Paroxysmal tachycardia diagnosis and treatment

Congenital heart defects

The causes of paroxysms of heart palpitations are diverse. For the convenience of classification, all causes are divided into cardiac and extracardiac.

The main cardiac causes of tachycardia paroxysms:

  • coronary heart disease, post-infarction condition,
  • congenital heart diseases,
  • primary disturbances in the electrical properties of muscle tissue of the heart (Brugada syndrome, prolonged QT syndrome). Wear a hereditary predisposition.
  • heart failure,
  • myocardiosclerosis.

The main extracardiac reasons due to which there is an attack of paroxysmal tachycardia:

  • increased thyroid function;
  • electrolyte disturbances;
  • physical or psychoemotional stress;
  • intoxication of the body due to the use of alcohol, nicotine, a large amount of coffee;
  • the effects of certain medications used in the treatment of other diseases: antidepressants, antiarrhythmics, antibiotics, anti-allergic, depressing appetite;
  • anemia;
  • infections, fever.

It is very important to find out the cause of paroxysms in order to correctly provide assistance and make life easier for the patient.

Although paroxysmal tachycardia is not a consequence of organic diseases of the heart muscle, it is necessary to deal with the search for the cause that caused such problems. The causes of supraventricular paroxysmal tachycardia can be several:

  1. Additional ways of conducting a nerve impulse is a congenital problem that can make itself felt at any stage of life. There are several varieties of this pathology, among which the Kent bundle and the James bundle are the most significant. Additional bundles cause an early discharge of the impulse, which leads to premature excitation of the ventricles. Most often, the signal is sent in the opposite direction, circulating between two beams (primary and secondary). This condition also causes supraventricular paroxysmal tachycardia.
  2. Cardiac glycosides can have a toxic effect on the body, the heart in particular, if an overdose is allowed. Antiarrhythmic drugs can have an arrhythmogenic effect.
  3. Problems of a neurogenic nature, stress and nervous shocks.
  4. Alcohol and drugs.
  5. Excessive amount of cardiotropic hormones.
  6. Problems with the stomach, kidneys, liver.

Ventricular paroxysmal tachycardia is caused by problems of a different kind, here organic heart lesions come to the fore:

  1. Coronary heart disease, myocardial infarction, which is accompanied by scar replacement of muscle tissue.
  2. Myocarditis, cardiomyopathy, myocardial dystrophy, and congenital heart defects.
  3. Brugada syndrome, in which proteins mutate at the genetic level. At the same time, the process of transporting sodium inward from the myocardial cell is disrupted, contractility decreases and the efficiency of the pulse is reduced.

Paroxysm may occur due to the following factors:

  • stress, strong emotional excitement, physical load on the body;
  • taking alcohol, drugs or smoking;
  • hypertensive crisis ;
  • another dose of glycoside or antiarrhythmic.

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.

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.

Attacks of tachycardia occur due to impaired transmission of electrical impulses in the heart. A small group of cells located in the upper part of the heart, in the sinus node, is responsible for its uniform work. It generates electrical signals that travel through the pathways to the atria, causing them to contract and push blood further into the ventricles.

After this, the signal enters another group of cells located in the middle part of the heart, the atrioventricular node. From there, the signal passes through the pathways of the ventricles, because of which they contract and push blood from the heart into the blood vessels of the body.

If this system malfunctions, tachycardia attacks occur, during which faster signals pass through the heart, which increases the heart rate. In most cases, this goes away within seconds, minutes or hours.

There are various disturbances in the electrical activity of the heart. One common is Wolf-Parkinson-White Syndrome (WPW Syndrome). People with WPW syndrome from birth between the atria and ventricles have an additional pathway (Kent bundle), due to which “short circuits” periodically occur in the heart. A nerve impulse runs in a short circle, bypassing the natural paths, causing an attack of tachycardia.

However, paroxysmal tachycardia can occur without additional pathways, and sometimes this happens because the electrical signal from another part of the heart is stronger than the signal from the sinus node.

Paroxysms of tachycardia usually occur after extrasystoles – an extraordinary contraction of the heart. Occasionally, extrasystoles occur in healthy people. However, the following factors increase their likelihood:

  • certain medications, such as asthma medications, dietary supplements, and cold medications;
  • excessive use of caffeine or alcohol;
  • fatigue, stress, or nervous shock;
  • smoking.

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Why arises

The development of tachycardia occurs under the influence of many factors. All the reasons that provoke the violation are functional and organic.

  • alcohol abuse
  • smoking;
  • improper diet;
  • excessive psycho-emotional stress.

Atrial forms are often found in people who have experienced severe stress. Violation of the heartbeat occurs in disorders of the autonomic nervous system in the form of neuroses.

The development of paroxysmal tachycardia occurs under the influence of disorders of the respiratory, urinary, and digestive systems.

The prerequisites for the disease include pathological changes in the heart muscle. This may be due to the formation of ischemic, dystrophic, necrotic processes.

Therefore, under the influence of injuries, infectious diseases, there is a violation of the heart rhythm, called paroxysmal tachycardia.

Ectopic foci and paroxysms are formed as a result of:

  1. Angina pectoris
  2. Hypertension.
  3. Rheumatism with damage to the heart valves.
  4. Heart failure in acute and chronic form.

The likelihood of developing paroxysms increases under the influence of provoking factors like:

  • fast and sharp movements;
  • increased physical stress;
  • unbalanced nutrition and overeating;
  • overheating or hypothermia;
  • stress and strong feelings.

In some cases, the development of paroxysmal tachycardia occurs with thyrotoxicosis, extensive allergic reactions, after surgical interventions on the heart.

What is dangerous paroxysmal tachycardia

An attack of paroxysmal tachycardia is dangerous if it is prolonged. In such a situation, cardiogenic shock may develop, it entails a violation of consciousness and removes blood circulation in the tissues of the body from a normal state. Acute heart failure and pulmonary edema may also occur. The last problem arises due to congestion in the lungs.

The situation is exacerbated by a reduced amount of cardiac output. This situation can lead to a decrease in coronary blood flow, which is responsible for supplying the heart muscle with blood. As a result of this, angina pectoris develops, it manifests itself as acute, but short-term painful sensations in the region of the heart muscle.

What are the different types

A pathological focus that produces irregular impulses can be located in the atrioventricular node, inside the ventricles or above them. Depending on this, supraventricular, ventricular and atrioventricular tachycardia are distinguished.

The disease can occur in acute, chronic, recurrent and continuously relapsing form.

Based on the development mechanism, focal tachycardia, multifocal, reciprocal, which is formed during a circular impulse transmission, is isolated.

Supraventricular

This species is also called supraventricular or atrial tachycardia. It develops in the process of receipt of electrical impulses from the atria through the bundles of His into the ventricles.

If there are additional ways of transmitting an impulse, then it is transmitted in a circle.

Atrioventricular

It is also called nodal, since the development of the pathological process begins in the atrioventricular node. After generating an impulse, it enters the myocardium through the bundles of His, and from there into the atria. Sometimes at the same time both organs are excited at the same time.

The problem usually worries people of a young age, mainly in women. This is due to the fact that the fair sex is more susceptible to emotional influences.

Paroxysms can be associated with an abnormality that occurs during fetal development. The atrioventricular node consists of several parts, instead of one. In the future, because of this, paroxysms appear.

Tachycardia often occurs in women during pregnancy as a result of hormonal changes in the body and increased stress on the heart.

Ventricular

Ventricular tachycardia is considered the most dangerous problem. It can gradually cause ventricular fibrillation. Under the influence of the ectopic focus, the work of the ventricles is coordinated, and the frequency of their contractions increases several times.

But the atria at the same time controls the sinus node, so they contract more slowly. Due to such a discrepancy in the work of the heart departments, a difficult clinical picture and dangerous consequences develop.

Diagnosis of paroxysmal tachycardia

Paroxysmal tachycardia occurs periodically in the form of sudden attacks. The heart begins to beat harder and more often, however, the intervals between beats remain equal, that is, the heartbeat remains rhythmic. If heartbeats seem arrhythmic, another rhythm disturbance may have occurred – atrial fibrillation or atrial fibrillation.

During an attack of paroxysmal tachycardia, additional signs may appear:

  • chest pain;
  • dizziness;
  • fainting condition;
  • feeling of lack of air (shortness of breath);
  • sharp weakness.

In rare cases, fainting is possible due to a sharp drop in blood pressure.

The attack (paroxysm) of tachycardia lasts several seconds or minutes. In very rare cases, symptoms persist for several hours or longer. Attacks of a rapid heartbeat can be repeated several times a day or 1-2 times a year. The disease rarely poses a threat to life, however, if symptoms appear, you should immediately consult a doctor.

In case of severe chest pain, respiratory failure and weakness, it is necessary to call an ambulance at number 03 from a landline phone, 112 or 911 from a mobile phone.

If you are concerned about bouts of heart palpitations, consult a cardiologist. To diagnose the disease, you will first be sent to an electrocardiogram (ECG). An ECG records the heart rate and electrical activity of the heart. This procedure is carried out in a clinic, lasts several minutes, does not require special preparation and is absolutely painless.

During the ECG, electrodes are glued to the arms, legs and chest, from which the wires go to the electrocardiograph. With every heartbeat, it generates a weak electrical signal. An electrocardiograph records these signals on a paper tape. Usually, during an attack of paroxysmal tachycardia, the heart beats at a frequency of 140-250 beats per minute, and the heart rate of a healthy person is 60-100 beats per minute.

If it is possible to conduct an examination during an attack, the ECG apparatus will record heart rhythm disturbances. This confirms the diagnosis and excludes the likelihood of other diseases.

However, it can be difficult to “catch” an attack, so the doctor may ask the person being examined to carry a small portable electrocardiograph for a day. Such a study is called daily ECG monitoring or Holter monitoring.

If surgical treatment of tachycardia is considered, additional examinations may be required to determine exactly where the problem area is located in the heart. For example, a doctor may prescribe an electrophysiological examination during which soft flexible electrodes are inserted through a vein in the leg into the heart.

The main manifestation of paroxysm is a feeling of a strong heartbeat. The heart rate may reach three hundred beats. Additional signs of the disease include the presence of:

  • chest discomfort on the left;
  • tides;
  • increased sweating;
  • irritability and anxiety;
  • weakness and increased fatigue.
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The development of such symptoms is associated with an increase in the activity of the sympathetic department of the nervous system.

With different forms, symptoms may vary. With ventricular tachycardia, sweating does not increase, the patient does not become irritable, and other symptoms do not occur.

If paroxysms are associated with dystrophic changes in the heart muscle, then shortness of breath, a feeling of lack of air, pain in the region of the heart also occur, blood pressure rises, lower limbs swell.

Changes in the appearance of the patient can signal the onset of an attack. He becomes pale, restless, irritable, begins to breathe often. Having laid a hand to large vessels, you can feel a strong pulsation.

There are changes in blood pressure indicators. Diastolic indicators remain within normal limits, and systolic indicators are reduced, which is associated with a violation of blood supply.

If hypotension occurs in severe form, this indicates cardiosclerosis, valve insufficiency, and extensive heart attack.

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.

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 formVentricular form
AgeDevelops at a young ageIt develops in adulthood and old age.
Heart rateWithin 200-250 bpmWithin 180-200 bpm
RhythmMaintaining a regular rhythmSome irregular rhythm
Course of paroxysmMore often lightMore often heavy
I tone over the topNormal, rarely – enhancedPeriodic occurrence of “cannon” tone
Intestinal peristalsisAmplifiesFine
The effect of vagal samplesThere isNo
The effect of verapamilThere isNo
ATP effectThere isNo
Effect of NovocainamideNoThere is

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.

Tachycardia treatment

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.

There is no single correct approach to the treatment of paroxysmal tachycardia. It all depends on its variety and the complications present. Let’s analyze all the cases:

  1. The ventricular form requires hospitalization and treatment in a hospital. Only idiopathies without complications do not require such drastic measures. The hospital prescribes the introduction of an antiarrhythmic drug or electro-pulse treatment if the first option was unsuccessful.
  2. Paroxysmal tachycardia requires outpatient monitoring by a cardiologist. The appointment of drugs is carried out under ECG control. To prevent the development of ventricular fibrillation, β-blockers are prescribed.
  3. Surgery for paroxysmal tachycardia is carried out only in severe cases that cannot be eliminated with medication. The essence of surgical treatment is the destruction of additional pathways that are used to conduct an impulse. Also, radiofrequency ablation, the installation of stimulants / defibrillators can be performed.

The elimination of any type of tachycardia is primarily carried out using vagal samples. Using this method, they affect the activity of the heart through the vagus nerve. To do this, inhale several times, exhale sharply, bend over or sit down.

If it was not possible to eliminate a sharp attack by such manipulations, medication is used. In most cases, relief occurs after taking adenosine triphosphoric acid and calcium antagonists.

Some patients after such treatment experience nausea, headache, and redness of the face. But these side effects quickly pass.

Antiarrhythmic drugs are prescribed in various combinations. A greater effect by such means is achieved in the case of atrial tachycardia. Usually the treatment is carried out:

  1. ATP.
  2. Verapamil.
  3. Novocainamide and its analogues.
  4. Cordaron.

To stop the attack, beta-blockers are used. Most often, Anaprilin is prescribed. It is injected into a vein. Oxprenolol may also be prescribed in tablets or as a solution for injection. Relief will come faster with intravenous medication.

If the patient is forbidden to use Novokainamid, Quinidine and beta-blockers, then Aymalin is prescribed. It is effective in 80% of cases. The medicine is administered intravenously, but before that it is diluted in physiological saline. To avoid re-development of the attack, the drug is prescribed in the form of tablets, one 4 times a day.

Mexityl is considered a highly effective tool in the treatment of ventricular paroxysmal tachycardia, which was caused by myocardial infarction. It is bred with glucose and injected into a vein. Tableted forms are used to prevent relapse.

If the attack cannot be eliminated by other methods, magnesium sulfate is prescribed, which is injected into a vein or muscle at a dosage of 10 ml.

The use of calcium salts is more effective for the treatment of atrial forms, and magnesium salts for ventricular.

With ventricular paroxysmal tachycardia, it is necessary to stop the attack and restore the rhythm of the sinus node, since ventricular fibrillation can occur.

After normalization, treatment is prescribed to prevent seizures.

In some cases, you can not do without surgical intervention. With its help, the ectopic focus is eliminated and the normal sinus rhythm is restored. This is achieved using a laser, cryodestructor, electric current.

Invasive techniques are practiced. They are prescribed if drug treatment has failed. The ectopic focus is eliminated by radiofrequency ablation. They can also install a pacemaker.

If the attack arose with hypertension and ischemic disorders, then it is easier to stop it than paroxysms with thyrotoxicosis, cardiac defects rheumatism.

Treatment of paroxysmal tachycardia, first of all, involves the relief of a paroxysmal attack. In the future, drug therapy is prescribed, in some cases, surgery is indicated. The methods of traditional medicine have also become widespread.

Urgent care

With the development of a paroxysmal attack, accompanied by a vivid clinical picture and worsening general condition, first aid begins with the following measures:

  • Move a person to a horizontal position, in the absence of consciousness, turn his head on his side;
  • Remove tight clothing (unfasten the top button, remove the scarf);
  • Provide access to fresh air (open the window);
  • Reassure a person;
  • Measure hemodynamic parameters (heart rate and blood pressure).

Further emergency care tactics depend on the form of paroxysmal tachycardia.

The supraventricular form, as a rule, is easier and does not require resuscitation.

The relief of paroxysm in this case should begin with vagal tests:

    Massage of the carot >

If vagal tests were ineffective, emergency care continues with the introduction of drugs:

  1. Intravenous jet administration of ATP (5-10 mg) diluted in physical. solution for several seconds;
  2. Intravenous administration of Verapamil (5 mg), diluted in physical. solution, in the absence of effect, the dose is repeated.

With the ineffectiveness of the above medicines, it is advisable to administer Propafenone (at the rate of 2 mg / kg) or Digoxin (0,5 ml) intravenously slowly.

Sustained paroxysm of ventricular tachycardia is several times more difficult and often requires resuscitation. Emergency care is carried out as follows:

  1. If consciousness is impaired, start with a cardioversion with a capacity of 150 J, with inefficiency, a repeated discharge is performed with a double power, after which Adrenaline 1 ml per phys. solution intravenously in a few seconds;
  2. If consciousness is maintained, help begins with the on / in the introduction of Lidocaine 10 ml or Novocainamide 0,2 ml / kg, diluted nat. solution; for hypotension, drugs are administered with Mesatone (0,1 ml / kg).
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Further drug treatment is aimed at stabilizing the condition and preventing the occurrence of the following paroxysms. Apply drugs that equip heart rate and normalize heart rate.

  • Beta-blockers (Bisoprolol, “Concor” 5-10 mg per day);
  • Calcium channel blockers (Verapamil 40-80 mg 3 r / day or Diltiazem 90 mg 2 r / day);
  • Antiarrhythmic drugs (“Cordarone” or Amiodarone 100-400 mg / day every other day).

Against the background of basic drugs, it is advisable to take antihypertensive drugs from the group of I-ACE or ARB, statins.

Operative therapy

Surgical intervention is indicated in the following cases:

  • With the ineffectiveness of drug treatment;
  • With severe tolerance to attacks of tachycardia;
  • In the presence of complex organic pathology;
  • With contraindications to antiarrhythmic therapy.

The essence of surgical intervention is the destruction (destruction) of ectopic foci that violate the heart rhythm, after which an artificial necrosis zone is formed in their place, which is no longer able to generate additional electrical pulses.

There are many methods of exposure – laser, electric, cryogenic, chemical; At present, radiofrequency ablation is widely used.

Prevention of tachycardia attacks

Emergency methods depend on the type of attack, the likelihood of developing heart failure.

At the first manifestations of an attack, you need to call an ambulance. Prior to her arrival, release the patient from squeezing clothes, which will facilitate his breathing. The victim should take a deep breath and exhale slowly. Such breathing exercises can slow down the heart rate.

As an emergency measure during an attack, you must:

  1. Change body position.
  2. Perform Ashner’s test, which consists in pressing on the eyeballs. With paroxysm in a child, this method can not be used.
  3. Provoke a gag reflex.

Of the medications you can use sedatives of herbal origin. The use of valocordin, valerian, motherwort is allowed for 40-50 drops.

Do not do without the help of doctors if improvised means did not help stop the attack. The doctor injects an antiarrhythmic drug and cardiac glycosides into a vein. In severe cases, if ventricular paroxysmal tachycardia caused fibrillation, electropulse therapy is necessary.

In newborns, the attack can be caused by pneumonia, acute respiratory infection, and other causes.

There are also various methods of preventing attacks of heart palpitations. If the attacks are caused by fatigue, the use of large amounts of alcohol or caffeine, heavy smoking, it is recommended to avoid these causes.

If necessary, to prevent tachycardia attacks, the doctor will prescribe a drug that will slow down the electrical impulses in the heart. Such drugs should be taken daily in tablet form. It can be digoxin, verapamil and beta-blockers. Side effects: dizziness, diarrhea, and blurred vision.

Radiofrequency ablation (RFA) is prescribed in rare cases when tachycardia attacks are very severe or often recur. The purpose of treatment is to remove additional ways of conducting an electrical impulse in the heart that cause rhythm disturbance. This is a safe and very effective treatment, after which you will no longer need to take medicine.

During the operation, a catheter (thin wire) is inserted into a vein on the thigh or groin, and then passed to the heart. There he measures his electrical activity to determine the exact location causing the disturbance. After that, the additional path of conducting pulses is destroyed by high-frequency radio waves, and a small scar remains at this place.

During the procedure, the person is conscious, but under the influence of a sedative. The venous catheter site is anesthetized. RFA usually lasts an hour and a half and you can immediately go home after it, but in some cases you need to stay in the hospital overnight (for example, if the ablation was done late in the evening).

This procedure is very effective in preventing future attacks of tachycardia (in 19 of 20 cases, a complete cure is achieved), but as with any operations, there is a risk of complications. For example, bleeding and bruising at the injection site, however, even large bruises do not require treatment and disappear in two weeks.

There is also a small risk (less than 1%) of damage to the electrical system of the heart (heart block). In this case, you may need to constantly wear a pacemaker to regulate your heart rate. The potential risks and benefits of radiofrequency ablation should be discussed with the surgeon before surgery.

If your loved ones have a similar problem, then you definitely need to know how to relieve an attack of paroxysmal tachycardia. Competent actions will help to avoid sad consequences and prevent the development of complications.

  1. The patient must be reassured and allowed to take a horizontal position in the presence of weakness in the body and dizziness.
  2. Access to fresh air must be provided, for this they open the collar and remove tight clothing.
  3. Vagus samples are collected.
  4. In the absence of improvement or in worsening conditions, they immediately call an ambulance.

Folk methods

In the process of diagnosis, the presence of clinical manifestations is primarily taken into account. At an external examination during auscultation, a popping tone is heard first, and the second is difficult to determine, the heart rate accelerates.

If there are indications, instrumental studies are prescribed. The main diagnostic method is considered electrocardiography. Depending on the type of tachycardia, the manifestations may be different.

On an ECG, ventricular tachycardia is manifested by the presence of a wide QRS complex.

In addition to standard electrocardiography, it may be necessary to:

  1. Daily monitoring by Holter.
  2. Ultrasound examination of the heart.
  3. Electrophysiological transesophageal examination.
  4. Magnetic resonance imaging.
  5. Coronarography.

These methods will accurately determine the presence of abnormalities in the work of the heart, the form of tachycardia, the location of the ectopic focus.

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.

Forecast

Paroxysmal tachycardia is a serious problem that requires treatment.

The supraventricular forms are considered more favorable. With them, a person remains able to work. In rare cases, spontaneous cure is observed.

With ventricular tachycardia, the situation is much more serious. A patient with this diagnosis can live years and decades. But there is a likelihood of developing ventricular fibrillation and atrial fibrillation. Usually people with heart disease who have undergone previous resuscitation or clinical death die from this.

This disease is dangerous by the presence of complications. Their list is given below:

  • ventricular fibrillation is a dangerous problem that can cause cardiac death;
  • acute heart failure may be accompanied by cardiogenic shock and pulmonary edema;
  • myocardial infarction and angina can also be triggered by paroxysmal tachycardia;
  • existing heart failure of a chronic type can progress and develop.

If we talk about supraventricular paroxysmal tachycardia, then in 85% of cases the course of the disease is favorable. Such a result is possible due to the correction of lifestyle, taking medications prescribed by a doctor, regular monitoring by a cardiologist. If you do not take such actions, then the disease will worsen and provoke the development of complications.

Timely access to a doctor, comprehensive diagnostics, strict adherence to the recommendations of a cardiologist and a healthy lifestyle – all this will help to cope with the problem and live a full life for many years.

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.

Prevention

Specific measures that would help prevent an attack do not exist. All patients are advised to regularly undergo a routine examination to avoid latent paroxysmal tachycardia. In addition, they advise:

  1. Follow a diet and make the right diet.
  2. In a timely manner, use antiarrhythmic drugs prescribed by your doctor.
  3. To treat heart disease.
  4. Avoid excessive emotional stress. If a stressful situation occurs, it is better to use a sedative.
  5. Do not drink alcohol in excessive quantities, quit smoking.
  6. Normalize physical activity. Excessive stress can also negatively affect a person’s condition, as well as a sedentary lifestyle.
  7. To prevent paroxysms, more attention should be paid to the treatment of the underlying disease.

With paroxysmal tachycardia, the manifestations of the problem cannot be ignored. If an attack occurs, you need to urgently call an ambulance. Some forms of tachycardia are life-threatening, therefore self-medication is not recommended.

Is it possible to protect yourself from such a diagnosis and avert the likelihood of complications? Of course yes. To do this, you must follow simple rules that will determine the lifestyle:

  1. Emotional excitability must be reduced with sedatives.
  2. Attacks are excluded due to drug therapy, which differs depending on the type of tachycardia.
  3. A healthy lifestyle is the main rule that underlies the prevention of heart disease. This refers to a complete, healthy, comprehensive diet without junk food, alcohol, coffee and tobacco.
  4. Excess weight is a problem that must be fought with. Otherwise, heart problems cannot be avo >

When such a diagnosis is established, many begin to worry about how they live with paroxysmal tachycardia. If you adhere to the recommendations described above, then life will not be overshadowed by anything. Again, it all depends on the form and degree of neglect of the disease.

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.

How is disability resolved?

In the same section, we decided to consider the issue of disability. Disability criteria are the following points:

  • CHF 1-2Ast. and higher;
  • attacks of paroxysmal ventricular tachycardia, which are accompanied by organic damage to the heart muscle
  • paroxysmal tachycardia of supraventricular and ventricular type.

How to be conscripts?

This is another pressing issue that worries young people and their parents. Are they taking into the army in the presence of paroxysmal paroxysmal tachycardia? Such a diagnosis allows you to recognize a young man unsuitable for military service, but with some amendments:

  • poor health is the reason for the delay, which is given for the passage of diagnosis and treatment;
  • the rapid disappearance of tachycardia symptoms after taking sedatives does not give the right to classify the young man as unsuitable for military service;
  • accompanying tachycardia with severe cardiovascular diseases allows you to get an exemption;
  • the presence of serious disorders in the functioning of the cardiovascular, nervous or endocrine system, one of the symptoms of which is paroxysmal tachycardia, is also a reason for suspension from service.

Summing up, we can say that paroxysmal tachycardia, not burdened with other diseases and complications, is not a reason for deviation from military service.

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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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