Ventricular tachycardia - a fast work of ventricular beats at a frequency of more than a century as a result of the emergence of the hearth, which generates and maintains electrical impulses often arise.Symptoms ventricular tachycardia depends on its duration and can manifest itself as an absolute lack of heartbeat sensations and development of the collapse and the onset of death.
ventricular tachycardia possible to establish with the help of an electrocardiogram.For the treatment of ventricular tachycardia used drugs cardioversion and antiarrhythmic action, who are appointed on the grounds.If necessary, the long-term therapy with cardioverter defibrillator.
fibrillation, which is characterized by ventricular rate with less rhythm called ventricular tachycardia slow.Such a state is considered to be benign, so does not need the use of drug treatment until symptoms appear hemodynamic.
On the occurrence of ventricular tachycardia can have a significant impact various c
Paroxysmal ventricular tachycardia
This kind of arrhythmia, which is characterized by paroxysms, ie attacks heartbeat, do not exceed, as a rule, one hundred and eighty beats per minute is a paroxysmal ventricular tachycardia.These heartbeat pulses result from ectopic character which subsequently replaces normal sinus rhythm.
for paroxysmal ventricular tachycardia characteristic rapid onset and quick ending Different durations at which saved a constant rhythm.Ectopic bumps can be formed in the ventricles, atria or atrioventricular connection.
This form of arrhythmia in its etiology and patogenetiki very similar to arrythmia.Thus, beats, consecutive, regarded as a short bout of tachycardia.In this condition, the blood circulation in the heart circulates ineffectively, so heart attacks, which are formed as a result of heart disease, can become a cause of heart failure.During the prolonged ECG nearly 25% of patients revealed paroxysmal ventricular arrhythmia.
This arrhythmia is classified by location in the forms such as ventricular, atrial and atrioventricular.The first two are combined and arrhythmias are supraventricular form.But paroxysmal ventricular tachycardia can occur acutely, chronically and continuously recurring.The latter form of arrhythmia may last for many years and thus cause arrhythmogenic cardiomyopathy and heart failure.
Depending on the mechanism for the development of this form of tachycardia, it may be reciprocal, ectopic, multifocal, and it is always preceded by beats.
tend to cause the formation of paroxysmal tachycardia is considered to increase the activation of the sympathetic nervous system and various lesions of the heart muscle in the form of inflammation, necrosis, dystrophy or multiple sclerosis.
for paroxysmal ventricular tachycardia characterized by ectopic excitations which are localized in the bundle branch block in Purkinje fibers and bundle branch block.Basically ventricular tachycardia is more common in older men with IBS, hypertension, heart defects, myocarditis and heart attacks.
important point in the development of paroxysmal ventricular tachycardia is considered to have the way of additionality for excitation in the myocardium with congenital etiology or arising after myocarditis, cardiomyopathy, or heart attack.Such paths cause pathological cycle of the excitation of the myocardium.
Symptoms attack in paroxysmal ventricular tachycardia can be folded out of the noise in the head, dizziness and feeling of the heart to contract.Less commonly observed hemiparesis and aphasia.Sometimes there sweating, nausea, bloating, and easy low-grade fever.At the end of the attack is marked polyuria long as substantial amounts of urine with a low density and light shade.The prolonged state of paroxysm may cause a decrease in blood pressure, weakness, fainting and development.For paroxysmal ventricular tachycardia with a heart rate more than one hundred and eighty beats per minute is characterized by the formation of the ventricular flickering.
long for attack can cause pulmonary edema, and cardiogenic shock.For paroxysmal ventricular tachycardia characterized by change and expansion of the entire complex QRS, which resembles a ventricular beats.Also on the electrocardiogram can be identified unmodified, conventional P-tooth.
As a rule, patients with a diagnosis of paroxysmal ventricular tachycardia urgently hospitalized.For relief of paroxysm intravenous procainamide, propranolol, Ajmaline, quinidine, Ritmodan, Cordarone, Isoptin and Etmozin.
forecast paroxysmal ventricular tachycardia unfavorable, especially if it develops with heart disease, such as the destruction of the heart muscle contribute to the formation of ventricular fibrillation.But in the absence of specific complications, patients achieve long-term survival.
lethal outcome in this case is observed in patients with underlying heart defects, as well as the previously transferred after clinical death or resuscitation.
Ventricular tachycardia causes
Ventricular tachycardia develops against the background of pathological heart disease and more often in the elderly after acute myocardial infarction.For the younger generation are characterized by other diseases, such as various forms of cardiomyopathy (arrhythmogenic right ventricular, dilated, hypertrophic) and Brugada syndrome, myocarditis, valvular heart disease and the syndrome, which is characterized by elongated QT.
With increased pressure develops an arrhythmia resulting marked increase in the left ventricle and its expansion in conjunction with coronary artery disease.
Very often ventricular tachycardia detected during surgery conducted in the chest, pericardial puncture during endoscopy or cardiac catheterization.This may be due to the mechanical stimulation of the heart muscle, and is also a consequence of the surgery, anesthesia, and hypoxia.
addition, hypokalemia, poisoning cyclopropane, chloroform can cause the appearance of ventricular tachycardia.Also, certain medicines, such as Alupet, norepinephrine and epinephrine, and even Etmozin, procainamide, quinidine (antiarrhythmic drugs) can cause tachycardia or make it for much worse.Pretty rare to observe gastric tachycardia with no apparent damage to the heart.This usually occurs in childhood or a little older, but the cause of this condition remains unclear.
Sometimes this type of arrhythmia may provoke some drugs that prolong the interval QT (Probukal, aminoglycosides, tricyclic antidepressants) or cause hypokalemia, iediuretics.
factors that contribute to gastric tachycardia, different voltages are considered a physical or mental nature, smoking, hypokalemia, hypoxia and disorders of acid and alkaline balance in the body.
symptoms in different patients ventricular tachycardia in their subjective feelings have unequal terms.Partly attacks can greatly affect the overall health and is therefore determined only by means of research on the ECG.
Symptoms sensations reminiscent of a sudden attack begins heartbeat, which are also unexpectedly terminate.Sometimes ventricular tachycardia manifests itself in the form of incipient weakness throughout the body, labored breathing, the appearance of pain or heaviness of the chest.But in some cases, there is a clinical picture, which is characterized by cerebral ischemia, t. E. Paresis, dizziness, aphasia, fainting, blurred vision syndrome Morgagni - Adams - Stokes equations, which is often diagnosed in patients who have a blockade atrium and ventricle.
attacks during ventricular tachycardia observed very often manifested cardiogenic shock and cardiac insufficiency.Cardiogenic shock of ventricular tachycardia form mainly occurs in patients with a diagnosis of myocardial infarction in acute or congestive heart failure shape.Sometimes arrhythmia triggers the development of pulmonary edema.During an attack of the heart rate can range from one hundred to two hundred beats per minute, and in some cases even up to 300 beats.As a rule, the right to determine the ECG heart rate, but long-term observation fails to reveal its irregularity.
When listening to the heart reveal loud vibrations of the first tone, qualifying as a "gun."It happens as a consequence of the short period of time (about 0.1 seconds) between the atrial systole and ventricular systole.
patients under reduced blood pressure is very weak the second heart sound is heard, and sometimes it is practically not possible to hear what can cause erroneous counting heartbeats.Splitting of heart sounds related to the non-simultaneous contraction of the ventricles, and in the same closing valves.If ventricular tachycardia is not involved in systole atrial ventricular filling, so it reduces cardiac output.But in the end it may cause collapse.In addition, the veins in the neck are minimal filling unlike pulsation of the arteries.This can be explained by the fact that the sinus node has control of atrial systole.It is this symptom associated with a difference ripple is an important diagnostic criterion.
remaining symptoms and disorders will depend on the underlying pathology of the patient.
Ventricular tachycardia ECG
electrocardiographic ventricular tachycardia appears as a broadened complexes QRS, which occur with a heart rate more than a hundred beats per minute.At the time of attack ventricular complexes may change or be changed.Using these data, it distinguishes monomorphic ventricular tachycardia, bidirectional ventricular tachycardia and pirouette (polymorph).When
pirouette QRS complex changes from one cycle to another.With bidirectional tachycardia is marked not only modified ventricular complexes, but also change the location of the lightin heart.Thus, blocked the right bundle branch block, which alternates with the heart lightin turns left and right.If ventricular tachycardia atrial contraction occurs, regardless of the ventricles.Arrhythmia is recognized on an electrocardiogram in detecting three consecutive ectopic complexes that follow a HR hundred beats per minute.The duration of an attack can be more or less than thirty seconds, so there is a stable ventricular tachycardia (& gt; 30 sec.) And unstable (& lt; 30 sec.).Unstable form can be recognized during the ECG monitoring during the day.A stable form is very often causes hemodynamic abnormalities that contribute to ventricular fibrillation.
heart rate of ventricular tachycardia is almost correct, and atrial reduced regardless of the ventricles.
characteristic features of ventricular tachycardia in the ECG are: dissociation atrioventikulyarnogo character;QRS greater of 0.14 seconds at existing ventricular complexes as in right bundle branch block or greater than 0.16 seconds, as in the left bundle branch block;lightin heart deviation to the left and ventricular complexes as in right bundle branch block;lightin heart sharp deviation to the left 90 degrees and QRS as in left bundle branch block;the same direction for all complexes leads thoracic;atypical form complexes QRS.
bidirectional ventricular tachycardia is characterized by alternating arranged in two directions ventricular complexes.The reason for these changes is not yet known.When this form of arrhythmia ECG detected a heavy defeat infarction or cardiac glycoside intoxication.Her prognosis is very bad, because it leads to ventricular fibrillation.
For parasistolicheskoy, rare ventricular tachycardia, characterized by short paroxysms.The first ectopic excitation formed at different distances from the previous complex sine, that is manifested in the form of non-permanent coupling interval.
Ventricular tachycardia or polymorphic pirouette is a periodic change lightin ventricular complex, which leads to negative and positive direction complexes QRS.Furthermore, changing tine R or S in its amplitude resembling spindles.Hence the name of the form of ventricular tachycardia, which is characterized by absolute randomness in the formation of ventricular excitation.In addition, it is able to spontaneously break.Very often, this form is also a lengthening of the interval QT, called hypokalemia and gipomagnezeimiey.
Ventricular tachycardia treatment
All therapy of this condition is to reduce heart rate and prevent further paroxysms minimizing complications.Typically, in the treatment of malignant need only forms of arrhythmias.There are a number of indications for the use of antiarrhythmic drugs action.To begin, it may be unfavorable prognosis ventricular tachycardia.Then its negative impact on hemodynamics and poor tolerance of arrhythmia.
To eliminate ventricular tachycardia is necessary to identify the source of its origin and, if possible, try to get rid of it, especially if it is associated with mental and emotional reactions, different physical stress, the effects of the parasympathetic nature, intoxication, arrhythmogenic effect of medicines, etc..
Persons who do not have chronic conditions of the heart, bad transporting ventricular arrhythmia, prescribe psychotropic drugs.If bradycardia use anticholinergics, while electrolyte imbalance using drugs with magnesium and potassium.
Today, for the relief of paroxysmal ventricular tachycardia used lidocaine.Although he is considered to be not very effective, but it works pretty quickly and causes minor complications.Also used during attacks intravenous procainamide hydrochloride, 10 mg / kg and sotalol.
antiarrhythmic drugs prescribed to treat tachycardia noncoronary myocardial pathology, which is not characteristic of reducing its contractile work.These medications include Propafenone, VFS and Etatsizin.
significant role in the treatment of ventricular tachycardia belongs to adrenergic blockers.These drugs reduce mortality in patients who have suffered a heart attack, as well as the frequency of sudden death.
Clinical studies suggest that the use of Bisoprolol for the treatment of patients diagnosed with heart failure contributes to the suppression of arrhythmias and reduce mortality.Furthermore, it is safely used in diseases of the heart, which are combined with an increase in the left ventricle, myocardial degeneration of various origins and for the treatment of idiopathic ventricular tachycardia.Sometimes verapamil therapy applies.
fundamental role in the treatment of ventricular tachycardia is given potassium channel blockers, which are characterized by slowing repolarization.Such agents include amiodarone, sotalol, as well as certain drugs, not practiced in Russia, such as Azimilide Ibutilide, dofetilide and others. However, research has shown that sotalol, with high efficiency, has many side effects, such as arrhythmogenic effect and