Various forms Arrhythmias are a common problem diagnosed in people of all ages around the world. Pathologies in this group are different etiology and symptoms, but all of them are violations of the rhythm and frequency of myocardial contractions. Such cardiac dysfunctions in many cases are harmless to human health and can be stopped at home. But there are also anomalies that require serious medical support or even surgical intervention. One type of violation heart rate is supraventricular tachycardia. This is the most common form of arrhythmia that can be diagnosed in both adults and children. V international classification diseases (ICD) pathology was assigned code 147.1.

Reasons for development

Rapid heartbeat can be formed for many reasons. Supraventricular or supraventricular tachycardia (SVT) occurs due to impaired passage nerve impulse through the conduction system of the heart. In this case, the pathological focus that prevents the normal functioning of the myocardium is located in the atria.

The main reasons for the development of SVT are:

1. Organic damage to the cardiovascular system is a morphological change in cardiac structures. These include complications of infectious, viral and invasive diseases, the consequences of coronary circulation disorders, myocardial necrosis and its replacement with connective tissue as a result of ischemic processes and infarction. All this leads to the destruction of the normal structure of the heart muscle, which further causes disorders in its contraction. This group also includes congenital developmental anomalies: different kinds defects, as well as Wolf-Parkinson-White syndrome, characterized by the presence of an additional node in the conduction system of the heart.
2. Functional disorders of the myocardium are also the etiological factor of tachycardia. Such disorders are a consequence of neurogenic dysfunctions. They are manifested by cardiovascular neurosis, neurocirculatory and vegetovascular dystonia, as well as asthenia.
3. Endocrine disorders are a consequence of dysfunction of the internal secretion organs. When hormone levels are imbalanced thyroid gland, pituitary or adrenal glands, changes in the rhythm and heart rate are possible, which, with persistent hormonal disorders, can be permanent. Endocrine pathologies also contribute to the restructuring of most metabolic processes in organism. Such changes often affect the function of the heart muscle, provoking the development of myocardial dystrophy.
4. The idiopathic form is established in the patient after the exclusion of all others. possible causes progression of the pathology.

Symptoms of the disease

Paroxysmal supraventricular tachycardia appears suddenly. The main sign of the presence of this type of arrhythmia is an increase in heart rate up to 180-220 beats per minute. Pathology is accompanied by other symptoms:

1. Dizziness and weakness up to loss of consciousness. This condition develops due to pressure surges that occur during tachycardia.
2. Speech disorders. During an attack, it becomes difficult for many patients to talk due to insufficient oxygenation of the speech centers of the brain.
3. Hemiparesis is a violation of coordination associated with a lack of sensitivity of the limbs on one side of the body. A similar state occurs as a result of either oppression or excessive excitement. nervous system sick.
4. Convulsions and involuntary urination can be observed in severe forms of supraventricular tachycardia, especially in the elderly. The manifestation of such symptoms requires emergency care.
5. Arrhythmogenic shock is an extreme degree of circulatory disorders. It develops extremely rarely in SVT and only in cases where the pathology leads to atrial flutter.

An attack of supraventricular tachycardia lasts from 20-30 minutes to 5-6 hours. In some patients, prolonged episodes of paroxysm up to several days or even months are possible.

In many cases, seizures stop on their own and do not require any treatment. However, with too frequent or prolonged, as well as excessively painful manifestation, medical support is necessary.

Diagnosis of tachycardia

Identification of all types of arrhythmias is carried out using an electrocardiogram. ECG is a research method based on the registration by a special device of electrical impulses and fields created during heart contractions. The difficulty lies in the paroxysmal nature of the disease. If the patient comes to see a doctor during an attack, the diagnosis is usually not difficult. However, in cases where episodes of tachycardia stop spontaneously, the electrocardiogram may not reveal abnormalities. This happens infrequently, and if the patient has complaints characteristic of the disease, doctors conduct functional tests to detect pathology. At conducting an ECG doctor draws attention to the following signs supraventricular tachycardia:

1. Maintain normal sinus rhythm.
2. Physiological complexes of contraction and relaxation of the ventricles.
3. The presence of a P wave, which characterizes atrial depolarization that occurs before, during, or after the ventricular complex. In one of the forms of supraventricular tachycardia, inversion of this tooth is also possible.

Such signs on the electrocardiogram indicate the presence of a pathological focus in the atria. If the development of organic cardiac damage is suspected, patients are also recommended to have an ultrasound of the heart to assess the functionality of the myocardium and valves.

Treatment of pathology

Treatment of supraventricular tachycardia is not always required. It is necessary in the absence of spontaneous cessation of seizures, with their protracted course, as well as in the presence of a risk of developing complications or life-threatening conditions. In cases of detection of organic damage or congenital anomalies in the development of various parts of the heart or its conduction system, they resort to surgery or the installation of a pacemaker. However, most often, supraventricular tachycardia is sufficient to be treated with medication. For the correct use of the many drugs available today, a doctor's consultation is necessary.

Drug Overview

Antiarrhythmic drugs include a large list of medicines, the action of which is aimed at various parts of the pathological process:

1. Beta-blockers reduce the strength and frequency of heart contractions by acting on neuroreceptors located in the heart. This group includes drugs based on betaxolol, atenolol, bisoprolol and a number of other substances.
2. Calcium channel blockers inhibit the introduction of calcium into the cell, thereby preventing the conduction of a nerve impulse. These include Verapamil, Diltiazem, Bepridil and others.
3. Membrane stabilizing agents are quinidine-like substances aimed at preventing damage and destruction of cell walls. This is due to the inhibition of the oxidation of fats that make up the membranes. Among them are drugs such as Intal, Tailed, Aditen and some others.
4. Drugs to slow down repolarization block potassium channels in one of the phases of the action potential of cardiomyocytes, slowing down their contractions. These are drugs such as Amiodarone, Ibutimide, Sotalol.

In many cases, data medicines used in combinations. However, they should be used only on the recommendation of the attending physician.

Providing emergency care

In the event of an acute attack of supraventricular tachycardia, the patient can help himself on his own. For this purpose, vagal tests have been developed in emergency cardiology. They are based on the inhibitory effect vagus nerve(vagus) on cardiac function. When the vagus is stimulated, there is a decrease in the frequency and a decrease in the strength of heart contractions, which makes it possible to smooth out and sometimes stop an attack of supraventricular tachycardia. Several vagal tests are used:

1. Stimulation of the vagus nerve by pressing on the root of the tongue and causing nausea. Since the vomiting center is located in medulla oblongata, from where the vagus originates, it is activated and the heart rate decreases.
2. Valsalva maneuver consists of straining the muscles chest, diaphragm and abdominals in combination with breath holding.
3. Immersion of the face in cold water to stimulate temperature receptors and transmit excitation to the vagus nerve.
4. A strong cough involves the inspiratory and expiratory muscles, which are actively involved in breathing, and are also innervated by the vagus.

Seizure Prevention and Prevention

To combat recurrent seizures at home, vagal tests are most often used. In cases where this is not enough, long-term medical support for patients is used. It involves oral administration of antiarrhythmic drugs, and in severe cases, intravenous in a hospital setting. However, unfortunately, with often recurrent attacks of supraventricular tachycardia, therapeutic treatment does not give visible results. In the absence of an objective effect when using medications, radiofrequency catheter ablation is used. It's minimally invasive surgical technique, based on the destruction of the pathological focus of arrhythmogenicity due to the use of high-frequency current. Such treatment of all types of tachyarrhythmias is by far the most effective, although it is associated with a certain risk of postoperative complications.

The main prevention of any cardiac disorders, including SVT, is the observance of the principles and rules healthy lifestyle life. Regular moderate physical exercise support cardiovascular system in good shape and help to normalize many of its functions. Balanced diet It is designed to control the natural metabolism, which is important for maintaining the work of the myocardium. The absence of stress is also a necessary condition for maintaining health. Preventive visits to the doctor are also important, which allow to identify many diseases on the early stage. Timely diagnosis cardiological diseases - the key to their successful treatment.

How hypertension is classified according to the ICD-10 code

Any ailment has its own code in a special classifier of diseases used in international practice. This article will focus on the ICD-10 codes for hypertension.

I10 - primary (essential) hypertension

In 9 out of 10 hypertensive patients, this type of disease is diagnosed. Among the possible provoking factors are genetic prerequisites, obesity and the presence of regular stressful situations.

Symptoms:

• pain and a feeling of squeezing in the head;
• state of insomnia;
• tachycardia;
• noise in the ears, spots before the eyes;
• increased rates blood pressure(HELL);
• excessive irritability;
• tachycardia;
• dizziness;
• bleeding from the nasal cavity.

If the correct treatment is not carried out, damage is done to the brain, kidneys, heart and capillaries. It is also fraught with severe complications ( kidney failure, cerebral hemorrhage, heart attack) and even death of the patient.

The benign form of the disease develops over a long period of time. In the first stages, the patient's pressure rises only sporadically and does not cause concern. Most often, benign hypertension is detected during dispensary examinations.

The disease in a malignant form is especially dangerous. It is difficult to cure and threatens with consequences incompatible with life.

I11 - pathologies associated with hypertensive heart disease

These include:

• I11.0 - when congestive insufficiency develops in the heart;
• I11.9 - the heart is affected, but congestive heart failure does not occur.

People of middle age and older are at risk of getting sick. The disease is accompanied by signs of primary hypertension, mainly cardiac symptoms ( pain, shortness of breath, angina pectoris).

I12 Hypertension predominantly affecting the kidneys

The ICD includes the following types of hypertension:

• I12.0 - in combination with functional kidney failure;
• I12.9 - without functional renal disorders.

Because of high performance pressure changes the structure of small renal vessels.

Primary nephrosclerosis may develop, provoking pathological processes:

• fibrosis;
• deformation of small arteries (loss of elasticity, thickening of their walls);
• the renal glomeruli do not work well, and the tubules of the kidneys atrophy.

There are no pronounced signs of kidney damage in hypertension. Special examinations will help to establish dysfunction.

These include:

• ultrasound examination;
• urine analysis (albuminuria exceeding 300 mg / day indicates obvious problems);
• blood test;
• study of the glomerular filtration rate (an alarming symptom - an indicator> 60 ml / min / 1.73 m2).

If such a violation is detected, the amount of salt in the diet should be reduced. If this measure is not effective, prescribe medications that protect the kidney tissue from deformation. These drugs include AP enzyme inhibitors and angiotensin II antagonists.

I13 Hypertension, predominantly affecting the heart and kidneys

Combines malfunctions of the kidneys and / or heart - up to signs of organic or functional insufficiency of these organs.

Included:

• I13.0 - hypertensive process with insufficient heart function;
• I13.1 - process with insufficient renal function;
• I13.2 - disease with renal and heart failure;
• I13.9 Hypertension, unspecified.

I15 Secondary (or symptomatic) hypertension

These include:

• 0 - increased blood pressure due to low blood supply to the kidneys;
• 1 - in relation to other renal diseases;
• 2 - secondary to endocrine diseases;
• 8 - another;
• 9 - unspecified character.

This type of disease is about 5% of all hypertensive conditions. It is caused by diseases of the organs that maintain the balance of blood pressure. The processes occurring in them lead to the fact that the tonometer begins to record excessively high values pressure.

Symptoms of secondary hypertension:

• the disease develops rapidly;
• there is no positive effect when prescribing two (or more) drugs;
• patients are usually young people;
• their relatives have never had hypertension;
• the course of the disease is aggravated, despite drug therapy.

It has been established that approximately 70 different ailments can provoke an increase in blood pressure.

Among them are called:

• disease endocrine system(strengthening or weakening of the thyroid gland, diabetes mellitus);
• kidney pathology (inflammatory or neoplastic processes, urolithiasis, polycystic disease, transplantation, diseases connective tissue etc.);
• diseases of the adrenal glands (pheochromocytoma, Kohn's disease, Itsenko-Cushing's disease);
• cardiovascular disorders (inflammatory process of the aorta);
• neurological pathologies (head trauma, inflammatory processes brain).

Secondary high blood pressure, which is difficult to stabilize, may be caused by taking certain drugs. For example, contraceptives containing hormones, anti-inflammatory drugs, MAO inhibitors simultaneously with ephedrine.

I60-I69 - disease with involvement of the cerebral vessels

ICD-10 classifies arterial hypertension of this type under the heading "Brain damage". It is not endowed with a specific code, because it can accompany any brain disorder.

If there is no treatment, increased blood pressure changes the structure blood vessels brain. In small veins and arteries, sclerosis is formed, causing vascular blockages or ruptures with cerebral hemorrhage. Both small and large vessels are deformed. In the latter case, this leads to a stroke. The deterioration of blood flow for a long time also causes a lack of nutrients. The result is mental disorders.

I27.0 Primary pulmonary hypertension

A rare type of disease with unknown causes. It usually develops by the age of 30.

Signs:

• blood pressure in the lungs<25 мм рт. ст. в состоянии покоя и <30 во время физической нагрузки;
• pain in the chest area, which is not eliminated by antianginal drugs (nitrates);
• heart failure, fainting;
• dry cough during physical effort;
• bloody discharge when coughing;

P29.2 Neonatal hypertension

The disease is characterized by insufficiency in the newborn of cardiac function, as well as an enlarged liver, cyanotic skin tones, and convulsions. The disease can cause swelling of the brain.

The main factor is usually an aortic narrowing or a blood clot in the renal artery. Other reasons include:

• mother taking drugs;
• polycystic kidney disease;
• Itsenko-Cushing pathology;
• inflammatory or oncological diseases;
• the use of pregnant glucocorticosteroids, theophylline, etc.

I20-I25 - hypertension affecting the coronary vessels

The coronary arteries are a target for hypertension. These vessels are the only ones that feed the myocardium. Under the influence of increased pressure, their lumen narrows, which threatens a heart attack.

O10 - pre-existing hypertension accompanying pregnancy, childbirth and the postpartum period

O10.0–O10.9 according to ICD-10 combines all types of hypertension.

O11 - pre-existing hypertension, accompanied by proteinuria

It belongs here if it was diagnosed before the conception of the child and was observed for at least 1.5 months after his birth.

O13 - pregnancy-induced hypertension (without proteinuria)

This section includes:

• hypertension developed during pregnancy (NOS);
• slight degree of preeclampsia.

O14 - hypertension in pregnancy, accompanied by severe proteinuria

• O14.0 - moderate preeclampsia;
• O14.1 - severe preeclampsia;
• O14.9 - preeclampsia, unspecified.

Occurs, as a rule, after the fifth month of bearing a child. Characteristic manifestations are severe swelling and high protein content in urine (0.3 g / l and above). It is a serious pathology that requires constant monitoring by a medical specialist.

O15 - eclampsia

According to ICD-10, this type of arterial hypertension includes the following conditions:

• O15.0 - observed during pregnancy;
• O15.1 - arising during the birth process;
• O15.2 - appeared immediately after childbirth;
• O15.9 - pathology, not specified in terms.

O16 Maternal eclampsia, unspecified

Pressure increased to critical limits. There is a threat to the life of the mother and fetus. Hypothetical reasons for development:

• hereditary predisposition;
• infectious pathologies;
• thrombophilia.

Symptoms:

• cyanotic color of mucous membranes and skin;
• wheezing;
• convulsions starting from the facial muscles;
• loss of consciousness;
• eclamptic coma.

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

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 complex tachycardia, narrow QRS complex 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 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

The question of the tactics of treating patients with paroxysmal tachycardia is decided taking into account the form of arrhythmia (atrial, atrioventricular, ventricular), its etiology, the frequency and duration of attacks, the presence or absence of complications during paroxysms (cardiac or cardiovascular failure).
Most cases of ventricular paroxysmal tachycardia require emergency hospitalization. The exception is idiopathic variants with a benign course and the possibility of rapid relief by administering a specific antiarrhythmic drug. With a paroxysm of supraventricular tachycardia, patients are hospitalized in the cardiology department in case of acute cardiac or cardiovascular failure.
Planned hospitalization of patients with paroxysmal tachycardia is carried out with frequent, 2 times a month, attacks of tachycardia for an in-depth examination, determination of therapeutic tactics and indications for surgical treatment.
The occurrence of an attack of paroxysmal tachycardia requires the provision of urgent measures on the spot, and in case of primary paroxysm or concomitant cardiac pathology, a simultaneous call to an ambulance cardiological service is necessary.
To stop the paroxysm of tachycardia, they resort to vagal maneuvers - techniques that have a mechanical effect on the vagus nerve. Vagal maneuvers include straining; Valsalva test (an attempt to exhale vigorously with the nasal fissure and oral cavity closed); Ashner's test (uniform and moderate pressure on the upper inner corner of the eyeball); Cermak-Goering test (pressure on the area of ​​one or both carotid sinuses in the area of ​​the carotid artery); an attempt to induce a gag reflex by irritating the root of the tongue; wiping with cold water, etc. With the help of vagal maneuvers, it is possible to stop only attacks of supraventricular paroxysms of tachycardia, but not in all cases. Therefore, the main type of assistance with developed paroxysmal tachycardia is the introduction of antiarrhythmic drugs.
As an emergency, intravenous administration of universal antiarrhythmics is indicated, effective for any form of paroxysm: novocainamide, propranolol (obzidan), aymalin (giluritmal), quinidine, rhythmodan (disopyramide, rhythmilek), ethmozine, isoptin, cordarone. With prolonged paroxysms of tachycardia that are not stopped by drugs, they resort to electrical impulse therapy.
In the future, patients with paroxysmal tachycardia are subject to outpatient observation by a cardiologist, who determines the volume and schedule of antiarrhythmic therapy. The appointment of anti-relapse antiarrhythmic treatment of tachycardia is determined by the frequency and tolerance of attacks. Carrying out continuous anti-relapse therapy is indicated for patients with paroxysms of tachycardia that occur 2 or more times a month and require medical assistance for their relief; with more rare, but prolonged paroxysms, complicated by the development of acute left ventricular or cardiovascular failure. In patients with frequent, short episodes of supraventricular tachycardia that resolve spontaneously or with vagal maneuvers, indications for anti-relapse therapy are questionable.
Long-term anti-relapse therapy of paroxysmal tachycardia is carried out with antiarrhythmic drugs (quinidine bisulfate, disopyramide, moracizin, etacizin, amiodarone, verapamil, etc.), as well as cardiac glycosides (digoxin, lanatoside). The selection of the drug and dosage is carried out under electrocardiographic control and control of the patient's well-being.
The use of β-blockers for the treatment of paroxysmal tachycardia can reduce the likelihood of the ventricular form turning into ventricular fibrillation. The most effective use of β-blockers in conjunction with antiarrhythmic drugs, which allows you to reduce the dose of each of the drugs without compromising the effectiveness of the therapy. Prevention of recurrence of supraventricular paroxysms of tachycardia, reduction in the frequency, duration and severity of their course is achieved by continuous oral administration of cardiac glycosides.
Surgical treatment is resorted to with a particularly severe course of paroxysmal tachycardia and the ineffectiveness of anti-relapse therapy. As a surgical aid for paroxysms of tachycardia, destruction (mechanical, electrical, laser, chemical, cryogenic) of additional pathways for impulse conduction or ectopic foci of automatism, radiofrequency ablation (RFA of the heart), implantation of pacemakers with programmed modes of paired and “exciting” stimulation, or implantation of electrical defibrillators.

1. Classification of paroxysmal tachycardia
2. Causes
3. Symptoms
4. Supraventricular paroxysmal tachycardia
5. Ventricular paroxysmal tachycardia (ventricular)
6. ECG signs
7. Supraventricular paroxysmal tachycardia
8. Ventricular paroxysmal tachycardia
9. Possible Complications
10. Emergency help during an attack
11. Treatment
12. Prevention
13. Forecast

Paroxysmal tachycardia (ectopic tachycardia) - an unexpected increase in heart rate up to 130-250 beats per minute. Symptoms will vary from form, and treatment is conservative or surgical. The attack develops suddenly and ends just as suddenly. The duration of the state can vary from a few seconds to a day or more. The regulatory rhythm is preserved in most cases. It develops against the background of a significant difference in electrical conductivity in different parts of the heart. The basis is an increase in the automatism of the ectopic centers of the second and third order, as well as the return and circular motion of the excitation wave (the "re-entry" mechanism).

Classification of paroxysmal tachycardia

The classification of paroxysmal tachycardia is made according to the mechanism of development and localization of the arrhythmogenic focus. There are the following forms of pathology:

1. Supraventricular (supraventricular):

• atrial (the focus is located in the atrial zone);
• atrioventricular (the pathological zone is located in the area between the ventricles and the atria).

1. Ventricular.

Supraventricular tachyarrhythmias have two possible mechanisms of development, which were discussed above. Ventricular varieties also develop during the formation of an ectopic trigger focus.

There are other classifications, partially used in clinical practice. The division is made according to the time of the course of the attack: short-term (several seconds), average time of the course (20-60 minutes), long-term (several hours), protracted (days or more). As a principle of classification, it is permissible to consider the time between attacks. However, such sorting does not really matter.

Causes

In most cases, paroxysms occur against the background of organic changes in the heart and coronary vessels. Among the diseases that play an initiating role are ischemic heart disease, atherosclerosis, hypertension, mitral valve prolapse, cor pulmonale, rheumatic changes. In addition, pathology can develop in the following conditions and diseases:

• hypokalemia;
• mechanical irritation of the vagus nerve;
• alcohol and nicotine intoxication;
• digitalis intoxication;
• acute myocardial infarction;
• postinfarction aneurysm;
• myocarditis;
• idiopathic forms of tachyarrhythmia, in which the cause remains unclear.

Note: some sources refer to idiopathic forms and various types of intoxication. The argument in favor of such statements is the absence of organic lesions of the heart.

Symptoms

Symptoms of paroxysmal tachycardia vary depending on its form. An increase in heart rate to 120-130 beats / min is relatively easily tolerated by patients. The condition worsens with an increase in heart rate to 170 beats / min and above. Patients feel the onset of an attack as a push in the region of the heart, after which a heartbeat occurs (a subjective sensation, not to be confused with tachycardia). At the same time, sweating, nausea, flatulence are noted, and slight hyperthermia (37-37.2 ° C) may appear. If the attack is delayed, there is a decrease in blood pressure, there is weakness, fainting.

Supraventricular paroxysmal tachycardia

The severity of atrial and atrioventricular tachyarrhythmias depends on the location of the focus. If the cause of the condition is the synatrial node, the tachycardia does not reach critical values, the correct rhythm is maintained. Such attacks are tolerated relatively easily. The patient complains of slight shortness of breath, discomfort in the chest. Tachycardia does not exceed 130-140 beats per minute.

Focal (flowing with the formation of foci of increased automatism) atrial forms are more difficult to tolerate. In a minute, the heart can make up to 200-250 contractions. The patient experiences chest pain, palpitations, shortness of breath, fear of death. When examining the pulse, episodic loss of the arterial pulse is noted. Hypotension (sometimes hypertension) develops, sweating, dizziness, and tinnitus occur. There may be a pulsation of the cervical veins.

Ventricular paroxysmal tachycardia (ventricular)

Subjective sensations do not differ from those in supraventricular varieties. A characteristic feature is the difference between the venous and arterial pulse. The first is slow, the second is fast. This is due to random simultaneous contraction of the ventricles and atria. Heart rate - 150-180, less often 200 or more beats / min. There is a high risk of developing ventricular fibrillation.

ECG signs

The definition of paroxysmal tachycardia as such is possible on the basis of the clinical picture, history and auscultation. However, the form of the disease is determined only according to electrocardiography. Each type of PT has its own ECG signs. Holter monitoring is used (data recording for 24 hours).

Supraventricular paroxysmal tachycardia

Supraventricular PT - as mentioned above, supraventricular PT are divided into atrial and atrioventricular. Their signs on the ECG differ:

1. Atrial: Deformed, inverted, or double-vasal P wave over each ventricular complex. The ventricular complexes themselves were not changed. Sometimes there is an increase in the P-Q interval of more than 0.02 seconds.
2. Atrioventricular: narrow or overly wide QRS complexes.

Other, more rare variants of changes are possible, which depend on the type of pathological mechanism for the development of supraventricular PT. It is irrational to consider them in the format of this article due to their extremely rare occurrence and diagnostic complexity.

Ventricular paroxysmal tachycardia

Ventricular PT is characterized by dissociation of the ventricular and atrial rhythms. At the same time, the latter retain normal operation. The QRS complex is expanded for more than 0.12 seconds, deformed. Paroxysms can be intermittent (no more than 3 in ½ minutes) or persistent (more than 30 seconds). Occasionally, unchanged sections of QRST appear.

Possible Complications

From the point of view of the risk of complications, ventricular PT is the most dangerous. Supraventricular forms can also lead to certain consequences, but their frequency is much lower. Possible causes of deterioration in the patient's condition include:

1. Ventricular fibrillation is a scattered contraction of individual muscle fibers, making normal heart function impossible.
2. Arrhythmogenic shock is a sharp decrease in blood pressure with centralization of blood circulation.
3. Sudden cardiac death is a cardiac arrest that occurs within an hour of the onset of paroxysms.
4. Acute left ventricular failure - insufficient contractility of the heart.
5. Pulmonary edema is the result of inefficient work of the heart and congestion in the pulmonary circulation.

All of these conditions are life-threatening and require emergency hospitalization of the patient in the intensive care unit.

Emergency help during an attack

Emergency care for PT depends on the type of attack. With supraventricular varieties of pathology, the following reflex methods and drugs are used:

1. Valsalva tests - holding the breath for 5-10 seconds with straining at the height of inspiration.
2. Diving reflex - the patient is dipped face in cool water for 10-30 seconds.
3. Ashner-Danini test - thumb pressure on the eyeballs in the area of ​​the superciliary arches for 5 seconds.
4. Veropamil - 10 mg, in saline, IV, bolus.
5. Cordarone - 300 mg NaCl 0.9% IV, bolus, then 300 mg IV drip in a 5% glucose solution.
6. Anaprilin - 5 mg of a 0.1% solution diluted with NaCl 0.9%.

In the absence of the effect of the therapy, the long duration of the attack, the development of acute left ventricular failure, arrhythmic collapse, tachycardia, electrical defibrillation is used.

The scheme of relief of ventricular attacks is somewhat different. Use the following scheme:

1. Lidocaine - 1 mg / kg, intravenously, in its pure form.
2. Novocainamide - 20-30 mg / minute, intravenously, until vomiting occurs.
3. Bretylium tosylate - 5-10 mg, intravenously, drip, per ml of 5% glucose solution.

Cardioversion is used for the ineffectiveness of medications, acute left ventricular failure, ventricular fibrillation, an attack of angina pectoris that developed against the background of gastrointestinal tract.

Treatment

Planned drug treatment of paroxysmal tachycardia consists in the systemic use of drugs that helped to stop the attack. Patients receive beta-blockers (Atenolol, Anaprilin, Bisoprolol), class I (Novocainamide) and III (Amiodarone, Kordaron) antiarrhythmic drugs. Severe supraventricular forms require the installation of a pacemaker - a pacemaker. In complicated ventricular PT, surgical resection of the area of ​​endocardial fibrosis, in which the ectopic focus is localized, is used - circular endocardial ventriculotomy.

Prevention

Specific measures for the prevention of PT tachycardia have not been developed. The primary measures to prevent heart disease are the presence of adequate physical activity, the rejection of bad habits, regular medical examinations. Secondary prevention - compliance with the treatment-and-prophylactic regimen and regular intake of drugs prescribed by the doctor.

Forecast

The prognosis for PT is favorable with the right treatment. Modern antiarrhythmic drugs allow you to quickly and effectively stop seizures. Severe focal disorders in terms of the risk of sudden cardiac death are the most dangerous. In the absence of therapy, the prognosis is poor. During the next attack, the patient develops complications that are incompatible with life.

Paroxysmal tachycardia is a severe heart rhythm disorder that cannot be ignored. These patients need urgent medical care. When characteristic clinical signs appear, the cardiological team of the SMP should be called and the patient should be hospitalized in a specialized hospital.

MARS diagnosis - minor anomalies of the heart

MARS (small anomalies of the development of the heart) - special conditions without pronounced disturbances in the activity of the heart muscle. However, they can be accompanied by unpleasant symptoms and sometimes even life-threatening. More recently, MARS in cardiology was considered a variant of the norm. However, a more detailed study of the functions of blood vessels and the heart has cast doubt on their relative harmlessness. Experts agreed: patients with minor heart anomalies require medical supervision, and sometimes - verified drug therapy.

What is MARS and why do they occur

MARS in a child occurs during its gestation or after the baby is born. Pathology is caused by:

• structural anomalies;
• metabolic disorders (exchange).

Certain defects in the structure of the heart muscle occur for several reasons:

• mutations at the gene level;
• unfavorable course of the mother's pregnancy;
• the impact of external factors.

Congenital MARS usually occurs due to disorders during the formation of organ tissues in the initial stages of intrauterine development. At the fifth or sixth week of pregnancy, a woman may not even be aware of her “interesting position”. Smoking and addiction to alcohol during this period can provoke heart disease in her unborn child.

Sometimes small anomalies of the heart develop in the absence of any congenital anatomical pathologies. In this case, provoking factors may be:

• poor environmental conditions in the place of residence;
• exposure to toxic chemicals;
• infectious diseases.

Often small cardiac anomalies are detected in children under three years of age. Usually these are minor anatomical defects in the structure of the heart muscle that do not manifest themselves clinically or are accompanied by single, mild symptoms. However, as the child grows older, signs of cardiac pathology may increase.

The decision to classify the identified structural disorders as MARS or to separate them into independent diseases should be made by a specialist.

Classification of small cardiac anomalies

MARS anomalies are usually systematized according to their localization in the area:

1. Atria and septa between them:

• prolapsing (sagging) pectinate muscles (muscle bundles on the inner surface of the right atrium);
• prolapse (protrusion) of the valve of the inferior vena cava;
• aneurysm (protrusion) of the atrial septum;
• a feature of the structure of the heart septum, called an open oval window (OOO);
• enlarged Eustachian valve (endocardial fold);
• altered trabeculae (tendon formations);

1. Pulmonary valve and tricuspid (tricuspid) valve:

• extension;
• valve prolapse;

1. Aortic openings:

• aneurysm;
• violation of the symmetry of the dampers;
• aortic root changes;

1. Left ventricle:

• additional trabeculae;
• altered chords in the heart and their incorrect position;
• defect in the outflow tract (area of ​​the heart through which blood enters the arteries);
• aneurysm of the septum separating the ventricles;

1. Bicuspid valve:

• prolapse of the valve flaps;
• defects in the attachment of chords and their distribution;
• additional, enlarged, incorrectly located or structurally altered muscles that continue the myocardium of the left ventricle.

With the established diagnosis of MARS, it is necessary to find out if there are changes in hemodynamics and regurgitation, and determine the degree of their manifestation. In adult patients, valve prolapse, “wrong” and additional chords in the left ventricle, and excessive trabecularity are more often diagnosed.

Symptoms of MARS

Clinical manifestations of MARS are minor, sometimes asymptomatic. Small cardiac anomalies are characterized by different types of arrhythmias and distortions in the passage of nerve signals through the myocardium:

• paroxysmal tachycardia;
• extrasystole;
• violation or termination of conduction in the bundle of His (in his right leg);
• weakness of the sinotrial node.

Arrhythmias occur when the valves of the anterior ventricular openings prolapse, aneurysms of the septum between the atria, the presence of altered chords. This is due to extraordinary signals that occur in additional chords or the mechanical effect of abnormal chords on the ventricle. The process of regurgitation causes excitation of the heart wall and sinotrial node. This condition is especially pronounced with defects in the tricuspid valve.

Patients with minor cardiac anomalies are negatively affected by psycho-emotional and physical stress. They feel disturbances in the work of the heart muscle, quickly get tired. They are characterized by various vegetative manifestations:

• panic states;
• unstable blood pressure;
• dizziness and fatigue;
• frequent mood swings;
• migraine;
• disorders in the digestive system;
• increased sweating.

One of the most common forms of MARS anomaly is mitral valve prolapse. It is often seen in adults as well. The symptoms of valve prolapse are affected by the severity of the defect and the manifestation of regurgitation. Its signs:

• lethargy;
• inability to adequately perceive physical activity;
• fatigue;
• pain in the region of the heart;
• dizziness.

Another common anomaly is an additional chord of the left ventricle. Often occurs without severe symptoms. Sometimes arrhythmias are inherent in it - due to the appearance of extraordinary impulses. LLC is a less explored form of MARS. Her symptoms:

• dizziness;
• lethargy;
• "failures" in the work of the heart muscle;
• emotional instability.

In most children, this form of small cardiac anomalies disappears on its own during maturation and growth of myocardial mass.

Diagnosis of small cardiac anomalies

The systolic murmur detected by the doctor during the examination is a reason for a serious examination for the presence of small cardiac anomalies. The proposed diagnosis in cardiology is based on:

• assessment of symptoms;
• analysis of the patient's appearance (asthenic body type, flat feet, scoliosis, visual impairment);
• auscultation (clicks, noises, changes in heart rate);
• these instrumental research methods - electrocardiography, ultrasound.

In some patients with minor cardiac anomalies, other organs are also examined. This is usually necessary for congenital or hereditary connective tissue diseases. Echocardiography provides reliable information about the structural features of the organ. The most effective method for valve prolapse. Three-dimensional echocardiography makes it possible to assess the degree of valve prolapse, the presence and degree of regurgitation, and negative changes in valvular structures. Pathologies of chords are more difficult to detect; two-dimensional echocardiography is used for their diagnosis.

With arrhythmia, electrocardiography with a dosed load is performed. These studies allow us to determine the functional reserve of blood vessels and myocardium. Transesophageal electrophysiological examination of the heart contributes to the identification of sources of extraordinary impulses.

With the seeming innocence of the diagnosis, the manifestations of MARS can provoke tangible changes in the blood supply and various complications. There is a probability:

• infective endocarditis affecting the valve flaps;
• insufficiency of the bicuspid valve;
• damage to excess or incorrectly located chords;
• unexpected death of cardiac etiology (with certain conduction pathologies).

Under such circumstances, when diagnosing small cardiac anomalies, doctors are forced to turn to drug therapy.

Treatment for MARS

A non-pharmacological approach for minor cardiac anomalies includes:

• compliance with the age-appropriate regime of the day;
• exclusion of excessive physical activity;
• organization of good nutrition;
• massage courses;
• physical therapy exercises;
• physiotherapy procedures;
• methods of psychological influence.

The ability to seriously engage in sports is an individual matter, since emotional and physical overload can bring down the heart rate. Drug therapy involves the appointment of:

• cardiotrophic agents (in case of failures in repolarization occurring in the myocardium);
• magnesium preparations;
• antiarrhythmic drugs (with certain forms of extrasystole against the background of impaired repolarization);
• antibacterial drugs (in acute forms of infectious diseases, during surgical interventions, to prevent the development of infectious endocarditis).

MARS research in medicine does not stop. Diverse specialists are trying to figure out what small cardiac anomalies are and to find the best methods for preventing complications and identified pathologies. With a careful approach, regular monitoring and following all medical recommendations, MARS in most cases is not dangerous.

Symptoms and treatment of labile arterial hypertension

Arterial hypertension is a condition in which blood pressure is higher than normal. Labile arterial hypertension is one of the varieties of this disease. It is considered quite mild, but without timely treatment, it can worsen and turn into full-fledged hypertension.

• What it is?
• Do they join the army?
• Causes
• Symptoms
• Treatment

What it is?

Hypertension is usually called a state when blood pressure becomes higher than 140 to 100. For each person, the threshold of pathological values ​​will be different, therefore, it is imperative to focus on age, physique, and gender when evaluating tonometer indicators.

Labile hypertension is usually called a state when blood pressure rises temporarily, deviations from the norm are not permanent. By itself, this form is not yet a pathology, but in most cases, over time, it turns into essential hypertension, which is a full-fledged disease that requires mandatory therapy.

This form is most common among older people, for whom hypertension is often the norm due to age-related changes occurring in the body. However, depending on many factors, pathology can develop at any age.

Labile arterial hypertension practically does not occur in children. Indicators may start to jump a little closer to the transition period. In preschoolers, elevated blood pressure values ​​may indicate the development of a serious circulatory pathology. This condition is much more common in teenagers. In them, it can negatively affect the work of the cardiovascular system in the future.

There is no ICD-10 code for the labile form - it is set only if the disease turns into full-fledged hypertension. The various forms of hypertension are in the registry, starting with the number I10. In general, information about the code in the ICD is usually required exclusively by specialists.

Do they join the army?

Labile arterial hypertension is not a sufficient reason not to join the army. According to the rules, the conscript must have full-fledged essential or secondary hypertension in the middle or severe stage, when the symptoms are constantly present, normal working capacity is limited.

With a labile form, they are usually called up for service. However, in any case, a full examination is required to assess the severity of hypertension. In some cases, the labile variety turns into full-fledged hypertension, with which they are usually not taken to the service.

Causes

Blood pressure surges can have many causes, both internal and external. Usually, the following factors can lead to labile hypertension:

1. Constant stress and severe emotional experiences. Strong emotional, mental stress, especially on an ongoing basis, leads to disruption of the cardiovascular system. The load on the heart increases under the influence of stress.
2. Wrong nutrition. The abundance of fatty and junk food in the diet, a large amount of salt and other additives leads to an increase in the load on the cardiovascular system. In addition, salt provokes fluid retention, which leads to an increase in blood pressure.
3. Lack of physical activity or vice versa their irrationality. Both cause disturbances in the work of the heart and blood vessels. The body simply cannot cope with the slightest load in the first case and is too exhausted in the second.
4. Age. The older the person, the less elastic the vessels and the greater the likelihood of developing heart problems. Hypertension is often a normal condition for people of age, it is extremely difficult to fix it - age-related changes are irreversible.
5. genetic predisposition. Some experts believe that many people are more prone to high blood pressure from birth.
6. Various diseases of the endocrine and nervous system. Such pathologies usually affect the entire body as a whole. They can also cause pressure surges.
7. Bad habits. Smoking and alcohol abuse negatively affect the functioning of the heart, leading to the development of cardiac pathologies and diseases of other organs.

Symptoms

In the labile form, the signs of the disease are usually not very pronounced. Often, an increase in blood pressure is detected only at preventive examinations by a cardiologist. Therefore, people with poor heredity, over 45-50 years old, must visit a doctor periodically. Typically, labile hypertension can manifest itself as follows:

• headaches, migraines, dizziness;
• pulse jumps, heart rhythm disturbances, tachycardia;
• slight nausea, feeling of fatigue, impaired coordination of movements;
• sleep disturbance, mild irritability.

When such symptoms occur, it is imperative to undergo an examination. These signs may indicate more serious pathologies, so it is important not to miss the developing disease and make the correct diagnosis.

Treatment

Labile hypertension is usually not treated with medications and other drugs, since the increase in pressure is small and is not accompanied by serious disorders of the heart and blood vessels. However, at this stage, it is extremely important to change the way of life so that the disease does not progress and does not eventually turn into full-fledged hypertension.

First of all, you need to switch to a healthy diet. It is necessary to reduce the amount of fatty and fried foods in the diet, limit salt intake. It is advised to drink less coffee and strong tea, more ordinary water. as well as juices and fruit drinks. Various herbal teas are also helpful.

It is necessary to normalize the daily routine, increase the level of physical activity. You should sleep at least eight hours a day, in the morning you need to do light exercises, it is advisable to pick up some kind of sport. You need to spend more time outdoors, it is advisable to walk often. You also need to stop smoking and drinking alcohol.

If, at elevated pressure, headache attacks begin to disturb, you can take various sedatives based on medicinal herbs, for example, motherwort, valerian. If, despite the measures taken, the labile form turns into hypertension and the condition worsens, you should consult a doctor.

Sinus tachycardia

Definition

Sinus (sinus) arrhythmia that occurs in a child is a consequence of a malfunction in the natural pacemaker (sinus node). It arises due to the influence of various external and internal factors (stress, overwork, pathologies, endocrine disruptions). A cardiologist treats irregular heartbeat.

Any parent can identify arrhythmia, knowing the pulse rate by age:

A deviation from the norm of more than 20 beats per minute (up or down) is already considered a violation of the heart rhythm. The baby cannot fully express his discomfort, so it is advisable to show the child to the doctor.

Expert opinion

Evgeny Olegovich Komarovsky is one of the best specialists in the field of pediatrics. In his opinion, mild forms of arrhythmia are characteristic of virtually all children. It is extremely difficult to meet a baby who has never suffered from this problem. Treatment is prescribed by a doctor, focusing on the patient's condition. If the case is not severe, then the specialist will seek to limit himself to lifestyle correction and folk remedies. Medicines and surgical intervention in the treatment regimen for children are used only as needed.

Types of failure

Sinus failure in the heart rhythm is divided into the following types according to the nature of the manifestation:

• tachycardia (rapid heartbeat);
• bradycardia (slow rhythm);
• extrasystole (extraordinary contraction).

The classification of the failure according to the severity will help to understand what the sinus form of arrhythmia of the heart in a child is:

• A mild form of palpitations is a consequence of the immaturity of the nervous system. It passes on its own and is not considered dangerous.
• A moderate form of failure occurs in children 5-6 years old. It has no special symptoms, therefore it is detected only with the help of an electrocardiogram (ECG).
• Severe sinus arrhythmia in a child occurs at 10-13 years of age. It is manifested by fairly persistent paroxysms and a vivid clinical picture. Experts consider this species dangerous because of the likelihood of developing heart pathologies.

Non-dangerous forms of failure

Respiratory arrhythmia occurs in many children. It is characterized by an increase in heart rate on inspiration and a slowdown on exhalation. A similar reflex reaction is checked during electrocardiography by laying the patient on a couch, on top of which a cold oilcloth is laid. Because of its impact, the child instinctively holds his breath. In the presence of this form of arrhythmia, the heart rate will decrease slightly.

There is a respiratory type of failure in the rhythm of the heart due to the immaturity of the nervous system. The frequency of manifestations of seizures and their intensity depends on the age of the patient. This arrhythmia develops due to the influence of the following factors:

• postnatal (from birth to 1 week) encephalopathy;
• high level of pressure inside the skull;
• prematurity of the child;
• rickets, provoking excessive excitation of the nervous system;

• excess body weight causes tachyarrhythmia after physical exertion;
• phase of active growth (6-10 years).

The severity of the failure depends on the cause of its occurrence. Often, arrhythmia is provoked by the inability of the autonomic department to keep up with the active growth of the child. Over the years, this problem resolves itself.

The functional form is not as common as the respiratory form. It is not considered dangerous, and in most cases passes without the intervention of a doctor. Arrhythmia occurs for the following reasons:

• endocrine disruptions;
• weakened immune defense;
• immature nervous system.

More dangerous is a functional failure due to the following factors:

• diseases caused by infections (bacterial or viral);
• disrupted thyroid function.

Dangerous types of failure

The organic form of arrhythmia is considered the most severe. It is characterized by prolonged paroxysms or a constant flow. The sinus node continues to work, but due to a violation of the integrity of cardiomyocytes (heart cells) or failures in the conduction system, the heart rate (HR) jumps. An organic form develops under the influence of various diseases.

The incidence of dangerous forms of heart failure in children is 25-30% of the total. You can find the reasons for them in the list below:

Sports and sinus arrhythmia

Parents send many children to sports sections, thanks to which the body is strengthened and its full development becomes possible. When detecting sinus arrhythmia, it is important to find out its nature in order to understand what physical activity is acceptable for a child:

• Non-hazardous types of failure are not a contraindication to playing sports. It is enough for parents to show the baby to a cardiologist and conduct an electrocardiographic study several times a year. The purpose of diagnosis is to monitor the development of arrhythmias. If it begins to turn into more dangerous varieties, then the process must be stopped in a timely manner.
• Dangerous forms of failure should be treated as soon as they occur. Permissible physical activity is determined by the attending physician, focusing on the causative factor and the condition of the baby.

In most cases, arrhythmia manifests itself when receiving physical activity due to hereditary predisposition. Children involved in sports professionally need to periodically consult a doctor and do an ECG every 3-4 months. If respiratory arrhythmia is detected, the child may be allowed to compete, but if its form is more severe, then the issue of stopping the athlete’s career and reducing the resulting physical activity will be decided.

Diagnosis and treatment

To draw up a full-fledged course of therapy, the child should be shown to a cardiologist. The doctor will conduct an examination and prescribe the necessary examinations. Chief among them is electrocardiography. Perform it in a standing and lying position, as well as with a load and during the day (daily monitoring).

An important indicator that is indicated on the electrocardiogram is the electrical axis of the heart (EOS). With its help, you can determine the location of the body and evaluate its size and performance. The position can be normal, horizontal, vertical or shifted to the side. This nuance is influenced by various factors:

• With hypertension, there is a shift to the left or a horizontal position.
• Congenital lung diseases cause the heart to move to the right.
• Thin people tend to have a vertical EOS, and full people have a horizontal one.

During the examination, it is important to identify the presence of a sharp change in the EOS, which may indicate the development of serious malfunctions in the body.
Other diagnostic methods can be used to obtain more accurate data:

• rheoencephalography;
• ultrasound examination of the heart;
• x-ray of the thoracic and cervical spine.

Based on the results obtained, a treatment plan is drawn up. Functional and respiratory arrhythmias are not eliminated by medication. Doctors give advice on lifestyle changes. The main focus will be on the following points:

• relaxation.

Moderate arrhythmia is stopped not only by lifestyle correction, but also by sedatives (Corvalol, tinctures of hawthorn, mint, glod) and tranquilizers (Oxazepam, Diazepam). Preparations and their dosages are selected exclusively by the attending physician.

The pronounced variety is eliminated by the correction of nutrition, rest and physical activity in combination with drug therapy. In advanced cases, as well as in the absence of the result of treatment with tablets, surgery is used.

To begin with, the specialist will have to stop the negative influence of the factor that causes arrhythmia. The following measures will help with this:

• elimination of the main pathological process;
• treatment of chronic infection;
• the abolition of medications that provoke a failure in the rhythm of the heart.

Supplement the treatment regimens with folk remedies and physiotherapy procedures. They are selected depending on the characteristics of the child's body and the presence of other pathologies.

Medical treatment

With sinus arrhythmia, the following drugs are prescribed to stabilize heart rate:

• Drugs with arrhythmic effects (Digoxin, Adenosine, Bretilium) dilate blood vessels and normalize heart rate.
• Tablets to improve metabolic processes ("Inosine", "Riboxin") protect the myocardium from oxygen starvation, thereby eliminating arrhythmia.
• Preparations based on magnesium and potassium ("Panangin", "Orokamag") normalize electrolyte balance, regulate blood pressure and stimulate neuromuscular transmission.

Surgery

If drug treatment has not helped to eliminate severe arrhythmia, then the following types of minimally invasive surgical intervention are used:

• Radiofrequency ablation, the purpose of which is to cauterize the focus of an ectopic signal in the heart by passing a catheter through the femoral artery.
• Installation of an artificial pacemaker (pacemaker, defibrillator).

Physiotherapeutic procedures complement the treatment regimen well. Their list is given below:

• acupuncture;
• therapeutic baths
• laser or magnetic therapy.

ethnoscience

Traditional medicines are prepared from plants with healing properties and have a minimum number of contraindications. Before using them, you should consult your doctor to avoid undesirable consequences. The most popular recipes are:

• 300 g of dried apricots, 130 g of raisins and walnuts must be thoroughly ground and mixed with 150 ml of honey and lemon. Such a gruel helps cleanse the blood and improve the functioning of the heart muscle. Use it in an amount of 1 to 2 tbsp. l., depending on age (up to 3 years, 15-20 ml, over four 45-60 ml).
• The daily diet must be saturated with fruits. They can be cut into cereals, desserts and other dishes. Instead of a regular drink, it is recommended to drink fresh juice (apple, grape).
• Pour 30 g of dry lemon balm with a glass of boiling water and let it brew for half an hour. It is advisable to drink such a tea with a sedative effect for at least 2 weeks.

• A decoction of valerian is prepared from the roots of the plant. They must be cleaned and poured with boiling water in a ratio of 30 g per 250 ml. Then put on fire. Remove from stove after 10 minutes and let cool. Take a decoction with a pronounced sedative effect of 0.5 tbsp. l. It can also be added to the bathroom.
• Pour 30 g of rose hips with 1 cup of boiling water and add 20 ml of honey. Ready drink well tones the nervous system and improves heart function.
• Adding celery and greens to salads will saturate the body with useful substances, which will have a beneficial effect on the functioning of the heart and nervous system.

Preventive measures

Compliance with the rules of prevention will prevent attacks of arrhythmia and improve the overall well-being of the child. They can be found below:

• Make the right diet, saturating it with herbs, vegetables, fruits and berries. Cooking is recommended by steaming or by boiling. Eat small meals, but 5-6 times a day, avoiding overeating. Dinner should be no later than 3-4 hours before bedtime.
• It is better to forget about intense physical activity. The child needs more rest. Among sports, it is recommended to choose running or swimming, but initially you should limit yourself to morning exercises.

• Regardless of the season, the child should be outdoors more. It is recommended to reduce the amount of time at the computer and TV to a minimum.
• From stressful situations, the child should be completely protected. Any experiences and conflicts can aggravate his condition.
• In case of complications, side effects and other problems, you should consult your doctor. Self-medication is strictly prohibited.

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).

Code according to the international classification of diseases ICD-10:

• I47 Paroxysmal tachycardia

Causes

Etiology - generation of excitation impulses by the sino-atrial node with an increased frequency. Physiological causes.. Fever (a 1 °C increase in body temperature causes an increase in heart rate of 10 per minute) .. Agitation (hypercatecholaminemia) .. Hypercapnia.. Exercise. Diseases and pathological conditions.. Thyrotoxicosis.. IM. Endocarditis. Myocarditis. TELA. Anemia. Syndrome of vegetative-vascular dystonia. mitral stenosis. Aortic valve insufficiency. Pulmonary tuberculosis. Shock. Left ventricular failure. Cardiac tamponade. Hypovolemia. drugs (epinephrine, ephedrine, atropine). Pain.

Symptoms (signs)

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

Diagnostics

ECG - identification. Heart rate at rest - 90-130 per minute. Each P wave corresponds to the QRS complex, the PP intervals are equal to each other, but when combined with sinus arrhythmia, they can differ by more than 0.16 s. With severe ST, the P waves may merge with 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.

What does sinus arrhythmia mean

The normal heart rate in a child according to the electrocardiogram (ECG) is sinus rhythm. Impulses for myocardial contraction are generated in the sinus node.

The intervals between the wave complexes on the ECG are the same. However, in children, heart rate is associated with age.

On the ECG, doctors sometimes make a conclusion - sinus arrhythmia. In most children, it is due to the growth of the body or hormonal changes in puberty. And only in rare cases indicates a serious illness.

Sinus arrhythmia is a group of heartbeat disorders in terms of frequency, strength and rhythm. Rhythm failures occur when changes occur in the node of the same name, which generates signals for the contraction of the heart. At a normal heart rate, the intervals between beats may vary.

In this case, the ECG reveals a rapid (tachyarrhythmia) or slow (bradyarrhythmia) heartbeat.

Respiratory arrhythmia

In some children, the frequency of myocardial contractions changes during breathing. When inhaling it increases, when exhaling it decreases. The number of heartbeats in a child decreases reflexively during an ECG on a cold couch. The so-called respiratory arrhythmia does not affect the health of children.

The main reason for changes in the heartbeat lies in the imperfection of the autonomic nervous system. Respiratory arrhythmia manifests itself with deviations in development or diseases:

• excess weight;
• rickets;
• encephalopathy;
• prematurity;
• intracranial hypertension;
• a period of intensive growth of 4-5 years, when the vegetative system does not keep up with the physical development of the child.

Most often, sinus rhythm disturbance is detected in children 7 years of age. At this age, the deviation is not considered a disease, because it is associated with puberty and physical maturation.

In adolescence, hormonal changes in the body occur, which also affects the autonomic function. Rhythm disturbance can occur after negative emotions.

By the way! Respiratory arrhythmia is not dangerous for children. As the physical development matures the nervous system, and the problem is eliminated by itself.

Moderate palpitations do not require treatment. Soothing herbal preparations are prescribed. However, the child should be consulted by a cardiologist and pediatrician.

Types of abnormal heartbeat

In 30% of children, non-respiratory arrhythmia is detected. It occurs in the form of seizures or is observed constantly:

• Sinus tachycardia is characterized by an increase in heart rate by 20–30 per minute. Occurs in diseases that occur with elevated body temperature. May appear with infection, emotional stress.
• Severe heart rhythm disturbance - paroxysmal tachycardia - begins suddenly, accompanied by dizziness, low blood pressure. The number of contractions of the heart reaches 160-180 beats per minute. In this case, the body can not cope with the function of blood supply. First of all, the brain suffers.
• Sinus bradycardia is a slow heartbeat. The production of signals to contract the heart is reduced by 20–30 beats compared to the age norm. It often develops after stressful situations.
• Sinus extrasystole is characterized by the appearance of extraordinary myocardial contractions more often of a functional origin. The reason is also vegetative-vascular dystonia, diseases of the endocrine glands or a strong negative emotion.
• Unstable sinus rhythm indicates that the intervals between the teeth differ from each other. The most common cause is sinus node weakness. Pathology is noted in children with a hereditary predisposition to cardiovascular diseases. But sometimes failures in the rhythm are caused by a violation of the autonomic nervous system. To identify the true cause, conduct a Holter study, ultrasound.

Important! Violation of the heartbeat may be manifested by loss of consciousness. If a child has ever experienced such an episode, a cardiological examination should be performed.

Children with a heart condition need a separate exercise regimen and vaccination schedule.

List of medicines for cardiac arrhythmias

Causes of abnormal heartbeat

The source of non-respiratory arrhythmias are transferred organic diseases that damage the sinus node.

Causes of violations of the pacemaker:

• bacterial or viral myocarditis after a sore throat or flu;
• Congenital heart defect;
• vegetative-vascular dystonia;
• rheumatic heart disease;
• pericarditis, endocarditis;
• poisoning;
• cardiomyopathy;
• heart tumors;
• mitral valve prolapse;
• thyroid problems;
• infections, including intestinal forms.

Genetic predisposition plays a leading role in the occurrence of arrhythmias. If parents suffer from diseases of the heart and blood vessels, there is a high probability of heart failure in the child.

What threatens the violation of the rhythm

Organic myocardial diseases occur with severe arrhythmia, which aggravates the course of the disease. Protracted attacks of atrial fibrillation and paroxysmal tachycardia are dangerous for the development of heart failure.

In some cases, rhythm disturbance ends in death. Sinus arrhythmia, which appeared after a severe illness, requires special complex treatment.

Signs of palpitations in a child

Sinus arrhythmia in young children is often diagnosed late. Usually it is detected during a routine examination. But still, there are signs by which a violation of the heartbeat in newborn children is determined.

Symptoms that may alert parents:

• excessive sweating;
• causeless crying;
• lethargy or restlessness;
• insufficient weight gain;
• shortness of breath after physical effort - turning over, crawling;
• pale or blue lips, nails;
• loss of appetite - the baby sucks sluggishly or does not take a bottle;
• interrupted sleep.

Signs of arrhythmia in preschool and older children:

• interruptions in the heart;
• bouts of weakness;
• shortness of breath after exercise;
• fatigue;
• fainting;
• stitching pains in the chest.

Important! Such signs should not be ignored. To find out the cause, your pediatrician will conduct a study, outline a plan for further action.

What to do in case of heart failure

Sinus arrhythmia most often does not affect the health of the child. But if it is found on the ECG, you should visit a pediatric cardiologist.

Diet and healthy foods for the treatment of cardiac arrhythmias

In such cases, an ultrasound examination (ultrasound) is performed. If necessary, the doctor prescribes Holter monitoring, which records several dozen ECG records for 24 hours, including at night. In addition to instrumental diagnostics, laboratory methods are used - a general analysis of urine and blood.

If sinus arrhythmia without organic pathology is detected, children are observed by a cardiologist. At the same time, an ECG should be done every 6 months.

With non-respiratory arrhythmia, therapeutic measures are carried out related to the main disease.

How is palpitations in children treated?

Most arrhythmias do not require therapeutic measures. Specific treatment is prescribed after a comprehensive study by laboratory and instrumental methods. Depending on the disease, a course of antibiotic therapy, antitumor treatment is carried out. With heart defects, surgical correction of the valves is required. The choice of medicines is associated with the clinical manifestations of pathology.

Types of drug therapy:

• with heart failure, glycosides and diuretics are prescribed;
• antiarrhythmic drugs are used that reduce and increase the conduction of the heart;
• medicines containing magnesium, potassium and vitamins;
• restorative treatment - aloe, propolis;
• Mildronate, Elcar are used to improve myocardial metabolism.

In addition to medicines, with children's arrhythmia, breathing exercises and special massage are prescribed. Dietary nutrition is of great importance. The diet includes plant products containing vitamins and magnesium - nuts, cashews, honey, dried apricots. The frequency of baby feeding is increased up to 6 times a day in small portions.

What is the difference from tachycardia?

According to the generally accepted classification of cardiac arrhythmias and conduction disorders, they are all divided into disorders according to the type of rapid heartbeat (tachycardia, more than 80 heart beats per minute) and according to the type of rare heartbeat (bradycardia, less than 60 beats per minute).

A rapid heartbeat, in turn, can be accompanied by a sinus (correct) and non-sinus (irregular) rhythm. In the first case, the violation is called tachycardia, when the heart contracts often, but at regular intervals, and in the second - tachyarrhythmia, when the heart contracts often and irregularly.

Clinically, tachyarrhythmias and tachycardias manifest themselves almost identically, so it can be quite difficult to distinguish between them without an electrocardiogram.

Tachyarrhythmia can be:

Causes of tachyarrhythmia

Tachyarrhythmia most often develops in people over 40-50 years old, but also quite often occurs in young people and in children. This happens due to various reasons.

So, sinus tachyarrhythmia, in principle, is not a sign of any organic damage to the heart muscle. This type of tachyarrhythmia can occur during stress, strong emotions, or after physical activity.

The causes of other tachyarrhythmias can be divided into the following groups:

1) Functional causes - a set of factors that, in principle, are not a manifestation of any disease:

• Violation of vascular tone in vegetative-vascular dystonia,
• Mild electrolyte disturbances, such as dehydration, alcohol poisoning, or hangovers

Nevertheless, despite the seeming "harmlessness" of this group of causes of tachyarrhythmia, the consequences of the arrhythmia itself can be deplorable if you do not seek medical help on time.

2) Non-cardiac causes. These include diseases of other organs and systems:

• Thyrotoxicosis, which develops due to increased secretion of thyroid hormones,
• Acute infectious diseases (flu, botulism, malaria, etc.),
• Fever,
• Diseases of the gastrointestinal tract,
• severe anemia,
• Alcoholism,
• Drug use.

3) Cardiac causes are due to the pathology of the heart and blood vessels. These include:

• arterial hypertension,
• Cardiac ischemia,
• Myocarditis is an inflammatory lesion of the heart muscle
• Postponed or acute myocardial infarction,
• Heart defects
• Cardiomyopathy - hypertrophic (thickening of the heart muscle of the ventricles), restrictive (impaired relaxation of the heart muscle) or dilated (expansion of the heart chambers) type.

Tachyarrhythmia in childhood

In children, tachyarrhythmias can be caused by organic myocardial damage (for example, after myocarditis or heart disease), as well as functional causes or a combination of the above factors. However, most often in children without heart defects, without surgical interventions on the heart and without myocarditis, sinus arrhythmia is most common, which is caused by a violation of autonomic influences on the heart and is easily corrected.

Symptoms

Tachyarrhythmia may begin in a patient gradually or acutely.

In an acute attack (paroxysm), the patient is disturbed by a sudden sensation of interruptions in the work of the heart and a feeling of rapid heartbeat, accompanied by severe weakness, discomfort in the chest, and a feeling of lack of air. Some patients immediately lose consciousness due to a decrease in cerebral blood flow, note cold sweat, a sharp pallor of the skin. The condition and well-being without emergency care worsens.

With a constant form of atrial fibrillation, the only type of tachyarrhythmia that occurs for a long time, for years, without the possibility of spontaneous restoration of the rhythm, patients report minor symptoms. They are mainly concerned about shortness of breath during exercise and periodic pressing pains in the chest.

The heart rate varies from patient to patient and may even remain slightly above normal, such as in patients with atrial fibrillation.

Diagnostics

A patient can suspect a paroxysm of tachyarrhythmia immediately after the onset of clinical symptoms, especially if paroxysms have occurred before. However, the main diagnostic criteria for tachyarrhythmia can only be determined from the ECG. For example, such as changes in the interval between complexes, reflecting ventricular contractions; flicker waves - atrial flutter; absence of teeth showing atrial contractions in front of ventricular complexes.

After the emergency doctor or polyclinic therapist has diagnosed paroxysmal tachyarrhythmia, the patient is taken to the hospital, as he needs hospitalization for further diagnosis and treatment. In the department of cardiology or therapy, additional examinations are prescribed:

1. heart ultrasound,
2. Daily monitoring of blood pressure and ECG,
3. TEFI (transesophageal electrophysiological examination) in case it is not possible to register a tachyarrhythmia during a standard ECG.

Treatment of tachyarrhythmia

Therapy for tachyarrhythmia begins at the stage of emergency medical care. The patient is given intravenous drugs such as novocainamide, strophanthin, cordaron, panangin, and in case of ventricular tachyarrhythmia - lidocaine.

After the patient has been taken to the Department of Internal Medicine or Cardiology, the treatment started continues. Basically, doctors use a solution of a polarizing mixture (potassium chloride + glucose 5% + insulin) in the form of intravenous infusions (droppers), or the above drugs. This treatment is a rhyme-restorative therapy. In addition, rhythm-reducing drugs are prescribed - egilok, concor, coronal, digoxin, etc.

In the event that sinus rhythm is restored at the prehospital stage with paroxysm of atrial fibrillation or supraventricular tachycardia, the patient can be left at home under the supervision of a local therapist in a polyclinic at the place of residence.

With a constant form of atrial fibrillation, rhythm-restoring therapy is not carried out, the patient is prescribed only rhythm-reducing drugs under the supervision of a district therapist, if the ambulance doctor does not suspect complications of tachyarrhythmia.

If the patient had a paroxysm of ventricular tachyarrhythmia recorded on the ECG, he should be taken to the hospital even with a restored rhythm.

Treatment of tachyarrhythmia in children

Treatment of the child should be carried out only by a pediatric cardiologist. Sinus arrhythmia does not require special treatment, and the child can go in for physical education if he does not have an organic pathology of the heart or central nervous system that led to the onset of arrhythmia. However, serious diseases (tumors, malformations, myocarditis) should be treated only by a cardiologist. In addition to antiarrhythmic drugs, patients are prescribed Elcar, Mildronate, Mexidol and vitamin complexes.

Lifestyle

Lifestyle in any form of tachyarrhythmia includes the main recommendations used in any other pathology of the heart and blood vessels. For example, the rejection of bad habits and malnutrition, the exclusion of significant physical activity and professional sports.

However, the most important thing in the correction of lifestyle after the diagnosis of tachyarrhythmia is established is timely, regular visits to the cardiologist and taking medications prescribed by the doctor. Sometimes drugs need to be drunk throughout life, for example, with a constant form of atrial fibrillation.

Complications and prognosis

In the absence of timely treatment of tachyarrhythmias, complications may develop. The most common are pulmonary embolism, arrhythmogenic shock, ischemic stroke, and acute myocardial infarction.

PE (thromboembolism) is manifested by sudden shortness of breath, suffocation, blue skin of the face and neck. With arrhythmogenic shock, an extremely serious condition of the patient immediately sets in, accompanied by loss of consciousness (collapse), pressure drop and pale skin. Stroke and heart attack have their own symptoms with paralysis of the limbs, chest pain and other symptoms.

Ventricular tachyarrhythmia can lead to sudden cardiac death.

In order for the patient not to develop complications, he should be immediately examined by a doctor at the first appearance of signs of a tachyarrhythmia.

The prognosis for sinus tachyarrhythmia, as well as for paroxysmal and permanent forms of atrial fibrillation, is favorable in the absence of complications.

In patients with ventricular tachyarrhythmia, especially those who have experienced clinical death, the prognosis is unfavorable, since fatal arrhythmias develop in more than 50% of cases in the first year after that.

Sources

• http://ifc-rt.ru/mkb-tahikardija/
• http://s-storm.ru/mkb-10-tahikardija-kod/
• https://MirKardio.ru/bolezni/sboi-ritma/sinusovaya-aritmiya-u-detej.html
• http://gipocrat.ru/boleznid_id34232.phtml
• https://serdce.guru/aritmiya/u-detej/
• http://sosudinfo.ru/serdce/taxiaritmiya/