Diagnostics of tachycardia
The pathology is not easy to diagnose. As a rule, the conclusion is based on electrocardiography, which has a priority among other research methods. The following characteristics should be determined on the ECG: heart rate is increased to 240 beats / min, the heart's electric axis is rejected, the sinus rhythm is irregular. Extrasystoles can also be found, mostly early and rare. Spider-like tachycardia is sometimes not determined by a standard ECG, then Holter monitoring is performed. From additional diagnostics, ultrasound of the heart is used, clinical analyzes, chest X-ray, load tests.
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In the process of diagnosing the disease, electrocardiography is primarily involved. With the help of this method available to many, signs of various forms of rhythm disturbance are detected: If the patient is concerned about sinus tachycardia, then the correct rhythm is observed at the ECG, which is roughly increased to 150 beats / min. In this case, the QRS complexes are not extended or deformed. Ischemic tachycardia with localization of the ectopic focal point in the ventricles is shown at ECG heart rate to 200 beats / min, the ventricular complexes are changed, especially if the patient has suffered a myocardial infarction earlier.
Ischemic tachycardia is often accompanied by other diseases of the cardiovascular system. In such cases, in addition to the ECG, ultrasound is performed, coronary angiography, Holter monitoring, electrophysiological examination. With some somatic pathology, evaluation of laboratory tests is required.
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During the pain syndrome that developed in the context of intercostal neuralgia, discomfort in the area of the heart and heartbeat often occur. These symptoms can alert the patient and make him contact the cardiologist. After medical examination, electrocardiography is firstly prescribed, which determines practically all types of arrhythmias.
In the intercostal form of rhythm disturbances sinus tachycardia is most often detected. In the ECG, it is expressed in the accelerated heart rate (in adults – above 100 beats / min), while the rhythm remains correct, the amplitudes of the teeth and the intervals remain within the normal range.
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The pathology varies by several types, and for each characteristic, certain ECG signs. Ventricular recurrent tachycardia is manifested by altered QRS complexes by increasing the amplitude of the tooth R and its positive or negative deviation, which depends on the lead. Also, an atrial recurrent tachycardia, which shows a violation of the sinus rhythm, changes in the sinus rhythm, is evident in the ECG. In both cases, the frequency of heart contractions increases in comparison with the age norm.
For more accurate diagnosis of recurrent tachycardia, additional research methods are carried out. Holter monitoring shows the duration and frequency of paroxysms. Echocardiography is done for the purpose of evaluating the functional capabilities of the heart. If radio frequency ablation is supposed to be performed, an electrophysiological study is performed before the operation.
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First of all, the patient is examined using standard electrocardiography. Sympathetic signs of sinus tachycardia (increased heart rate, stored sinus rhythm, no changes in the ventricular complex) should be detected on the ECG for the diagnosis of synodiac tachycardia. In addition, clinical manifestations should be detected in the form of paroxysmal tachycardia.
In the development of sinatoilar tachycardia there is a relationship between the appearance of atrial extrasystoles and the subsequent occurrence of an attack of the heartbeat. To determine such a connection, transesophageal pacing is performed.
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Developed against an implanted pacemaker, so two important points are identified during the diagnosis of the disease. The first is whether the main cause of rhythm disturbance is ACS. If not, then an assessment of the conditions for stimulating cardiac activity should be conducted. Pacemaker tachycardia is a pathology associated only with implanted pacemakers, so if before, the patient had no signs of tachycardia, and after the introduction of the device appeared, then the diagnosis should be unambiguous. If paroxysms are required, then standard electrocardiography is performed, which may indicate the form of tachyarrhythmias.
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Left ventricular tachycardia
The rhythm disturbance represented by its ECG symptoms is similar to supraventricular tachycardia. Similarly, changes in the tooth P, heart rate are detected in the region of 150 bpm. Additional features characteristic of left ventricular tachycardia are considered: atrioventricular dissociation, drainage complexes, seizures. Since the heartbeat associated with the pathology of the left ventricle often occurs on the background of heart failure, other symptoms of the disease are determined, mainly in the form of complaints (pain in the heart, shortness of breath, severe breathing). Left ventricular tachycardia is determined by Holter monitoring. Also, a good result shows bicycle ergometry, because the pathology often manifests itself when exercise. Echocardiography is performed to study the mechanical functioning of the heart and evaluate its basic structural elements. Last but not least, you can focus on the reaction received on the drugs you take. In particular, the presented rhythm disorder positively reacts to the administration of verapamil and practically does not stop with lidocaine, adenosine and vagal specimens.
The pathological condition combines various forms of arrhythmia, one of which is represented by extrasystole, and the other is tachycardia. Correspondingly, on the electrocardiogram there will be signs that are characteristic for each of them. Tachycardia is mainly manifested as a symptom, that is, a frequent heartbeat, and on an ECG such a violation is characterized by an increase in the frequency of heart rate. In adults it is above 100 bpm.
Extrasystolic tachycardia on an ECG should be manifested by this or that type of extraordinary contraction. Ventricular extrasystoles appear on the ECG in the form of discordant teeth T, the absence of the tooth P before extrasystole and the expansion of the QRS complex. Atrial extrasystoles are characterized by ECG with extraordinary contractions and teeth P, which can merge with teeth T.
Video Violations of heart rhythm and conductivity on the monitor
The presented violation of the rhythm can be resolved on its own rather quickly, and it can often be established from the patient's words to establish its presence. In such cases, patients complain of frequent heartbeat, pain or discomfort in the chest. There may also be a ripple in the area of the neck and temples.
If transient tachycardia is noted on arrival of the doctor, then the attack can be diagnosed with electrocardiography. For this purpose, in the standard leads, an electrocardiogram is examined, in which, in the event of a rhythm disturbance, changes in the teeth may occur (more often, P and T, as well as the QRS complex). In addition, the heart rate will be increased and often an irregular rhythm with the emergence of extrasystole or ectopic foci is observed.
Video The QRS complex on an electrocardiogram is normal and at a pathology
Physiological sinus tachycardia
It is diagnosed in the absence of any heart disease or somatic diseases that disturb the cardiac activity. Therefore, to determine the fast heartbeat, it is sufficient to use standard electrocardiography during exercise and in a calm condition. If the patient's heartbeat is noted only under the influence of external factors and does not cause particular anxiety, then this is a physiological tachycardia.
Physiological sinus tachycardia is the most common type of tachycardia, since it develops in virtually every healthy person. The heart activity shown on the ECG is manifested by the heart rate in an adult within the range of 100-140 beats / min. Also, the rhythm should be correct, sinusoid, without disturbances of the teeth and complexes, changes in intervals. In the opposite case, it is a pathological condition.
Video Normal ECG
In view of the fact that the presented pathology develops very quickly, electrocardiography is not always possible to use. Unless, if a person is in an intensive care room, then an instantaneous fixation of changes in his condition is made. In extreme tachycardia, various forms of rhythm disturbance may occur. Most often it is fibrillation or paroxysmal tachycardia, but there may be other tachyarrhythmias.
If, after determining the extreme tachycardia, the patient was taken to the hospital or was already there (for example, in an intensive care unit), then refinement studies may be performed. In particular, magnetic resonance imaging, echocardiography, chest x-rays, laboratory tests can be performed.
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In its course pathology is, in essence, fibrillation (flickering) of the atrium. In this condition it is necessary to make an electrocardiogram, on which immediately marked f-waves - low-amplitude and frequent teeth. Also, very frequent cardiac contractions are observed on the ECG, about 400-600 beats / min, the heartbeat is not rhythmic, whereas the atrioventricular holding is maintained in the normal state.
With flickering tachycardia, additional diagnosis may be required with echocardiography. This method allows you to determine the size of the heart, the function of the left ventricle, the state of the valve apparatus. If it is necessary to find out the contours of the heart, to determine the size of the organ and to further evaluate the condition of the lung system, then the radiography of the organs of the chest is performed.
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Research begins with electrocardiography, which is conducted in standard leads. If the disease is diagnosed by an adult, then the increased frequency of heart rate is determined first of all - 100 beats / minute or more. Progressive tachycardia is often accompanied by heart failure. In this case, to assess the state of the left ventricle is the ultrasound of the heart, the fraction of the ejection is determined. In addition, this method allows us to assess the function of the valve apparatus and other structures of the heart cavity. If necessary, magnetic resonance imaging, laboratory tests are performed.
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First of all, patients with suspected cardiac arrhythmia are assigned an electrocardiography. In the absence of an attack, the patient should be shown normal ECG. If diagnostics is performed during paroxysm, then signs characteristic for nodal tachycardia are marked: heart rate is increased to 250 beats / min, the root of the prune is superimposed on the ventricular complex, or followed by it. Also, in some cases, thoracic deviations may be different in the presence of pseudo-r.
The nodal tachycardia may not always be clearly manifested in the electrocardiogram. In such cases an electrophysiological diagnosis is additionally performed. Also, if necessary, laboratory tests and load tests are performed, if it is required to clarify the conclusion of the diagnosis or a variety of complications of the underlying disease.
Electrocardiogram video at AV node reciprocal re-entry tachycardia (AVRT, AVURT)
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Pathology is often combined with orthodromic tachycardia, so it is important to correctly determine the rhythm abnormalities that occur in the patient. With antidromic tachycardia, as with other cardiovascular diseases, electrocardiography is primarily performed. With its help, narrow ventricular complexes, which are superimposed on the pruritus, are determined. An important feature is the extraordinary contraction (extrasystole) before the onset of tachycardia, and the expressed delta wave is also determined on the ECG. Due to the excitation of the ventricles through impulses through additional channels, the signs of the QRS complex change on the ECG.
Antydromnaya chashche Total tachycardia syndrome is determined at Wolf-Parkynsona-White, availability Therefore эtoho uproschaet diagnosis process for determining violations of rhythm. Since WPW syndrome javljaetsja nasledstvennыm disease, it is important in the process learn about patient Survey availability of disease in relatives.
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There are certain criteria for diagnosing the impairment of the rhythm. First and foremost, the beginning and end of the attack are estimated. In non-paroxysmal tachycardia, a gradual increase and extinction of paroxysm is observed. Also, the heart rate is comparatively low - about 100-130 beats per minute. Additionally, a non-sinus rhythm and atrioventricular dissociation are detected. In this case, the contraction of the ventricles, as a rule, is not disturbed.
Nonparoxysmal tachycardia is often asymptomatic, and therefore the patient may, in rare cases, have specific complaints. Often, standard electrocardiography is used in pathology diagnostics. If there are doubts about the diagnosis, an electrophysiological study is used.
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When questioning a patient, attention is paid to the frequency of paroxysms, their duration, the severity of their completion. It is also important to provide information on the beginning of the very first attack, when it emerged and how it proceeded. Further, after the collection of anamnesis, additional diagnostic methods, in particular, electrocardiography, are prescribed. In this study, the following symptoms of rhythmic tachycardia are defined: preserved sinus rhythm, heart rate increases insignificantly, ventricular complexes may not change or expand in case of myocardial damage. Therefore, the ECG-based pathology is very similar to supraventricular tachycardia.
Rhythmic tachycardia is determined not only with the help of an ECG. Other methods of investigation are used to help clarify the localization of the ectopic focus. In particular, an electrophysiological study is used, during which a rhythm disturbance is induced. Upon refinement of the electrophysiological properties of the pathways, more effective therapy of the disease is prescribed.
The disease is often associated with neurogenic pathology, so in the process of diagnosis of rhythm disturbances, various tests are often effective, including the transition from one position to another. In determining the causes of functional tachycardia, vagal tests help. In heartbeats associated with thyrotoxicosis, their performance is unproductive, whereas in the case of sinus tachycardia of neurogenic origin, the cardiac rhythm is slowed down.
The functional tachycardia on the electrocardiogram is most often manifested by the following symptoms: a relatively small increase in heart rate (depending on the form of rhythm disturbance on average up to 180 beats / min), not deformed by the ventricular complexes, preservation of the tooth P, which in some cases may become monomorphic and merge with the teeth T. If necessary, standard diagnostic methods are supplemented by load tests.
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