Ventricular tachycardia mkb 10. What is paroxysmal tachycardia: causes, symptoms, ECG signs, treatment and prognosis. Features of the course in children

Cardiac arrhythmias 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 a few seconds to several days, with even greater frequency, distinguishes this kind of arrhythmia from other cardiopathologies.

A type of arrhythmia, in which attacks of increased heart rate exceed 140 pulses per minute, is called paroxysmal tachycardia.

Similar phenomena occur due to the occurrence of arrhythmic foci, provoking the replacement of the activity of the sinus node. Bursts of an ectopic source may be localized in the atria, the atrioventricular junction, or the ventricles. Hence the names of various forms of paroxysmal tachycardia: ventricular, atrioventricular or atrial.

General concept of the disease

It must be understood 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 hard. As a result of this dysfunction, internal organs can suffer from hypoxia. Various forms of such phenomena are detected in about 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 phenomena of cardiac and cardiovascular insufficiency is directly promoted by the long duration of an attack of tachycardia.

ICD code 10

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 physicians from countries belonging to the World Health Organization (WHO) to systematize, monitor and treat a patient according to the type of coded disease.

The classification system allows you to determine the incidence, methods of treatment, statistics of cure and mortality in different countries in any period of time. Such coding ensures the correct execution of medical records and allows you to keep records 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, due to which the heart rate increases, is characterized by premature contraction of the ventricles. As a result, the patient has a feeling of interruptions in the work of the heart, there is weakness, dizziness, 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, the ventricular myocardium is damaged, which poses a danger to the patient's life and requires emergency hospitalization.

Occurs as an unexpected burst of arrhythmia with a heart rate of 160 to 190 beats per minute. It ends as abruptly as it begins. Unlike ventricular, does not affect the myocardium. Of all, this pathology has the most harmless course. Often the patient himself can stop the occurrence of seizures 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, the diagnosis and treatment of this disease should be carried out by a qualified specialist - a cardiologist.

atrial

Supraventricular tachycardia, the ectopic focus of which is formed in the myocardium, is called atrial. Such cardiac pathologies are divided into "focal" and so-called "macro-re-entry" arrhythmias. The latter variety in another way can still be called atrial flutter.

Focal atrial paroxysmal tachycardia is caused by the appearance of a source in the local region of the atria. It can have several foci, but all of them most often occur in the right atrium, in the border crest, interatrial septum, in the annulus of the tricuspid valve, or at the mouth of the coronary sinus. On the left, such pulsating foci rarely occur.

Unlike focal, "macro-re-entry" atrial tachycardias occur due to the appearance of flutter wave circulation. They affect areas around large heart structures.

atrioventricular

This pathology is considered the most common among all forms of paroxysmal tachycardia. It can occur at any age, but most often occurs in women in their 20s and 40s. Atrioventricular paroxysmal tachycardia is provoked by psycho-emotional states, stress, overwork, exacerbation of diseases of the gastric system or hypertension.

In two out of three cases, palpitations occur according to the re-entry principle, the source of which is formed in the atrioventricular junction or between the ventricles and the atrium. The origin 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, which is based on the principle of re-entry. As a rule, the heart 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 an extraordinary entry of the excitation wave formed by the fast and slow pathways in the AV node.

The reasons

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 due to 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 diseases 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" paths of impulse conduction 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 is formed 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, while it has a different time duration. An arrhythmia of this kind begins with a perceptible shock in the region of the heart, and then comes a rapid heartbeat. With 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 with their prolonged continuation, a decrease in blood pressure occurs, a feeling of weakness develops up to fainting.

Supraventricular supraventricular paroxysmal tachycardia develops with manifestations of autonomic disorders and is accompanied by sweating, nausea and mild fever. When the outbreak of arrhythmia stops, 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 has a hemodynamic disorder:

• the minute volume of the heart decreases;
• increased blood pressure in the left atrium and pulmonary artery.

Every third patient has 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 the crisis.

Signs on the 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 indications. This allows you 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 this kind of cardiac pathology is formed in the sinoatrial node, which in fact is the coordinator of the heart pulsation.

Paroxysmal atrial tachycardia on the ECG is characterized by the presence of a convex or concave P wave in front of the ventricular QRS readings. If the protrusion P merges with QRS or is shown after it, then the cardiogram indicates a paroxysm, the source of which is in the atrioventricular node.

The clinic 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 ledge P on the ECG.

Ventricular paroxysmal tachycardia on the ECG has such signs as:

• a wider range and change in QRS indicators, according to the configuration of the line, they resemble the blockade of the legs of His;
• clearly expressed dissociation of the functions of the atria and ventricles.

If the signs of paroxysmal ventricular tachycardia on the ECG were not recorded, then daily monitoring is carried out with a portable electrocardiograph, which fixes even minor manifestations of the pathology that the patient may not feel.

Treatment

The tactics of healing patients suffering from symptoms of paroxysmal tachycardia is determined by the form of cardiac pathology, the causes of its occurrence, the frequency and temporary continuation of arrhythmias, and the presence of complicating factors.

In cases of idiopathic seizures with a harmless development and the admissibility of relief, hospitalization is usually not required.

With manifestations of supraventricular tachycardia, the definition of a patient in a hospital is advisable only with the formation of heart or vascular insufficiency. With 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 carried out. Such practices include:

• attempts;
• an attempt to exhale sharply with a plugged nose and a closed mouth;
• equal pressure on the upper part of the eyeball;
• moderate pressure in the area of ​​the carotid artery;
• rubbing with cold water;
• inducing vomiting by pressing two fingers on the root of the tongue.

However, such methods work only in cases of supraventricular arrhythmias, so the main way to stop an attack is the introduction of antiarrhythmic drugs.

The patient is routinely referred to the hospital if the frequency of seizures occurs more than twice a month. In a hospital setting, an in-depth study of the symptoms of paroxysmal tachycardia is performed. Treatment is prescribed only after a complete examination.

Emergency care for paroxysm

The onset of an arrhythmic crisis requires the adoption of emergency actions on the spot: the specific condition of the patient will allow you to accurately determine what it is. Paroxysmal tachycardia, the treatment of which requires medical intervention, at the initial manifestation causes the call of the cardiological team of doctors. With secondary and subsequent exacerbations, the patient must urgently take a medicine that made it possible to stop the attack for the first time.

As an emergency, intravenous administration of universal antiarrhythmic drugs is recommended. This group of drugs includes: quinidine bisulfate, disopyramide, moratsizin, etatsizin, amiodarone, verapamil, etc. If the crisis could not be localized, then electrical impulse 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, heart attack.

People who have signs of ventricular paroxysmal tachycardia on the ECG should be observed by a cardiologist on an outpatient basis. The appointment of permanent anti-relapse therapy is mandatory for people who have attacks of palpitations two or more times a month.

Patients who experience short episodes of supraventricular arrhythmias, self-limited or with 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 a personal assessment of the patient's condition and an ECG.

Features of the course in children

Paroxysmal tachycardia in children occurs 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 a child;
• stress and overexertion 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 should be carried out in a hospital, under the supervision of doctors. You should contact a specialist if you experience symptoms such as:

• cardiopalmus;
• increased breathing and shortness of breath;
• pallor and cyanosis of the skin (especially in the region of the nasolabial triangle);
• allocation of jugular arteries and veins;
• frequent urination, nausea and vomiting.

Symptoms of irregular heart rhythms in a child appear unexpectedly and also suddenly disappear. In this case, the duration of the attack can be either a few seconds or several hours. In any case, you need to urgently call the cardiological ambulance team.

Attacks of palpitations may have a gradual increase in heart rate. In this case, non-paroxysmal tachycardia most often becomes the culprit of the pathology. Similar phenomena are formed as a result of a gradual increase in the activity of the centers of automatism located in the atria, atrioventricular junction or ventricles. If the ectopic source of arrhythmia arose in the sinoatrial junction, then this phenomenon is called sinus non-paroxysmal tachycardia.

conclusions

1. Any heart disease is a dangerous harbinger that should not be left to chance.
2. In any form (ventricular or atrial), treatment of paroxysmal tachycardia should be mandatory.
3. All pathologies associated with cardiac activity should be diagnosed by a cardiologist.

The correct rhythm of the heart depends on the uniform occurrence of impulses in the sinus node and their conduction through the conducting system of fibers. The sinus node is a collection of nerve cells located in the atrium. He receives "commands" on a special nerve from the brain.

Further, the "instructions" are distributed along the nerve bundles. Thanks to a clear work, contractions of the atria and ventricles, the phases of filling (diastole) and contraction (systole) are consistent. The endocrine system is involved in rhythm regulation through the hormone adrenaline and its derivatives.

The norm for sinus rhythm is the number of contractions in the range from 60 to 90 beats per minute. Sinus tachycardia is an increase in frequency over 90.

Sinus tachycardia is also called "normotopic" because it always depends on the main sinus, in contrast to "heterotopic", which occurs due to increased activity of other nodes. This is how paroxysmal tachycardia is formed. At the same time, the heart rate (HR) will also be above 90, but the heart rhythm goes the wrong way, the work of different departments becomes inconsistent, inferior. This form is dangerous for the development of complications. The terms "sinus tachycardia" and "sinusoidal" used by inexperienced patients are medically incorrect.

Types of sinus tachycardia

The causes of sinus tachycardia are well understood. They are not always associated with cardiac pathology. Moderate sinus tachycardia is a normal physiological mechanism for overcoming physical exertion, emotional stress. Depending on the predominance of causes, several varieties are distinguished.

constitutional

It occurs relatively rarely. Associated with a congenital disorder of the formation of excitation in the sinus node. A person suffers from tachycardia all his life. Heart rate in childhood - 120 per minute, in adolescents and adults 100 and above.

neurogenic

Endocrine

An increase in thyroid function in thyrotoxicosis leads to the production of an excess of the hormone thyroxine. It speeds up basal metabolism, heart rate and blood circulation speed.

toxic

Sinus tachycardia is caused by substances such as atropine, adrenaline, caffeine, nicotine, alcohol, digitalis.

This type of arrhythmia is characteristic of infectious diseases. Here, in addition to the toxic effect on the node, play a role:

• temperature rise;
• drop in blood pressure;
• anemia (decreased hemoglobin level).

It is believed that an increase in temperature by one degree causes an increase in heart rate by 8-10 beats per minute. Hypertension is accompanied by a decrease in heart rate, with reduced pressure, tachycardia is observed. Sinus tachycardia is especially pronounced in severe infections, septic conditions, in which all types of exposure are combined.

Cardiogenic

This type of tachycardia is characteristic of the initial symptoms of heart failure. It arises as a result of a compensatory mechanism that improves the supply of oxygen to tissues. Observed at

• myocardial infarction,
• heart aneurysm,
• endocarditis,
• heart defects,
• hypertensive crises,
• atherosclerosis of the coronary arteries.

Orthostatic

When moving from a lying position to a vertical position, an increase in heart rate occurs. In people with a certain type of nervous system, this acceleration is very strong. Such manifestations are especially often observed during the period of recovery from various diseases, if a person has been forced to stay in bed for a long time.

Diagnostics

According to ICD-10 (international classification of diseases of the tenth revision), sinus tachycardia is classified as class I 47.1, "supraventricular tachycardia." The terminology adopted in Russia, in this case, does not contradict the ICD, but clarifies it.

Clinical manifestations of tachycardia from the sinus node in the form of palpitations, pulsating tinnitus, dizziness, shortness of breath are often symptoms of other diseases associated with neuroses.

The diagnosis can be made by a doctor after an electrocardiographic examination (ECG). The usual listening to the heart and counting the pulse allow you to note the increase in heart rate, but does not say anything about the correctness of the rhythm. So the symptoms of sinus tachycardia can only be seen with a special study. The ECG is taken in the supine position. Pulses are registered by electrodes and translated into a graphic image. By the nature of the teeth, the length and position of the intervals, the doctor of the functional diagnostics office can judge many diseases, including the correctness of the rhythm.

Holter observation during the day is carried out in a cardiological hospital. This is important for diagnosis if the ECG does not register an acceleration of the rhythm.

Sometimes, to resolve the issue of a person’s suitability for work in difficult conditions (service in the army, in parts of the Ministry of Internal Affairs, admission to a military school, contact with occupational hazards), the medical commission prescribes stress tests. The most popular is taking an ECG before the test, then the patient is asked to do 20 squats at a moderate pace and take an ECG after the load. According to the increase in the frequency of heart beats, the adaptive capabilities of the cardiovascular system are judged.

A more thorough examination is carried out on specially equipped simulators. At the same time, not only the rhythm is controlled, but also other indicators of the functioning of different parts of the heart.

Treatment

To eliminate sinus arrhythmia, it is enough to conduct a good treatment of the diseases that caused it (thyrotoxicosis, infectious diseases, hypertension, heart disease). When prescribing therapy, the doctor always takes into account the heart rate. Usually warn about the need to control the pulse in the treatment of certain drugs.

General procedures that strengthen the nervous system (massage, baths, showers), physiotherapy at the same time calm the patient and normalize arrhythmia. In complex neurogenic cases, consultations of a psychologist, treatment with hypnosis, auto-training are recommended.

If a heartbeat occurs, a self-help method is known: try to breathe deeply, after several breathing movements, hold your breath at the height of the breath, tighten the abdominal muscles. This simple method helps to cope with tachycardia.

• melissa herbs,
• hawthorn flowers and fruits,
• viburnum berries,
• valerian root.

Useful video:

You can cook them without a steam bath, pour a tablespoon of crushed raw materials into a half-liter thermos and pour boiling water over it. Leave it overnight or for 5-6 hours. After straining, drink before meals throughout the day, combine with honey. Hawthorn can be purchased at a pharmacy in the form of an alcohol tincture. It can be added to tea in 10-15 drops.

We should not forget that prolonged tachycardia is dangerous for its consequences. Incomplete and incorrect contraction of the heart muscle causes its overstrain, requires more oxygen, disrupts the delivery of blood to the brain. An examination by a specialist doctor should be carried out as early as possible. Timely initiation of treatment will prevent the development of serious diseases.

Drugs for the treatment of sinus tachycardia

Normal heart rate in children and adults

• Joint treatment
• weight loss
• Varicose veins
• Nail fungus
• Fight against wrinkles
• High blood pressure (hypertension)

Causes and symptoms of pulmonary edema in myocardial infarction

Pulmonary edema in myocardial infarction is a pathological process that accompanies heart failure. At the same time, the cells of the affected area of ​​the myocardium (heart muscle) die, because due to the failure of the blood flow of the coronary arteries, the supply of oxygen and nutrients to the heart stops. This may be accompanied by the development of edema in the lungs, which is caused by the accumulation in the lung tissues and alveoli of blood plasma released from the vessels. Thus, a heart attack is complicated by problems with the patient's breathing, this is an extremely dangerous condition that can lead to the death of the patient and requires an immediate response.

According to ICD-10, the disease was assigned code 121, and its complication in the form of pulmonary edema - 150.1.

Why does the disease develop?

Cardiologists associate the development of this complex of pathologies with two factors:

1. Blockage of the coronary artery as a result of atherosclerosis, or significant narrowing of the lumen.
2. Too high pressure in the ventricle due to some pathologies of the heart.

As you know, the work of the heart is to pump blood. The heart contracts in cycles, while the myocardium then relaxes, then contracts again. When the heart relaxes (so-called diastole), the ventricle fills with blood, and during systole (contraction), it is pumped by the heart into the vessels.

When a patient develops a heart attack, the ventricles lose the ability to completely relax. This is due to the death of part of the muscle cells - necrosis.

Similar problems with the ventricles are observed in other pathologies:

• ischemic disease;
• aortic stenosis;
• high pressure;
• hypertrophic cardiomyopathy.

But if in a heart attack the cause of ventricular dysfunction is necrosis, in the cases listed, other pathological changes act as such.

It lies in the fact that during a heart attack, blood stagnates in the capillaries of the lungs and the pulmonary circulation. Gradually, hydrostatic pressure increases in them, and plasma penetrates into the lung tissue and interstitial volume, which it "squeezes" out of the blood vessels. This process causes acute respiratory dysfunction and can be fatal to the patient.

Symptoms

In medicine, it is customary to consider the following symptoms as indicators of a heart attack with edema:

• significant pain "under the spoon", behind the sternum or in the region of the heart;
• progressive weakness;
• increased heart rate up to 200 beats per minute, and even more (severe tachycardia);
• increase in blood pressure;
• shortness of breath, shortness of breath;
• the presence of wheezing in the lungs. They are dry at first, gradually turning into wet;
• shortness of breath on inspiration;
• wet cough;
• cyanosis (blue of the skin and mucous membranes);
• the patient breaks into a cold sweat.

As the pathological condition develops, the temperature rises, but does not exceed 38 degrees. A symptom can develop both five to six hours after a heart attack, and a day later.

When the edema completely spreads to the lungs (this is especially true for heart failure with damage to the left ventricle and the heart attack itself), shortness of breath increases. Gas exchange in the lungs continues to deteriorate, and the patient experiences asthma attacks. The liquid gradually enters the bronchi and alveoli, the latter stick together, while wet rales are heard in the lungs of patients.

Consequences of a heart attack with edema

The death of the patient can be prevented if timely and correct assistance is provided to him. If first aid was not provided, then there is a high probability of death due to asphyxia or atrial fibrillation of the ventricles.

The considered type of myocardial infarction can cause the following consequences:

• cardiogenic shock. The patient's blood pressure drops, the pulse becomes thready, and the heart muscle eventually stops;
• cardiosclerosis: after a heart attack, the heart tissue that has died as a result of an attack is scarred;
• atrioventricular blockade: a violation of the conduction of electrical impulses inside the heart, up to the complete cessation of their passage;
• fibrinous pericarditis. This pathology is characterized by an inflammatory process that affects the fibrous-serous membrane of the heart;
• post-infarction aneurysm, in which the part of the wall of the cardiac ventricle that was affected begins to bulge. This pathology can occur several months after a heart attack, and is fixed in about 15 cases out of 100;
• there is a possibility of developing a pulmonary infarction. Part of the lung tissue may also die off and be replaced by scar tissue;
• cerebral infarction.

Diagnosis and assistance to the patient

The initial diagnosis is usually carried out by ambulance doctors called to the scene. It is quite simple for a trained specialist to determine the cause of the patient's ailment, since the clinical picture of the manifestations of infarction and pulmonary edema is visible very clearly and allows a fairly accurate conclusion based on the initial examination.

The diagnosis is confirmed with the help of an ECG, as well as listening to the heart rhythm. When a patient enters a hospital for treatment, he is also given an ultrasound diagnosis of the lungs and heart (or an X-ray examination of those). Additionally, tests are taken: blood is examined for specific proteins and enzymes, as well as for the content of various blood cells.

In diagnosis, it is important to remember that a number of symptoms of a heart attack are similar to those of internal hemorrhage, pneumothorax, perforation of a gastric ulcer, pancreatitis, and some other diseases.

Before the arrival of the ambulance, the patient should be placed in a half-sitting position. To expand the arteries of the heart, nitroglycerin is placed under the tongue, one or two tablets, with an interval of 15 minutes. It is also advisable to let the patient chew and swallow aspirin in the amount of 150 milligrams. Then you should wait for the doctors who will begin professional treatment.

Ways to prevent a heart attack include:

1. Physical exercises.
2. Bringing the body mass index to normal.
3. Rejection of bad habits.

Regular medical examinations and timely treatment of identified diseases are of great importance.

Symptoms and treatment of hypoplastic anemia

A pathological condition characterized by a reduced content of blood cells and hemoglobin is called anemia (the popular version is anemia). A reduced hemoglobin is the main necessary sign for making a diagnosis. A decrease in red blood cells with anemia may not be observed and does not apply to the defining criterion. It is important to know that anemia is not an independent disease, but only a manifestation (symptom) of the underlying pathology. With a decrease in the level of hemoglobin in the blood, a thorough diagnosis should be carried out to find the cause of the symptom. Anemia develops against the background of increased blood loss, reduced formation of hemoglobin, increased destruction of blood cells. According to these criteria, it is divided into the following types:

1. Posthemorrhagic develops as a result of acute or chronic blood loss (wounds, injuries).
2. Hemolytic is formed against the background of increased intra- and extravascular destruction of erythrocytes. The predominant symptom is jaundice.
3. Iron deficiency is observed with a reduced concentration of iron in the blood.
4. B12-, folic deficiency occurs with a low content of these trace elements. Vitamin B12 deficiency is characterized by anemia and neurological symptoms.
5. Hypoplastic is the most severe type of pathology, it develops as a result of a violation of hematopoiesis by the bone marrow.

General concepts of hypoplastic anemia

Hypoplastic anemia is a pathological change in the blood picture due to suppression of the red bone marrow. This is manifested by a decrease in the production of all blood sprouts (erythrocyte, leukocyte, platelet) or only red (reduction of erythrocytes). The history of the first description and appearance of this disease begins in 1888. At this time, P. Ehrlich revealed a disease in the girl, manifested by the acute development of bleeding, fever, deep anemia and leukopenia. According to the results of the autopsy and examination of the bone marrow, there were no signs of hematopoietic disorders. Anaplastic anemia as an independent disease was identified by Chauffard in 1904. Later, aplastic anemia of the Ehrlich type appeared with symptoms of sepsis, necrosis, hemorrhage and aplasia (absence of all hematopoietic sprouts in the bone marrow), which manifests itself in young people (18–20 years old). The main contingent suffering from this disease are young girls and children. There are several stages in the pathogenesis of development. First, tissues, due to lack of oxygen and nutrients, atrophy and lose their functions. Further, adipose and connective tissues replace the dead cells, which leads to the spread of the pathological process. The progression of the disease occurs very quickly and, if left untreated, can lead to death.

Classification

Depending on the origin, hypoplastic anemia is:

• congenital. Symptoms of the disease appear in early childhood and progress rapidly. The causes of development may be genetic DNA mutations in the fetus; hereditary predisposition (there is evidence of a similar anomaly in one of the relatives); impaired intrauterine development (pathological changes in the hematopoietic system of the fetus under the influence of an unfavorable factor). Studies have shown that boys suffer from congenital aplastic syndrome twice as often as girls;
• acquired. This type of hypoplastic anemia is typical for any age group.

There are idiopathic (the cause of the disease is unknown) and myelotoxic (a prerequisite is the toxic effect of an external factor) forms. The reasons that determine the development of myelotoxic form of anemia include:

• chronic intoxication with chemicals;
• drugs with side effects on hematopoiesis (hormonal, tranquilizers, cytostatics);
• exposure of the body to high doses of radiation (radiologists are susceptible);
• diseases of the endocrine system (may be complicated by hypoplastic anemia);
• the effect of viruses on blood cells;
• against the background of tuberculosis and pregnancy, hypoplastic anemia can also develop, but such cases are rare in medical practice.

Depending on the duration of the course of the disease, there are:

1. Acute anemia (lasts up to 4 weeks).
2. Subacute (lasts 1-6 months).
3. Chronic (present for more than six months).

Depending on the massiveness of the lesion of bone marrow functions, there are pathologies:

1. Moderate severity. Violation of hematopoietic elements occurs selectively, while maintaining the minimum formation of full-fledged blood cells.
2. Severe severity. The main part of the bone marrow atrophies and is replaced by adipose tissue. 30 percent of the bone marrow is functionally active.
3. Extremely severe. There is an almost complete loss of functions of the bone marrow and its replacement with adipose tissue.

Depending on the affected blood sprouts, there are:

1. Erythrocytopenia, or partial hypoplastic anemia, (inhibition of erythrocyte hematopoiesis).
2. Erythrocyto-, thrombocytopenia (decrease in the production of red blood cells and platelets).
3. Pancytopenia, or true hypoplastic anemia, (reduced production of all blood cells).

According to the international classification of diseases (ICD-10), anaplastic anemia has the code D60 (erythroblastopenia - acquired red cell aplasia), D61 (other aplastic anemia).

The reasons

There are three groups of main causes of hypoplastic anemia:

1. Genetic. The hereditary factor ensures the transmission of parental genes that cause the formation of anemia, or the destructuring of chromosomes, when, under the influence of various causes, chromosomal aberrations occur, manifested by doubling, breaking, loss, rearrangement of their chains. A person normally has 46 chromosomes, with the described disorders, their number can change (45, 47), which is manifested by various chromosomal diseases and syndromes.
2. Main. This group includes exposure to radiation, chemotherapeutic agents, chemical compounds based on benzene and arsenic, autoimmune diseases.
3. Rare. This category includes drugs, the side effect of which may be manifested by the development of hypoplastic anemia. These are drugs such as anticonvulsants, sulfanilamide, NSAIDs (non-steroidal anti-inflammatory), antibiotics, antitoxic (in inflammatory processes in the thyroid gland), tranquilizers. Fungal diseases, tuberculosis, infections of viral etiology, pregnancy can also be the cause of the disease.

The mechanism of bone marrow damage is that under the influence of the above reasons, a change in the chromosome set occurs, causing impaired DNA synthesis. The formation of blood cells is inhibited and the tissue of the red bone marrow is replaced by fatty tissue, which is not able to perform a producing function. The general condition of the patient worsens, and the blood picture appears to be pancytopenia.

The main symptoms of pathology

The pathogenesis of the manifestations of this disease is explained by the inability of blood cells (due to their low content) to perform their functions. Thus, the appearance of hemorrhagic syndrome is due to thrombocytopenia and damage to the vascular wall (serotonin deficiency and hypoxia leads to an increase in its permeability).

The main manifestations of hemorrhagic syndrome include:

• frequent causeless nosebleeds;
• the appearance of bruising and bruising on the skin with pressure (finger and cuff test);
• bleeding from the gums;
• women often complain about the abundance and lengthening of menstruation.

In the case of a protracted pathological process or with massive damage to platelets, complications such as profuse internal bleeding or cerebral infarction with hemorrhage may develop. As a result, this can lead to the death of the patient.

A decrease in immunity and resistance to infectious agents is associated with inhibition of the leukocyte germ. Hypoplastic anemia with immunodeficiency is represented by the following symptoms:

1. Bone marrow aplasia.
2. renal hypoplasia.
3. Microcephaly.
4. Skeletal deformities.

The child is more susceptible to such changes, since his body is at the stage of active growth and development of all systems. The disease is prone to chronicity of the process with periodic exacerbations.

Reduced formation of red blood cells leads to the development of an anemic symptom complex:

1. Fatigue, decreased performance.
2. Syncope (manifested by fainting), flies before the eyes, dizziness.
3. Complaints of shortness of breath at rest and with low physical exertion.
4. Headache.
5. A disturbed dream.
6. Discomfort behind the sternum (pain, feeling of pressure, tingling).
7. Rapid heartbeat (over 90 beats per minute).
8. Decreased appetite.
9. weight loss.
10. Dryness, pallor, marbling of the skin.

If an acute severe form of the disease is detected, the prognosis for such a patient is unfavorable: death occurs within 3 months. A common cause of death is internal bleeding or persistent infections leading to sepsis.

Blood tests and their interpretation

To correctly make a clinical diagnosis, it is necessary to take an anamnesis, examine the patient, perform a bone marrow puncture, and examine the blood for signs of hypoplasia. If at the same time the spleen, lymph nodes and liver are not enlarged, then hypoplastic anemia can be set.

If this is an acquired form of the disease, then a blood test is presented:

• normochromic (no changes in color index), normocytic (erythrocyte sizes are normal) anemia;
• the content of reticulocytes may be reduced or normal;
• lymphocytopenia (decreased concentration of lymphocytes), the decrease occurs to a greater extent due to neutrophils;
• platelet concentration is reduced, which is manifested by delayed thrombus formation and prolonged bleeding time. At the same time, clotting factors are normal;
• there is an increase in total iron-binding capacity and serum iron.

If the etiology of the disease is congenital, then the following changes are detected in the blood:

• macrocytosis (increased diameter) of erythrocytes;
• reticulocytopenia (low content of reticulocyte cells);
• the platelet and leukocyte counts are normal.

Aplastic anemia is not completely curable. If detected at the initial stages of development, correct differential diagnosis and timely treatment started, it is possible to stop the progression of the pathology.

Treatment of hypoplastic anemia

Treatment of the disease is carried out depending on the severity, severity of manifestations and the form of pathology. There are the following methods:

Conservative

1. Glucocorticosteroids (course of treatment 3-6 months) are used to stimulate the production of blood cells and in autoimmune processes. The drug of choice is Prednisolone.
2. Means from the group of anabolic steroids ("Nerobol", "Oxymetholone") contribute to enhanced hematopoiesis after a splenectomy.
3. Androgens ("Testosterone") - hormonal drugs prescribed to the male sex for a long course of treatment to increase the effect. Pharmaceutical action is to stimulate erythropoiesis.
4. Immunosuppressants (cytostatics, antilymphocyte globulin, "Cyclosporin"). If a hypoplastic symptom develops against the background of autoimmune processes, then cytostatic drugs are prescribed for up to 3-6 months with a gradual dose reduction.
5. The colony-stimulating factor eliminates the hypoplasia of the leukocyte germ, increases the content of neutrophilic leukocytes to prevent the development of an infectious process.
6. Immunoglobulin can stimulate thrombocyto- and erythropoiesis (course of treatment - 5 days). Transfusion therapy with washed erythrocytes and platelets.

Operational

• with a congenital or autoimmune form of aplastic syndrome, splenectomy is performed, which gives a good result;
• in young people and in the case of an anaplastic syndrome for less than 3 months, bone marrow transplantation is performed. Preliminary diagnostics of donor material for HLA compatibility is required. Before surgery, radiation and immunosuppressive therapy is performed.

Hypoplastic anemia is an incurable pathology, but with proper treatment and following the doctor's recommendations, you can stop the progression of the disease and prevent the development of complications. By identifying impaired hematopoiesis at the initial stages, and by conducting its correct treatment, it is possible to improve the prognosis of the outcome of events.

In Russia, the International Classification of Diseases of the 10th revision (ICD-10) is adopted as a single regulatory document for accounting for morbidity, reasons for the population to apply to medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. №170

The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.

With amendments and additions by WHO.

Processing and translation of changes © mkb-10.com

Sinus tachycardia micb code 10

Types, causes, symptoms and treatment of arrhythmias

An arrhythmia is a condition in which the frequency, strength, and sequence of the contraction of the heart changes. In the International Classification of Diseases 10th revision (ICD-10), arrhythmias are assigned class 149 - Other cardiac arrhythmias. According to ICD-10, we can distinguish:

1. Fibrillation and ventricular flutter - 149.0 (ICD-10 code).
2. Premature atrial depolarization - 149.1.
3. Premature depolarization from the atrioventricular junction - 149.2.
4. Premature depolarization of the ventricles - 149.3.
5. Other and unspecified premature depolarization - 149.4.
6. Sinus node weakness syndrome (bradycardia, tachycardia) - 149.5.
7. Other specified heart rhythm disturbances (ectopic, nodular, coronary sinus) - 149.8.
8. Unspecified rhythm disorder - 149.9.

This ICD-10 class excludes unspecified bradycardia (code R00.1), neonatal arrhythmias (R29.1), and arrhythmia complicating pregnancy, abortion (O00-O07) and obstetric surgery (O75.4).

In most cases, an arrhythmia involves an abnormal heart rhythm even when the heart rate is normal. Bradyarrhythmia is an abnormal rhythm, accompanied by a slow heart rate, not exceeding 60 beats per minute. If the frequency of contractions exceeds 100 beats per minute, then we are talking about tachyarrhythmia.

Types of arrhythmia and the causes of their development

To find out the causes of rhythm disturbance, it is necessary to understand the nature of the normal rhythm of the heart. The latter is provided by a conducting system consisting of a system of successive nodes formed from highly functional cells. These cells provide the ability to create electrical impulses passing along each fiber and bundle of the heart muscle. Such impulses provide its reduction. To a greater extent, the sinus node, located in the upper part of the right atrium, is responsible for the generation of impulses. The contraction of the heart occurs in several stages:

1. Impulses from the sinus node spread to the atria and to the atrioventricular node.
2. In the atrioventricular node, the impulse slows down, which allows the atria to contract and distill blood into the ventricles.
3. Next, the impulse passes through the legs of the bundle of His: the right one conducts impulses passing through the Purkinje fibers to the right ventricle, the left one - to the left ventricle. As a result, the mechanism of excitation and contraction of the ventricles is launched.

If all the structures of the heart function smoothly, the rhythm will be normal. Rhythm disturbances occur due to the pathology of one of the components of the conduction system or due to problems with the conduction of an impulse along the muscle fibers of the heart.

There are such types of arrhythmia:

1. Extrasystoles - premature contractions of the heart, the impulse in which does not come from the sinus node.
2. Atrial fibrillation, or atrial fibrillation, is an arrhythmia of the heart, provoked by disordered excitation and contraction of atrial fibers.
3. Sinus arrhythmia is caused by abnormal sinus rhythm, accompanied by alternating slowing and speeding up.
4. Atrial flutter - an increase in the frequency of atrial contractions up to 400 beats per minute, combined with their regular rhythm.
5. Supraventricular tachycardia is formed within a small area of ​​atrial tissue. There is a violation of the conduction of the atrium.
6. Ventricular tachycardia is an acceleration of the heart rate emanating from the ventricles, due to which they do not have time to fill with blood normally.
7. Ventricular fibrillation is a chaotic flutter of the ventricles, provoked by the flow of impulses from them. This condition makes it impossible for the ventricles to contract and, accordingly, further pumping of blood. This is the most dangerous type of rhythm disturbance, so a person falls into a state of clinical death in a few minutes.
8. Sinus node dysfunction syndrome - a violation of the formation of an impulse in the sinus node and its transition to the atria. This type of arrhythmia can provoke cardiac arrest.
9. The blockade occurs against the background of a slowdown in the conduction of an impulse or its termination. They can appear both in the ventricles and in the atria.

Causes of arrhythmias include:

1. Organic organ damage: congenital or acquired defects, myocardial infarction, etc.
2. Violation of the water-salt balance, which occurred due to intoxication or loss of potassium (magnesium, sodium) by the body.
3. Thyroid diseases: due to the increased function of the thyroid gland, the synthesis of hormones increases. It increases the metabolism in the body, which increases the heart rate. With insufficient production of hormones by the thyroid gland, a weakening of the rhythm occurs.
4. Diabetes mellitus increases the risk of developing cardiac ischemia. With a sharp drop in sugar levels, a violation of the rhythm of its contractions occurs.
5. Hypertension provokes a thickening of the wall of the left ventricle, thereby reducing its conductivity.
6. The use of caffeine, nicotine and drugs.

Symptoms

For each type of rhythm disturbance, certain symptoms are characteristic. With extrasystoles, a person practically does not feel any discomfort. Sometimes a strong push can be felt coming from the heart.

With atrial fibrillation, symptoms such as chest pain, shortness of breath, weakness, darkening of the eyes and characteristic gurgling in the heart are traced. Atrial fibrillation can manifest as attacks that last several minutes, hours, days, or be permanent.

Symptoms of sinus arrhythmia are as follows: increased (slow) heart rate, extremely rarely pain in the left side of the chest, fainting, darkening of the eyes, shortness of breath.

With atrial flutter, blood pressure drops rapidly, the heart rate increases, dizziness and weakness are felt. There is also an increase in the pulse in the neck veins.

As for supraventricular tachycardia, some people who have a similar heart rhythm disorder do not feel any symptoms at all. However, most often this arrhythmia is manifested by increased heart rate, shallow breathing, profuse sweating, pressure in the left side of the chest, throat spasm, frequent urination and dizziness.

With unstable ventricular tachycardia, symptoms such as palpitations, dizziness, and fainting are observed. With persistent arrhythmias of this type, there is a weakening of the pulse in the neck veins, impaired consciousness, an increase in the heart rate to 200 beats per minute.

Ventricular fibrillation is characterized by circulatory arrest with all the ensuing consequences. The patient instantly loses consciousness, he also has severe convulsions, the absence of a pulse in large arteries and involuntary urination (defecation). The pupils of the victim do not react to light. If resuscitation measures are not implemented within 10 minutes after the onset of clinical death, a fatal outcome occurs.

Sinus node dysfunction syndrome is manifested by cerebral and cardiac symptoms. The first group includes:

• fatigue, emotional instability, amnesia;
• feeling of cardiac arrest;
• noise in ears;
• episodes of loss of consciousness;
• hypotension.

• slow heart rate;
• pain in the left side of the chest;
• increased heart rate.

A violation of the function of the sinus node may also indicate a disorder of the gastrointestinal tract, weakness in the muscles, and insufficient amount of urine output.

Symptoms of heart block include a decrease in heart rate to 40 beats per minute, fainting, convulsions. Possible development of heart failure and angina pectoris. The blockade can also cause the death of the patient.

Signs of arrhythmia should not be ignored. Rhythm disturbances significantly increase the risk of developing serious diseases such as thrombosis, ischemic stroke and congestive heart failure. Selection of adequate therapy is impossible without preliminary diagnosis.

Diagnostics

First of all, a cardiologist studies the complaints of a patient who suspects a heart rhythm disorder. The subject is shown the following diagnostic procedures:

1. Electrocardiography allows you to study the intervals and duration of the phases of heart contraction.
2. Daily monitoring of electrocardiography according to Holter: a portable heart rate recorder is installed on the patient's chest, which records rhythm disturbances throughout the day.
3. Echocardiography allows you to study images of the chambers of the heart, as well as evaluate the movement of the walls and valves.
4. A test with physical activity makes it possible to assess rhythm disturbances during physical activity. The subject is offered to work out on an exercise bike or a treadmill. At this time, with the help of an electrocardiograph, the heart rhythm is monitored. If physical activity is contraindicated for the patient, then they are replaced by drugs that stimulate the heart.
5. Tilt table test: performed for frequent episodes of loss of consciousness. The person is fixed on a table in a horizontal position, and the pulse and pressure of the subject are measured. Then the table is moved to a vertical position, and the doctor re-measures the patient's pulse and pressure.
6. Electrophysiological examination: electrodes are inserted into the cavity of the heart, thanks to which it is possible to study the conduction of the impulse through the heart, thereby determining the arrhythmia and its nature.

Treatment

This type of heart rhythm failure, such as ventricular fibrillation, can cause instant death. In this case, the patient is shown immediate hospitalization in the intensive care unit. A person is given an indirect heart massage. Connection to a ventilator is also shown. Ventricular defibrillation is performed until the rhythm disturbances are eliminated. After the restoration of the rhythm, symptomatic therapy is indicated, aimed at normalizing the acid-base balance and preventing a recurrent attack.

If violations of the rhythm of heart contractions do not threaten a person's life, one can limit oneself to drug therapy, combined with a healthy lifestyle. Heart rhythm disturbances are corrected with antiarrhythmic drugs: Ritmonorm, Etatsizin, Quinidine, Novocainamide. For any violations of the heart rhythm, medication is indicated that prevents the formation of blood clots. These include aspirin cardio and clopidogrel.

It is also worth paying attention to strengthening the heart muscle. For this purpose, the doctor prescribes Mildronate and Riboxin. The patient may be prescribed calcium channel blockers (Finoptin, Adalat, Diazem) and diuretics (Furosemide, Veroshpiron). Correctly selected drugs can stop the progression of arrhythmia and improve the patient's well-being.

If heart rhythm disturbances provoke heart failure and threaten with serious consequences for a person’s life up to death, the decision is made in favor of surgical treatment. With arrhythmia, the following types of operations are performed:

1. Implantation of a cardioverter-defibrillator: the implantation of an automatic device in the heart, which contributes to the normalization of the rhythm.
2. Electropulse therapy: the supply of an electrical discharge to the heart, which normalizes the rhythm. The electrode is inserted through a vein into the heart or esophagus. It is also possible to use the electrode externally.
3. Catheter destruction: an operation that involves the elimination of the focus of arrhythmia.

Lifestyle

People who have a heart rhythm disorder should follow all the recommendations of a cardiologist. Controlling body weight, limiting the intake of salty, fatty and smoked foods, moderate exercise and avoiding smoking and alcohol will help to enhance the effectiveness of treatment. It is also important to monitor your blood pressure daily. Patients with arrhythmia should be regularly examined by a cardiologist and have an electrocardiogram performed at least once a year. All medications must be taken in consultation with your doctor.

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Sinus tachycardia

An increase in heart rate can be both a physiological reaction of the body and a sign of a serious pathology.

Sinus tachycardia coding according to ICD-10

Sinus tachycardia (heart rate over 100 per minute) is one of the most common forms of paroxysmal tachycardia, sinus tachycardia code ICD 10 I47.1. Cardiologists and general practitioners use the code of this disease according to the International Classification of Diseases of the Tenth Revision to conduct morbidity records and correct medical documentation.

Causes

Not always the occurrence of tachycardia should be regarded as a manifestation of the disease. An increase in heart rate is a normal response to strong emotions (both positive and negative), exercise, lack of oxygen. Sinus tachycardia is also a consequence of such pathological processes:

• external or internal bleeding;
• anemia of any etiology;
• hypotension;
• high fever;
• hyperfunction of the thyroid gland;
• dysfunction of the left ventricle of the heart;
• cardiopsychoneurosis.

An increase in heart rate in the presence of the above diseases occurs at rest and is often accompanied by other unpleasant symptoms. Sometimes arrhythmia (violation of the correct rhythm of heart contractions) can join the increase in heart rate. An increase in heart rate can occur with atrial and ventricular blockade, Wolff-Parkinson-White syndrome.

Diagnosis and treatment

Paroxysmal tachycardia in ICD 10 has the code I47 and belongs to the section of heart disease. If there is an increase in resting heart rate, you should consult a general practitioner or cardiologist. An obligatory instrumental research method for patients with an increase in heart rate or rhythm disturbances is an ECG, EchoCG and a number of other studies are also additionally performed to determine the cause of the disease. Tachycardia and bradycardia (heart rate less than 60 per minute) are serious symptoms, so you need to see a doctor in a timely manner.

Treatment depends on the cause that caused the increase in heart rate, the presence of rhythm disturbances, concomitant diseases. You also need to limit the use of caffeine, alcoholic beverages, quit smoking. Lifestyle modification gives a good result for all patients, regardless of the stage and severity of the underlying disease.

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Sinus tachycardia - description, causes, symptoms (signs), diagnosis, treatment.

Short description

Sinus tachycardia (ST) - an increase in heart rate at rest more than 90 beats per minute. With heavy physical exertion, the normal regular sinus rhythm increases to 150-160 per minute (in athletes - up to 200-220).

The reasons

Etiology - generation of excitatory impulses by the sinoatrial node with an increased frequency Physiological causes Fever (an increase in body temperature by 1 ° C causes an increase in heart rate by 10 per minute) Excitation (hypercatecholaminemia) Hypercapnia Exercise Diseases and pathological conditions Thyrotoxicosis MI Endocarditis Myocarditis PE Anemia vegetative-vascular dystonia Mitral stenosis Aortic valve insufficiency Pulmonary tuberculosis Shock Left ventricular failure Cardiac tamponade Drug hypovolemia (epinephrine, ephedrine, atropine) Pain.

Symptoms (signs)

Clinical manifestations Palpitations, a feeling of heaviness, sometimes pain in the region of the heart Symptoms of the underlying disease.

Diagnostics

ECG - identification of heart rate at rest - 90–130 per minute Each P wave corresponds to the QRS complex, the P–P intervals are equal to each other, but when combined with sinus arrhythmia, they can differ by more than 0.16 s. the T waves preceding them, simulating atrial or atrioventricular paroxysmal tachycardia. The differential sign is that vagal reflexes (massage of the carotid sinus, Valsalva maneuver) slow down the rhythm for a short time, helping to recognize P waves.

Differential diagnosis Supraventricular paroxysmal tachycardia Atrial flutter with regular conduction to the ventricles 2:1.

Treatment

Treatment Elimination of the identified risk factor: exclusion of smoking, drinking alcohol, strong tea, coffee, taking spicy food, sympathomimetic drugs (including nasal drops) Treatment of the underlying disease b - Adrenoblockers in small doses orally (rarely prescribed) Sedative drugs With concomitant heart failure - cardiac glycosides, pathogenetic therapy.

Reduction. ST - sinus tachycardia.

Sinus tachycardia: symptoms and treatment

Sinus tachycardia - the main symptoms:

• mood swings
• Dizziness
• Sleep disturbance
• Loss of appetite
• Dyspnea
• Fainting
• Lack of air
• Fast fatiguability
• Heartache
• Insomnia
• Low blood pressure
• Feeling the heartbeat
• Decreased urine output
• cold extremities
• Feeling disgusted with food
• Discomfort in the chest area

Sinus tachycardia - is a disease in which the heart rate becomes more frequent, which occurs against the background of the active work of the sinus node. This condition is typical for both adults and children. A wide range of predisposing factors, which are not always associated with the course of any other disease, can become the cause of the development of such a violation. The source can also be severe stress or excessive physical exertion.

The disease has characteristic symptoms, including pain in the chest area, a person's feeling of his own heart rhythm, weakness and severe dizziness.

To make a correct diagnosis, a whole range of measures is needed - from a physical examination performed by a cardiologist to instrumental examinations of the patient.

You can cure the disease with the help of conservative methods, which boil down to physiotherapy, taking medications and observing a sparing diet.

The tenth revision of the International Classification of Diseases categorizes this disorder as supraventricular tachycardia. It is worth noting that this is a specified name for such a pathology. Thus, sinus tachycardia has the following ICD-10 code - I 47.1.

Etiology

The correct heart rhythm directly depends on how uniformly impulses arise in the sinus node and are conducted through the fiber system. The sinus node is a collection of nerve cells that are located in the atrium.

Normally, the optimal values ​​for sinus rhythm are the number of contractions, which range from sixty to ninety beats per minute. It follows from this that sinus tachycardia is nothing more than an increase in heart rate over 90 times per minute. It is worth noting that in children such a disorder is diagnosed if the heart rate rises by more than 10% of the norm characteristic of a particular age.

A similar pathology occurs in any age category, in the vast majority of cases in healthy people, as well as among those diagnosed with heart disease. Against the background of the fact that the disease develops due to a large number of factors, they are usually divided into several groups - pathological and not associated with the course of a particular disease.

Physiological predisposing sources of the formation of sinus tachycardia of the heart are presented:

• excessive physical exertion - the permissible values ​​\u200b\u200bin this case can be no more than 160 beats per minute, the rest, higher rates, refer to this type of arrhythmia. It should be noted that the only exception is professional athletes - heart rate can reach 240 beats per minute - only in such cases there is no need for emergency care;
• prolonged exposure to stressful situations or a single strong nervous strain;
• addiction to bad habits;
• irrational use of drugs, for example, glucocorticoids, antidepressants, calcium antagonists, diuretics, substances containing caffeine, as well as medications aimed at treating bronchial asthma.

In addition, it should be noted that the increase in heart rate can be affected by an increase in body temperature. Each increase in the values ​​​​of the thermometer by one division leads to the fact that the heart rate in a child increases by about 15 beats per minute, and in an adult - by 9.

Causes of sinus tachycardia in women can be:

• the period of bearing a child - despite the fact that sinus tachycardia in pregnant women is a normal phenomenon, it can develop against the background of pathological causes, which is why the appearance of symptoms of the disease should be the impetus for seeking qualified help;
• the flow of menstruation;
• hot flashes observed during menopause, as well as any other hormonal disorders.

In childhood, such a disorder can be an individual norm. It is noteworthy that it is most often observed in girls.

Classification

The main division of sinus tachycardia in a child or adult divides the disease into:

• functional - is such in cases of influence on the human body of strong emotions or physical activity, as well as an increase in temperature;
• pathological - also called prolonged sinus tachycardia.

Forms of a long-term variety of the disease, depending on the etiological factor:

• neurogenic - develops due to an unstable or labile nervous system;
• toxic - caused by the negative impact on the body of toxic substances;
• medicinal;
• endocrine;
• hypoxic - is a natural response of the body to a lack of oxygen;
• myogenic - is formed against the background of cardiac pathologies.

Separately, it is worth highlighting orthostatic or vertical sinus tachycardia. This means that a violation of the heart rate is observed when the body moves from a lying to a standing position.

There are also three degrees of severity of the course of the disease:

• mild sinus tachycardia - does not provide for any specific therapy;
• moderate sinus tachycardia - often occurs in children under the age of six, as well as in adolescents during puberty. This variety should not cause concern, since its symptoms are completely absent or mild;
• severe sinus tachycardia - most often occurs in older people, but can also occur in a child. In such cases, the alternation of a fast pulse with a condition such as bradycardia, in which the heart rate is reduced, is considered dangerous. This combination requires urgent emergency care.

Symptoms

The presence and severity of symptoms of such a pathology depends on several factors:

• severity of sinus tachycardia;
• duration;
• predisposing factor.

With a mild course of the disease, the symptoms are completely absent, which is why a person may not even suspect that he has such a disorder.

Moderate sinus tachycardia can also be completely asymptomatic, but sometimes the signs can be minor. They should include:

• sense of one's own heartbeat;
• discomfort and stiffness in the chest;
• shortness of breath
• sleep disturbance;
• fast fatigue;
• frequent mood swings.

Symptoms of severe sinus tachycardia, in addition to increasing the severity of the above clinical manifestations, has the following symptoms:

• frequent and severe dizziness;
• intense pain in the area of ​​the heart;
• lack of air;
• the appearance of shortness of breath at rest;
• complete lack of sleep;
• loss of appetite or complete aversion to food;
• fainting;
• lowering blood pressure;
• cold extremities;
• decrease in daily urine output.

It is worth noting that this is only the main symptomatology of sinus tachycardia, which will be supplemented by the clinical manifestations of the disease against which such a violation has developed.

All of the above symptoms are typical for both adults and children, but in the second case, the disease will be much more severe. It is for this reason that there are several emergency care rules aimed at lowering heart rate, including:

• calling a team of doctors at home;
• pressure on the area of ​​the carotid node;
• massaging both eyeballs in a circular motion;
• straining with a deep breath with a pinched nose;
• squeezing the upper abdomen;
• pressing the lower extremities to the anterior wall of the abdominal cavity;
• cold rubs.

Such measures should alleviate the patient's condition before the arrival of doctors.

Ignoring the symptoms can lead to heart failure or the consequences of the disease that led to such a violation of the heart rate - this is what sinus tachycardia is dangerous for.

Diagnostics

Despite the fact that such a disease has rather specific symptoms, in order to make a diagnosis of sinus tachycardia, it is necessary to perform a whole range of diagnostic measures.

First of all, the cardiologist needs:

• to study the medical history and life history of the patient - in some cases this will help to establish the most likely causes of sinus tachycardia in a particular person;
• conduct a thorough physical examination aimed at studying the condition of the skin, assessing the frequency of respiratory movements and listening to the patient using special instruments;
• to interrogate the patient or his parents in detail - to establish the severity of symptoms and determine the severity of the course of the disease.

Laboratory research should include:

• general clinical blood test - to identify possible anemia and the course of ailments that could cause sinus tachycardia;
• general urine analysis;
• blood biochemistry - for the final establishment of an ailment provocateur;
• blood test for thyroid hormones.

The most valuable in the diagnostic plan are such instrumental examinations:

• Echocardiography - for the possible detection of structural changes in the heart;
• ECG is the main technique confirming the presence of sinus tachycardia;

In addition, you may need advice:

• pediatrician - if the patient is a child;
• psychotherapist;
• otolaryngologist;
• endocrinologist;
• obstetrician-gynecologist - in cases of detection of sinus tachycardia during pregnancy.

Only after studying the results of all diagnostic measures, the cardiologist will draw up an individual scheme for each patient on how to treat sinus tachycardia.

Treatment

Therapy of such an ailment is based on eliminating the cause of its occurrence. Thus, treatment may include:

• rejection of bad habits;
• balanced diet;
• full sleep;
• taking antibacterial agents - during the course of infectious diseases;
• the use of drugs that suppress the active functioning of the thyroid gland;
• ingestion of iron preparations;
• intravenous administration of special solutions that restore the full volume of circulating blood;
• oxygen therapy - to eliminate diseases of the bronchi or lungs;
• psychotherapy or autotraining.

Direct treatment of sinus tachycardia with medication is necessary only in cases where the patient is difficult to tolerate palpitations. For this, patients are advised to take:

• beta blockers;
• inhibitors of if-channels of the sinus node;
• tinctures based on plants such as valerian root, hawthorn or motherwort.

With a severe course of the disease in a woman during pregnancy, urgent stimulation of labor is necessary. Often, childbirth with sinus tachycardia is carried out by caesarean section.

The only consequence of such an ailment is the development of heart failure.

Prevention and prognosis

In order to prevent people from developing paroxysmal sinus tachycardia, the following general recommendations should be observed:

• complete rejection of alcohol and nicotine;
• proper nutrition, enriched with vitamins and trace elements necessary for the body;
• avoiding emotional and physical overwork;
• control over body weight;
• maintaining a moderately active lifestyle;
• ensuring sufficient sleep duration;
• timely diagnosis and treatment of cardiac pathologies;
• taking medication strictly according to the instructions of the attending physician;
• regular full examination in a medical institution.

Physiological sinus tachycardia often has a favorable prognosis, then only if it is started in a timely manner and complex therapy. If the disease was caused by other ailments, then there is a high probability of developing life-threatening consequences.

If you think you have sinus tachycardia and its symptoms, a cardiologist can help you.

We also suggest using our online disease diagnostic service, which, based on the symptoms entered, selects probable diseases.

Arrhythmia in children is a heart rhythm disorder of various etiology, which is characterized by a change in the frequency, regularity and sequence of heartbeats. Externally, arrhythmia in children manifests itself in the form of a non-specific clinical picture, which actually leads to a belated diagnosis.

Cardiac chronic malaise, which occurs due to the formation of connective tissue in the thickness of the heart muscle, is called cardiosclerosis. This disease is predominantly not independent in nature, and often manifests itself against the background of other ailments of the body. Cardiosclerosis refers to a serious disease that disrupts the functioning of the heart and occurs against the background of various causes and pathogens.

Defect or anatomical anomalies of the heart and vascular system, which occur mainly during fetal development or at the birth of a child, are called congenital heart disease or congenital heart disease. The name congenital heart disease is a diagnosis that doctors diagnose in almost 1.7% of newborns. Types of CHD Causes Symptoms Diagnosis Treatment The disease itself is an abnormal development of the heart and the structure of its vessels. The danger of the disease lies in the fact that in almost 90% of cases, newborns do not live up to one month. Statistics also show that in 5% of cases, children with CHD die before the age of 15 years. Congenital heart defects have many types of heart anomalies that lead to changes in intracardiac and systemic hemodynamics. With the development of CHD, disturbances in the blood flow of the large and small circles, as well as blood circulation in the myocardium, are observed. The disease occupies one of the leading positions in children. Due to the fact that CHD is dangerous and fatal for children, it is worth analyzing the disease in more detail and finding out all the important points, which this material will tell about.

Neurocirculatory dystonia, or heart neurosis, is a disorder in the functioning of the cardiovascular system, which is associated with a violation of the physiological neuroendocrine regulation. Most often manifested in women and adolescents due to the influence of severe stress or heavy physical exertion. It is much less common in people under the age of fifteen and over the age of forty.

Premenstrual syndrome is a complex of painful sensations that occur ten days before the onset of menstruation. The signs of manifestation of this disorder and their combination are individual in nature. Some female representatives may experience symptoms such as headache, mood swings, depression or tearfulness, while others may experience pain in the mammary glands, vomiting, or constant pain in the lower abdomen.

With the help of exercise and abstinence, most people can do without medicine.

Symptoms and treatment of human diseases

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Questions and suggestions:

Sinus tachycardia mkb 10

Atrioventricular block first degree

When making a diagnosis

Level of consciousness, respiratory rate and efficiency, heart rate, pulse, blood pressure, ECG, history if possible

Additional (according to indications)

Laboratory tests: hemoglobin, blood gases, KOS indicators,

electrolytes (K, Na, Mg, Ca, Cl), blood glucose, leukocytes, blood formula, enzymes CPK, AlAT, AsAT

R-graphy of the chest organs

During treatment

Monitoring according to clause 1.5. Repeatedly according to indications - ECG, laboratory parameters, depending on the clinical situation

Cancellation of drugs that lengthen the PQ interval on the ECG. Ensuring adequate ventilation, oxygen inhalation, intravenous access

Atropine 0.5-1 mg IV, up to a total dose of 0.04 mg/kg

Transcutaneous external pacing, if not possible or as a temporary alternative until transvenous pacing is provided - dopamine 5-20 mcg/kg/min. adrenaline 2-10 mcg / min. as a continuous dosed infusion

Correction of water and electrolyte balance

Extracardiac pathological sinus tachycardia occurs with an increase in body temperature, acidosis, hypoglycemia, hypoxemia associated with anemia or lung damage, with pheochromocytoma and thyrotoxicosis, infectious toxicosis (neurotoxicosis when taking or overdose of drugs: adrenaline, izadrin, eufillin, atropine, inhalation of large doses agonists of 2-adrenergic receptors (terbutaline, salbutamol, etc.).

Lymphostasis, chronic fatigue syndrome. Osteopathy helps at any age. Treatment by an osteopath will be useful even for babies - two or three treatment sessions can help restore normal sleep, get rid of causeless whims and anxiety. A course of pediatric osteopathy helps to improve the child's appetite, contributes to the normalization of reflexes and muscle tone.

Hypercatecholaminemia, hypersensitivity of the sinus node to catecholamines, as well as hypovagotonia determine the pathogenesis, clinic and tactics of treating this type of tachycardia 35. According to O.N. Voronina 9, in children with chronic sinus tachycardia, the leading is a pronounced autonomic dysfunction with a high tone of the parasympathetic division of the autonomic nervous system.

Any symptoms of a violation of cardiac activity, complaints of teenagers about feeling unwell, should alert parents and be a reason to see a doctor. Also pay attention to the outdoor games of younger children. If the child's behavior changes during the game: Rapid fatigue, shortness of breath, pale skin, he should be examined by a cardiologist.

In this case, it is necessary to remove the child's electrocardiogram. Heart murmurs are not always audible. With obvious tachycardia, extrasystole, we can talk about the late manifestation of cardiopathy in children. Therefore, it is important to identify this pathology in a timely manner. To do this, you should constantly maintain the health of the child, observe preventive measures, and also at least once a year appear at the appointment with a cardiologist, with a mandatory examination.

In children, heart rate depends on age (Table 1). There are sinus tachycardia: 1) moderate (I degree) increase in heart rate by 1020 above the age norm; 2) medium (II degree) for 2040; 3) expressed (III degree) on. Sinus tachycardia can be physiological and pathological, and pathological is divided into extracardiac and cardiac 2, 21.

V. I. Starodubov dated March 6, 2008 N 1619-sun organization of selection of patients for high-tech methods of treatment in the profile "cardiovascular surgery" guidelines

Cardiac arrhythmias, unspecified

For selection for high-tech treatments, arrhythmias are rationally classified based on their clinical relevance.

When examining young people, it is advisable to distinguish two types of arrhythmias: Type I - unstable, not significantly affecting well-being and prognosis; Type II - persistent arrhythmias that affect the patient's condition and have prognostic value.

Type I (unstable arrhythmias): supraventricular extrasystoles, rare ventricular extrasystoles (up to 10 per hour), pacemaker migration, sinus bradycardia and sinus tachycardia, if they do not manifest themselves clinically. When such arrhythmias are detected, these individuals usually do not need additional research; in most cases, these arrhythmias are a finding when examining young people.

Type II (persistent, significant arrhythmias): frequent (more than 10 in 1 minute or 100 in 1 hour) and polytopic ventricular extrasystoles, paroxysmal cardiac arrhythmias (supraventricular and ventricular tachycardia, atrial fibrillation and flutter), sinus node weakness syndrome. This group also includes the WPW syndrome and the CLC syndrome, since it can be combined with the latent WPW syndrome. If group II arrhythmias are detected, these individuals need additional examination to clarify the nature and severity of the arrhythmia, identify the mechanisms for the development of arrhythmia and decide on the need for their correction. The main instrumental methods for diagnosing cardiac arrhythmias are presented in Table 6.

Basic instrumental diagnostic methods

Recurrent ventricular arrhythmia

Supraventricular tachycardia

Paroxysmal tachycardia, unspecified

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International Statistical Classification of Diseases and Related Health Problems.

Paroxysmal tachycardia ICD code 10

I47 Paroxysmal tachycardia

The information posted on the site is for reference only and is not official.

Wiktionary has an entry for "paroxysm"

Paroxysm (from other Greek παροξυσμός "irritation, anger; encouragement") - an increase in any painful attack (fever, pain, shortness of breath) to the highest degree; sometimes this word also refers to periodically returning attacks of the disease, for example, swamp fever, gout. Paroxysms reflect the presence of dysfunction of the autonomic nervous system and can be a manifestation of a number of diseases. The most common cause of them - neuroses. In second place are organic (usually not gross) brain lesions: hypothalamic disorders, stem disorders (especially dysfunction of the vestibular systems). Quite often crises accompany attacks of temporal lobe epilepsy, migraine. They can also occur against the background of severe allergies. Cerebral autonomic paroxysms should be differentiated from the primary lesion of the endocrine glands. So, for pheochromocytoma, sympathetic-adrenal paroxysms are characteristic, and for insuloma, vago-insular ones. Studies of catecholamine excretion and glycemic profile are also needed. Contrast examination of the retroperitoneal region (aortography, pneumothorax) makes it possible to differentiate these conditions.

Treatment is primarily causal. Normalization of emotional disorders (see. Neurosis), desensitization, reduction of vestibular excitability. When using vegetotropic agents, one should focus on the nature of the vegetative tone in the intercrisis period: sympatholytic agents with tension of the sympathetic system (chlorpromazine, ganglioblockers, ergotamine derivatives), anticholinergic agents with increased parasympathetic manifestations (amizil, atropine drugs). In the case of amphotropic shifts - combined agents: belloid, bellaspon. During the attack - soothing, tranquilizing drugs, muscle relaxation, deep slow breathing and symptomatic drugs (with sympathetic-adrenal crises - dibazol, papaverine, chlorpromazine, with vago-insular - caffeine, cordiamine).

Vegetative-vascular paroxysms begin either with a headache, or with pain in the region of the heart and palpitations, redness of the face. Blood pressure rises, pulse quickens, body temperature rises, chills begin. Sometimes there is an unreasonable fear. In other cases, general weakness sets in, dizziness, darkening of the eyes, sweating, nausea, blood pressure decreases, and the pulse slows down. Seizures last from a few minutes to 2-3 hours, and many go away without treatment. With exacerbation of vegetovascular dystonia, the hands and feet become purple-cyanotic, wet, cold. Areas of blanching on this background give the skin a marbled appearance. Numbness, crawling, tingling, and sometimes pain appear in the fingers. Sensitivity to cold increases, hands and feet become very pale, sometimes the fingers become puffy, especially with prolonged hypothermia of the hands or feet. Overwork and excitement cause more frequent attacks. After an attack, a feeling of weakness and general malaise may remain for several days.

One of the forms of vegetative-vascular paroxysms is fainting. When fainting, it suddenly darkens in the eyes, the face turns pale, severe weakness sets in. The person loses consciousness and falls. Seizures usually do not occur. In the supine position, fainting passes faster, this is also facilitated by the inhalation of ammonia through the nose.

Paroxysmal supraventricular tachycardia - Tachycardia supraventricularis paroxismalis

Against the background of stable hemodynamics and a clear consciousness of the patient, the relief of paroxysm begins with techniques aimed at irritating the vagus nerve and slowing down conduction through the atrioventricular node. Carrying out vagal tests is contraindicated in the presence of acute coronary syndrome, suspected PE, in pregnant women.

■ Sharp straining after a deep breath (Valsalva test).

■ Stimulation of vomiting by pressing on the root of the tongue.

■ Swallowing a crust of bread.

■ The use of verapamil, digoxin in WPW syndrome (wide complexes QRS).

■ Simultaneous combination of several drugs that slow down AV conduction. In particular, with the ineffectiveness of verapamil, only not earlier than 15 minutes after its administration, procainamide (novocainamide *) can be prescribed, provided that hemodynamic stability is maintained.

■ Appointment of verapamil to patients taking β-blockers.

■ Prophylactic use of phenylephrine (mezaton) in initially normal blood pressure, as well as insufficient knowledge of contraindications to this drug.

Man 41 Complaints of palpitations, weakness, dizziness. A similar state - for half an hour. Suffering from congenital heart disease - an open oval hole. Rarely, palpitations occur. She is taking verapamil.

Objectively: the patient's condition is grave, consciousness is clear. The skin is pale, normal moisture. AD = 80/60 mm. Heart rate 210 per minute. Respiration is vesicular. The abdomen is soft and painless. ECG shows supraventricular tachycardia.

D.S. Supraventricular paroxysmal tachycardia. (I47.1)

In / through the catheter introduced 200 ml of saline, 0.2 ml of 1% solution of mezaton. At the stage of introduction of the mezaton, the rhythm recovered independently. On the repeated ECG - sinus rhythm, heart rate 65 per minute. BP - 130/80 mm Hg The patient was left at home.

Woman 62 years old. Complaints about palpitations, general weakness.

This morning, about an hour ago, there was a heartbeat, dizziness in an upright position. Periodically, palpitations occur, which are relieved by intravenous administration of verapamil.

suffering from IBS. Doesn't take medication all the time. The presence of other hr. diseases and drug allergies denies. Habitual blood pressure 130/80 mm.

Objectively. Consciousness is clear. The skin and mucous membranes are pale, of normal moisture. Respiration is vesicular. Heart rate 180 per minute, the rhythm is correct. BP 100/80 mm Hg The abdomen is soft and painless. ECG shows supraventricular tachycardia.

Ds. Supraventricular paroxysmal tachycardia

In / in slowly (within 1-2 minutes), the introduction of 4 ml of 0.25% solution of verapamil without dilution was started. After the introduction of 3 ml, the rhythm was restored.

Notes improvement in well-being. BP 120/70 mm, heart rate 85 per minute.

Paroxysmal tachycardia (I47)

Excluded:

• complicating:
  • abortion, ectopic or molar pregnancy (O00-O07, O08.8)
  • obstetric surgery and procedures (O75.4)
• tachycardia:
  • NOS (R00.0)
  • sinoauricular NOS (R00.0)
  • sinus NOS (R00.0)

In Russia, the International Classification of Diseases of the 10th revision (ICD-10) is adopted as a single regulatory document for accounting for morbidity, reasons for the population to apply to medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. №170

The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.

With amendments and additions by WHO.

Processing and translation of changes © mkb-10.com

Paroxysmal supraventricular tachycardia

Paroxysmal supraventricular tachycardia (PNT) is one of the types of arrhythmia, which is characterized by a sudden paroxysmal increase in the frequency of contractions of the heart muscle. Heart rate increases to 140 - 250 beats per minute, while the correct rhythm of the heartbeat is maintained.

The occurrence of PNT is associated with the activation in the myocardium of a highly active ectopic focus of automatism or a focus of post-depolarization trigger activity. In the vast majority of cases, PNT is based on the mechanism of impulse re-entry and circular circulation of excitation through the myocardium (or the so-called re-entry reentry mechanism). In any of these cases, the occurrence of PNT contributes to the preliminary appearance of extrasystole.

ICD-10 code

Of all types of arrhythmias, in 95% of cases, it is PNT that occurs in children. In patients under 18 years of age, PNT is the most common cause leading to arrhythmogenic collapse and heart failure. For every 1000 people in the population, there are 2.29 patients with PNT. In women, this disease occurs twice as often as in men. The risk of developing tachycardia increases at the age of more than 65 years - a five-fold increase in patients who have crossed this age limit is recorded.

With any mechanism for the occurrence of paroxysmal supraventricular tachycardia, extrasystole preliminarily develops. Extrasystole is the most common type of arrhythmia, which manifests itself as a violation of the heart rhythm and is characterized by the occurrence of single or paired premature contractions of the heart (extrasystoles). Arrhythmic contractions of the heart muscle are caused by excitation of the myocardium, which comes from the pathogenic focus of excitation. The disease is functional (neurogenic).

The causes of paroxysmal supraventricular tachycardia of an organic nature are as follows:

1. Organic damage to the heart muscle and conduction pathways of the heart, which are inflammatory, dystrophic, necrotic and sclerotic. Such damage occurs in acute myocardial infarction, chronic coronary heart disease, heart defects, cardiopathy, myocarditis.
2. The presence of additional abnormal conduction pathways, for example, in Wolff-Parkinson-White syndrome.
3. Presence of additional viscerocardinal reflexes and mechanical effects (eg, additional chords, mitral valve prolapse, adhesions).
4. The emergence of pronounced vegetative-humoral disorders in the syndrome of neurocircular dystonia.

The above violations are called intracardiac factors for the occurrence of PNT.

Experts believe that the presence of certain structural features of the heart or damage is not enough for the occurrence of paroxysmal supraventricular tachycardia. In the development of this disease, psychoemotional factors play an important role. It is known that increased sympathoadrenal activity leads to various forms of ectopic arrhythmias.

In childhood and adolescence, it is often difficult to diagnose the causes of paroxysmal tachycardia. In these cases, the presence of a violation of the contractions of the heart muscle is defined as essential (or idiopathic). Although, experts believe that the causes of paroxysmal supraventricular tachycardia in such patients are minimal, undiagnosed dystrophic damage to the myocardium.

Like extrasystole, PNT can also occur in healthy people due to pathogenic factors. With intense physical or mental stress, with strong and long-term stress. These reasons are called extracardiac. These factors also include smoking and the abuse of alcohol, strong tea, coffee and spicy foods.

When tachycardia appears, it is necessary to check the level of thyroid hormones in the blood. Although thyrotoxicosis is almost never the only cause of PNT. But when choosing a therapy, difficulties may arise that are associated with the need to stabilize the hormonal level.

Disease of some other organs can cause paroxysmal tachycardia. For example, kidney prolapse and other kidney diseases, lung diseases (acute, and especially chronic), dysfunction and diseases of the gastrointestinal tract. The above diseases of the internal organs are extracardiac factors; as a result of the transfer of such diseases, paroxysmal supraventricular tachycardia occurs as a complication.

The clinical picture of the manifestation of paroxysmal supraventricular tachycardia is characterized by the presence of the following symptoms:

1. The palpitations begin with a "thump" or "prick" in the heart, a sensation of stopping or turning over.
2. The heart rate rises to 250 beats per minute.
3. There are interruptions in the beating of the heart.
4. The pulse has a weak filling, it is often impossible to feel it.
5. There is unmotivated anxiety, shortness of breath, weakness, dizziness, noise in the head, sweating.
6. There is pain in the chest area or angina pectoris occurs.
7. With a pronounced tachycardia, blood pressure decreases.
8. During an attack, the pulse has a constant stable frequency that does not change over time.
9. There is frequent and profuse urination; manifestations of flatulence are possible.

The minimum duration of paroxysmal supraventricular tachycardia is three cardiac cycles. Such manifestations are called "jogging" tachycardia. Usually, attacks of paroxysmal supraventricular tachycardia last from several hours to several days. Perhaps a longer manifestation of tachycardia, up to several months,

Symptoms of supraventricular paroxysmal tachycardia most often disappear spontaneously and on their own. In some cases, with seizures that last for several days, a fatal outcome is possible if no treatment measures are applied.

Where does it hurt?

What worries?

There are two main types of paroxysmal tachycardia:

• ventricular (ventricular).
• supraventricular (supraventricular).

This classification arose due to the focus of localization of pathological excitation. PNT, in comparison with the gastrointestinal tract, proceeds more gently and favorably; more cases of positive dynamics are also recorded in the treatment of PNT. Since paroxysmal supraventricular tachycardia is less often associated with organic heart disease and left ventricular dysfunction. And yet, PNT potentially poses a threat to life, since it is characterized by sudden manifestations that can lead to disability of the patient or his death (in 2-5% of cases).

Paroxysmal supraventricular tachycardia has two subspecies:

• atrial paroxysmal tachycardia - in 15-20% of cases.
• atrioventricular (atrioventricular) paroxysmal tachycardia - in 80-85% of patients.
• The division into subtypes of PNT is due to the localization of the pathological zone or the circulating wave of excitation.

According to the nature of the course of the disease, three forms are distinguished:

• acute (paroxysmal).
• constantly recurrent (chronic).
• continuously recurring, which constantly develops over several years.

Considering the mechanism of the development of the disease, there are three types of PNT:

• reciprocal (associated with the re-entry mechanism in the sinus node).
• ectopic (or focal).
• multifocal (or multifocal).

The diagnosis of "paroxysmal supraventricular tachycardia" is established if the patient complains of sudden attacks of rapid, sharp heartbeat. Confirmation can be obtained using the following methods: physical examination and instrumental diagnostics.

At the initial stage, it is enough to collect an anamnesis. A characteristic sign for PNT is the occurrence of a heartbeat, "as if on the flip of a switch." When examining a patient, it is important to find out how suddenly a violation of the rhythm of the heartbeat occurs. At the beginning of the collection of data on the onset of symptoms, patients may claim that the failure in the heartbeat occurs suddenly. But with a detailed and thorough questioning of patients, it sometimes turns out that the change in the rhythm of heart contractions occurs gradually, over several minutes. These symptoms are characteristic of another disease called sinus tachycardia.

PNT is diagnosed using external signs and autonomic manifestations of the disease. This type of tachycardia is characterized by increased sweating, frequent urination, nausea, dizziness, noise in the head, and so on.

Physical examination

If, during auscultation, the heart rate exceeds 150 beats per minute, then this excludes the diagnosis of sinus tachycardia. A heart rate of more than 200 beats per minute disproves the diagnosis of gastric tachycardia. But auscultation does not reveal the source of tachycardia, and also does not always distinguish sinus tachycardia from paroxysmal.

When measuring the pulse, it is almost impossible to count it, it is so frequent. In this case, the pulse is soft and weakly filled.

During the physical examination, vagal tests are used. They are mechanical stimulation of the vagus nerve receptors, which is carried out in the form of pressure. This procedure causes a rapid and reflex increase in the tone of the above nerve. With vagal tests, the method of pressure on the carotid sinus, the Valsalva test, pressure on the eyeball, and other methods are used.

The vagus nerve is connected to the atrium and the atrioventricular node. Increased nerve tone slows down the atrial rate and atrioventricular conduction, resulting in a decrease in the rate of contractions of the ventricles of the heart. This facilitates the interpretation of the supragastric rhythm, which allows for the correct diagnosis of tachycardia. You can conduct a comprehensive diagnosis, which increases the value of vagal tests. In this case, continuous ECG and cardiac auscultation are performed along with vagus nerve stimulation. Such diagnostics are carried out before, during and after vagal tests. With PNT, a sudden stop of arrhythmic contractions occurs and sinus rhythm is restored. In some cases, during the diagnosis, there are no changes in the frequency of contraction of the heart muscle. This is due to the “all or nothing” law, which is characteristic of the clinical picture of the course of this type of tachycardia.

At the same time, it must be remembered that vagal tests can provoke unforeseen complications not only in patients, but also in healthy people. There are a number of cases that have ended in death. In rare cases, with pressure on the carotid sinus in elderly patients, thrombosis of the cerebral vessels may occur. Stimulation of the vagus nerve can lead to a decrease in cardiac output. And this, in turn, in some cases leads to a sudden decrease in blood pressure. There may be an attack of acute left ventricular failure.

Instrumental diagnostics

Instrumental diagnosis of PNT is carried out using the following methods:

1. Study of the work of the heart using an electrocardiogram.
2. Holter monitoring.
3. Stress ECG tests or stress test.
4. Echocardiography.
5. Transesophageal stimulation of the heart.
6. Intracardiac electrophysiological study.
7. Magnetic resonance imaging (MRI) of the heart.
8. Multispiral CT-cardiography (MSCT of the heart).

Supraventricular paroxysmal tachycardia on ECG

One of the main methods for diagnosing paroxysmal tachycardia is electrocardiography.

Conducting an electrocardiogram is a non-invasive method of research, which has proven itself to be quick and painless. The essence of this method is to check the electrical conductivity of the heart. On the body of the patient - his chest, arms and legs - 12 electrodes are placed, thanks to which it is possible to obtain a schematic image of the activity of the heart at different points. With the help of an electrocardiogram, you can establish the diagnosis of PNT, as well as identify its causes.

Supraventricular paroxysmal tachycardia on the ECG has the following signs, which are clearly visible on the electrocardiogram tape:

1. The sharp initial appearance of paroxysm and the same end of the attack.
2. There is a heart rate of more than 140 beats per minute.
3. Regular heartbeat.
4. Usually, QRS complexes are normal in appearance.
5. The P waves are different on visual diagnosis. With paroxysmal tachycardia of the atrioventricular form, the P waves are located after the QRS complexes or are layered on them. In atrial PT, P waves are located in front of the QRS complexes, but have an altered or deformed appearance.

What needs to be examined?

How to investigate?

Who to contact?

Emergency care for paroxysmal supraventricular tachycardia

Some attacks of PNT require urgent medical attention, because the attack does not go away on its own, and the patient's condition worsens. Treatment is provided on the spot by an ambulance team that arrives. If an attack of paroxysm occurred for the first time or there are suspicions for the hospitalization of the patient, an additional cardiological ambulance team is called. In this case, the following methods of emergency care are used for paroxysmal supraventricular tachycardia:

• The use of vagal samples helps to stop the attack. First of all, the Valsalva test is used when you need to strain and hold your breath for 20 or 30 seconds. This is the most effective test. Deep, rhythmic breathing can also help. The Ashner test is also used, which is pressure on the eyeballs for five seconds. You can also squat down. The use of vagal tests is contraindicated in the following diseases: conduction disorders, severe heart failure, sick sinus syndrome, stroke, dyscirculatory encephalopathy, glaucoma.
• If the face is in cold water for 10 seconds, this will help stop an attack of PNT.
• Massage one of the carotid sinuses. Massage is contraindicated if there is a sharp decrease in heart rate and there is noise over the carotid artery.
• If all of the above actions did not give a result, then you need to stop the attack with the help of transalimentary cardiac stimulation (CHPSS) or electrical impulse therapy (EIT). CHPSS is also used in case of impossibility of using arrhythmic drugs due to intolerance. The use of CPSS is indicated in the presence of data on conduction disturbance during the recovery from an attack.
• To most effectively stop an attack of PVT, it is necessary to determine its form - PVT with narrow or wide QRS complexes.
• In PNT with narrow QRS complexes, the following drugs must be administered intravenously: adenosine phosphate, verapamil, procainamide, and others. Without an electrocardiographic examination, the use of drugs is possible only in extreme, critical cases. Or when there is evidence that the drug has been used on the patient during previous attacks, and the procedure has not brought complications. It is necessary to constantly monitor the patient's condition using an ECG. If there is no effect from the administration of drugs, then you need to use chewed tablets, namely propranolol, atenolol, verapamil and others. In any case, these procedures are carried out only by the ambulance team that came to the patient.
• In an attack of PNT with wide QRS complexes, there is a suspicion of paroxysmal ventricular tachycardia. Therefore, the tactics of arresting an attack in this case are somewhat different. Electropulse therapy is effective, as is transalimentary stimulation of the heart. Drugs are used that stop both attacks of supraventricular and ventricular PT. The most commonly used drugs are procainamide and/or amiodarone. For unspecified wide complex tachycardia, adenosine, aimaline, lidocaine, sotalol are used.

Indications for hospitalization of the patient are as follows:

• An attack of PNT cannot be stopped on the spot.
• An attack of PNT is accompanied by acute cardiac or cardiovascular failure.

Patients who have PNT attacks occur at least 2 times a month are subject to mandatory planned hospitalization. In the hospital, the patient undergoes an in-depth diagnostic examination, during which he is prescribed treatment.

Treatment of paroxysmal supraventricular tachycardia

Mode and diet

• With the manifestation of tachycardia, you should lead a certain lifestyle.
• First of all, you must stop smoking and drinking alcohol.
• It is necessary to monitor the maintenance of an even psycho-emotional state during the day and avoid stress. To strengthen the psyche, it is useful to do autogenic training and other types of self-regulation. It is also possible to use sedatives prescribed by a doctor.
• It is necessary to adhere to a stable daily routine, get enough sleep and not stay up late watching TV or chatting on social networks. There should be enough time during the day for rest or naps if needed by the patient.
• Include feasible physical activity in your daily routine, namely, morning exercises, evening walks in the fresh air, swimming in the pool or open water.
• Be sure to monitor your cholesterol and blood sugar levels.
• It is necessary to maintain optimal body weight.
• Food should be taken in small portions 4-5 times a day. Because an overfilled stomach begins to irritate the receptors of the nerves responsible for the work of the heart, which can lead to an attack of tachycardia.
• To avoid overeating, you need to exclude reading books, watching TV and working at the computer while eating. When the focus is only on the process of absorption of food, it is much easier to feel full in time to stop.
• Do not eat food at night; It is advisable to spend the last meal two to three hours before bedtime.

From the use it is necessary to exclude products that provoke the appearance of tachycardia:

• tea and coffee.
• foods containing starch and sugar, high-calorie foods - pastries, chips, crackers, chocolate bars, sweets, and so on.
• fatty foods - fatty meat, mayonnaise, sour cream, lard, margarine; It is worth limiting the consumption of butter.

Most of these products contain "bad" cholesterol, which negatively affects the condition of the heart muscle.

It is necessary to minimize salt intake, if necessary, replacing it with spices (for example, dried seaweed). Salt should only be added to cooked foods.

You should also exclude from the diet:

• canned and refined foods, as they contain a large amount of fats, salt and other foods that are dangerous for the heart.
• fried food.

The diet for patients with paroxysmal supraventricular tachycardia should include a large amount of low-fat and plant foods.

Include the following foods in your diet that support healthy heart function:

• foods rich in magnesium and potassium - dried apricots, buckwheat porridge, honey, pumpkin, zucchini.
• foods containing omega 3 unsaturated fatty acids - sea fish, flax seeds, walnuts, canola oil.
• foods containing omega 6 unsaturated fatty acids - vegetable oils, various seeds and soy.
• monounsaturated fats - they are found in sufficient quantities in cashews, almonds, peanuts, avocados and oils from various types of nuts.
• low-fat foods - skimmed milk, yogurt and cottage cheese.
• various types of cereals, which contain a large amount of nutrients, as well as fresh and stewed vegetables.
• it is necessary to introduce a certain amount of freshly squeezed juices into the diet, as they are rich in vitamins and minerals.
• There are several useful recipes that should be included in the diet of patients with tachycardia.
• Take 200 grams of dried apricots, walnuts, raisins, lemon and May honey. Grind everything and mix in a blender, pour into a jar and store in the refrigerator. Take one tablespoon twice a day.
• A good remedy for tachycardia is celery root. You need to prepare salads with it: grate it on a coarse grater and add greens - celery leaves, dill and parsley. Salad must be salted and seasoned with low-fat yogurt (or put a small amount of low-fat sour cream).

Medical treatment of paroxysmal supraventricular tachycardia

It must be remembered that taking medications, as well as their dosage, is prescribed by a doctor.

In the treatment of PNT, sedative drugs are used: tranquilizers, bromine, barbiturates.

Drug treatment begins with the use of beta-blockers:

• Atenolol - daily dose for 4 doses or propranolol (anaprilin, obzidan) - daily dose for 3 doses.
• Metoprolol (vasocardin, egilok) - mg 4 times a day.

Quinidine is prescribed for patients who do not have myocardial damage and heart failure. The average dose is 0.2 - 0.3 grams 3-4 times a day. The course of treatment is several weeks or months.

Quinidine bisulfate (quinidine dureter, quinidine duriles), as the latest generation drugs, cause fewer side effects from the gastrointestinal tract, and also have a higher concentration in the patient's blood. Quinidine dureter is applied at 0.6 grams 2 times a day.

In the treatment of patients with affected myocardium and heart failure, as well as pregnant women, it is recommended to use digitalis preparations - isoptin. The daily dose of the drug is from 120 to 480 mg per day and is used in 4 doses. It is good to use the drug digoxin - 0.25 grams per day.

The best results are obtained by combining digitalis and quinidine preparations.

The drug procainamide is prescribed for use as follows: 1 or 2 tablets, dosage of 0.25 grams, 4 times a day.

The following drugs are also prescribed:

• Aymalin - 50 mg 4-6 times a day.
• Verapamil - 120 mg 3-4 times a day.
• Sotalol - 20 - 80 mg 3-4 times.
• Propafenone - mg, 3-4 times a day.
• Allapinin - 15 - 30 mg, 3-4 times a day.
• Etatsizin - 50 mg, 3 times a day.

Experts recommend a long course of treatment with potassium preparations; potassium chloride, panangin, tromkardin are used. These drugs are prescribed in combination with some of the main antiarrhythmic drugs. Potassium chloride in a 10% solution is used at a dosage of 20 ml 3 or 4 times a day during a long course of treatment.

Physiotherapy for paroxysmal supraventricular tachycardia

In the treatment of paroxysmal supraventricular tachycardia, water procedures are actively used:

Treatment of paroxysmal supraventricular tachycardia by folk methods

It happens that patients suffering from paroxysmal supraventricular tachycardia are contraindicated in some drugs prescribed by a doctor. Traditional medicine will come to the aid of patients. Here are a few recipes that patients can easily use to alleviate their condition.

• Using lovage: you need to take 40 grams of plant roots and pour 1 liter of hot water (but not boiling water). The infusion must be kept for 8 hours, and then filtered. Take the drink throughout the day in small portions until the state of health improves.
• Pour three glasses of viburnum berries into a three-liter jar and pour two liters of boiling water. After that, you need to carefully close the jar, wrap it up and leave for six hours. Then it is necessary to strain the infusion into an enamel bowl and also squeeze the berries there. Then add 0.5 liters of high-quality honey to the infusion and refrigerate for storage. Take an infusion before meals three times a day, one third of a glass. The course of treatment is one month, then you need to take a break of ten days and repeat the infusion. Thus, it is necessary to carry out three courses of treatment.
• The method of treating hawthorn has also proven itself. In the pharmacy, you should purchase alcohol tinctures of hawthorn, motherwort and valerian (one bottle each). Next, you need to mix the tinctures thoroughly and leave for one day in the refrigerator. Take the medicine three times a day for a teaspoon half an hour before meals.
• It is good to use rosehip infusion in the treatment of tachycardia. It is necessary to take 2 tablespoons of wild rose, place them in a thermos and pour half a liter of boiling water. Leave to brew for one hour, and then add 2 tablespoons of hawthorn. The resulting infusion should be drunk in small portions throughout the day and a fresh drink should be brewed daily. Within three months it is necessary to drink the infusion, and then take a break for one year.

Treatment of paroxysmal supraventricular tachycardia at home

With an attack of paroxysmal tachycardia, you need to resort to self-help and mutual assistance:

• First of all, you need to calm down, the most important thing at this moment is to acquire physical and emotional peace.
• With a sharp weakness, nausea and dizziness, it is necessary to sit in a comfortable position or lie down in a horizontal position.
• Be sure to ensure the penetration of fresh air to the patient. To do this, unbutton clothes that hold your breath, as well as open a window.
• An attack of paroxysmal tachycardia can be removed by irritating the vagus nerve using reflex methods. To do this, you need to perform the following exercises: strain to squeeze the abdominal press; press on the eyeballs; hold your breath for a second; induce vomiting.
• If the attending physician has shown how vagal tests are performed, it will be useful to conduct them.
• It is necessary to take the drugs prescribed by the doctor and in no case change the dosage of the medication on your own.
• If the state of health and well-being worsens, then you need to urgently call an ambulance. If there is pain in the heart, sudden weakness, suffocation, loss of consciousness and other signs of deterioration, medical attention should be called immediately.

Treatment of paroxysmal supraventricular tachycardia requires the restoration of the required concentration in the blood, the so-called electrolyte substances. These include potassium, calcium and chlorine. If you choose the right herbal therapy, then the body will receive the necessary substances in sufficient quantities, as well as plant glycosides.

In paroxysmal tachycardia, plants containing cardiac glycosides and having a sedative (sedative) effect are widely used. These include hawthorn, motherwort, valerian, mint, lemon balm. They need to be used for a long time in courses with certain breaks in the form of decoctions and infusions. There are also alcohol analogues of medicinal tinctures, but due to the presence of alcohol in the preparation, they can not be used by all patients. In any case, before taking herbs, you should consult with your doctor. Since, there are contraindications to taking various traditional medicines, as well as their incompatibility with pharmaceuticals prescribed by a doctor.

With attacks of paroxysmal tachycardia, breathing techniques should be used. For example, "yogic breathing" well stops attacks of accelerated heartbeat. A breathing exercise is performed as follows: inhale through one nostril (while closing the other nostril with your finger) - exhale through the other nostril.

Another modification of the breathing technique is possible, in which inhalation and exhalation are performed rhythmically, with a breath hold. For example, inhale for 3 counts, hold for 2 counts, exhale for 3 counts, hold for 2 counts.

It is good to learn breathing exercises according to the Strelnikova method or Buteyko breathing. These techniques do not eliminate the cause of the disease, but they make it possible to alleviate the patient's condition, and also contribute to the training of the heart muscle, which significantly reduces the number and duration of attacks.

Surgical treatment of paroxysmal supraventricular tachycardia

This method is used if conservative treatment has shown to be ineffective. Also, with irreversible sclerotic changes in the heart and with the detection of heart disease, surgery is recommended.

There are two types of surgical treatment - partial and radical. With a radical method of treatment, the patient permanently gets rid of the symptoms of the disease. With a partial method of treatment, tachycardia attacks lose their strength and occur much less frequently; also increases the effectiveness of the use of antiarrhythmic drugs.

There are two types of treatment used in surgery:

• Destruction of additional pathways or foci of heterotopic automatism. Surgical intervention is carried out using minimally invasive methods using mechanical, electrical, laser, chemical, cryogenic agents. This is the so-called closed operation, in which two types of catheters are used - diagnostic and therapeutic. They are introduced into the patient's body through the femoral or subclavian vein. A diagnostic catheter using a computer allows you to determine the exact zone of occurrence of tachycardia. And a therapeutic catheter is used to carry out the procedure for influencing the PNT zone.
• The most common is radiofrequency ablation. The term "ablation" means removal, but in this treatment procedure, cauterization of the zone that caused the tachycardia is used.
• Implantation of two types of pacemakers - an artificial pacemaker (pacemaker) and an implantable cardioverter-defibrillator. Pacemakers must function in predetermined modes - paired stimulation, "exciting" stimulation, and so on. Devices are set to automatically turn on after the onset of an attack.

Surgery for paroxysmal supraventricular tachycardia

With the ineffectiveness of drug therapy for paroxysmal supraventricular tachycardia, surgery is prescribed. Also, with congenital malformations in the structure of the heart muscle and impaired cardiac conduction (for example, with Wolff-Parkinson-White syndrome), surgical intervention is used.

The classical method is open heart surgery, the purpose of which is to interrupt the impulse conduction along additional pathways. Relief of the symptoms of tachycardia is achieved by cutting or removing pathological sections of the conduction system. Surgical intervention is performed using cardiopulmonary bypass.

So, surgery for paroxysmal supraventricular tachycardia is indicated for the following symptoms:

1. The occurrence of ventricular fibrillation, even in a single case.
2. Paroxysms of atrial fibrillation, which are repeated many times.
3. Sustained attacks of tachycardia that cannot be stopped with the use of antiarrhythmic therapy.
4. The presence of congenital malformations and anomalies in the development of the heart.
5. Intolerance to drugs that block an attack of tachycardia and maintain a satisfactory condition of the patient between attacks.
6. The occurrence of PNT attacks in children and adolescents, which greatly complicate their physical, psycho-emotional and social development.

More about treatment

Medications

Prevention of paroxysmal supraventricular tachycardia is carried out with the help of a healthy lifestyle, proper daily routine and diet, which were described in detail in the section "Treatment of paroxysmal supraventricular tachycardia". A patient with PNT should avoid strong psycho-emotional and physical stress, lead a sparing lifestyle, in which movement and rest are evenly combined. It is also necessary to exclude factors provoking tachycardia - smoking, drinking alcohol, coffee, strong tea, and so on.

Timely diagnosis and the use of antiarrhythmic drugs are also among the methods of primary prevention of PNT. As well as the treatment of the underlying disease that causes attacks of paroxysms of the heart. Taking sedatives is also a prophylactic in the event of paroxysmal supraventricular tachycardia. One of the means of preventing attacks of PNT is timely surgical intervention.

There are forms of paroxysmal supraventricular tachycardia that cannot be prevented. The essential form of PNT belongs to this case, since the causes of its occurrence are still not known.

When making forecasts, it is necessary to take into account the causes and form of PNT. The frequency of occurrence and the duration of paroxysmal attacks, the presence or absence of complications, as well as the state of the myocardium are taken into account. For example, with severe damage to the heart muscle, acute heart or cardiovascular failure may occur. There is a high risk of ventricular fibrillation and ischemia with the affected myocardium; cases of unexpected death due to an attack of PNT have also been reported.

The effectiveness of the treatment of the underlying disease, as well as the rate of its progression, affect the condition of the patient with PNT.

The prognosis of the course of the disease in the essential form of paroxysmal supraventricular tachycardia is favorable, although its prevention is difficult due to the lack of identified causes of the disease. Patients with PNT may be able to work and maintain an active lifestyle for several years or decades. Rarely, there are also cases of sudden cure of PNT.

Paroxysmal supraventricular tachycardia can slow down its course with timely diagnosis and prevention of this disease.

Medical Expert Editor

Portnov Alexey Alexandrovich

Education: Kyiv National Medical University. A.A. Bogomolets, specialty - "Medicine"

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Sinus tachycardia

Sinus Tachycardia: A Brief Description

sinus tachycardia(ST)- increased heart rate at rest more than 90 per minute. With heavy physical exertion, the normal regular sinus rhythm increases to 150-160 per minute (for athletes - up to 200-220).

Etiology

Sinus tachycardia: Signs, Symptoms

Clinical manifestations

Sinus Tachycardia: Diagnosis

Primary Menu

C e eh uh t a P a: arrhythmias preceding circulatory arrest require the necessary treatment to prevent cardiac arrest and stabilize hemodynamics after successful resuscitation.

The choice of treatment is determined by the nature of the arrhythmia and the patient's condition.

It is necessary to call for the help of an experienced specialist as soon as possible.

I47 Paroxysmal tachycardia

I 47.0 Recurrent ventricular arrhythmia

I47.1 Supraventricular tachycardia

I47.2 Ventricular tachycardia

I47.9 Paroxysmal tachycardia, unspecified

I48 Atrial fibrillation and flutter

I49 Other cardiac arrhythmias

I49.8 Other specified cardiac arrhythmias

I49.9 Cardiac arrhythmia, unspecified

physiological sequence of heart contractions as a result of a disorder in the functions of automatism, excitability, conduction and contractility. These disorders are a symptom of pathological conditions and diseases of the heart and related systems, and have independent, often urgent clinical significance.

In terms of the response of ambulance specialists, cardiac arrhythmias are clinically significant, since they represent the greatest degree of danger and must be corrected from the moment they are recognized and, if possible, before the patient is transported to the hospital.

There are three types of periarrest tachycardia: wide QRS tachycardia, narrow QRS tachycardia, and atrial fibrillation. However, the basic principles for the treatment of these arrhythmias are general. For these reasons, they are all combined into one algorithm - the tachycardia treatment algorithm.

UK, 2000. (Or arrhythmias with dramatically reduced blood flow)

Bradyarrhythmia:

sick sinus syndrome,

(Atrioventricular block II degree, especially atrioventricular block II

degree type Mobitz II,

3rd degree atrioventricular block with a wide QRS complex)

Tachycardias:

paroxysmal ventricular tachycardia,

Torsade de Pointes,

Wide QRS complex tachycardia

Tachycardia with a narrow QRS complex

Atrial fibrillation

PZhK - extrasystoles of a high degree of danger according to Laun (Lawm)

during diastole. With an excessively high heart rate, the duration of diastole is critically reduced, which leads to a decrease in coronary blood flow and myocardial ischemia. The frequency of the rhythm at which such disturbances are possible, with narrow-complex tachycardia, is more than 200 per 1 minute and with wide-complex

tachycardia more than 150 in 1 minute. This is due to the fact that wide-complex tachycardia is worse tolerated by the heart.

Rhythm disturbances are not a nosological form. They are a symptom of pathological conditions.

Rhythm disturbances act as the most significant marker of damage to the heart itself:

a) changes in the heart muscle as a result of atherosclerosis (HIHD, myocardial infarction),

b) myocarditis,

c) cardiomyopathy,

d) myocardial dystrophy (alcoholic, diabetic, thyrotoxic),

d) heart defects

e) heart injury.

Causes of non-cardiac arrhythmias:

a) pathological changes in the gastrointestinal tract (cholecystitis, peptic ulcer of the stomach and duodenum, diaphragmatic hernia),

b) chronic diseases of the bronchopulmonary apparatus.

c) CNS disorders

d) various forms of intoxication (alcohol, caffeine, drugs, including antiarrhythmic drugs),

e) electrolyte imbalance.

The fact of the occurrence of arrhythmia, both paroxysmal and permanent, is taken into account in

syndromic diagnosis of diseases underlying cardiac arrhythmias and conduction disorders.

Treatment for most arrhythmias is determined by whether the patient has adverse signs and symptoms. About the instability of the patient's condition

in connection with the presence of arrhythmia, the following testifies:

Signs of activation of the sympathetic-adrenal system: pallor of the skin,

increased sweating, cold and wet extremities; increase in symptoms

disturbances of consciousness due to a decrease in cerebral blood flow, Morgagni's syndrome

Adams-Stokes; arterial hypotension (systolic pressure less than 90 mm Hg)

Excessively fast heart rate (more than 150 beats per minute) reduces coronary

blood flow and can cause myocardial ischemia.

Left ventricular failure is indicated by pulmonary edema, and increased pressure in the jugular veins (swelling of the jugular veins), and enlargement of the liver is

indicator of right ventricular failure.

The presence of chest pain means that the arrhythmia, especially the tachyarrhythmia, is due to myocardial ischemia. The patient may or may not complain about

quickening of the rhythm. May be noted during examination "dance of the carotid"

The diagnostic algorithm is based on the most obvious characteristics of the ECG

(width and regularity of QRS complexes). This makes it possible to do without indicators,

reflecting the contractile function of the myocardium.

The treatment of all tachycardias is combined into one algorithm.

In patients with tachycardia and an unstable state (presence of threatening signs, systolic blood pressure less than 90 mm Hg, ventricular rate more than

150 in 1 minute, heart failure or other signs of shock) recommended

immediate cardioversion.

If the patient's condition is stable, then according to the ECG data in 12 leads (or in

one) tachycardia can be quickly divided into 2 variants: with wide QRS complexes and with narrow QRS complexes. In the future, each of these two variants of tachycardia is subdivided into tachycardia with a regular rhythm and tachycardia with an irregular rhythm.

ECG monitoring,

ECG diagnostics

In hemodynamically unstable patients, priority is given to ECG monitoring during rhythm assessment and subsequently during transport.

Evaluation and treatment of arrhythmias is carried out in two directions: the general condition of the patient (stable and unstable) and the nature of the arrhythmia. There are three options

immediate therapy;

Antiarrhythmic (or other) drugs

Electrical cardioversion

Pacemaker (pace)

Compared to electrical cardioversion, antiarrhythmic drugs act more slowly and are less effective in converting tachycardia to sinus rhythm. Therefore, drug therapy is used in stable patients without adverse symptoms, and electrical cardioversion is usually preferred in unstable patients with adverse symptoms.

1. Oxygen 4-5 l in 1 min