Paroxysmal tachycardia is a sharp and sudden acceleration of the heartbeat. It is associated with the influence of an ectopic focus, which generates impulses for myocardial contraction.
Causes and types
Paroxysmal tachycardia occurs during cardiac infarction, myocarditis. The etiology of the development of this pathology includes cardiomyopathies and hypertension. In addition, paroxysmal tachycardias develop without organic damage to the myocardium. So, they can be observed with abuse of coffee or alcohol, with hormonal disorders.
The following types of heart rhythm disturbances are distinguished:
- supraventricular - characterized by the formation of an ectopic focus in the atrioventricular node or in the atria (paroxysmal atrial tachycardia);
- if additional impulses come from the ventricles, this indicates the development of a ventricular paroxysmal heart rhythm.
Clinical manifestations
An attack of such tachycardia appears and disappears suddenly. It lasts from a few seconds to several days. The patient experiences a sudden shock in the heart area, which turns into pronounced palpitations and discomfort in the chest. Sometimes patients report heart pain and shortness of breath. Quite often, paroxysmal tachycardia is accompanied by general weakness and dizziness. Sometimes there is an increase in blood pressure, a feeling of shortness of breath, or excessive urination may occur after the end of the attack.
Less commonly, with paroxysmal tachycardia, neurological symptoms in the form of aphasia and hemiparesis are observed. There may also be manifestations of autonomic dysfunction. Patients complain of nausea, sweating, and flatulence. After an attack, polyuria is characteristic, urine is excreted of low density. Prolonged paroxysmal tachycardia is manifested by a decrease in blood pressure, weakness and loss of consciousness.
Treatment
With paroxysmal tachycardia, you can try to eliminate the attack using reflex methods. So, you can massage the carotid sinus area, hold your breath and immerse your face in cold water for 30 seconds, inflate a balloon, or press the eyeballs with moderate force.
Drug therapy includes taking special medications. The most commonly prescribed drugs are “Novocainamide”, “Propafenone”, “Amiodarone”, “Verapamil”. If pharmacological treatment is ineffective, electrical defibrillation is resorted to, especially in cases where arrhythmic collapse develops.
When severe paroxysmal tachycardia occurs, surgery is effective because it involves isolating or directly removing the ectopic lesion in the heart. Surgical treatment is also indicated for frequent relapses of the disease and ineffectiveness
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.
The term “paroxysmal tachycardia” was first used in medical literature in 1900. This is one of the types of rapid heartbeat, which is characterized by attacks of sporadic increases in rhythm up to 140-220 or more beats per minute. Paroxysm in medicine means an aggravated, intensified attack of the disease.
Paroxysmal tachycardia is a serious pathology
General concepts
Attacks (paroxysms) of tachycardia occur under the influence of ectopic centers formed in any part of the electrically conductive fibers of the myocardium.
Sudden attacks of paroxysmal tachycardia (PT) have an unexpected beginning and an equally unexpected end, varying in duration with a regular rhythm. The term “ectopia” means the occurrence, formation out of place. Ectopic impulses are generated:
- in the atria,
- in the ventricles,
- in the area of the atrioventricular junction.
With a sudden increase in heart rate, the heart works wastefully, blood circulation through the vessels is irrational, which leads to incomplete blood circulation.
Classification of pathology
Depending on the source of impulse formation, such tachycardias are divided into the following types:
- atrial, that is, excitation occurs in one of the two atria;
- atrioventricular, or atrioventricular. With such a PT, the impulse originates in the atrioventricular node;
- ventricular
There are different types of paroxysmal tachycardia
Atrial and atrioventricular tachycardias combine into a supraventricular or supraventricular form.
The nature of the course differs:
- acute, characterized by a short attack of paroxysm;
- chronic, called in cardiology constantly recurrent,
- a recurrent form that lasts for years, then subsiding, then resuming again.
Tachycardias differ in the mechanism of progression:
- reciprocal (returning, pendulum);
- orthodromic (in which the impulse moves in the normal given direction);
- focal;
- multifocal.
The nature and shape are influenced by the causes that cause heart rhythm disturbances.
Reasons for the development of deviation
In pathology, a disorder in the conduction of electrical impulses is observed. An attack of increased heart rate can last from several seconds to several days and is accompanied by disruption of the atrioventricular (atrioventricular) node. This disorder results in the heart having only one path for conducting electrical signals – through the ventricles. As a result, the electrical impulse is carried out faster than is necessary for the normal functioning of the circulatory system.
One form of tachycardia is atrial fibrillation
Paroxysmal atrial tachycardia includes the following heart rhythm pathologies:
- atrial fibrillation, also known as atrial fibrillation. This is frequent and unsystematic excitation and contraction of the atria;
- multifocal atrial tachycardia, caused by multiple formation of impulses from several foci simultaneously;
- atrial flutter;
- Wolff-Parkinson-White syndrome, observed more on the ECG than felt physically. The cause of its occurrence is pre-excitation of the ventricles.
There are many reasons for the occurrence and development of PT. The factors presented in the table influence heart palpitations.
| Causes of supraventricular paroxysm | Causes of ventricular paroxysm |
|---|---|
| Congenital and hereditary features - the presence of additional pathways in the heart | Chronic forms of coronary heart disease |
| Taking medications - antiarrhythmic and glycoside, such as Digoxin, Quinidine Strophantine, Propaferon, Korglykon, etc. More precisely, their overdose leads to PT | Myocardial infarction |
| Neurogenic disorders such as | |
| neurasthenia, neurosis | |
| Ulcerative lesions of the gastrointestinal tract | Myocarditis of any nature and origin |
| Cholecystitis and gastritis | Myocardial damage with cardiac rhythm and conduction disturbances |
| Abuse of alcohol, smoking tobacco and especially hookah | Metabolic disorders in the heart muscle leading to cardiomyopathy or cardiomyodystrophy |
| Hyperthyroidism, or overactive thyroid gland | Electrocardiographic syndrome, or Brugada syndrome, is dangerous because it can lead to sudden cardiac arrest |
| Neoplasms in the adrenal glands (pheochromocytoma), provoking increased production of adrenaline and norepinephrine | Congenital heart defects |
| Any serious illness that leads to weakening, intoxication, electrolyte imbalance | Cardiosclerosis of a focal nature (after a heart attack) and diffuse (general, widespread) |
| Kidney or liver failure | |
| Stress and increased emotionality | |
| Excessive exercise | |
| Hypertension |
Thus, supraventricular paroxysms are generally provoked by pathological changes in the body, and ventricular paroxysms are provoked by various organic lesions of the heart.
Clerk-Levy-Christesco syndrome is not common,
Not the least important factor in the causes of tachycardia is the influence of congenital pathogenic factors. This is a syndrome of ventricular preexcitation, called Clerk-Levy-Christesco syndrome. Pathology can make itself felt at any age. Its essence lies in the fact that the electrical impulse leads to premature excitation of the ventricles and returns back.
The frequency of this pathology is observed in 0.1-0.3% of the population and is the second most common cause of tachycardia with supraventricular localization.
Clinical manifestations of pathology
Symptoms of paroxysmal tachycardia are heterogeneous. The first sign of a beginning attack of paroxysmal increased rhythm is a shock in the heart, which is then accompanied by a feeling of squeezing and chest pain, shortness of breath.
Sometimes, with sudden tachycardia, a slight malaise occurs. With a prolonged attack of tachycardia, which can last up to several days, congestion in the liver is observed. Sometimes during an attack the following symptoms are observed:
- dizziness;
With tachycardia, tinnitus may occur
- a feeling of constriction in the region of the heart;
- signs of VSD.
After the attack is over, polyuria (leakage of a large amount of urine) is observed, blood pressure drops, even to the point of fainting. Attacks of PT are more severe in patients with concomitant cardiopathy. For example, ventricular tachycardia develops in the presence of serious heart disease, and therefore its prognosis is difficult.
Tachycardia in children
For children under 8 years of age, a physiological increase in heart rate is normal. Paroxysmal tachycardia in children is extremely rare and can pose a threat to the life and health of the child if congenital heart pathologies occur. Tachycardias that develop as a result of an infectious disease, intoxication or bleeding are also dangerous.
Tachycardia is also rarely detected in the prenatal period, and the reason for this is usually infectious diseases of the mother, abnormalities in the development of the fetus, or its incorrect position during gestation.
In adolescence, tachycardia is observed due to hormonal changes in the body. As your teen gets older, the symptoms of a fast heart rate will subside.
Deviation during pregnancy
Paroxysmal tachycardia during pregnancy is complicated by an increase in the frequency of attacks. Tachycardia can pose a threat to both the pregnant woman and her unborn child, so the woman should be under medical supervision throughout pregnancy.
In pregnant women, tachycardia requires proper and timely treatment
Medicines may have a different pharmacological effect on a pregnant woman than would normally occur, and may also harm the developing fetus. The woman herself, having decided to bear a child with such a diagnosis, must understand the full degree of responsibility for her health and the health of the future person and follow all the instructions and prescriptions of the attending physicians: obstetrician, gynecologist, cardiologist.
Possible complications
Pathology cannot be treated indifferently, since its attacks are fraught with serious complications:
- myocardial infarction;
- heart failure;
- loss of consciousness.
If medical care is not provided, the attack can be fatal.
Diagnosis of deviation
Diagnosis of pathology is carried out in several stages. The patient himself can feel the onset of an attack by a characteristic shock in the heart area. When counting the pulse, which is performed by modern tonometers and heart rate monitors, you can notice an increase in heart rate. The blood pressure monitor will also show a drop in blood pressure.
You can monitor your heart rate using a heart rate monitor
A rapid heartbeat can be heard when listening to the heart with a stethoscope. In this case, the first blow has a popping character, and the second one is somewhat weakened.
The doctor will also read the rapid pulsation on the electrocardiogram. Paroxysmal atrial tachycardia on the ECG is characterized by the appearance of the P wave in front of the ventricular complex.
To determine the causes of PT, the following is carried out:
- ultrasonography;
- Magnetic resonance imaging;
- multislice computed tomography.
The doctor needs to know the causes of PT in order to prescribe differentiated treatment aimed at eliminating the root cause of the development of tachycardia.
From this video you can learn everything about this pathology:
Treatment of pathology
The choice of therapeutic methods for the treatment of paroxysmal tachycardia is carried out taking into account the following factors:
- forms of pathology;
- etiology (causes of the disease);
- frequency and duration of attacks;
- presence or absence of complications.
In most cases, the patient is prescribed hospitalization and treatment in a hospital. The occurrence of an attack of PT requires immediate medical assistance on site. The patient and his relatives should know that sometimes attacks of supraventricular PT can be stopped if the following measures are applied:
- Gently press the upper area of the eyeball several times;
- press in the area of the widening of the internal carotid artery, known as the carotid sinus;
- act on the root of the tongue and thereby provoke a vomiting reaction;
- wipe the patient with cold water.
All these measures act on the vagus nerve and are called vagal maneuvers. Sometimes they can become an emergency aid for tachycardia and ease the patient’s attack.
The main type of emergency care when an attack of PT occurs is the intravenous administration of antiarrhythmic drugs, such as Novocainamide, Aymalina Propranol, Quinidine, Rhythmodan, Ethmozin, etc.
Quinidine can be used to alleviate the condition.
If medications are unable to stop an attack, electropulse therapy is used. Electrical cardioversion is used as the most effective method of restoring cardiac sinus rhythm. Synchronized cardioversion is used for patients who have:
- symptoms of impaired blood supply to the heart muscle,
- pulmonary edema.
But if the patient has atrial fibrillation, cardioversion is not used to avoid the occurrence of blood clots in the heart area.
After hospital treatment, the patient with PT continues to be monitored on an outpatient basis by a cardiologist, who will determine the volume and regimen of antiarrhythmic therapy, depending on the frequency and tolerability of attacks. Continuous anti-relapse therapy is indicated for the following patients:
- those who experience PTs more than 2 times a month and require inpatient care to eliminate them;
- those who experience paroxysms less frequently, but they differ in duration and are complicated by the development of cardiovascular failure.
Treatment often involves surgery
Surgical treatment is used in particularly complex episodes of tachycardia, when anti-relapse therapy is powerless. Destruction (destruction) of additional foci of impulse conduction is carried out. Destruction can be mechanical, electrical, laser, chemical and cryogenic.
In order to suppress AT, a pacemaker is also implanted or an electrical defibrillator is implanted.
Prognosis for tachycardia
In general, attacks of the supraventricular form of PT do not pose a threat to the patient’s life. However, prolonged attacks of tachycardia, complicated by coronary atherosclerosis or damage to the heart muscle, lead to a deterioration in the blood supply to the myocardium and the appearance of unfavorable changes in it. The greatest danger is posed by ventricular tachycardia, which is observed in organic cardiac pathologies and can easily develop into a threatening form of ventricular atrial fibrillation.
Drug treatment for WPW syndrome is quite effective
The emergence of new antiarrhythmic drugs and electrical pulse therapy in clinical practice has qualitatively changed the prognosis in the treatment of PT. Cordarone therapy shows good results. With WPW syndrome, 90% of patients achieve stable remission (without serious adverse reactions).
The use of catheter electrical destruction, cryo- and laser destruction gives hope for a radical cure of focal AV tachycardias.
Paroxysmal tachycardia is a serious condition in which three or more narrow QRS complexes occur in a row (< 100 мсек) из верхних отделов проводящей системы миокарда и патологическое учащение сердечных сокращений от 140 до 250 ударов в минуту. Происходит такая реакция из-за повышение автоматизма клеток проводящей системы сердца — эктопических центров II и III порядка и повторного входа и кругового движения волны возбуждения (re-entry).
Paroxysmal tachycardia usually requires emergency care and arrest of the attack, followed by lifelong treatment. In the absence of competent assistance, the patient dies or becomes disabled with severe injuries. In order to notice a growing problem in time, it is important to know the signs of pathology and begin to eliminate them immediately.
The disease begins to manifest itself with the following signs:
- suddenly a person begins to feel a heartbeat, which quickly increases, exceeding 140 beats per minute, then also suddenly ends;
- dyspnea;
- dizziness;
- Quite often, patients note pain in the heart;
- in rare cases, symptoms such as aphasia and hemiparesis appeared;
- weakness, up to loss of consciousness;
- As soon as the attack is stopped, the patient notes the release of a significant amount of clear urine.
Attention! This pathology always begins and ends completely unexpectedly, and the attack can last from a couple of seconds to several days.
Symptoms of complicated paroxysmal tachycardia
Once the attack becomes prolonged, patients may also experience fainting and a significant drop in blood pressure. But conditions in which the number of heart beats exceeds 180 beats per minute are especially dangerous. With this type of paroxysmal tachycardia, ventricular fibrillation may begin.
Also, in severe conditions, patients experience pulmonary edema, cardiogenic shock, and poor nutrition of the heart muscle, which leads to the development of angina pectoris and myocardial infarction.
Attention! If patients have cardiac pathologies, emergency medical care is required. In such patients, the attack is always of a complicated type, which can cause rapid death.
Vagal maneuvers for paroxysmal tachycardia
Such techniques include several manipulations that should be repeated periodically until the ambulance arrives or the attack of tachycardia is relieved:
- The Valsalva test involves a manipulation in which the patient completely blocks the flow of air with his palms, placing them on his mouth and nose, and tries to exhale sharply (straining while holding his breath for 20-30 seconds), but deep breathing can also be useful;
- Aschner's test involves applying pressure with your fingertips to the eyeballs for 5 seconds;
- lowering your face into cold water for 10-30 seconds, which will reduce blood vessels and therefore calm your breathing and heart;
- induce vomiting by pressing on the root of the tongue;
- squatting;
- The Hering-Chermak test involves applying slight pressure to the area of the carotid artery.
Attention! Such methods can only support the patient’s condition, but do not in any way exclude seeking medical help even if the attack is quickly relieved. It can happen again in just a few hours.
Antiarrhythmic drugs for paroxysmal tachycardia
Sodium adenosine triphosphate (ATP)
When using the drug, there is a decrease in smooth muscle tone, normalization of the conduction of nerve impulses in the autonomic nodes, as well as transmission of excitation from the vagus nerve to the heart. Due to ATP metabolism, there is some suppression of Purkinje fibers and the sinus node. The drug is not prescribed to patients with acute myocardial infarction.
The drug is available in the form of a solution, which should be administered to the patient intramuscularly, intravenously or by infusion. The exact route of administration of the drug is determined by the doctor, taking into account the severity of the patient. When administered intramuscularly, the dose is calculated based on the patient’s weight; for each kilogram of body, he is prescribed 50 mg of the active substance. When administered intravenously, the dose is 100 mg; when administered intravenously, the patient receives treatment in the form of 500 mg. The exact daily dose and duration of administration is determined individually.
Isoptin
To relieve paroxysmal therapy, the patient may be prescribed 240-360 mg of the active substance. After eliminating the attack, you can take Isoptin tablets, and it is advisable to take the drug in the morning at a dosage of 240 mg. In severe cases of the disease against the background of arterial hypertension, the daily amount of the active substance can be increased to 480 mg of Isoptin. At these doses, your doctor may recommend dividing the dosage into morning and evening doses. Duration of treatment as directed by the attending physician.
Attention! This group of drugs is usually administered to quickly relieve an attack and its dangerous consequences such as angina pectoris and myocardial infarction.
Cardiac glycosides against tachycardia
Strophanthin
Strophanthin is a powerful glycoside that is used as an intravenous injection.
A fairly powerful glycoside that is used in the form of intravenous injections. Strophanthin solution should be prepared and injected only in a hospital setting, since constant monitoring of the patient’s condition is necessary. The dosage is selected individually, as is the frequency of taking the drug. The prepared solution is administered over a long period of time over 5-7 minutes, since faster administration threatens to put the patient in shock. If it is impossible to perform an intravenous injection, the patient is first injected with 5 ml of novocaine. After which the same needle is used to inject a medication diluted in an anesthetic.
Korglykon
The drug should be administered intravenously very slowly and in precise doses. Patients can be prescribed 10-20 ml of Korglykon twice a day. This applies to a solution of 20-40%. Higher concentrations of the drug should be administered once a day, and their amount should not exceed 1 ml at a time. The duration of therapy is determined only by the attending physician and is carried out exclusively in a hospital inpatient setting.
The drug has a special treatment regimen. First, the body is saturated with the active substance, taking 2-4 tablets of the medication. After this, every six hours the patient should be given one dose of the medication until the patient’s condition is stabilized. As soon as the necessary therapeutic effect has been achieved, the patient should be transferred to maintenance doses, which are selected individually for each core. Therapy continues as directed by the attending physician.
Attention! Glycosides can significantly reduce the risk of re-development of paroxysmal tachycardia, and therefore should be taken in individually selected doses. In this case, the administration must be carried out under ECG monitoring.
Beta blockers against tachycardia
Metoprolol
The medication has a positive effect on blood pressure and at the same time restores heart rhythm. To obtain an adequate therapeutic result, patients can be prescribed 100 mg of the active substance in the morning. If necessary, the dosage can be divided into two doses. If it does not produce results, it can be gradually increased to 200 mg of the drug. Intravenous administration of Metoprolol in an amount of 5 mg of the active substance is allowed. Duration of therapy as prescribed by the attending physician.
Anaprilin
In case of heart rhythm disturbances, patients are recommended to first take 0.02 g of the active substance three times a day. With normal tolerability of the drug, the dosage can be gradually increased to 120 mg of Anaprilin, also in two or three uses. The maximum permissible dosage in this condition is 240 mg. If it is exceeded, no pronounced effect occurs, and the patient experiences a large number of side symptoms, including bradycardia.
Betalok
A good drug that allows you to adjust your heart rhythm and equalize your blood pressure. To obtain the desired result and quickly alleviate the patient’s condition, he may be recommended to consume 0.1-0.2 g of the active substance. Reception is carried out 1-2 times a day on the recommendation of the attending physician. Betaloc is well tolerated in combination therapy and can be included in treatment with other antianginal agents. It is advisable to take the first dose before breakfast. Duration of therapy as directed by the cardiologist.
Attention! These medications can be taken without direct medical supervision, but only in tablet form.
Cost of drugs against paroxysmal tachycardia
| A drug | Image | Price in Russia in rubles | Price in Belarus in rubles | Price in Ukraine in hryvnia |
|---|---|---|---|---|
| 150 | 4,8 | 62 | ||
| Isoptin | 500 | 16 | 205 | |
| Strophanthin |
Heart rhythm disturbances are a common syndrome that occurs in people of all ages. According to medical terminology, an increase in heart rate to 90 or more beats per minute is called tachycardia.
There are several varieties of this pathology, but the greatest danger to the body is paroxysmal tachycardia. The fact that this phenomenon occurs in the form of sudden attacks (paroxysms), the duration of which varies from several seconds to several days, with even greater frequency, distinguishes arrhythmia of this kind from other cardiopathologies.
A type of arrhythmia in which attacks of increased heart rate exceed 140 pulses per minute is called paroxysmal tachycardia.
Such phenomena occur due to the occurrence of arrhythmic foci, provoking replacement of the activity of the sinus node. Bursts from an ectopic source may be localized to the atria, atrioventricular junction, or ventricles. Hence the names of the various forms of paroxysmal tachycardia: ventricular, atrioventricular or atrial.
General concept of the disease
It is necessary to understand that paroxysmal tachycardia causes a decrease in blood output and provokes circulatory failure. With the development of this pathology, blood circulation is defective, and the heart works harder. As a result of this dysfunction, internal organs may suffer from hypoxia. Various forms of such phenomena are detected in approximately a quarter of all examined patients during long-term ECG studies. Therefore, paroxysmal tachycardia requires treatment and control.
It has been proven that the development of congestive heart and cardiovascular failure is directly promoted by the long duration of an attack of tachycardia.
ICD 10 code
To classify and monitor the formation of cardiac pathological phenomena throughout the world, tachycardia is included in the international ICD system. The use of an alphanumeric coding system allows doctors in countries that are members of the World Health Organization (WHO) to systematize, monitor and treat a patient according to the type of disease coded.
The classification system makes it possible to determine morbidity, treatment methods, cure and mortality statistics in different countries at any time. Such coding ensures the correct execution of medical documentation and allows you to keep track of morbidity among the population. According to the international system, the code for paroxysmal tachycardia according to ICD 10 is I47.
Paroxysmal tachycardia on ECG
Ventricular pathology, which causes increased heart rate, is characterized by premature contraction of the ventricles. As a result, the patient experiences a feeling of heart failure, weakness, dizziness, and lack of air.
Ectopic impulses in this case come from the bundle and legs of His or from peripheral branches. As a result of the development of pathology, damage to the ventricular myocardium occurs, which poses a danger to the patient’s life and requires emergency hospitalization.
Occurs in the form of a sudden outbreak of arrhythmia with a heart rate of 160 to 190 pulsations per minute. It ends as unexpectedly as it begins. Unlike ventricular, it does not affect the myocardium. Of all, this pathology has the most harmless course. Often the patient himself can stop the occurrence of attacks with the help of special vagal maneuvers. However, in order for paroxysmal supraventricular tachycardia to be accurately diagnosed, consultation with a cardiologist is necessary.
Supraventricular arrhythmia is a less dangerous pathology with a more favorable prognosis. However, diagnosis and treatment of this disease must be carried out by a qualified specialist - a cardiologist.
Atrial
Supraventricular tachycardia, the ectopic focus of which forms in the myocardium, is called atrial. Such cardiac pathologies are divided into “focal” and so-called “macro-re-entry” arrhythmias. The latter type can also be called atrial flutter.
Focal atrial paroxysmal tachycardia is caused by the occurrence of a source in the local area of the atria. It can have several foci, but all of them most often arise in the right atrium, in the ridge border, interatrial septum, in the tricuspid valve annulus or in the ostium of the coronary sinus. On the left, such pulsating lesions rarely occur.
Unlike focal, “macro-re-entry” atrial tachycardias occur due to the appearance of circulation of flutter waves. They affect areas around large cardiac structures.
Atrioventricular
This pathology is considered the most common among all forms of paroxysmal tachycardia. It can occur at any age, but is most often observed in women aged 20–40 years. Atrioventricular paroxysmal tachycardia is provoked by psycho-emotional states, stress, fatigue, exacerbation of diseases of the gastric system or hypertension.
In two out of three cases, rapid heartbeat occurs according to the re-entry principle, the source of which is formed in the atrioventricular connection or between the ventricles and the atrium. The occurrence of the latter phenomenon is based on the mechanism of abnormal automatism with the localization of the arrhythmogenic source in the upper, lower or middle zones of the node.
AV nodal reciprocal
AV nodal reciprocal paroxysmal tachycardia (AVNRT) is a type of supraventricular arrhythmia, the occurrence of which is based on the re-entry principle. As a rule, the heart pulsation rate in this case can vary between 140–250 beats per minute. This pathology is not associated with heart disease and occurs more often in women.
The onset of such an arrhythmia is associated with the extraordinary entry of an excitation wave formed by the fast and slow pathways in the AV node.
Causes
The process of development of arrhythmia provoked by paroxysm is very similar to the manifestations of extrasystole: similar disturbances in the rhythm of the heartbeat caused by extraordinary contractions of its parts (extrasystoles).
However, in this case, the supraventricular form of the disease is caused by the motility of the nervous system, and the ventricular form is caused by anatomical ailments of the heart.
Paroxysmal ventricular tachycardia causes the formation of an arrhythmic pulsar in the ventricular zones - in the bundle and legs of His or Purkinje fibers. This pathology is more often observed in older men. Heart attacks, myocarditis, and heart defects can also be the root cause of the disease.
The appearance of this pathology is facilitated by congenital “extra” impulse pathways in the myocardium, which contribute to unwanted circulation of excitation. The causes of paroxysmal tachycardia are sometimes hidden in the occurrence of longitudinal dissociation, which provokes uncoordinated work of the fibers of the AV node.
Children and adolescents may experience idiopathic paroxysmal tachycardia, which occurs for unknown reasons. Nevertheless, most doctors believe that such a pathology is formed against the background of the child’s psycho-emotional excitability.
Symptoms
Paroxysmal tachycardia occurs unexpectedly and also ends suddenly, and has a different time duration. This kind of arrhythmia begins with a noticeable shock in the heart area, and then a rapid heartbeat occurs. In different forms of the disease, it can reach 140–260 beats per minute, while maintaining the correct rhythm. Usually, with arrhythmias, noise in the head and dizziness occur, and when they continue for a long time, a decrease in blood pressure occurs, and a feeling of weakness develops, even to the point of fainting.
Supraventricular paroxysmal tachycardia develops with manifestations of autonomic disorders and is accompanied by sweating, nausea and mild fever. When the outbreak of arrhythmia ceases, patients may experience polyuria with the separation of light urine.
Ventricular pathology most often develops against the background of heart disease and does not always have an unfavorable prognosis. During an arrhythmic crisis, the patient experiences hemodynamic disturbances:
- cardiac output decreases;
- blood pressure in the left atrium and pulmonary artery increases.
Every third patient experiences regurgitation of blood from the left ventricle into the left atrium.
The main factor in the severity of the disease is the stability and lability of the pathological process during a crisis.
Signs on ECG
Paroxysmal tachycardia during an ECG during an arrhythmic crisis causes certain changes in the type, polarity of the P wave and its displacement relative to the combination of QRS readings. This allows us to identify the form of pathology.
Sinus paroxysmal tachycardia - refers to the supraventricular form of arrhythmias. This pathology is characterized by an increase in the number of contractions of the heart muscles. Such heartbeats can exceed the norm for a given age several times. An arrhythmic source of cardiac pathology of this kind is formed in the sinoatrial node, which is essentially the coordinator of heart pulsation.
Paroxysmal atrial tachycardia on the ECG is characterized by the presence of a convex or concave P wave before the ventricular QRS readings. If the P protrusion merges with the QRS or is depicted after it, then the cardiogram indicates a paroxysm, the source of which is in the atrioventricular node.
The clinical picture of the atrioventricular or otherwise AV nodal type of tachycardia is very similar to the manifestations of the atrial form. A feature of this type of disease is the presence of a negative P protrusion on the ECG.
Ventricular paroxysmal tachycardia on the ECG has the following signs:
- a wider range and change in QRS indicators, the configuration of the line resembles a branch block;
- the dissociation of the functions of the atria and ventricles is clearly expressed.
If signs of paroxysmal ventricular tachycardia were not recorded on the ECG, then daily monitoring is carried out with a portable electrocardiograph, recording even minor manifestations of pathology that the patient may not feel.
Treatment
The tactics for improving the health of patients suffering from symptoms of paroxysmal tachycardia are determined by the form of cardiac pathology, the reasons for its occurrence, the frequency and temporary continuation of arrhythmias, and the presence of complicating factors.
In cases of idiopathic attacks with a harmless development and the possibility of relief, hospitalization is usually not required.
In case of manifestations of supraventricular tachycardia, it is advisable to admit the patient to a hospital only in the event of the formation of cardiac or vascular insufficiency. For ventricular forms of paroxysmal tachycardia, emergency care is necessary.
Sometimes outbreaks of arrhythmia can be stopped at home; for this, so-called vagal tests are performed. Similar techniques include:
- pushing;
- an attempt to exhale sharply with the nose plugged and the mouth closed;
- equal pressure on the upper part of the eyeball;
- moderate pressure in the area of the carotid artery;
- wiping with cold water;
- induce vomiting by pressing two fingers on the root of the tongue.
However, such methods only work in cases of supraventricular arrhythmias, so the main way to stop an attack is the administration of antiarrhythmic drugs.
The patient is routinely sent to the hospital if the frequency of attacks occurs more than twice a month. In a hospital setting, an in-depth study of the symptoms of paroxysmal tachycardia is carried out. Treatment is prescribed only after a complete examination.
Emergency care for paroxysm
The onset of an arrhythmic crisis requires the adoption of emergency measures on the spot: the specific condition of the patient will make it possible to accurately determine what it is. Paroxysmal tachycardia, the treatment of which requires medical intervention, at the initial manifestation causes a call to the cardiology team of doctors. In case of secondary and subsequent exacerbations, the patient must urgently take the medicine that stopped the attack the first time.
As an emergency, intravenous administration of universal antiarrhythmic drugs is recommended. This group of drugs includes: quinidine bisulfate, disopyramide, moracizine, etacizine, amiodarone, verapamil, etc. If the crisis cannot be localized, then electrical pulse therapy is performed.
Forecast
Prolonged attacks of arrhythmia, in which the heart rate reaches 180 or more pulsations per minute, can cause ventricular fibrillation, acute heart failure, and heart attack.
People who have shown signs of ventricular paroxysmal tachycardia on an ECG should be observed by a cardiologist on an outpatient basis. Prescription of continuous anti-relapse therapy is mandatory for people who have attacks of heart palpitations two or more times a month.
Patients who experience short attacks of supraventricular arrhythmias that resolve on their own or with the help of vagal methods do not need continuous therapy.
Long-term treatment of ventricular paroxysmal tachycardia is carried out with antiarrhythmic drugs in combination with cardiac glycosides (digoxin, lanatoside). The treatment regimen allows the use of. The determination of the drug and its dosage is carried out under the control of the patient’s personal assessment of his condition and an ECG.
Features of the course in children
Paroxysmal tachycardia occurs in children as often as in adults. The reasons for its appearance are usually:
- disruptions in the activity of the nervous system;
- endocrine diseases;
- cardiological pathologies and heart defects;
- the presence of intrauterine hypoxia, asphyxia;
- some blood diseases, changes in its electrolyte composition, the presence of anemia in the child;
- stress and strain during study;
- dehydration.
Due to these and, possibly, a number of other reasons, an infant, even in infancy, can develop both ventricular and paroxysmal supraventricular tachycardia. Treatment in both cases should be carried out in a hospital, under the supervision of doctors. You should contact a specialist if symptoms such as:
- cardiopalmus;
- increased breathing and shortness of breath;
- pallor and bluishness of the skin (especially in the area of the nasolabial triangle);
- isolation of jugular arteries and veins;
- frequent urination, nausea and vomiting.
Symptoms of heart rhythm disturbances in a child appear unexpectedly and also disappear unexpectedly. In this case, the duration of the attack can be either several seconds or several hours. In any case, you need to urgently call a cardiology ambulance team.
Attacks of heart palpitations may have a gradual increase in heart rhythms. In this case, the culprit of the pathology most often becomes non-paroxysmal tachycardia. Such phenomena are formed due to a gradual increase in the activity of centers of automaticity located in the atria, atrioventricular junction or ventricles. If the ectopic source of arrhythmia occurs in the sinoatrial junction, then this phenomenon is called sinus non-paroxysmal tachycardia.
conclusions
- Any heart disease is a dangerous harbinger that should not be left to chance.
- In any form (ventricular or atrial), treatment of paroxysmal tachycardia should be mandatory.
- All pathologies associated with cardiac activity must be diagnosed by a cardiologist.
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