycardia:

  • sudden development of an attack;
  • an increased number of heart contractions (with the ventricular form of CSS, it is usually 150-180 times per minute);
  • a strong pulsation of the vessels located on the neck can be felt.

The work of the ventricles is closely connected with central circulation, therefore, with VT, symptoms of hemodynamic disturbance often appear: weakness, dizziness, heart pain, low blood pressure. In especially difficult cases, edema develops, shortness of breath appears, it becomes difficult to breathe, which indicates acute heart failure.

The disease in 2% of cases is asymptomatic and with minimal organic damage to the heart.

The early stages of the development of the disease can proceed unnoticed by the patient. Changes in the body are minor and do not reveal themselves.

Pirouette tachycardia is manifested by the following symptoms:

  • dyspnea;
  • dizziness;
  • fainting;
  • interruptions and a decrease in heart rate.

Especially often, patients complain of fainting, which occur due to impaired hemodynamics. When a pirouette type of arrhythmia occurs, the heart rate increases to 200-300 beats per minute. This contributes to oxygen starvation of the brain and other organs of the human body due to a violation of the blood supply process. These symptoms are alarms.

Diagnosis of ventricular tachycardia

The main way to diagnose an ailment is an electrocardiogram. Using this procedure, it is easy to recognize the main symptom of the disease – an extended QT interval, which can be recorded between attacks. In some cases, as an additional diagnostic measure, ultrasound of the heart is prescribed. In addition, for the diagnosis of violations apply:

  • Hotler heart monitoring;
  • general blood test, for biochemistry and hormonal;
  • echocardiography;
  • magnetic resonance imaging;
  • Analysis of urine.

At the first appearance of a sharp and rapid heartbeat, you should consult a doctor, since only with the help of an ECG it will be possible to establish an accurate diagnosis. In some cases, patients tolerate the disease on their feet, then it is more advisable to use daily monitoring of ECG. If there is no result from this research method, a load test is prescribed, during which, in most cases, a heart pathology is detected.

Typical signs of ventricular tachycardia on an ECG:

  1. QRS complexes are expanding and can be deformed, vary in amplitude and directions.
  2. Heart rate from 100 beats per minute.
  3. The electrical axis of the heart (EOS) deviates to the left.

As additional diagnostic methods use:

  • An electrophysiological study that identifies various types and forms of tachycardia. Well suited for accurate diagnosis of changes in the bundles of His.
  • Echocardiography – examines various areas of the heart, helps determine the location of the pathological focus and its prevalence in the myocardium.
  • Coronarography – for the most part, is prescribed to clarify the diagnosis of coronary heart disease.

Laboratory tests (general, biochemistry) are important, which help to identify concomitant pathology, as well as determine the electrolyte composition, blood sugar and cholesterol levels.

The disease is diagnosed by carrying out standard procedures. The patient turns to the doctor with certain complaints, after which he is prescribed a referral for an ECG.

It should be borne in mind that sometimes the device does not show the presence of tachycardia. A more detailed and true picture will be presented by an ultrasound of this body.

This research technique allows you to analyze the features of the heart, which makes it possible to detect the localization of arrhythmia.

Treatment of the disease

Treatment of pathology involves eliminating the likely cause and installing a pacemaker (EX).

Zhelud tahikard 7 - What is arrhythmia or ventricular tachycardia such as pirouette

The treatment regimen before radical intervention:

  • 25% magnesium sulfate intravenously (8 mmol jet, then infusion 2,5 mmol/h);
  • withdrawal of antiarrhythmic drugs;
  • installation of a temporary pacemaker until the drugs are completely withdrawn or metabolized.

The occurrence of fibrillation involves the implementation of resuscitation. First aid for a sharp decrease in blood pressure consists in conducting cardioversion, administered by magnesium sulfate, beta-blockers or lidocaine.

Therapy of pirouette type arrhythmias is divided into two types: urgent and permanent. To stop the attack, cardioversion is used, adrenergic blockers, magnesium sulfate and lidocaine are administered intravenously. Ongoing treatment requires the use of antiarrhythmic drugs and vitamins (“Guide”). If the development of the disease was caused by the use of drugs, their use ceases.

Special drugs are prescribed that contribute to the removal of toxic substances from the patient’s body. With stable pirouette arrhythmias, a defibrillator-cardioverter is used, a device that recognizes heart rhythm disturbances and corrects them with an electric signal. When drug treatment does not bear fruit, resort to surgical intervention.

To date, there are no methods that would give 100% improvement in the clinical picture. As a rule, treatment of VT begins with the introduction of medications. First of all, lidocaine or procainamide. Drugs can dramatically reduce pressure, which must be considered when administered to patients prone to hypotension. If there are contraindications to the above drugs, sotalol is used.

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In some cases, the use of antiarrhythmic drugs is indicated:

  • attacks occur frequently or are poorly tolerated by patients;
  • due to VT attacks, blood circulation suffers greatly;
  • the prognosis of the disease is defined as dysfunctional or arrhythmia is malignant.

The ineffectiveness of drug therapy is an indication for cardioversion. The initial dose is determined at the rate of 1 W per kg.

Treatment of ventricular tachycardia of malignant course and drug-resistant therapy is carried out by amiodarone. In the absence of effect, propanolol is added to the proposed monotherapy. The combination of the two drugs is successful in 80% of cases. Medications are prescribed for both adults and children, including newborns, in whom a life-threatening VT is determined.

Surgical treatment consists in improving the quality of life of the patient with persistent forms of VT, developed against the background of IHD. Other organic disorders may also occur. During surgery, a cardiological device is implanted to prevent cardiac arrest. Such an operation is expensive, so it is rarely practiced. There are several techniques for its implementation:

  • defibrillator implantation is performed;
  • some paths conducting an electrical impulse and considered pathological intersect;
  • an electric pacemaker is installed.

Emergency care for VT

It must be provided before the doctor or medical team approaches the patient. An attack can happen anywhere and under any circumstances, therefore, it is advisable for every conscious citizen to know those first aid measures that will help save the patient’s life:

  • If a person grabbed his heart, began to stagger, sharply leaned forward or fell, he should be seated or laid on a flat surface if possible.
  • If the person is conscious, you need to ask him to squeeze and unclench the muscles of the abdomen, arms and legs.
  • Ask the patient to exhale sharply.
  • Massage movements to rub the area of ​​the carotid arteries on the neck from one and the other side in turn.
  • If possible, apply something cold to your forehead and temples, you can wet a towel or handkerchief.

The most important thing when giving first aid is to call an ambulance, because only medical staff with the right medicines and equipment can stop an attack of ventricular tachycardia.

Arrhythmia in the initial stages with a small heart rate does not need therapy. Patients need to avoid stressful situations and lead the advantage of a calm lifestyle. If the disease has gone into more severe stages and the patient has complaints of regular attacks, then magnesium sulfate preparations are prescribed to patients intravenously.

Pirouette tachycardia may occur due to certain medications. In this case, the doctor cancels their intake completely and prescribes other medications to the patient. In order for the body to be cleaned of the drugs used, the patient is prescribed certain drugs that will remove them from the blood.

It is necessary to know that medications for arrhythmias of this type can have an adverse effect on the body of a sick person. For example, group 1A medicines that increase the interval between atrial contractions. In this situation, it is necessary to suspend or reduce the dosage of the drug.

Therapy with medications to get rid of arrhythmias is allowed only under the supervision of a doctor and with regular ECG to monitor treatment results.

Individual drugs have a large number of contraindications and side effects. So, antiarrhythmic drugs are forbidden to patients who have suffered myocardial infarction, patients suffering from ventricular arrhythmia. This is associated with an increased risk of heart failure as a result of taking medications.

Along with medical treatment, doctors recommend a diet. Patients should refuse to use the following products:

  • bakery products;
  • salty and spicy dishes;
  • high cholesterol foods;
  • coffee, alcoholic drinks.

At the same time, you need to add porridge and non-fat sour-milk products, boiled fish to your diet. It is recommended to take tincture of hawthorn and wild rose.

Complications of ventricular tachycardia

The most dangerous complication is arrhythmia with a complete cessation of heart function. This occurs due to the development of cardiac fibrillation.

If paroxysms occur periodically over a long period of time, blood clots may form, which then pass into large vessels. Therefore, in patients with VT, the risk of developing thromboembolism of the arteries of the brain, lungs, gastrointestinal tract and extremities is increased.

Without treatment, the prognosis of VT with organic changes is unfavorable. With the timely appointment of therapy and the restoration of normal heart function, it changes in a positive direction.

A good prognosis is considered when determining VT in children under one year of age. In some cases, tachycardia, which appeared in infancy, lasts in children from a month or two to 10 years.

Prevention

When seizures occur for the first time, it is necessary to diagnose and treat the disease that caused VT in the shortest possible time. After that, therapy is selected individually, which is essentially a secondary prevention of ventricular tachycardia.

With the development of frequent paroxysms, which are difficult to stop and significantly affect the quality of life of the patient, the doctor may give a direction for implantation of a defibrillator.

In order to prevent relapse of VT, it is useful to adhere to general recommendations for adjusting your usual lifestyle:

  • Regularly monitor blood pressure, blood glucose, body weight.
  • Eat right, with the inclusion of foods that are good for the heart.
  • Bad habits must be excluded.
  • Engage in physical therapy and perform acceptable physical activity.

Video Ventricular Tachycardia. Symptoms, Symptoms and Treatment Methods

Preventive measures of the pirouette type arrhythmia include a diet. In the menu you need to add products containing potassium, calcium and magnesium. For example, raw vegetables and fruits (apples, cranberries, currants, celery), as well as dried fruits (dried apricots, raisins). Seafood has a positive preventive effect.

Simple physical exercises, giving up bad habits, minimizing stress, walking in the fresh air are effective preventive measures to prevent the development of arrhythmias such as “pirouette”.

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Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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