ICD-10
I47
General information
– a type of arrhythmia characterized by attacks of palpitations (paroxysms) with a heart rate from 140 to 220 or more per minute, arising under the influence of ectopic impulses that lead to the replacement of normal sinus rhythm. Paroxysms of tachycardia have a sudden onset and end, varying duration and, as a rule, a preserved regular rhythm. Ectopic impulses can be generated in the atria, atrioventricular junction or ventricles.
Paroxysmal tachycardia is etiologically and pathogenetically similar to extrasystoles, and several extrasystoles in a row are regarded as a short paroxysm of tachycardia. With paroxysmal tachycardia, the heart works uneconomically, blood circulation is ineffective, therefore paroxysmal tachycardia, developing against the background of cardiopathology, leads to circulatory failure. Paroxysmal tachycardia in various forms is detected in 20-30% of patients during long-term ECG monitoring.
Classification of paroxysmal tachycardia
Based on the location of pathological impulses, atrial, atrioventricular (atrioventricular) and ventricular forms of paroxysmal tachycardia are distinguished. Atrial and atrioventricular paroxysmal tachycardias are combined into a supraventricular (supraventricular) form.
According to the nature of the course, there are acute (paroxysmal), constantly recurrent (chronic) and continuously recurrent forms of paroxysmal tachycardia. The continuously relapsing form can last for years, causing arrhythmogenic dilated cardiomyopathy and circulatory failure. According to the mechanism of development, there are reciprocal (associated with the re-entry mechanism in the sinus node), ectopic (or focal), multifocal (or multifocal) forms of supraventricular paroxysmal tachycardia.
The mechanism of development of paroxysmal tachycardia in most cases is based on re-entry of the impulse and circular circulation of excitation (reciprocal re-entry mechanism). Less commonly, paroxysm of tachycardia develops as a result of the presence of an ectopic focus of abnormal automaticity or a focus of post-depolarization trigger activity. Regardless of the mechanism of occurrence, paroxysmal tachycardia is always preceded by the development of extrasystole.
Causes of paroxysmal tachycardia
According to the etiological factors, paroxysmal tachycardia is similar to extrasystole, while the supraventricular form is usually caused by increased activation of the sympathetic nervous system, and the ventricular form is caused by inflammatory, necrotic, dystrophic or sclerotic lesions of the heart muscle.
In the ventricular form of paroxysmal tachycardia, the focus of ectopic excitation is located in the ventricular sections of the conduction system - the His bundle, its legs, and Purkinje fibers. The development of ventricular tachycardia is more often observed in older men with ischemic heart disease, myocardial infarction, myocarditis, hypertension, and heart defects.
An important prerequisite for the development of paroxysmal tachycardia is the presence of additional impulse conduction pathways in the myocardium of a congenital nature (Kent’s bundle between the ventricles and atria, bypassing the atrioventricular node; Macheim’s fibers between the ventricles and the atrioventricular node) or resulting from myocardial lesions (myocarditis, infarction, cardiomyopathy). Additional impulse pathways cause pathological circulation of excitation throughout the myocardium.
In some cases, the so-called longitudinal dissociation develops in the atrioventricular node, leading to uncoordinated functioning of the fibers of the atrioventricular connection. With the phenomenon of longitudinal dissociation, part of the fibers of the conduction system functions without deviations, the other, on the contrary, conducts excitation in the opposite (retrograde) direction and serves as the basis for the circular circulation of impulses from the atria to the ventricles and then through retrograde fibers back to the atria.
In childhood and adolescence, idiopathic (essential) paroxysmal tachycardia sometimes occurs, the cause of which cannot be reliably determined. Neurogenic forms of paroxysmal tachycardia are based on the influence of psychoemotional factors and increased sympathoadrenal activity on the development of ectopic paroxysms.
Symptoms of paroxysmal tachycardia
Paroxysm of tachycardia always has a sudden, distinct beginning and the same ending, while its duration can vary from several days to several seconds.
The patient feels the onset of paroxysm as a shock in the heart area, 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, noise in the head, and a feeling of constriction of the heart. Less commonly observed are transient focal neurological symptoms – aphasia, hemiparesis. 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 observed for several hours with the release of a large amount of light-colored, low-density urine (1.001-1.003).
A prolonged course of tachycardia paroxysm can cause a drop in blood pressure, the development of weakness and fainting. Tolerability of paroxysmal tachycardia is worse in patients with cardiac pathology. Ventricular tachycardia usually develops against the background of heart disease and has a more serious prognosis.
Complications of paroxysmal tachycardia
In the ventricular form of paroxysmal tachycardia with a rhythm frequency of more than 180 beats. per minute, ventricular fibrillation may develop. Prolonged paroxysm can lead to serious complications: acute heart failure (cardiogenic shock and pulmonary edema). A decrease in cardiac output during a paroxysm of tachycardia causes a decrease in coronary blood supply and ischemia of the heart muscle (angina pectoris or myocardial infarction). The course of paroxysmal tachycardia leads to the progression of chronic heart failure.
Diagnosis of paroxysmal tachycardia
Paroxysmal tachycardia can be diagnosed by the typicality of the 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, the heart rate usually does not exceed 180 beats. per minute, and tests with excitation of the vagus nerve give negative results, while with supraventricular tachycardia the heart rate reaches 220-250 beats. per minute, and the paroxysm is stopped using the vagal maneuver.
Treatment of paroxysmal tachycardia
The question of treatment tactics for patients with paroxysmal tachycardia is decided 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 (heart or cardiovascular failure).
Most cases of ventricular paroxysmal tachycardia require emergency hospitalization. The exception is idiopathic variants with a benign course and the possibility of rapid relief by administering a certain antiarrhythmic drug. In case of paroxysm of supraventricular tachycardia, patients are hospitalized in the cardiology department in case of development of acute cardiac or cardiovascular failure.
Planned hospitalization of patients with paroxysmal tachycardia is carried out in case of frequent, > 2 times a month, attacks of tachycardia to conduct an in-depth examination, determine treatment tactics and indications for surgical treatment.
The occurrence of an attack of paroxysmal tachycardia requires emergency measures on the spot, and in case of primary paroxysm or concomitant cardiac pathology, a simultaneous call to the emergency cardiological service is necessary.
To relieve paroxysm of tachycardia, they resort to vagal maneuvers - techniques that have a mechanical effect on the vagus nerve. Vagal maneuvers include straining; Valsalva maneuver (an attempt to vigorously exhale with the nasal cleft and oral cavity closed); Aschner's test (uniform and moderate pressure on the upper inner corner of the eyeball); Chermak-Hering test (pressure on the area of one or both carotid sinuses in the area of the carotid artery); an attempt to induce 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 assistance for developing paroxysmal tachycardia is the administration of antiarrhythmic drugs.
As an emergency treatment, intravenous administration of universal antiarrhythmics is indicated, effective for any form of paroxysms: novocainamide, propranoloa (obsidan), ajmaline (gilurythmal), quinidine, rhythmodan (disopyramide, rhythmileka), ethmosin, isoptin, cordarone. For prolonged paroxysms of tachycardia that cannot be controlled by medications, they resort to electrical pulse therapy.
In the future, patients with paroxysmal tachycardia are subject to outpatient monitoring by a cardiologist, who determines the volume and regimen of antiarrhythmic therapy. The prescription of anti-relapse antiarrhythmic treatment of tachycardia is determined by the frequency and tolerability of attacks. Continuous anti-relapse therapy is indicated for patients with paroxysms of tachycardia that occur 2 or more times a month and require medical assistance to stop them; with more rare but prolonged paroxysms, complicated by the development of acute left ventricular or cardiovascular failure. In patients with frequent, short attacks of supraventricular tachycardia, self-limiting or with the help of vagal maneuvers, the indications for anti-relapse therapy are questionable.
Long-term anti-relapse therapy of paroxysmal tachycardia is carried out with antiarrhythmic drugs (quinidine bisulfate, disopyramide, moracizine, etacizine, amiodarone, verapamil, etc.), as well as cardiac glycosides (digoxin, lanatoside). The selection of the drug and dosage is carried out under electrocardiographic control and monitoring the patient’s well-being.
The use of β-blockers for the treatment of paroxysmal tachycardia can reduce the likelihood of the transition of the ventricular form to ventricular fibrillation. The most effective use of β-blockers in combination with antiarrhythmic drugs, which allows you to reduce the dose of each drug without compromising the effectiveness of the therapy. Prevention of relapses of supraventricular paroxysms of tachycardia, reducing the frequency, duration and severity of their course is achieved by constant oral administration of cardiac glycosides.
Surgical treatment is resorted to in particularly severe cases of paroxysmal tachycardia and ineffectiveness of anti-relapse therapy. As a surgical aid for paroxysms of tachycardia, destruction (mechanical, electrical, laser, chemical, cryogenic) of additional impulse pathways or ectopic foci of automatism, radiofrequency ablation (RFA of the heart), implantation of pacemakers with programmed modes of paired and “capturing” stimulation, or implantation of electrical defibrillators.
Prognosis for paroxysmal tachycardia
Prognostic criteria for paroxysmal tachycardia are its form, etiology, duration of attacks, 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 course is the essential supraventricular form of paroxysmal tachycardia: most patients do not lose their ability to work for many years, cases of complete spontaneous recovery are rarely observed. The course of supraventricular tachycardia caused by myocardial diseases is largely determined by the rate of development and effectiveness of therapy for the underlying disease.
The worst prognosis is observed in the ventricular form of paroxysmal tachycardia, developing against the background of myocardial pathology (acute infarction, extensive transient ischemia, recurrent myocarditis, primary cardiomyopathies, severe myocardial dystrophy caused by heart defects). Myocardial lesions contribute to the transformation of paroxysms of tachycardia into ventricular fibrillation.
In the absence of complications, the survival rate of patients with ventricular tachycardia is years and even decades. Fatal outcome in the ventricular form of paroxysmal tachycardia, as a rule, occurs in patients with heart defects, as well as in patients who have previously suffered sudden clinical death and resuscitation. Continuous anti-relapse therapy and surgical rhythm correction improve the course of paroxysmal tachycardia.
Prevention of paroxysmal tachycardia
Measures to prevent the essential form of paroxysmal tachycardia, as well as its causes, are unknown. Preventing the development of tachycardia paroxysms against the background of cardiopathology requires prevention, timely diagnosis and treatment of the underlying disease. When paroxysmal tachycardia has developed, secondary prevention is indicated: exclusion of provoking factors (mental and physical stress, alcohol, smoking), taking sedative and antiarrhythmic anti-relapse drugs, surgical treatment of tachycardia.
At least once in his life, a person was bothered by attacks of sudden rapid heartbeat. Especially if you are afraid of something or worried. These short-term attacks in most cases are physiological in nature and do not require any treatment. But the opposite cases also happen.
Features of attacks
Paroxysmal tachycardia is an attack of rapid heart contractions that suddenly begin and end just as suddenly. Usually this is from 100 to 250 beats per minute while maintaining a normal regular rhythm. Moreover, the regularity of the rhythm and frequency throughout the attack is a distinctive feature of this type of tachycardia.
For example, with physiological tachycardia during physical activity and emotional stress, the heart rate will gradually increase - which is not typical for paroxysmal tachycardia.
The duration of the attack can vary - from a few seconds to several days. Most often, the trigger for paroxysm is extrasystole.
We'll talk about the types of paroxysmal tachycardia further.
Paroxysmal tachycardia on ECG
Classification and forms of paroxysmal tachycardia
Depending on which cardiac chamber contracts first and where electrical impulses are generated, paroxysmal tachycardia is divided into the following types:
- Ventricular develops if the focus of excitation comes from the ventricle.
- Supraventricular tachycardia accounts for about 80% of all cases of tachycardia. It is divided into atrial (the source of excitation in the atrium) and arterioventricular (AV node is the source of excitation). Atrial and artrioventricular paroxysmal tachycardia are slightly different when performing an ECG.
We will tell you further about the causes of paroxysmal tachycardia in children and adults.
The following video will tell you about the features of paroxysmal tachycardia:
Causes
Most often, paroxysmal tachycardia occurs due to:
- atherosclerosis of coronary vessels;
- acute and chronic;
- congenital anomaly of the conduction system (the presence of another nerve bundle in the myocardium);
- thyrotoxicosis;
- nervous breakdowns;
Symptoms
The main sign of the development of paroxysmal tachycardia is a rapid heartbeat (more than 100 beats per minute).
- At this moment, a person feels general weakness and malaise, lack of air, dizziness, and trembling throughout the body.
- With a prolonged attack, the patient may experience acute heart pain, loss of consciousness, and headache.
If such symptoms are associated with atrial tachycardia, then the disease is mild and is associated with neuropsychic sources of influence. If this is ventricular tachycardia, a more dangerous form of the disease, in its further development it will be characterized by more pronounced clinical manifestations.
Read below about the diagnostics of paroxysmal tachycardia.
Diagnostics
After a person has felt an attack of paroxysmal tachycardia, it is very important to talk to the doctor about your complaints. It is important for the cardiologist to know the following points:
- what the person was doing when the attack of rapid heartbeat began;
- what were the sensations, were there interruptions in the functioning of the heart or a feeling of emptiness in the heart, a feeling of cardiac arrest;
- whether the patient felt dizzy and darkened in the eyes;
- did the person lose consciousness or fall;
- whether there was pain in the heart;
- how the attack ended, quickly or gradually.
The doctor should tell you about all cardiovascular diseases, which are the most common cause of paroxysmal tachycardia. After collecting data, the doctor will prescribe:
- ECG to detect signs of paroxysmal tachycardia (24- or 48-hour monitoring);
- Ultrasound of the heart;
- radionuclide scanning;
- tomography of the heart.
Read on to find out what treatment nodal, supraventricular, ventricular, supraventricular, atrial, atrioventricular paroxysmal tachycardia requires.
Treatment
Therapeutic
To determine what methods to treat the patient, you must first establish the cause of the development of paroxysmal tachycardia. As a result of the examination, it may turn out that therapy is not necessary at all. This applies to those cases where paroxysm began to develop as a result of ordinary physical overload or a stressful situation. To do this, it will be enough to take a sedative, lie down and relax.
The video below will tell you more about new trends in the treatment of paroxysmal and other types of tachycardia:
Medication
In the case of supraventricular tachycardia, they begin with the so-called “vagal tests”. They are performed until sinus rhythm is restored.
- If the patient is resistant to this procedure, with repeated attacks and complications, antiarrhythmic drugs are prescribed.
- If the latter is ineffective, they resort to electrical pulse therapy, as well as transesophageal or intracardiac electrical stimulation.
Antiarrhythmic drugs are prescribed strictly individually.
Operation
The surgical method is the most effective way to get rid of paroxysm. The purpose of performing an operation in the clinic for paroxysmal tachycardia is to interrupt the passage of the impulse along the additional path. The modern method is the ablation method, the essence of which is to remove the source of excitation using a laser, low temperatures or cauterization.
Radiofrequency ablation is a method that does not require surgery. Its essence is that a catheter is passed through the femoral vein. Everything is controlled on the display. Then radiomagnetic waves are directed to the source of excitation, which have a destructive effect. After the procedure, a test is carried out to determine its effectiveness - changes in heart rhythm are observed.
This operation can be repeated several times until the desired result is achieved. After drug treatment, the patient needs to be constantly monitored by a cardiologist. The effectiveness of the method is 100%.
Folk remedies
Traditional medicine advises treating paroxysm in the following ways:
- take baths with valerian decoction (300 ml);
- eat peaches and black currants;
- take eleutherococcus extract (20 drops half an hour before meals).
If your heart rate increases, you can also make the following decoction:
- Pour 2 small spoons of calendula into a glass of boiling water and leave.
- Strain.
- Drink half a glass 4 times.
Disease prevention
To avoid developing paroxysmal, you should adhere to the following rules:
- avoid stress and conflicts;
- adhere to a daily routine and diet;
- eliminate unnecessary load;
- do not drink coffee, do not eat spicy foods, .
Remember this too:
- For easily vulnerable people who are susceptible to emotional experiences, it is better to seek advice from a psychotherapist. The doctor will prescribe some sedatives: Corvalol, valerian tincture, valocordin.
- If thyrotoxicosis is the cause of paroxysm, the patient should consult an endocrinologist. If paroxysm occurs against the background of thyrotoxicosis, then an endocrinologist will treat thyroid diseases.
And of course, you should undergo regular medical examinations, eliminate factors that provoke the disease, and take medications prescribed by your doctor.
Read on to find out what emergency care is required for paroxysmal tachycardia.
Urgent Care
If tachycardia occurs, the following actions should be taken:
- calm down and lie down;
- provide access to fresh air, free your neck from clothing;
- if it gets worse, call an ambulance;
- do not take any medications, as only a doctor can prescribe them.
Relief of paroxysm of supraventricular tachycardia is carried out as follows:
- Enter into the vein:
- Isoptin intravenously (10 mg in 10 ml of isotonic NaCl solution over 2 minutes). If there is no effect, the drug is reintroduced after 10 minutes (5-10 mg).
- Carrying out vagal tests (massage of the carotid sinus, Valsalva maneuver).
- bolus Digoxin (0.5-0.1 mg) in 20 ml of isotonic NaCl solution for 5 minutes.
- bolus Disopyramide (100-150 mg/2-3 capsules) in 20 ml of isotonic NaCl solution for 5 minutes.
- stream Anaprilin (5 mg/1 kg) in 20 ml of isotonic NaCl solution (or 5% glucose) for 5 minutes.
- slowly Cordarone for 3-5 minutes (dose 5 mg/kg in 20 ml glucose solution).
- for 4-5 minutes Novocainamide (10ml 10% solution)
If there is no effect from the above-described therapy, electrodefibrillation or frequent stimulation of both atria is performed.
The video below will tell you how to relieve an attack of paroxysmal tachycardia at home:
Complications
Paroxysmal tachycardia is dangerous due to the following consequences:
- semi-fainting state;
- sudden electrical death;
- fainting;
- cardiac tamponade;
- pulmonary edema;
- cardiac asthma;
- cardiocerebral syndrome.
Forecast
The prognosis is favorable under the following conditions:
- atrial or atrioventricular tachycardia;
- with a repetition frequency of attacks - no more than 1 minute;
- with a heart rate less than 180 beats per minute.
The prognosis is uncertain and worse in the case of ventricular paroxysmal tachycardia.
Paroxysmal tachycardia is a dangerous symptom, which in some cases can be fatal.
In this article we will look at paroxysmal tachycardia from all sides - its symptoms, treatment, causes, whether it is dangerous and in what cases.
Paroxysmal tachycardia is abnormal heart rhythm with a frequency of 150–300 beats per minute. The source of excitation occurs in any part of the conduction system of the heart and causes high-frequency electrical impulses.
The reasons for the appearance of such lesions have not yet been fully studied. For this form of tachycardia characterized by a sudden onset and end of the attack, which lasts from several minutes to several days.
With paroxysmal tachycardia, diastolic pauses are shortened as much as possible, therefore the time for recovery processes is reduced to a minimum, which is why changes occur.
Also cardiac dysfunction occurs, due to “atrial blockage” by Wenckebach. Then the blood accumulated in the atria is thrown back into the vena cava and pulmonary veins, as a result of which pulse waves are formed in the jugular veins. The blockage further complicates the filling of the ventricles with blood and provokes congestion in the systemic circle.
The paroxysmal form is distinguished from the sinus form by the suddenness of the attack and the fact that the focus does not arise in the sinus node, the normal source of impulses.
Paroxysmal tachycardia is usually accompanied by coronary atherosclerosis.
How the disease develops
The rhythm is disrupted due to the fact that the electrical signal, following the heart, encounters obstacles or finds additional paths. As a result, the areas above the obstacle contract, and then the impulse returns again, forming an ectopic focus of excitation.
Areas that receive impulses from additional bundles are stimulated at a higher frequency. As a result, the recovery period of the heart muscle is shortened and the mechanism of blood ejection into the aorta is disrupted.
According to the mechanism of development, they distinguish three types of paroxysmal tachycardia- reciprocal, as well as focal and multifocal, or ectopic and multifocal.
Reciprocal mechanism- the most common, when an impulse is re-formed in the sinus node under the influence of certain causes or circulation of excitation is observed. Less commonly, paroxysm gives rise to an ectopic focus of abnormal automatism or post-depolarization trigger activity.
Regardless of what mechanism is involved, Extrasystole is always observed before an attack. This is the name for the phenomenon of untimely depolarization and contraction of the heart or its individual chambers.
Basic classification, differences between species by localization
Depending on the current there are acute, constant recurrent (chronic) and continuously relapsing forms. The latter type of course is especially dangerous, since it causes circulatory failure and arrhythmogenic dilated cardiomyopathy.
There are such forms of paroxysmal tachycardia:
- ventricular - persistent (from 30 seconds), unstable (up to 30 seconds);
- supraventricular (supraventricular) - atrial, atrioventricular.
Supraventricular
The atrial form is the most common. The source of increased impulse production is the atrioventricular node. Brief attacks often not diagnosed on an electrocardiogram.
The atrioventricular form is characterized by the fact that it arises at the atrioventricular junction.
For this form, the heart rate reaches 250 beats per minute, stopping paroxysmal tachycardia is performed using the vagal method.
Ventricular
The focus of excitation in the ventricular form is in the ventricles - bundle of His, its legs, in Purkin fibers. The ventricular form often develops against the background of cardiac glycoside poisoning (approximately 2% of cases). This is a dangerous condition that sometimes develops into ventricular fibrillation.
In children it is typical idiopathic paroxysmal tachycardia, or essential. Its causes have not been reliably established.
There are extracardiac (outside the heart) and intracardial (cardiac) risk factors.
Extracardiac
So, in people with a healthy heart, an attack of paroxysmal tachycardia develops after stress, heavy stress - physical or mental, as a result of smoking, drinking alcohol.
Spicy foods, coffee and tea also provoke an attack.
This also includes diseases:
- thyroid gland;
- kidney;
- lungs;
- gastrointestinal system.
Intracardiac
Intracardiac factors directly refer to cardiac pathologies - myocarditis, defects, mitral valve prolapse.
Symptoms
The clinical picture of paroxysmal angina can be so expressive that a conversation with the patient is enough for the doctor. The disease is distinguished by the following symptoms:
- a sudden shock in the heart area and a subsequent increase in heart rate;
- possible pulmonary edema in patients with heart failure;
- weakness, general malaise, chills, body trembling (tremor);
- headache;
- feeling of a lump in the throat;
- changes in blood pressure;
- in severe cases - loss of consciousness.
If paroxysmal tachycardia does not cause heart failure, then a frequent attack is severe polyuria- copious discharge of light-colored urine with low specific gravity.
Also, the symptoms are complemented by manifestations characteristic of the disease that provoked tachycardia. For example, if the function of the thyroid gland is impaired, the patient loses weight, his hair condition worsens, with diseases of the gastrointestinal tract, his stomach hurts, nausea, heartburn, etc.
Between attacks, the patient may not complain about his health.
Diagnosis and signs on the ECG
When carrying out diagnostic measures, the doctor conducts patient interview about the nature of the sensations and the circumstances under which the attack began, clarifies the medical history.
The main hardware research method is. But at rest, deviations are not always recorded. Then studies with loads are indicated to provoke an attack.
ECG allows to distinguish forms of paroxysmal tachycardia. So, with the atrial location of the focus, the P wave is located in front of the QRS complex. At the atrioventricular junction, the P wave takes on a negative value and merges or is located behind the QRS.
The ventricular shape is determined by a deformed and widened QRS, while the P wave is unchanged.
If the paroxysm is not recorded, they are prescribed, showing short episodes of paroxysm that are not noticed by the patient.
In some cases, a recording is made to clarify the diagnosis. endocardial ECG with intracardiac insertion of electrodes.
Ultrasound examination, MRI or MSCT of the organ are also performed.
Emergency care during an attack and treatment tactics
First aid for paroxysmal tachycardia is as follows:
- They calm the patient; in case of dizziness and severe weakness, they sit or lie down.
- They provide air flow, free them from tight clothing, and unbutton collars.
- Vagal tests are performed.
- If the condition suddenly worsens, call an ambulance.
Treatment tactics depend on the form of the disease and complications.
With ventricular paroxysmal tachycardia in most cases, hospitalization is carried out, with the exception of idiopathies with a benign course. The patient is immediately administered a universal antiarrhythmic drug - novocainamide, isoptin, quinidine, etc. If medication does not bring results, they resort to the electric pulse method.
If attacks of ventricular tachycardia are more than 2 times a month, planned hospitalization is indicated. Patients diagnosed with paroxysmal tachycardia are observed on an outpatient basis by a cardiologist.
Drugs for treatment are selected under ECG control. To prevent the transition of the ventricular form to ventricular fibrillation, β-blockers are prescribed, which are most effective in combination with antiarrhythmic drugs.
How to treat paroxysmal tachycardia in severe cases? Doctors resort to surgical treatment. It consists of the destruction of additional impulse pathways or foci of automatism, radiofrequency ablation, and the implantation of stimulators or defibrillators.
Prognosis, complications, possible consequences
Possible complications of prolonged paroxysm with a frequency above 180 beats per minute include:
- - one of the reasons ;
- acute heart failure with cardiogenic shock and;
- angina pectoris, myocardial infarction;
- progression of chronic heart failure.
Whether paroxysmal tachycardia will lead to heart failure depends largely on the condition of the heart muscle and the presence of other changes in the circulatory system.
Attacks lasting 6–8 days are dangerous.
The first sign of developing heart failure is tension in the neck which occurs due to the overflow of blood in the veins, shortness of breath, fatigue, heaviness and pain in the liver area.
Relapse prevention and prevention measures
The main preventative measure is healthy lifestyle, which assumes:
- healthy diet, with a sufficient amount of vitamins, minerals, reduction in fatty, sweet, spicy foods in the diet;
- exclusion from the diet of alcoholic beverages, caffeine-containing drinks, especially instant coffee;
- to give up smoking.
For emotional excitability, it is prescribed sedatives.
To prevent seizures for the patient may prescribe drug therapy:
- for ventricular paroxysms - anaprilin, diphenin, novocainamide, isoptin in preventive courses;
- for supraventricular paroxysms - digoxin, quinidine, Mercazolil.
Medicines are prescribed if attacks occur more than twice a month and require the help of a doctor.
The article describes the causes of paroxysmal tachycardia. Methods of diagnosis and treatment are described.
Paroxysmal tachycardia is a sudden attack of rapid heartbeat. The heart rhythm remains correct. This is a common cardiac pathology that is observed in children and adults. In most cases, it is not life-threatening.
Paroxysmal tachycardia is a type of cardiac arrhythmia. It is characterized by sudden attacks of rapid heartbeat, in which the ventricles or atria contract up to 200 times per minute.
Such attacks, or paroxysms, occur under the influence of ectopic impulses. Ectopic impulses are those that occur out of turn, or are not generated by the main pacemaker - the atrioventricular node (photo).
Paroxysm occurs and stops suddenly and can last up to several hours. The heartbeat rhythm is correct. Pathology is detected in 20-30% of cardiac patients. During an attack, the heart consumes a large volume of blood, which leads to the formation of heart failure. The more often attacks occur, the faster it develops. According to ICD 10, the disease has code I47.
Classification
Paroxysmal tachycardia occurs in several variants, depending on the location of generation of ectopic impulses and the nature of the course.
Based on the location of impulse generation, the following are distinguished:
- supraventricular - atrial and atrioventricular;
- ventricular
According to the nature of the flow, they are distinguished:
- acute (the attack itself);
- chronic, lasting for years;
- constantly relapsing, leading to the development of cardiomyopathy.
The mechanism of development of an attack of paroxysmal tachycardia is the principle of re-entry (literally “re-entry”). Paroxysmal AV nodal reentrant tachycardia occurs when an ectopic focus generates an impulse that travels around the heart and back to that focus. This is how a “vicious circle” is formed.
Causes
The causes of PT are the same as for extrasystole. The supraventricular form is caused by dysfunction of the sympathetic department. Ventricular tachycardia occurs against the background of inflammatory or dystrophic heart diseases.
Predisposition to the development of the disease is the presence of extra pathways for conducting impulses - the Kent bundle, the Maheim fibers. The idiopathic form of the disease occurs in newborns and adolescents.
How it manifests itself
A characteristic feature of paroxysmal tachycardia is the sudden onset and end of the attack. It can occur both under load and at complete rest.
The attack has the following symptoms:
- The patient feels the onset of an attack as a jolt in the heart area;
- then the rapid heartbeat itself develops, against the background of which the person feels weakness, dizziness, and tinnitus;
- Neurological symptoms may rarely be observed - clouding of consciousness, impaired speech and motor function;
- with VSD, sweating, nausea, and redness of the skin will be observed.
The attack lasts from several minutes to several hours. Prolonged course leads to hypotension and fainting.
Complications
More common in the ventricular form:
- ventricular fibrillation or flutter;
- fibrillation;
- pulmonary edema;
- myocardial infarction.
With long-term paroxysmal tachycardia, chronic heart failure develops.
How to diagnose
Making a diagnosis is not difficult. Characteristic symptoms and objective examination data (HR) are taken into account. The diagnosis is confirmed using an ECG. It needs to be removed precisely at the moment of the attack, so the person undergoes 24-hour monitoring.
With paroxysmal atrial tachycardia on the ECG, the P wave is located in front of the QRS complex and can be positive or negative. If the ectopic impulse comes from the AV node, the wave is located behind the ventricular complex. Signs of an ECG of the ventricular form are a deformed QRS complex with a normal P wave.
How to treat
How to treat paroxysmal tachycardia depends on the nature of the disease, the frequency and duration of attacks, and the underlying heart disease. The supraventricular form is usually treated on an outpatient basis. An attack of ventricular tachycardia requires hospitalization in the cardiology department.
Emergency care for paroxysmal tachycardia involves performing vagal maneuvers:
- straining;
- exhale through a closed mouth;
- gentle squeezing of the eyes;
- pressing on the area of the carotid artery.
Such tests can only help with supraventricular forms. First aid for paroxysmal tachycardia with ventricular damage is the administration of antiarrhythmic drugs.
The following tools are used:
- procainamide;
- obzidan;
- quinidine;
- rhythmylene;
- isoptin;
- cordarone.
If treatment with tablets does not produce an effect, electrical pulse therapy is required. Patients with the chronic form require constant anti-relapse treatment.
Surgical intervention is indicated for severe disease. The operation consists of cauterization or resection of ectopic lesions.
Paroxysmal tachycardia is a common cardiac pathology that occurs in several variants. The most favorable prognosis is observed with the supraventricular form. Chronic and recurrent ventricular forms of the disease have the most unfavorable prognosis, since they are more likely to develop complications.
Questions for the doctor
Good afternoon. The cardiologist diagnosed me with paroxysmal tachycardia. He said that no treatment is required yet, since attacks occur rarely. I would like to know if there is a possibility of treatment with folk remedies.
Victor, 54 years old, Moscow
Good afternoon, Victor. Paroxysmal tachycardia requires constant treatment if attacks develop more than twice a month. Therapy is carried out only with antiarrhythmic drugs. Folk remedies for this disease are useless. The only thing that can be recommended are plants with sedative properties (valerian, lemon balm, motherwort).
Hello. Before entering school, the child underwent a medical examination; an ECG revealed an attack of rapid heartbeat. Now we need to be regularly examined by a pediatric cardiologist and, if necessary, receive treatment. How is this disease treated in children?
Olga, 28 years old, Saratov
Good afternoon, Olga. Treatment of childhood tachycardia is carried out with antiarrhythmic drugs, their dosage is calculated according to age.
Tachycardia is a disease in which the heart rate increases significantly. This article talks about the dangers of paroxysmal tachycardia.
Tachycardia is a disease in which the heart rate increases. Paroxysmal tachycardia is a phenomenon characterized by a pathological increase in heart rate that begins suddenly.
How paroxysmal tachycardia will manifest itself in each specific case depends on the background of the disease it appeared, where the ectopic focus is located, and how long the attack lasts.
An attack of this disease is characterized by the following indicators: the heart contracts rhythmically, the contraction frequency is 120-220 beats per minute. The duration of the attack can fluctuate and reach several weeks. During an attack, the frequency of strokes does not change. The onset of an attack is felt by a specific freezing or interruption in the functioning of the heart muscle.
Long attacks can cause fear or just restlessness, and dizziness may also occur. High frequency may cause the patient to faint.
When paroxysmal tachycardia appears against the background of vegetative-vascular dystonia (supraventricular paroxysmal tachycardia). it is accompanied by body trembling, increased sweating, and frequent cases of excessive urination.
Heart contractions occur at a rate of 140-220 beats per minute. Ventricular tachycardia (130-170 beats per minute) is an indicator that a person already has heart disease. This type of tachycardia is more severe.
Complications
If an attack of paroxysmal tachycardia continues for a long time, this can lead to cardiogenic shock. This is a serious condition in which there is a disturbance of consciousness and a sharp disruption of blood circulation in the tissues.
In addition, acute heart failure coupled with pulmonary edema may occur. This happens because blood stagnates in the lungs, some of the blood penetrates the walls of blood vessels and floods the lungs.
Plus, cardiac output is significantly reduced. This can cause a decrease in coronary blood flow, that is, the arteries that supply blood to the heart. All this can lead to an attack of angina, which is characterized by acute short-term pain in the heart.
Treatment
The most important point in providing assistance to a large person when an attack of tachycardia occurs is to ensure physical and mental rest. An attack of supraventricular tachycardia can be managed using reflex methods. The vagus nerve needs to be stimulated.
This can be achieved by performing the actions of “straining”, squeezing the abdominal press, you can also put pressure on the eyeballs and induce vomiting. If this method is not effective, then medications are used. The most commonly used is lidocaine. If the case is very severe, then it is necessary to perform electrical stimulation of the atria, which makes heart contractions less frequent. Electrical pulse therapy can also be performed.
Seizure prevention
To take the right actions to prevent attacks, it is necessary to take into account the form of paroxysmal tachycardia, its frequency and causes. If attacks occur rarely, then the patient needs to maintain a healthy lifestyle, give up alcohol and smoking, and also eliminate physical and mental stress as much as possible.
When frequent attacks are observed, then drug treatment with drugs is used. If tachycardia is directly related to heart disease, this very disease must be actively treated.
Types of paroxysmal tachycardia
Paroxysmal tachycardia can be supraventricular and ventricular. The cause of supraventricular tachycardia is most often nervousness. In this case, the heart contracts at a speed of 180-260 beats per minute. Ventricular appears in heart disease. With this type of tachycardia, the heart contracts at a speed of 140-200 beats per minute.
Symptoms of supraventricular paroxysmal tachycardia:
Paroxysmal tachycardia
Paroxysmal tachycardia is one of the types of arrhythmia, which is characterized by attacks of palpitations (paroxysms) with a heart rate from 140 to 220 or more per minute. They arise under the influence of ectopic impulses, leading to the replacement of normal sinus rhythm
Causes of paroxysmal tachycardia
There are many reasons for the occurrence of paroxysmal tachycardia, the main ones are:
- Coronary heart disease Arterial hypertension Myocardial infarction Heart defects Cardiomyopathies
Symptoms of paroxysmal tachycardia
An attack of such tachycardia always has a sudden onset and the same ending, and the duration can vary from several seconds to several days.
The onset of paroxysm feels like a shock in the heart area, which turns into increased heartbeat. The heart rate during paroxysm can reach 220 or more beats per minute, while the rhythm is maintained. The attack may be accompanied by noise in the head, dizziness, and a feeling of constriction of the heart. Some patients complain of nausea, bloating, sweating and even a slight increase in body temperature. At the end of the attack, increased urine output is noted.
A prolonged attack of paroxysmal tachycardia can lead to a decrease in blood pressure, severe weakness and fainting.
Diagnosis of paroxysmal tachycardia
The diagnosis of paroxysmal tachycardia can be made on the basis of the clinical picture - a typical attack with a sudden onset and end, with an increase in heart rate.
When recording an ECG during an attack, characteristic changes in the shape and polarity of the P wave and its location relative to the ventricular QRS complex are determined - these signs allow the doctor to distinguish the form of paroxysmal tachycardia.
If the attack cannot be detected by electrocardiography, 24-hour ECG monitoring is prescribed, which records short episodes of paroxysmal tachycardia that the patient himself does not feel.
In some cases, recording of an endocardial electrocardiogram is prescribed by intracardiac insertion of electrodes.
To exclude organic pathology of the heart, ultrasound of the heart, MRI or MSCT of the heart is prescribed.
What can you do
Quit alcohol and smoking, lead a healthy lifestyle.
What can a doctor do?
As an emergency treatment during attacks of paroxysmal tachycardia, intravenous administration of universal antiarrhythmics, effective for all forms of paroxysms, is indicated. In case of prolonged paroxysms in the absence of effect from conservative treatment, electrical pulse therapy is prescribed.
Prescription of anti-relapse antiarrhythmic treatment of tachycardia is made taking into account the frequency and tolerability of attacks. The selection of the drug and dosage is carried out under the control of the patient’s well-being and ECG.
The use of β-blockers in the complex treatment of paroxysmal tachycardia can reduce the likelihood of the transition of the ventricular form to ventricular fibrillation, a life-threatening condition.
In severe cases and in the absence of effect from conservative treatment, surgical intervention is prescribed - cryogenic, electrical, mechanical, laser and chemical destruction, radiofrequency ablation (RFA of the heart), implantation of pacemakers with programmed modes.
Prevention of paroxysmal tachycardia
Prevention of attacks of paroxysmal tachycardia against the background of heart pathology requires timely diagnosis and treatment of the underlying disease. It is important to exclude provoking factors, such as mental and physical stress, alcohol and smoking, and overeating.
The doctor may prescribe sedative and antiarrhythmic anti-relapse drugs, surgical treatment of tachycardia.
Prevention and treatment of tachycardia
Since tachycardia is not an independent disease, but is associated with some organic damage to the heart muscle, treating it alone is not very effective. Therefore, the first thing to do when treating tachycardia is to find the cause of its occurrence and, accordingly, determine a method for treating the disease that led to the development of tachycardia. If it is coronary heart disease, select a set of medicinal and physiotherapeutic measures for its treatment; if myocarditis or pericarditis, conduct a course of antibacterial and anti-inflammatory therapy; if it is a matter of a person’s lifestyle, conduct psychological rehabilitation, convince people to stop drinking caffeine and alcohol, and reduce the stress factor. in life.
Treatment of tachycardia
Treatment of tachycardia itself, without regard to the possible causes of its occurrence, is carried out in emergency situations - when tachycardia threatens to develop into a life-threatening arrhythmia. In this case, medications are selected depending on the form of tachycardia: for example, for atrial tachycardia, drugs of the verapamil group (isoptin, obzidan, strophanthin) show the greatest effectiveness, and for ventricular tachycardia - lidocaine. There are also drugs with universal action (for example, quinidine, cordarone, novocainamide).
In some cases (for example, if paroxysmal tachycardia appears during myocardial infarction), planned electrical defibrillation of the heart is performed. It is carried out in the same way as an emergency one (two electrodes are placed on the chest and voltage is applied to them), with the difference that the patient is first given painkillers. This is not the safest procedure, and it is used mainly if there is no effect from the administration of drugs.
With frequent recurring severe attacks of tachycardia and tachyarrhythmia, it also makes sense to think about implanting a pacemaker that can monitor the heart rhythm constantly or turn on “on demand” - when the rhythm goes beyond predetermined parameters.
In general, paroxysmal tachycardia is considered as a symptom of a deteriorating condition: the main danger of tachycardia is not an increase in heart rate as such (although this can be quite dangerous under certain circumstances), but that this increase can transform into a life-threatening arrhythmia.
Prevention of tachycardia
Prevention of paroxysmal tachycardia, as well as treatment, by and large consists of regularly taking antiarrhythmic drugs and drugs that lower the heart rate, as well as treating the underlying disease.