Paroxysmal tachycardia

Author Ольга Кияница

2017-11-10

Among all disorders of the heart rhythm, paroxysmal tachycardia occurs in one third of cases. Pathology develops due to excessive myocardial excitation, and among such disorders is diagnosed both by young and elderly people.

It  is important for all people with heart discomfort to know that this is a paroxysmal tachycardia. As a disease, it is very insidious, as it contributes to the disruption of blood supply to both the heart muscle and the body as a whole. If you do not pay attention to attacks of paroxysms in a timely manner, more complex illnesses in the form of heart failure may develop.

Paroxysmal tachycardia (PT) is characterized by the formation of pathological centers, which increase the excitation of the heart and thereby increase the heart rate.

Paroxysm begins without apparent reason, suddenly. In the same way it finishes. The only time it can vary in individual clinical cases.Depending on the location of the ectopic focus, several forms of pathology are distinguished, so timely referral to a doctor will help not only to find out how dangerous paroxysmal tachycardia is, but also to start an urgent treatment.

Description of paroxysmal tachycardia

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The main feature of paroxysmal tachycardia is the generation of additional impulses with an ectopic foci, which can be located in different areas of the heart - atrium, ventricles, atrioventricular node. Correspondingly, the same types of PT are distinguished - atrial, ventricular and nodular.

The duration of PA may be different - from second seizures to prolonged paroxysms, lasts for hours and days. Most prolonged paroxysmal tachycardia is unpleasant, is it dangerous? Of course, because not only the heart suffers, but also other organs and systems of the body. Therefore, treatment is prescribed to all without exception patients with paroxysmal tachycardia, which differs by methods of conducting.

Symptoms of paroxysmal tachycardia

During the PA, the patient feels a frequent heartbeat, reaching in one minute from 150 to 300 beats. Impulses from an abnormal focus propagate on the heart muscle regularly, but more often. Their occurrence can not be related to specific visible factors. Therefore, researchers are more likely to identify the occurrence of FT with extrasystoles, which can also be generated by an ectopic foci one after another.

Additional signs of the disease are:

  • discomfort in the heart;
  • tides;
  • increased sweating;
  • irritability and anxiety;
  • weakness and fatigue.

Similar manifestations are associated with increased activity of the sympathetic department of the nervous system.

Some forms of PT differ in the presence or absence of vegetative symptoms. For example, at atrial fibrillation there is sweating, irritability and other symptoms. With a ventricular type there are no similar symptoms.

The disease may develop in the context of dystrophic myocardial disorders, which are expressed by shortness of breath, heart pain, high blood pressure, swelling of the lower extremities, a feeling of air shortage.

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The appearance of the patient may also indicate the onset of the attack. Skin covers become pale, breathing increases, the person becomes restless and irritable. If you attach a hand to the main sites of probing large vessels, their strong pulsation is felt.

Measuring blood pressure helps in diagnosis. As a rule, the diastolic index does not change, whereas systolic pressure (upper) often decreases from insufficient blood supply. Expression of hypotonia indicates structural changes in the myocardium (cardiosclerosis, valvular insufficiency, extensive infarctions).

Causes of paroxysmal tachycardia

In many respects, they are similar to the development of extrasystole. Depending on age, predisposing factors, the surrounding environment and the presence of changes in the structure of the myocardium, the functional causes of the appearance of paroxysmal tachycardia and organic are distinguished. There are also provocative factors potentiating the development of pathology.

Functional factors

They are considered more often in young people who do not show strong complaints in the event of paroxysms.Pathology may develop due to alcohol abuse, strong drinks, smoking, unbalanced diet, frequent psycho-emotional overloads.

The atrial fusion of the functional genesis occurs in the wounded and contoured, who suffered severe stress. Also, the occurrence of attacks can contribute to disorders of the autonomic nervous system, frequent manifestation of which is vegetative-vascular dystonia, neurosis and neurasthenia.

Paroxysmal tachycardia may be associated with pathology of a number of other organs and systems. In particular, indirect effects on the work of the heart are diseases of the urinary, biliary and gastrointestinal system, diaphragm and lung.

Organic prerequisites

They are associated with profound organic changes in the heart muscle. These can be as areas of ischemia or dystrophy, as well as necrosis or cardiosclerosis. Therefore, any maladaptation, injury, infectious processes can cause the development of heart rhythm disturbances, including paroxysmal tachycardia.

Paroxysms in 80% of cases are observed after a myocardial infarction, against a background of stenocardia, hypertension, rheumatism, which affects the valves of the heart. Cardiac insufficiency, acute and chronic, also contributes to the damage to the myocardium, which means the emergence of ectopic foci and paroxysms.

Protozoan factors of paroxysm

If a person has already had paroxysms, one must be especially attentive to the predisposing factors that may contribute to the occurrence of new attacks. They include:

  • Rapid and sharp movements (walking, running).
  • Reinforced physical stress.
  • The food is unbalanced and in large quantities.
  • Overheating or overcooling, as well as inhaling very cold air.
  • Transfer of stress and strong experience.

In a small percentage of cases, PA appears on the background of thyrotoxicosis, extensive allergic reactions, and manipulation of the heart (catheterization, surgical interventions). Accepting some medications, mainly cardiac glycosides, causes paroxysms, as well as an electrolyte disorder, so any medications should be used after consultation with a doctor.

Before the onset of paroxysm may appear precursors, manifesting in the form of dizziness, noise in the ears, discomfort in the region of the heart .

Video Causes of Tachycardia of the Heart

Species / photos of paroxysmal tachycardia

Localization of pathological pulses allows to separate all paroxysmal tachycardia into three types: supraventricular, nodular and ventricular. The latter two species are characterized by the location of an abnormal focus outside the sinus node and occur more often than the ventricular one.

In the course of the course, an acute paroxysmal tachycardia, chronic, or recurrent, and continuously recurring, is released.

According to the mechanism of development, the pathology is defined as focal (in the presence of one ectopic focal point), multifocal (multiple foci) or reciprocal, that is, formed as a result of the circular transmission of the impulse.

Regardless of the mechanism of the occurrence of PA, an extrasystole always appears before an attack.

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Nadjulyodochkovaya paroxysmal tachycardia

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It is also known as supraventricular PT and atrial, since electrical impulses come mainly from the atrium of the Guys beams to the ventricles. In other embodiments, a circular impulse transfer occurs, which becomes possible in the presence of additional paths for the passage of the excitation pulse.

Atrioventricular paroxysmal tachycardia

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Known as a nodal, since the ectopic focal point is in the region of the atrioventricular node. After generation, electrical impulses come from the AV node on the hyza beams to the ventricular myocardium, from where they pass into the atrium. In some cases simultaneous excitation of the atrium and ventricles is performed.

It is more commonly defined in young people under 45 years of age, in 70% in women. This is due to a greater exposure to emotional influences.

Sometimes, during intrauterine development, the atrioventricular node is laid out in two parts instead of one, which in the future leads to the development of paroxysm. Also, pregnant women are at risk of developing tachycardia, which is associated with hormonal reorganization of the body and an increased load on the heart.

Ventricular paroxysmal tachycardia

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Of all types of PT is the most complex and dangerous because of the possible development of ventricular fibrillation.The eccentric focal point coordinates the work of the ventricles, which are reduced several times more often than norm.At the same time, the atrium continues to be controlled by the sinus node, so their contraction rate is much smaller. The difference in the work of the heart departments leads to a serious clinic and serious consequences.

Pathology is characteristic for patients with cardiac diseases: 85% are found in coronary heart disease. Men show twice as often in women as in women.

Diagnosis of paroxysmal tachycardia

An important role is played by clinical manifestations - a sudden start and end of an attack, a rapid heartbeat and jerking sensations in the heart zone. Auscultatory will be clear tones, the first clapping, the second weakly determined. Heart rate is accelerated. When measuring blood pressure, the systolic index can be reduced, or hypotension is generally determined.

Electrocardiography is the main method of confirming the diagnosis. Depending on the shape of the tachycardia, various ECG pictures can be seen:

  • Reciprocal atrial fibrillation is characterized by a change in the tooth P, which may become negative. PR interval is often lengthened.

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  • Focal atrial paroxysm on an ECG is unstable. The rod P morphologically changes and can merge with the T wave.

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  • Atrioventricular PA in typical cases up to 74% is manifested in ECG due to the absence of a tooth P and narrow-necked tachycardia.

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  • Ventricular PA is manifested by extensive QRS complexes, and 70% of the atrial punctures are not visible.

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Additionally, other instrumental methods of examination are assigned to the ECG: ultrasound of the heart, coronary angiography, MRI (magnetic resonance imaging). Clinical diagnosis helps to monitor daily ECG, physical activity tests.

Treatment of paroxysmal tachycardia

With any tachycardia, vagal tests are indicated , that is, the effect on cardiac activity through the vagus nerve. A sharp exhalation, a slope or squat is made several times in a row. Cold water also helps. Carotid sinus massage should be performed only by those who do not suffer from acute cerebrovascular abnormalities. The commonly used eye contact (Ashner-Danninin test) should not be used, as it can damage the structure of the eyeballs.

Drug treatment is used when there is no effect on vagal tests or severe tachycardia. In 90% of cases, ATP and calcium antagonists help. Some patients complain about side effects after taking ATP in the form of nausea, facial reddening, headache. These subjective feelings pass rather quickly.

Ventricular FV requires compulsory disruption of the attack and restoration of sinus rhythm, as it is possible to develop ventricular fibrillation. With the help of the ECG, they try to determine the area of the abnormal focus, but if this is not done, then lidocaine, ATP, novocainamide and cordarone are sequentially injected intravenously. Subsequently, patients with ventricular paroxysmal tachycardia are observed by a cardiologist, who is an anti-remitting treatment.

When is it necessary to treat between attacks? If paroxysms occur once a month or more often. Or they rarely manifest themselves, but at the same time there is a heart failure.

In some cases surgical treatment is required, which is aimed at eliminating the ectopic focus with the restoration of normal sinus rhythm. Various physical effects can be used for this: laser, cryostatin, electric current.

Paroxysms associated with thyrotoxicosis, cardiac defects, vegeto-vascular dystonia, rheumatism are worse off. It is easier to treat attacks that have developed because of hypertension and ischemic heart disease.

Preparations

There are various combinations of antiarrhythmic agents. The most effective use is in atrial paroxysmal tachycardia. The following drugs are used in descending order:

  1. ATP
  2. Verapamil (isoptin)
  3. NovoKainamide and its analogues
  4. Cordaron

Beta-adrenoblockers are often used to stop attacks. The most famous is anaprilin, which is given at a dose of 0.001 g for 1-2 minutes intravenously. Another drug from this group is oxprenolol, administered intravenously over 0.002 g, or is taken in tablets of 0.04-0.08 g. It should be remembered that the faster action of the drug begins after its administration through the vein.

Aymaline is often used in cases where beta-blockers, novocainamide and quinidine are contraindicated. Helps the drug in 80% of cases. The drug is administered via a vein with a single dose of 0.05 g diluted in saline. To prevent the development of an attack, it is prescribed on a tablet up to 4 times a day.

Mexicil is an antiarrhythmic drug that is considered a highly effective agent for the treatment of ventricular FT that has developed in the background
myocardial infarction. It is administered on a glucose solution in a dose of 0.25 g. It is also prescribed to prevent recurrence in tablets up to 0.8 g per day.

In some cases, the onset of paroxysm is difficult to stop. Then it is recommended to use magnesium sulfate, injected intravenously or intramuscularly in a dose of 10 ml.

It is important to note that potassium salts are more effective at atrial fibrillation, and magnesium salts - in the ventricular form.

Prevention of paroxysmal tachycardia

General recommendations

There is no specific warning of the development of attacks. The only thing that all cardiac patients should undergo is a timely screening to exclude the possibility of latent PA. It is also important to follow the following guidelines:

  • stick to a diet, or arrange the right diet;
  • To receive prescribed antiarrhythmic medications in time;
  • not to start the main illness, especially if it is cardial pathology;
  • to avoid stressful situations or, when they occur, to take sedative medications;
  • Do not abuse alcohol, give up smoking (even passive).

Tests of antiarrhythmic drugs

Used for the selection of prophylactic therapy of paroxysmal tachycardia, especially the ventricular form. To do this, use two methods:

  • Daily (holter) ECG monitoring - Takes into account the efficacy of the drug relative to the reduced number of ventricular arrhythmias determined initially.
  • The method of EFI - with its help cause tachycardia, then enter the drug and cause it again. The remedy is considered appropriate if a tachyarrhythmia can not be called up.

Video What you need to know about paroxysmal tachycardia

 


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