Treatment of rhythmic tachycardia
Author Ольга Кияница
Rhythmic tachycardia is expressed in a rapid heartbeat, with which the RR intervals are displayed with a small variation on the electrocardiogram. It often develops against a background of reciprocal tachycardia (nodal or orthodromic), and can also occur with atrioventricular blockade.
In the absence of an organic pathology of the heart, rhythmic tachycardia does not cause serious complications. The only thing that can be indicated is the atrial fibrillation, then timely medical care should be provided.
The disease can cause significant discomfort to the patient, since the heart rate, despite the cardiac activity, can be 150 bpm or more. Therefore, the first thing to do is to stop the attack, but there are other no less important treatment tactics.
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Before starting treatment for rhythmic tachycardia, it is important to determine the underlying cause of its development.When it is eliminated, the heartbeat may be stopped by itself. The most common causes are hypokalemia, hyperthyroidism, coronary atherosclerosis.
There are predisposing factors that are important to minimize. Then the rhythmic tachycardia can stop disturbing at all.In particular, heart rate is increased with sympathicotonia and a lack of oxygen, which can be caused by anemia or a banal finding in a stuffy room.
In some cases, predisposing factors may be combined, then complex treatment for tachyarrhythmia is required.
The main provocative factors causing tachyarrhythmia:
- alcohol and smoking;
- disruption of the autonomic nervous system;
- emotional and physical strain;
- violation of the normal functioning of the digestive system;
- osteochondrosis, increased blood sugar or cholesterol.
The presence of predisposing factors is not always correlated with the severity of the clinical picture of the disease. Yet it is extremely important to use all the possibilities to minimize the risk of subsequent attacks of the heart palpitations.
- When there is a rapid heartbeat, you do not always have to think about a pathological tachycardia immediately. Anxiety or excitement for any reason is immediately reflected in the frequency of heart rate.
- If the medication was prescribed in the middle-dose dose and its effectiveness is negligible, then it is better not to increase the dosage, but to change the medication.
- Drugs from the same group have the same mechanism of action, so the ineffectiveness of one drug indicates that others from the same group also take no sense.
- Combined therapy is considered more effective, therefore it is often advised to take some antiarrhythmic drugs from different groups.
- Prolonged treatment with antiarrhythmic drugs is often complicated by the appearance of resistance to them. To solve such a problem there are several ways: drug change, interruption of treatment, selection of a higher dose.
Medicinal treatment of rhythmic tachycardia
The active heartbeat can be removed by a vagal breakdown, for which the strain after inspiration or pressure in the epigastric area is performed. If stimulation of the parasympathetic nerve does not produce results, then adenosine (ATP) at a dose of 6-12 mg is used. The drug is most often effective in atrioventricular reciprocal tachycardia. In such cases, the development of the ventricular and sinus reciprocal tachycardia is not so frequent.
The efficacy of performing vaginal tests or the administration of adenosine may indicate the localization of an ectopic focal point that facilitates the appearance of tachycardia. For example, in case of atrial arrhythmia, after the above-mentioned method of compression, the heart rate decreases; however, if the palpitations persist, then this indicates ventricular tachycardia,
Basic principles of treating patients with tachycardia:
- Bump attack
- With a permanent pathology clinic, heart rate is maintained at normal levels.
- Identification and elimination of the cause of rhythmic tachycardia or the underlying disease, against which it developed.
During the treatment of heart palpitations, the first thing is to determine whether there are any critical conditions accompanied by a hemodynamic disorder (shock, collapse, myocardial infarction, stroke, acute heart failure). In the presence of a hemodynamic disorder, electropulse therapy is used which helps to quickly bring a person into a feeling.The absence of such disorders makes it possible to carry out antiarrhythmic therapy with special preparations.
The selection of antiarrhythmic drugs is carried out taking into account the severity of the clinical picture, the location of the pathological focus. There are different classes of drugs, among which the following are most frequently used in rhythm disturbances:
- Class 1A is procaineamide.
- 1B class - Mexilletin, lidocaine.
- 1C class - ethaczine, propafenone.
- Class 2 - propranolol, beta-blockers.
- Class 3 - sotalol, amiodarone.
- Grade 4 - verapamil, cardiac glycosides, calcium antagonists.
Attacks in the atrioventricular reciprocal tachycardia, on the background of which rhythmic tachycardia is often observed, are successfully stopped by verapamil and adenosine.
The most delayed action is noted in amiodarone. The result of its introduction is observed on average in 5 hours. This drug is a medicine with long-term efficacy, so amiodarone is often used for long-term treatment of rhythmic tachycardia.
Interventional treatment of rhythmic tachycardia
The disease can develop with atrial flutter, and in such cases, radiofrequency ablation is shown. Destruction of the pathological circle of pulse circulation in the area of the isthmus is carried out. Positive results after surgery are observed in 95% of patients, but the relapse rate is determined on average in 28% of patients in the first 33 months. At the same time, against the background of antiarrhythmic therapy, recurrence of seizures occurs in half of patients.