Nadzheludochkovaya tachycardia

Supraventricular or supraventricular tachycardia refers to the type of cardiac arrhythmia caused by primary disorders with regulation of contraction frequency (more than one hundred beats per minute), problems of electrical impulses.

Such a disease is found in children, it is often hereditary, genetic pathology.

There are the following types of supraventricular tachycardia:

• atrial;
• arrhythmia associated with WPW syndrome;
• atrial flutter;
• atrial-ventricular nodal disorder.

Such arrhythmias are diseases bordering between potentially dangerous (sometimes fatal) and benign abnormalities from the rate of heart rhythm. Physicians note a more favorable course of this tachycardia.

Causes of supraventricular tachycardia

Prerequisites for the development of functional tachycardia in adolescence, childhood are: disturbances, strong emotions, nervous stress, stress.

In adult patients, cardiac arrhythmia develops against a background of nervous disorders and an unstable emotional state. Often, arrhythmia provocators are climacteric changes, neurasthenia, concussion, neurocirculatory disorders. Failures of the functioning of the departments of the gastrointestinal tract, kidneys, gall bladder and diaphragm can also become a trigger mechanism, negatively affecting the work of the heart muscle. Provoke an attack capable of some pharmacological drugs, such as quinidine or novocainamide. Very dangerous is an overdose of glycosides, which can lead to death of the patient.

The causes of supraventricular tachycardia lie in concomitant heart diseases, which often precede the onset of seizures. So in younger patients, pathology can indicate congenital malformation of the conductive pathways - the Wolff-Parkinson-White syndrome. Prolonged, often recurring infections, hypertension and thyrotoxicosis are factors that provoke a pathological condition.

The presence of negative addictions, such as smoking, the use of alcohol, caffeine, narcotics at times increase the risk of tachycardia.

[1], [2], [3], [4]

Symptoms of supraventricular tachycardia

A tachycardia attack, lasting up to several hours, is characterized by a rapid and even heartbeat. The disease affects people of any age group, but more often the pathology is diagnosed in childhood or adolescence.

As a rule, the symptoms of supraventricular tachycardia are noted suddenly. They include:

• acceleration of contractile activity of the heart;
• pain syndrome (compression) of the neck or chest;
• dizziness;
• fainting;
• anxiety, panic attacks.

Prolonged seizures cause signs of cardiovascular failure: swelling, pale-cyanotic areas of skin on the face, hands or feet, problems with the implementation of inspiration. Lowering blood pressure is another sign of tachycardia. Persons with low blood pressure, in turn, are most affected by the appearance of this arrhythmia. This is due to the fact that the organism of the hypotonic tries to normalize the blood supply to the organs by increasing the number of cardiac contractions.

Quite often the disease develops asymptomatically. But even episodic attacks have a negative effect on the entire body, which is due to insufficient intake of blood into the organs due to inefficient pumping by the heart muscle.

Danger appears only with concomitant heart diseases. In view of the sudden appearance of seizures, the patient's quality of life is significantly reduced. The patient is in constant tension, not knowing when the next deterioration of the state will happen and how heavy it will be.

Paroxysmal supraventricular tachycardia

By paroxysmal tachycardia is understood as an unexpected increase in the rate of contractile activity of the heart (150-300 beats per minute) noted in the upper divisions. Seizures are associated with impaired circulation of the pulse or the appearance in the heart muscle of the zones that provoke a tachycardia. As a rule, young people are more prone to pathology. And a sudden malaise can disappear automatically after a few seconds or days.

Paroxysmal supraventricular tachycardia can have the following symptoms:

• spontaneous, sharp acceleration of the heartbeat, which passes by itself;
• discomfort in the heart;
• fatigue, fatigue;
• the appearance of shortness of breath;
• a state of causeless anxiety;
• signs of nausea;
• dizzy, fainting;
• frequent urge to urinate.

Allocate heart and non-cardiac causes of the disease. Among cardiac factors:

• vices / features of an innate nature (appear in the process of intrauterine development);
• problems of reducing contractility (heart failure);
• acquired defects (changes in the structure) of the heart;
• presence in the anamnesis of an inflammation (a myocarditis) or disturbances of structure and functions (cardiomyopathy) of a cardiac muscle.

Not related to cardiac activity, disease:

• pathology of the endocrine type;
• pulmonary embolism;
• bronchopulmonary diseases;
• disorders of the autonomic nervous system.

The pathology of the paroxysmal species can be provoked by a number of negative habits, namely:

• impact of stress;
• Abuse of tobacco and alcoholic beverages;
• excessive physical loading;
• caffeine consumption.

Paroxysm of supraventricular tachycardia

Paroxysm of supraventricular tachycardia is formed in the case of the location of a lesion in the atria or atrioventricular junction. And attacks of an arrhythmia happen not on a regular basis, and only under the influence of irritating factors.

Paroxysm is realized by two mechanisms:

• Detection of excitation center in atrial tissues. The impulse rhythm in the sinus node is lower, therefore normal contractile activity is replaced by a pathological one;
• there are problems associated with changing the structure of the conducting system. The presence of additional pathways for the passage of a nervous excitation pulse, forming Re-entry is the clear cause of the paroxysm of tachycardia.

The causes of the pathological condition are:

• activation of nervous excitability as a result of fright, stress;
• hypersensitivity of cardiac muscle receptors to the group of catecholamines;
• presence of heart defects;
• infringements of a congenital species with a structure of conducting ways;
• organic dysfunction (infection, dystrophy, ischemia);
• changes due to toxic damage to drugs, alcohol and other substances.

Running through the supraventricular tachycardia

Supplements of supraventricular tachycardia are divided into:

• bigemniyu - alternation of one extrasystole and one rhythm of contractions;
• bigemniyu and aberrant extrasystole - blockade of the bundle of the bundle of Guiss on the right or so-called ears V1, V2;
• trigeminia - repeat of two QRS complexes with one extrasystole;
• insertion extrasystole - an increase in the PQ segment following the extrasystole, which has some differences from the normal values of neighboring complexes;
• blocked extrasystoles - the end of the T-wave on the second complex shows premature appearance of the P-wave, but because of refractivity, excitation to the ventricles is not performed;
• a series of blocks of extrasystoles of the type bigemini - P-wave, following the T-wave of the previous complex, is visible on the cardiogram.

Diagnosis of supraventricular tachycardia

The disease can be suspected based on the patient's complaints, which marks the primary disruption of the heart, shortness of breath, a pressing feeling in the chest, does not tolerate the load and is perplexed about the constant weakness, nausea, dizziness. The doctor complements the anamnesis with information about cardiac pathologies in close relatives and cases of sudden deaths with physical activity.

Diagnosis begins with a physical examination, revealing excessive body weight, skin problems, jumps in blood pressure. Be sure to conduct laboratory tests of blood and urine. A blood test for biochemistry gives an idea of the level of cholesterol and triglycerides, the content of sugar and potassium.

The main diagnosis of supraventricular tachycardia is electrocardiography. Daily monitoring of the activity of the cardiac muscle by means of a cardiogram fixes seizures (including the onset and termination of the pathological condition) that the patient himself does not feel allows to assess the nature, severity of arrhythmia.

The technique of transesophageal stimulation of the heart serves to clarify the development of paroxysmal tachycardia, as well as to differentiate pathology in patients with rare seizures, which the electrocardiogram does not record.

[5], [6], [7], [8], [9], [10], [11]

Nadzheludochkovaya tachycardia on the ECG

Re-entry in the AV node zone (nodal reciprocal arrhythmia) accounts for more than half of the cases of supraventricular tachycardia. Nadzheludochkovaya tachycardia on the ECG, as a rule, does not give a QRS-deformation. Often, the re-entry of the atrioventricular node leads to an increase in the heart rate. Moreover, a tachycardic attack is characterized by simultaneous ventricular and atrial excitation, and P-teeth are combined with QRS and are invisible on the cardiogram. At blockade, the impulse is interrupted at the very atrioventricular Re-entry node. The blocking of the bundle of the Hisnus or from below it does not affect the tachycardia. Such blockages occur rarely even in young patients.

Arrhythmia with Re-entry of the sinus node area is not common. In this case, the P-wave arrhythmia and sinus curve coincide in shape.

A small percentage of cases of tachycardia are manifested as a result of Re-entry in the atrial zone. The tooth P is recognized in front of the QRS complex, which indicates an anterograde transfer of the pulse between the atria.

Treatment of supraventricular tachycardia

Treatment of supraventricular tachycardia is carried out conservatively and surgically. Conservative therapy includes:

• prevention of tachycardia with antiarrhythmic drugs prescribed by a cardiologist;
• relief of attacks by intravenous injection of antiarrhythmic substances or electropulse action.

As a supportive anti-relapse therapy, antiarrhythmic drugs, as well as glycosides, are prescribed. Dosage and the drug itself are detected by experiment, taking into account the efficacy, toxicity and pharmacokinetic characteristics of the drug. Violation of the rhythm of the heart paroxysmal type is treated with amiodarone only if other agents are ineffective, taking into account side effects. For long-term maintenance treatment are suitable: sotalol, diltiazem, etatsizin, quinidine, verapamil, etc.

Indication for surgical intervention is:

• Increases in seizures and their severity;
• the presence of tachycardia even when taking special drugs;
• professional activity is associated with a health risk due to loss of consciousness;
• conditions in which drug therapy is not possible (for example, young patients).

Surgical treatment is understood as the method of radiofrequency ablation, i.e. Recognition and elimination of the source of pathology. To this end, an electrode is introduced into a large vein and the pathological focus is treated with a high-frequency current. If there are several sections, then the procedure is repeated. Therapy is expensive and has a number of complications, including dilatation of the ventricles or atria, which will require the installation of a pacemaker. But even this does not stop patients who are in constant fear of another bout.

Suppression of supraventricular tachycardia

Arrhythmia in severe form with frequent attacks requires treatment in a hospital setting where antiarrhythmic agents and oxygen are administered . Particularly difficult cases are amenable to therapy with electropulse and radiofrequency action, which normalizes the rhythm of the heart.

Suppression of supraventricular tachycardia of a short-term nature can be carried out independently by massaging the neck region above the carotid artery. As practice shows, rubbing movements stimulate the vagus nerve, allowing thereby to control the heart rate. Fight with an attack without qualified care should not be given to patients who reached the age of 50 (the risk of stroke is high). Washing with ice water followed by a stiffening, like with defecation, tipping over the head, an ice collar around the neck and pressure on the eyeballs, are also capable of arresting a tachycardia attack.

It should be noted that for massaging the neck and pressing on the eyes, a person must have medical skills, since incorrect performance is quite traumatic.

It is recommended to start the drug stopping of an attack with beta-blockers (bisoprolol, atenolol, etc.). If the drug was ineffective, it is not advisable to use a drug from the same group. Often, combinations of beta-blockers with antiarrhythmics are used. Such therapy allows to reduce the dosage of active components while preserving the effectiveness of treatment.

Emergency care for supraventricular tachycardia

Emergency care for supraventricular tachycardia is the following:

• provocation of a vomiting reflex;
• squeezing the right carotid node;
• pressure on the eyeballs;
• straining at a deep breath with a clamped nose;
• Pushing the abdomen from above;
• pressing of the bent legs to the abdomen;
• cold wiping;
• application of sedatives (tincture of motherwort / valerian, valocordin, diazepam in amounts commensurate with the age of the patient);
• in the absence of effect from these methods, antiarrhythmics are used in an hour.

Remove the attack of tachycardia with verapamil intravenously (dosage 0.005g), then outside the attack drink on a pill (0.04g) two or three times a day. If verapamil does not help, then beta-blockers are recommended: vine, anaprilin or oxprenolol. The lack of effect from drugs requires the use of pacing or defibrillation.

Urgent hospitalization is indicated if an attack of tachycardia leads to:

• loss of consciousness;
• hemodynamic abnormalities;
• manifestations of ischemic disorders.

[12], [13], [14], [15], [16], [17],

Prevention of supraventricular tachycardia

When a provocateur is found, an attack of tachycardia is sometimes sufficient to eliminate it in order to prevent repeated disturbances of the heart rhythm. For example, the use of caffeine, alcohol and tobacco can serve as factors that cause tachycardia. Exclusion of addiction data, as well as reduced physical exertion and elimination of stress effects reduce the risk of repeated relapses or completely relieve the patient of cardiac arrhythmias.

Antiarrhythmic prophylaxis of supraventricular tachycardia in accordance with the type of pathology:

• radiofrequency ablation (RFA) - a method of preventing asymptomatic arrhythmia or focal atrial with Wolff-Parkinson-White syndrome, ectopic atrioventricular nodal tachycardia, and unstable atrial;
• diltiazem, verapamil - drugs are recommended for prophylactic purposes with paroxysmal reciprocal atrioventricular nodal arrhythmia;
• β-adrenoblockers - used in poorly tolerated tachycardia, ectopic nodal atrioventricular, atrial, symptomatic paroxysmal reciprocal arrhythmia;
• amiodarone is a medicinal preventive agent in cases of nodal tachycardia of paroxysmal reciprocal atrioventricular type, resistant to beta-adrenoblockers or verapamil.

Prognosis of supraventricular tachycardia

Complications of the disease can be dysfunctions of blood circulation in the tissues, heart failure, pulmonary edema (the heart does not cope with pumping the blood due to what the lungs fill), an attack of angina (as a result of a decrease in the cardiac output with a decrease in coronary blood flow).

The prognosis of supraventricular tachycardia is made on the basis of the underlying disease, the frequency and duration of the attack, the presence of complications during the attack, as well as the characteristics of the myocardium.

For example, a sinus arrhythmia of a physiological type is not dangerous, has a favorable course. The presence of concomitant pathologies of the heart, in turn, aggravates the pathological picture and the outcome of the disease can be serious.

The disease allows patients to lead a normal life. Rare seizures are themselves or from drug therapy. The worst prognosis for frequently recurring tachycardias, leading to disruption of the nervous system, worsening performance, often making a person disabled.