Paroxysmal tachycardia – causes, diagnosis, treatment

But not always the sinus node and other centers of the conducting system work harmoniously and clearly, causing the heart to contract with a normal frequency. Sometimes the operation of the sinus node can be disrupted or stop altogether. Then pathological activity of the centers of automatism of the second and third orders or even other heart cells, called ectopic ones, can be observed.

They contract chaotically, with a high frequency, generating pathological impulses from various sources. Such a mechanism for the emergence of impulses from ectopic centers is called the “re-entry mechanism.” As a result of this, the impulses move as if in a closed circle, repeated excitation waves are formed. This leads to an increase in heart contractions, and paroxysmal tachycardia may occur.

Paroxysmal tachycardia is a suddenly occurring and suddenly ending heart attack with a frequency of 140-250 beats per minute while maintaining the correct rhythm of heart contractions.

Development mechanism

The natural center of heart automatism is the sinus node (I rhythm driver). The generation of an impulse from such an excitation source provides a rhythmic atrial contraction.

Then the impulse passes to the AV node (second-order pacemaker), which temporarily delays it and allows the atria to push blood into the ventricles; then the impulse passes through the bundles of His, Purkinje fibers and enters the ventricles, reducing them and pushing blood into the aorta.

Failure in the work of pacemakers occurs due to structural changes in the heart muscle or activation of triggering factors – electrolyte imbalance, ischemic damage, the effects of certain medications. As a result of this, the atria contract faster – supraventricular tachycardia develops.

Supraventricular tachycardia occurs through two main processes:

  1. The re entry mechanism is the formation of an additional pathological pathway for conducting an electric pulse, accompanied by re-entry and circular motion of the excitation wave; the re entry mechanism is most often diagnosed.
  2. The formation of ectopic (pathological) foci of excitation and the occurrence of trigger activity – such processes provoke the development of paroxysmal or ectopic forms of arrhythmia.

To clarify the development mechanisms and determine the ectopic foci of tachycardia, electrophysiological, often invasive research methods are used. Some of them are diagnosed – a Bachmann bundle, anterograde and retrograde paths in the AV node.

Causes of Paroxysmal Tachycardia

The development of paroxysms is observed as a result of pathologies of the nervous system and organic heart lesions. The first problem causes seizures by nerve stimulation of the heart muscle. A pathogenic focus develops, causing abnormal myocardial activity. The heart rhythm is disturbed, and untimely contractions of the organ periodically appear.

Organic causes that can cause arrhythmia include:

  1. Heart attacks, coronary heart disease, myocarditis and cardiomyopathies that damage the heart muscle and pathways.
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Ventricular Paroxysmal Tachycardia

Paroxysmal tachycardia is classified, depending on the source of the pacemaker, into the supraventricular and ventricular. The supraventricular can be sinus (if pathological impulses come from the sinus node), atrial (if the ectopic atrial cells take on the role of the pacemaker), or atrioventricular (if, due to a malfunction of the sinus node, the second-order automatism center – the AV node – helps )

If ventricular cells become a pulse generator, paroxysmal tachycardia will be called ventricular, respectively. There are observations that in elderly people with diseases of the cardiovascular system, ventricular tachycardia is more common. And supraventricular tachycardia is observed more often in young people without symptoms of heart damage. To clarify the diagnosis, as well as the localization of the source, provide timely assistance, helps the ECG.

Classification

First of all, supraventricular tachycardia is classified depending on the location of the ectopic focus:

  1. Sinoarthrial form – the focus of excitation is in the region of the sinus node.
  2. Atrial paroxysmal form – a pathological focus of excitation is in the atria.
  3. Atrioventricular paroxysmal form – the ectopic focus is localized in the AV node.

Depending on the characteristics of the ventricular complex, tachyarrhythmias are divided into the following:

  1. Rhythm disturbance with a narrow QRS complex, where anterograde conduction of an impulse through the AV node is observed (with a supraventricular paroxysmal form).
  2. Violation of the rhythm with a wide ventricular complex, in which there is anterograde conduction of an electric pulse through additional paths (with atrial and ventricular tachycardia).

The nature of the course of atrial tachycardia is also different. Based on this, several forms are distinguished:

  • Paroxysmal form – characterized by a sharp onset and cessation of the attack, which lasts from several minutes to 2 hours; in the absence of organic pathologies and the provision of adequate assistance has a favorable prognosis.
  • Persistent form – characterized by protracted seizures up to several days: clinical signs are more pronounced, paroxysm of supraventricular tachycardia is more difficult for patients to tolerate.
  • Chronic form – is accompanied by an enduring course, paroxysmal seizures are observed almost constantly; has a less favorable prognosis, since the risk of complications increases significantly.

At the initial stages, the paroxysmal form is well adjusted by lifestyle, in this case, you can do without taking medications. While the chronic course requires a serious approach to treatment, often with surgical intervention.

At the place of localization of pathological impulses, atrial, atrioventricular (atrioventricular) and ventricular forms of paroxysmal tachycardia are distinguished. Atrial and atrioventricular paroxysmal tachycardia are combined into a supraventricular (supraventricular) form.

By the nature of the course, acute (paroxysmal), constantly recurring (chronic) and continuously recurring forms of paroxysmal tachycardia are found. The course of a continuously recurring form can last for years, causing arrhythmogenic dilated cardiomyopathy and circulatory failure. According to the development mechanism, reciprocal (associated with the re-entry mechanism in the sinus node), ectopic (or focal), multifocal (or multi-focal) forms of supraventricular paroxysmal tachycardia are distinguished.

The basis for the development of paroxysmal tachycardia in most cases is the re-entry of the pulse and the circular circulation of excitation (reciprocal re-entry mechanism). Less commonly, tachycardia paroxysm develops as a result of the presence of an ectopic focus of abnormal automatism or a focus of post-depolarization trigger activity. Regardless of the mechanism of occurrence of paroxysmal tachycardia, the development of extrasystole is always preceded.

Causes of Paroxysmal Tachycardia

ECG signs of supraventricular paroxysmal tachycardia

The diagnosis of paroxysmal tachycardia is established during the collection of complaints, examination and diagnostic tests. With an objective examination, a frequent, rhythmic, correct pulse is noteworthy. When listening to heart sounds, I tone can be amplified, or, with severe damage to the heart, tones will be deaf. Heart rate can reach 250 beats per minute, but an average of 140-180 beats. Assistance in the diagnosis of ECG.

ECG signs of supraventricular paroxysmal tachycardia:

  • the correct heart rhythm, with a frequency of 160-180 (up to 250 per minute), the RR intervals are the same,
  • the attack has a sudden onset and suddenly stops (if the ECG manages to fix the entire attack),
  • the presence of P wave on the ECG before each QRS complex,
  • P waves with paroxysm differ from normal P waves on an ECG: they are jagged, reduced, biphasic, positive or negative,
  • QRS complexes are not changed.

Ventricular paroxysmal tachycardia has its own ECG features: P waves are often disconnected from the QRS complex, QRS complexes are wider than normal. Diagnostics also use daily monitoring of ECG by Holter, EchoCG.

Ventricular paroxysmal tachycardia requires urgent medical attention, since complications often develop: pulmonary edema, collapse, sudden cardiac death. Paroxysm of supraventricular tachycardia has a more favorable prognosis, but also requires compulsory treatment. Treatment should be aimed at stopping the attack and preventing the appearance of new ones.

If the patient’s tachycardia paroxysm occurs for the first time, try to calm him down; you can give 45-60 drops of valocordin, 30-45 drops of valerian or motherwort. Apply reflex methods of stopping paroxysm. If supraventricular tachycardia, then the attack can stop. Reflex methods include testing with straining, inflating a rubber ball or ball, simulating vomiting.

If the attack does not stop within 5-10 minutes, you must definitely call emergency cardiological care. With supraventricular tachycardia, verapamil, novokainamid, rhythmorm, and amiodarone are used in treatment. If drug treatment is ineffective, electric defibrillation with a discharge of 50 J is used to stop an attack of supraventricular tachycardia, if there is no effect, the second discharge is applied with more power.

Emergency antiarrhythmic care in the treatment of paroxysm of ventricular tachycardia consists in the intravenous administration of lidocaine or procainamide, verapamil may be equally effective. Indications for electrical defibrillation in the treatment of supraventricular tachycardia can be a serious condition requiring emergency care: acute left ventricular failure, collapse, or lack of effect of medication treatment.

When an attack is stopped, treatment is aimed at preventing the appearance of new attacks. For this purpose, antiarrhythmic drugs, b-blockers, digoxin for continuous use are used. Doses of these medicines are set individually, treatment is prescribed by a cardiologist.

Surgical treatment of paroxysmal tachycardia occurs with frequent attacks, ineffective drug treatment, and disability of patients. It is possible to install a special pacemaker with a given heart rate or established algorithms for recognizing and stopping paroxysms, or the area where pathological impulse occurs is surgically destroyed.

Paroxysmal tachycardia is a type of arrhythmia, manifested by paroxysms (heart attacks with a heart rate of 140-220 or more beats / min). It develops under the influence of ectopic impulses in the atria, ventricles, or atrioventricular junction, provoking the replacement of the normal sinus rhythm.

As a rule, attacks of paroxysmal tachycardia begin and end suddenly, have different durations. They make the work of the heart uneconomical, reduce the efficiency of blood circulation, and lead to its insufficiency.

According to the mechanism of development and etiology, paroxysmal tachycardia resembles extrasystole. Therefore, cardiologists regard the following extrasystoles, as a short attack of tachycardia.

1. At the site of localization of ectopic impulses, doctors distinguish:

  • atrial paroxysmal tachycardia;
  • atrioventricular (atrioventricular) paroxysmal tachycardia;
  • ventricular paroxysmal tachycardia.

In turn, the atrioventricular and atrial tachycardia are combined in a supraventricular or supraventricular form.

2. Given the nature of the course, the following types of paroxysmal tachycardia are distinguished:

  • chronic (constantly returnable);
  • sharp;
  • continuously recurring (lasts for years, can cause circulatory failure and dilated, arrhythmogenic cardiomyopathy).

3. According to the features of the development mechanism, paroxysmal supraventricular tachycardia is classified into:

  • focal (ectopic);
  • reciprocal (associated with the re-entry mechanism in the sinus node);
  • multifocal (multifocal).

In children, paroxysmal tachycardia manifests itself in the same way as in adults.

An attack of paroxysmal tachycardia always begins and ends abruptly. Its duration can be from several minutes to several days. The patient feels an incomprehensible “push” in the region of the heart. Then the heartbeat sharply increases and reaches 120-220 beats / min. The correct heart rate is maintained.

In some cases, there is a neurological focal symptomatology – hemiparesis, aphasia.

When the attack ends, after a few hours, polyuria is observed (increased urine formation). If paroxysmal tachycardia is delayed, blood pressure may decrease, severe weakness, fainting may occur.

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Paroxysmal tachycardia is recognized by the severity of the attack (sudden onset and sudden termination) and data obtained from a study of the heart. The supraventricular and ventricular forms differ in the degree of increased heart rate:

  • with ventricular tachycardia, the heart rate is up to 180 beats / min, samples with excitation of the vagus nerve are negative;
  • with supraventricular tachycardia, the heart rate is about 220-250 beats / min, the attack is easily stopped by excitation of the vagus nerve.

An ECG for paroxysmal tachycardia shows a change in the polarity and shape of the P wave, as well as a violation of its location in relation to the ventricular complex QRS. These signs allow you to judge what form of the disease in question.

So, an ECG with atrial paroxysmal tachycardia shows the location of the positive / negative P wave in front of the QRS complex. If paroxysm originates from the atrioventricular junction, a negative P wave located behind / merging with the QRS complex is fixed. An ECG during ventricular paroxysmal tachycardia registers the expansion and deformation of the QRS complex, and an unchanged R wave can also be recorded.

Paroxysm of tachycardia is not always possible to fix using an ECG. Then cardiologists resort to daily monitoring of the ECG, which allows you to observe short episodes of seizures that are not subjectively felt by the patient.

In some cases, an endocardial electrocardiogram is recorded by introducing electrodes into the heart.

The treatment regimen for paroxysmal tachycardia depends on:

  • forms of arrhythmia (ventricular, atrial, atrioventricular);
  • the causes of the disease;
  • duration and frequency of paroxysms;
  • presence / absence of complications.

Attacks of paroxysmal tachycardia require emergency hospitalization (with the exception of idiopathic options with a benign course, which are easily stopped by administering an antiarrhythmic drug).

Emergency care for paroxysmal tachycardia includes intravenous administration of antiarrhythmic drugs (Propranolol, Aymalin, Ritmodan, Quinidine, Etmozin, Cordaron, Isoptin, etc.). If the attack is long and does not stop with drugs, electro-pulse therapy is performed. Then the patient undergoes outpatient cardiological treatment, during which effective antiarrhythmic drugs are selected.

Doctors often use vagal maneuvers – techniques that have a pronounced mechanical effect on the vagus nerve, to stop tachycardia paroxysm. These include:

  • straining;
  • Ashner’s test (moderate and uniform pressure on the inner upper corner of the eyeball);
  • Valsalva test (vigorous exhalation with a closed oral cavity and nasal cleft);
  • irritation of the root of the tongue to cause a vomiting reflex;
  • Chermak-Goering test (uniform pressure on the carotid sinuses in the carotid artery).

If attacks of paroxysmal tachycardia occur several times a month, the patient is prescribed long-term anti-relapse therapy:

  • quinidine preparations (Disopyramide, Kinilentin, Amiodarone, Verapomil, etc.);
  • cardiac glycosides (Celanide, Digoxin).

The selection of an effective dosage is carried out taking into account the well-being of the patient and the results of the ECG.

Surgical treatment of paroxysmal tachycardia is used only if the disease is severe and can not be stopped by drugs. Among the most common surgical methods:

  • mechanical, laser, electrical, cryogenic, chemical destruction of additional pathways for conducting an impulse or ectopic foci of automatism;
  • RFA;
  • implantation of a pacemaker;
  • implantation of an electric defibrillator.

Paroxysm of tachycardia always has a sudden distinct beginning and the same end, while its duration can vary from several days to several seconds.

The patient feels the onset of paroxysm as a push in the region of the heart, turning into an increased heartbeat. The heart rate during paroxysm reaches 140-220 or more per minute while maintaining the correct rhythm. An attack of paroxysmal tachycardia may be accompanied by dizziness, a noise in the head, a feeling of constriction of the heart. Transient focal neurological symptoms – aphasia, hemiparesis, are less common. The course of paroxysm of supraventricular tachycardia can occur with symptoms of autonomic dysfunction: sweating, nausea, flatulence, mild subfebrile condition. At the end of the attack, polyuria is noted for several hours with the release of a large amount of light urine of low density (1,001-1,003).

The protracted course of tachycardia paroxysm can cause a drop in blood pressure, the development of weakness and fainting. Tolerance to paroxysmal tachycardia is worse in patients with cardiopathology. Ventricular tachycardia usually develops against a background of heart disease and has a more serious prognosis.

Paroxysmal tachycardia can be diagnosed by the typicality of an attack with a sudden onset and end, as well as data from a study of heart rate. Supraventricular and ventricular forms of tachycardia differ in the degree of increased rhythm. With the ventricular form of tachycardia, heart rate usually does not exceed 180 beats. per minute, and samples with excitation of the vagus nerve give negative results, while with supraventricular tachycardia, heart rate reaches 220-250 beats. per minute, and paroxysm is stopped by vagal maneuver.

When registering an ECG during an attack, characteristic changes in the shape and polarity of the P wave, as well as its location relative to the ventricular complex QRS, are determined, allowing to distinguish the form of paroxysmal tachycardia. For the atrial form, the location of the P wave (positive or negative) in front of the QRS complex is typical. In case of paroxysm coming from the atrioventricular junction, a negative P wave located behind the QRS complex or merging with it is registered. The ventricular form is characterized by deformation and expansion of the QRS complex, resembling ventricular extrasystoles; a regular, unchanged R wave can be recorded.

If the paroxysm of tachycardia cannot be fixed during electrocardiography, resort to daily monitoring of the ECG, recording short episodes of paroxysmal tachycardia (from 3 to 5 ventricular complexes), not subjectively felt by patients. In some cases, with paroxysmal tachycardia, an endocardial electrocardiogram is recorded by intracardiac injection of electrodes. To exclude organic pathology, ultrasound of the heart, MRI or MSCT of the heart is performed.

The question of treatment tactics for patients with paroxysmal tachycardia is solved taking into account the form of arrhythmia (atrial, atrioventricular, ventricular), its etiology, frequency and duration of attacks, the presence or absence of complications during paroxysms (cardiac or cardiovascular failure).

Most cases of ventricular paroxysmal tachycardia require emergency hospitalization. The exception is idiopathic options with a benign course and the ability to quickly stop by introducing a certain antiarrhythmic drug. With paroxysm of supraventricular tachycardia, patients are hospitalized in the cardiology department in the event of the development of acute cardiac or cardiovascular failure.

The occurrence of an attack of paroxysmal tachycardia requires emergency measures in place, and with primary paroxysm or concomitant cardiac pathology, a simultaneous call to the emergency cardiology service is necessary.

To stop paroxysm, tachycardia resort to vagal maneuvers – techniques that have a mechanical effect on the vagus nerve. Vagus maneuvers include straining; Valsalva test (attempt of vigorous exhalation with closed nasal slit and oral cavity); Ashner test (uniform and moderate pressure on the upper inner corner of the eyeball); Chermak-Goering test (pressure on the region of one or both carotid sinuses in the region of the carotid artery); an attempt to cause a gag reflex by irritating the root of the tongue; rubbing with cold water, etc. With the help of vagal maneuvers, it is possible to stop only attacks of supraventricular paroxysms of tachycardia, but not in all cases. Therefore, the main type of help with the developed paroxysmal tachycardia is the introduction of antiarrhythmic drugs.

As an emergency aid, intravenous administration of universal antiarrhythmics effective for all forms of paroxysms is shown: novocainamide, propranoloa (obzidan), aymaline (hiluritmal), quinidine, rhythmodan (disopyramide, rhythmilek), ethmosin, isoptin, cordarone. With prolonged paroxysms of tachycardia that are not stopped by drugs, they resort to electro-pulse therapy.

In the future, patients with paroxysmal tachycardia are subject to outpatient monitoring by a cardiologist who determines the volume and schedule of antiarrhythmic therapy. The appointment of anti-relapse antiarrhythmic treatment of tachycardia is determined by the frequency and tolerance of seizures. Conducting continuous anti-relapse therapy is indicated for patients with tachycardia paroxysms that occur 2 or more times a month and require medical attention to stop them; with rarer, but protracted paroxysms, complicated by the development of acute left ventricular or cardiovascular failure. In patients with frequent, short attacks of supraventricular tachycardia, stopping on their own or with the help of vagal maneuvers, indications for anti-relapse therapy are doubtful.

Long-term anti-relapse therapy of paroxysmal tachycardia is carried out with antiarrhythmic drugs (quinidine bisulfate, disopyramide, morazizin, etatsizin, amiodarone, verapamil, etc.), as well as cardiac glycosides (digoxin, lanatoside). The selection of the drug and dosage is carried out under electrocardiographic control and the patient’s well-being.

The use of β-blockers for the treatment of paroxysmal tachycardia reduces the likelihood of the transition of the ventricular form to ventricular fibrillation. The most effective use of β-blockers in conjunction with antiarrhythmic drugs, which allows to reduce the dose of each of the drugs without compromising the effectiveness of the therapy. Prevention of relapse of supraventricular tachycardia paroxysms, reducing the frequency, duration and severity of their course is achieved by constant oral administration of cardiac glycosides.

Surgical treatment is resorted to with a particularly severe course of paroxysmal tachycardia and the ineffectiveness of anti-relapse therapy. As a surgical aid for tachycardia paroxysms, destruction (mechanical, electrical, laser, chemical, cryogenic) of additional pathways for conducting an impulse or ectopic foci of automatism, radiofrequency ablation (RFA of the heart), implantation of pacemakers with programmed paired and “exciting” electrical stimulation modes or implantation are used defibrillators.

The prognostic criteria for paroxysmal tachycardia are its form, etiology, duration of seizures, the presence or absence of complications, the state of myocardial contractility (since with severe damage to the heart muscle there is a high risk of developing acute cardiovascular or heart failure, ventricular fibrillation).

The most favorable over the course of the essential supraventricular form of paroxysmal tachycardia: most patients do not lose their ability to work for many years, cases of complete spontaneous cure are rarely observed. The course of supraventricular tachycardia due to myocardial diseases is largely determined by the pace of development and the effectiveness of therapy for the underlying disease.

The worst prognosis is observed with the ventricular form of paroxysmal tachycardia that develops against the background of myocardial pathology (acute heart attack, extensive transient ischemia, recurrent myocarditis, primary cardiomyopathies, severe myocardial dystrophy due to heart defects). Myocardial lesions contribute to the transformation of tachycardia paroxysms into ventricular fibrillation.

In the absence of complications, the survival rate of patients with ventricular tachycardia is years or even decades. The lethal outcome in the ventricular form of paroxysmal tachycardia, as a rule, occurs in patients with heart defects, as well as patients who have previously experienced sudden clinical death and resuscitation. The course of paroxysmal tachycardia is improved by constant anti-relapse therapy and surgical rhythm correction.

Methods of diagnosis

To establish the cause of the problem, first collect a medical history, examine and interview the patient. The doctor learns about the frequency and duration of arrhythmia. If paroxysmal tachycardia is suspected, then appoint:

  1. A physical examination, during which the pulse and pressure are measured, hear noises in the heart. If the organ contracts with a frequency greater than 200, then this is an attack of paroxysmal tachycardia. During the examination, the vagus nerve, which has a direct connection with the atrium, can be stimulated.
  2. Instrumental research. These include electrocardiography, Holter daily monitoring, stress tests, echocardiography, MRI and CT.

On an ECG, the signs of supraventricular paroxysmal tachycardia accurately confirm the diagnosis.

On the tape you can clearly see when paroxysm began, and ended, the frequency of heart contractions, a specific image of the teeth, characteristic of this problem.

Suspected supraventricular tachycardia can be due to a feeling of palpitations, the occurrence of shortness of breath or dizziness. With the development of such symptoms, you must consult a doctor who will conduct a comprehensive examination.

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Clinical

The main (clinical) diagnosis includes the following methods:

  • Collection of complaints – information on the features of the clinical picture is being specified;
  • Collection of an anamnesis of life and disease – the nature of nutrition and lifestyle, risk factors is determined
  • Diseases, the presence of concomitant pathologies; the features of the course of seizures are specified;
  • Physical examination – an assessment of the general condition, skin, the work of the basic systems of the body;
  • Auscultation of the heart – a possible pulse deficiency is diagnosed, the heart rate and rhythm are estimated.

After collecting the basic information, additional studies are assigned:

  • Clinical and biochemical blood tests – performed to diagnose concomitant diseases.
  • Blood test for hormones – diagnosis of hyperteriosis, pheochromocytoma.
  • Ultrasound of the heart and thyroid gland – diagnosis of organic pathologies.
  • Holter monitoring is a daily study of the electrical activity of the heart using portable equipment, which is carried out to determine the characteristics of paroxysms.
  • An electrophysiological study (EFI) of the heart – stimulation of the myocardium with physiological doses of current through special electrodes with registration of the reaction to the ECG – is performed to diagnose rhythm disturbances.

The main instrumental method for diagnosing tachycardia is an electrocardiogram (ECG), which also studies the electrical activity of the heart. All forms are diagnosed with an increase in heart rate (on average, from 150 to 250 beats / min), however, other ECG signs will differ:

  1. Before paroxysm of sinoarthrial tachycardia on an ECG, atrial extrasystole is observed;
  2. The deformation of the P wave is characteristic of the atrial form – it becomes negative, its amplitude decreases; lengthening of the PQ interval is possible (sign of AV blockade of I degree);
  3. With tachycardia against the background of VPU syndrome, deformation of the QRS complex, a decrease in the PQ interval and the occurrence of a delta wave are diagnosed;
  4. In case of atrial flutter or atrial fibrillation, the absence of P waves is observed – instead of them waves f are formed; the ventricular complex remains normal, but the RR distance is different.

Differential diagnosis is carried out with ventricular forms of tachycardia, sick sinus syndrome, ventricular overexcitation.

How is the first aid for an attack

If paroxysm occurs, first aid consists of the following techniques:

  • To unfasten a tight collar, to remove a scarf from a neck;
  • Provide access to fresh air – open a window or window;
  • Help a person lie down and calm down;
  • Measure blood pressure and heart rate.

To stop paroxysm, the use of vagal samples is effective:

  1. Massage of the carotid sinus, which is located in the region of the carotid arteries;
  2. Holding breath with straining at the same time (Valsalva test);
  3. Pressure on closed eyeballs for several seconds (Ashner test);
  4. Holding your breath and dropping your face into a basin of cold water;
  5. Artificially induced cough and vomiting reflex.

Treatment of paroxysmal tachycardia

Therapy of supraventricular tachycardia includes the use of drugs, the use of physiotherapy techniques. According to indications, surgery is performed.

The basis of conservative treatment is medication. The choice and dosage of tablet preparations depends on the form of tachycardia, the presence of background pathologies, individual characteristics of the body.

Treatment includes the integrated use of beta-blockers and antiarrhythmic drugs.

From the group of beta-blockers, one of the following drugs is prescribed:

  • Bisoprolol 2,5-5 mg 1 time per day;
  • Atenolol 25-50 mg 1 time per day;
  • Metoprolol 100-200 mg 2 times a day;
  • Anaprilin 20-40 mg 2-3 times a day.

Among antiarrhythmic drugs, the drugs of choice are:

  • Amiodarone – 200 mg once a day;
  • Diltiazem – 60 mg 3 times a day or 90 mg 2 times a day;
  • Propafenone – 150 mg 3 times a day.

With VPU syndrome, the use of Verapamil and cardiac glycosides is contraindicated.

As emergency medical care for the relief of paroxysm, drugs intended for intravenous administration are used:

  1. ATP – 5-10 mg iv in a jet for several seconds;
  2. Verapamil – 5 mg iv in a jet, if necessary, the dose is repeated;
  3. Novocainamide 10% – 10 ml iv slowly over several minutes or Digoxin 0,025% 0,5 ml iv slowly.

All drugs are administered diluted with 0,9% sodium chloride or 5% glucose under continuous monitoring of hemodynamic parameters.

Drug therapy is often carried out in conjunction with physiotherapeutic methods: rubbing, dousing, circular showers, bathtubs with hydromassage.

Another treatment option for tachycardia is surgery. Indications for surgical intervention are:

  1. Continuously recurring paroxysms;
  2. Poor tolerance of seizures by the body;
  3. Ineffectiveness of drug therapy;
  4. Contraindications to taking antiarrhythmic drugs.

Currently, the main operational method for the treatment of tachyarrhythmias is radiofrequency ablation (RFA), which is one of the methods of endovascular surgery.

The operation is performed under local anesthesia as follows: a catheter is inserted into the peripheral vein and an electrode is inserted through which the ectopic focus is cauterized and an artificial zone of necrosis is created, after which it can no longer generate pathological impulses.

  • Minimally invasive surgery, which reduces the risk of postoperative complications;
  • Short rehabilitation period due to good tolerance and quick recovery;
  • Painless procedure – discomfort occurs only at the time of catheterization.

Less commonly, an operation to install a pacemaker (EX) is performed. A special device is implanted in the heart, which plays the role of an artificial pacemaker. The supply of its electrical pulses prevents the occurrence of an excitation wave from pathological foci, preventing the development of paroxysm.

The treatment option is selected depending on the form of arrhythmia, the reasons for its development, the number and duration of attacks, the presence of complications. In severe cases, the patient needs to be hospitalized for planned treatment, a more in-depth examination and evaluation of indications for surgical intervention.

To stabilize the work of the heart, drugs, physiotherapeutic techniques, and surgical procedures are used.

Drug treatment consists in the use of:

  • sedatives in the form of bromine, tranquilizers and barbiturates;
  • beta blockers. These are Atenolol, Verapamil, digitalis preparations;
  • potassium preparations. Panangin or potassium chloride, which is administered in 20 ml four times a day.

If supraventricular paroxysmal tachycardia on an ECG has been confirmed and medication and physiotherapy have failed, resort to more radical methods. Surgical options are also used if irreversible sclerotic changes have begun in the heart or an organ defect has been identified.

Most often, minimally invasive procedures are practiced:

  • Destruction of pathways or foci. This intervention does not require direct access to the heart. Catheters are inserted into the arteries through a large puncture. One finds a focus of pathology, and through another they deliver chemical or mechanical elements that destroy it.
  • Implantation of pacemakers. An artificial pacemaker or cardioverter-defibrillator can implant. The apparatus sets the rhythm in advance, and they automatically turn on after the start of the attack.

To avoid worsening the situation, the patient must also make changes to the daily routine and lifestyle. The patient is prescribed a diet with reduced intake of fat and salt. It is necessary to abandon bad habits, avoid stress and excessive physical exertion.

It is important to regularly take walks in the fresh air. The doctor can also choose a set of exercises that will help improve the general condition of the body.

Possible complications and prognosis

If the attacks are short-term and do not have vivid manifestations, then they do not cause discomfort, and a person does not consider paroxysmal tachycardia a problem. But this is a dangerous pathology that can cause disability.

A prolonged course of arrhythmia is dangerous for the development of heart failure, which is characterized by a violation of contractility. No less serious complication is ventricular fibrillation, which, without appropriate assistance, can lead to death. Therefore, it is important to begin treatment in the early stages of development.

Paroxysmal supraventricular tachycardia has a different prognosis and depends on the following factors:

  • Features of the course of tachycardia;
  • Causes of tachycardia;
  • The number of risk factors that provoke paroxysmal attacks;
  • Human age;
  • The presence of concomitant diseases;
  • The individual characteristics of the body.

Elderly people suffering from coronary heart disease, heart failure or chronic pulmonary diseases have a less favorable prognosis – in such cases, the risk of complications and death is significantly increased.

Complications

The vast majority of complications of supraventricular tachycardia are associated with increased thrombosis. Thromboembolism (clogging of a vessel with a blood clot) leads to the following conditions:

  1. Myocardial infarction – acute ischemia of the heart muscle, followed by necrosis; manifested by pain behind the sternum of various intensities, a sense of fear, shortness of breath.
  2. A cerebral infarction (ischemic stroke) is an acute violation of cerebral circulation, the symptoms of which may be impaired speech and swallowing, paresis of limbs on one side, asymmetry of the face, impaired consciousness.
  3. Pulmonary embolism (pulmonary embolism) is a sudden artery occlusion accompanied by acute hemodynamic disorders; clinically manifested by pain behind the sternum, shortness of breath, dizziness, falling blood pressure and increased heart rate.

In addition, an attack of tachyarrhythmia can lead to the development of arrhythmogenic shock – circulatory failure with a sharp decrease in cardiac output and hemodynamic disorders.

Its main symptoms are severe pallor of the skin, impaired consciousness, decreased urine output, sticky sweat, decreased blood pressure and increased heart rate.

Prevention

  • maintaining a healthy lifestyle;
  • treatment of the underlying disease;
  • taking antiarrhythmic and sedative drugs;
  • exclusion of provoking factors (physical, mental stress).

This article is posted for educational purposes only and is not scientific material or professional medical advice.

Prevention of supraventricular tachycardia, as well as other cardiovascular diseases, includes correction of nutrition and lifestyle.

When compiling a diet, the following rules must be considered:

  1. Eat often (5-6 times a day), servings should contain a small amount;
  2. Consume approximately 500 g of fresh fruits and vegetables daily;
  3. Cook by boiling, baking, steaming;
  4. Avoid eating fatty types of meat and fish, dairy products;
  5. Limit salt intake (5 g per day), eliminate the use of spices and seasonings.

Lifestyle correction implies the following:

  • Prevention of physical inactivity – regular exercise, exercise; if there are contraindications to physical activity – daily walks, Nordic walking has a good effect.
  • Refusal of addictions – it is necessary to quit smoking, give up alcohol; For this purpose, special sobriety and smoking cessation schools have been created on the basis of polyclinics.
  • Avoidance of stress on the nervous system – stresses and other emotional overloads must be avoided; people with emotional instability are favorably influenced by yoga classes, meditation.
  • Normalization of weight – in the presence of excess body weight or obesity, it is recommended to lose extra pounds – they significantly increase the risk of heart pathologies.
  • Control of hemodynamic parameters is a daily measurement of blood pressure and heart rate, which is especially important for people with underlying cardiovascular pathology (IHD, arterial hypertension).

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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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