Causes of ventricular tachycardia. Ventricular tachycardia (I47.2) Can ventricular tachycardia resolve

Ventricular tachycardia (VT) disease is a dangerous condition that requires immediate care followed by rehabilitation. VT is an irregular heart rhythm from an ectopic focus of one ventricle. The onset of the disease is abrupt and the frequency of the rhythm can exceed 190 beats per minute. This disease has several types, is diagnosed on the ECG and almost never occurs in healthy people with normal functioning of the cardiovascular system.

Timely detection of VT makes it possible to prevent sudden cardiac arrest and to conduct a preventive course, and, if necessary, surgical treatment by installing an implant to control heart rate.

Description and pathogenesis

Tachycardia is a type of arrhythmia that is diagnosed on an ECG and is characterized by an increase in heart rate. If this is a ventricular type of tachycardia, then the pathological process initially manifests itself in one of the ventricles of the heart.

Organic diseases of the cardiovascular system often provoke various arrhythmias, and one of them is ventricular tachycardia. Only in 0.2% of cases this disease occurs without symptoms of organic heart disorders.

In other cases, ventricular tachycardia is observed against the background of acute conditions or chronic ailments. Pathological processes in the myocardium, violation of the structure of its fibers are a predisposing factor in the appearance of VT at different stages of the patient's life.

During an attack - a paroxysm of ventricular tachycardia, the heart rate rises and at the same time there are ectopic impulses with a frequency of up to 200 beats per minute. These impulses begin with the legs of Hiss and their branches, and the ventricle remains the main source of this pathological condition.

Often, this condition turns into atrial fibrillation, since these two ailments provoke each other, and the result of such a transition with untimely assistance is death due to cardiac arrest. Therefore, paroxysmal ventricular tachycardia is considered one of the most dangerous manifestations of cardiac arrhythmias and requires immediate treatment.

Advice! Any kind of arrhythmia, regardless of the causative factor and the age of the patient, can lead to sudden death. It is this violation that is a risk factor in cardiac arrest, which all patients are warned about.

Causes of ventricular tachycardia

As already mentioned, ventricular tachycardia never acts as an independent disease. In patients, after diagnosis on the ECG with a diagnosis of VT, several more organic disorders associated with each other can be observed. Therefore, such a violation is considered to be an addition to the underlying disease. Common causes of ventricular tachycardia.

Advice! In rare cases, ventricular tachycardia occurs against the background of an overdose of drugs. The percentage of such cases is very small, but people taking cardiac glycosides should be aware of the high risk of developing tachycardia.

Clinic and signs

The clinical symptoms of this disease are similar to other manifestations of arrhythmia. Often, VT can be distinguished only on an ECG, but there are also specific signs. It is important that the initial course of the disease is completely asymptomatic, and it can only be detected if there is a suspicion of problems with the heart of the patient himself and daily monitoring on the ECG.

Typical signs of cardiac pathology in patients on VT:

Advice! The presented complex of symptoms is suitable for any type of arrhythmia, therefore, self-diagnosis in case of a violation of cardiac activity is impossible. The appearance of these signs depends on the frequency of the onset of tachycardia, but you need to seek help already at the first manifestations.

The development of tachycardia in parallel with other existing organic heart defects increases the chance of cardiac arrest, fatal arrhythmias and acute myocardial infarction. Often, against the background of tachycardia, if not treated, cardiogenic shock develops, which is also deadly.

Persistent and non-persistent tachycardia

The intermediate phase between tachycardia and extrasystoles is unstable ventricular tachycardia, which is asymptomatic, passes quickly and appears only on the ECG. Another type, the reverse of the intermediate one, is persistent tachycardia, which occurs more often against the background of coronary heart disease.

It is the ischemic disease that is the decisive and supporting factor in the appearance and strengthening of persistent tachycardia. What is the difference between persistent and non-sustained ventricular tachycardia?

Advice! The danger of persistent and unstable tachycardia is equal, the difference is only in the manifestation and main symptoms. The treatment of different types of arrhythmia is similar to each other, as are the possible complications.

Disease risk and prognosis

It is possible to determine the paroxysm of ventricular tachycardia by the general signs of arrhythmia and after an ECG. The outcome depends on which symptoms prevail during a paroxysm. It is possible that the patient will have a persistent violation of the respiratory function, organic diseases of the brain, and cardiac arrest.

If we talk about unstable tachycardia, it does not cause significant damage to a patient with a diagnosed tachycardia paroxysm. The presence of a complex of other cardiac disorders complicates any attack, and the outcome will depend on this. The doctor can announce the final prognosis after the complex treatment, preventive course and repeated monitoring of the ECG.

Diagnosis of VT on ECG

At the first manifestations of this ailment, it is necessary to immediately undergo diagnostic measures to identify the underlying and concomitant ailments. If these are primary symptoms that have not previously manifested, it will be necessary to be examined by several specialists.

If, however, the paroxysm of ventricular tachycardia was before, re-diagnosis and adjustment of treatment will be required. Diagnosis in paroxysms of tachycardia:

1. The main diagnostic method - ECG, is carried out to detect blockade of the Hiss bundle, abnormalities in cardiac activity, ventricular extrasystoles and other ailments that provoke paroxysm of ventricular tachycardia. On the ECG, the cardiologist observes morphological changes, traces the possibility of transferring a heart attack and coronary heart disease.
2. EFI (electrophysiological study) is one of the main diagnostic measures for detecting tachycardia. The study allows you to observe hemodynamics and the frequency of tachycardia, as well as negative changes in the bundles and branches of Hiss.
3. Echocardiography is a mandatory diagnostic measure that allows to clarify the diagnosis in case of suspected ventricular tachycardia. The study helps to determine the localization and prevalence of the pathological process in different parts of the heart.
4. Coronary angiography is performed in case of ischemic heart disease.
5. Load tests - indicated for the diagnosis of various arrhythmias and functional disorders of the heart. Carrying out stress tests involves the use of various medications and simulators.

Advice! In most patients with suspected paroxysmal tachycardia, hemodynamic disturbances and arterial hypertension are noted, which also plays a role in clinical trials.

First aid for VT

Sudden ventricular tachycardia requires immediate medical attention. An attack can happen at any time, and everyone should know the procedure for providing emergency care to a patient. After carrying out urgent measures, the doctor stops the attack with medication, but until that moment everything possible must be done to prevent the sudden death of the patient.

1. When a person shrinks, falls, staggers and holds his hand to his heart, you need to quickly seat him.
2. Ask the patient to squeeze the muscles of the abdomen, arms, legs for ten seconds, and so on for several minutes, and at this time call an ambulance.
3. Close the patient's nose and mouth, asking to simulate a sharp exhalation.
4. After exhalation, close the patient's eyes and press the eyeball with your finger, moderately and evenly.
5. Perform a massage of the carotid artery in the neck area on the left and right sides alternately.
6. Try to make the patient vomit.
7. Wipe the patient with a wet towel dipped in cold water.

Advice! When providing first aid, first of all, you need to call an ambulance, reporting all the signs, while simultaneously holding the patient in a sitting position, and asking him to perform the above tasks. If you spend a lot of time on help, forgetting about the call, you can lose the patient.

After the arrival of the ambulance, you need to describe all your actions and the state of the person. Next, the doctors will conduct drug treatment, and a decision will be made on further therapeutic measures.

Treatment in a hospital

Simple suppression of arrhythmia in such a violation of cardiac activity is not enough. The main task of doctors is to prevent sudden death and create comfortable conditions for a patient with such an ailment. This can be achieved through drug treatment.

Antiarrhythmic drugs, sedatives, cardiological are prescribed. The most optimal treatment for ventricular tachycardia is the installation of a cardiac implant, which starts in response to an attack and starts the heart. This option allows the patient to freely perform daily work without the risk of sudden cardiac arrest.

Whatever treatment the patient chooses, it is in any case long and has its own risks. Long-term therapy is not prescribed to the patient in case of unstable intermediate tachycardia, provoked by electrolyte imbalance or myocardial infarction. In this case, the symptoms are eliminated, a prophylactic course is prescribed, and the patient is allowed to go home.

Operation

Surgical treatment of a patient with diagnosed ventricular tachycardia is carried out with a persistent disease against the background of coronary disease or other organic diseases of the cardiovascular system.

This is a serious step towards recovery when a patient is implanted with a cardiac apparatus responsible for preventing cardiac arrest. Such operations are rare, they are expensive, so not everyone can afford such an opportunity. Operation options for ventricular pathology:

• implantation of a defibrillator implant;
• destruction of some pathways for conducting an electrical impulse;
• installation of a pacemaker.

Advice! The most dangerous and at the same time necessary operation is the installation of a pacemaker. This is a sensor that is triggered by a possible cardiac arrest. Its service life depends on the frequency of attacks, during which the device starts to work and is discharged. The approximate time to replace the stimulator is every 2-4 years.

Additional treatment for VT

Additional treatments for VT include specific and drug prophylaxis, as well as cardiac ablation:

Ablation of the heart is carried out in several ways: radiofrequency, surgical. Such treatment can also be prescribed to prevent the disease when predisposing factors appear. In parallel, antiarrhythmic drugs are prescribed, the patient's diet is adjusted and the lifestyle changes.

Some activities become prohibited, especially sports and work with increased physical and mental stress. Also, the patient is forced to take sedatives to eliminate emotional stress, both negative and positive, which in any case provoke tachycardia.

Advice! Even after full-fledged treatment, there is a risk of developing life-threatening complications, because the patient is constantly monitored by the best cardiologists.

Complications

Persistent tachycardia can haunt the patient throughout life, and this affects other organs and systems, not to mention the heart itself. Untimely first aid, provision of incompetent medical rehabilitation can result in a number of serious complications for the patient:

1. Transition of tachycardia to ventricular fibrillation.
2. Loss of orientation in space and a sharp fall without loss of consciousness.
3. Sudden cardiac arrest and death.
4. Cardiac tamponade.
5. Pulmonary disorders: pulmonary edema, difficulty breathing, asthma.
6. Loss of consciousness without previous symptoms.

Among the most dangerous complications that ventricular tachycardia gives are cardiac arrest, acute heart failure, cerebral ischemia. A favorable prognosis is possible with ventricular tachycardia after adequate treatment. Paroxysms will be eliminated with medication, after which the patient will be able to continue a normal life.

And a change in the nature of cardiac activity in a generalized form is called arrhythmia. This is a condition in which a muscle organ begins to beat too fast (tachycardia) or too slowly (bradycardia).

Possible violations of the time interval between each subsequent contraction. There are many variants of the problem, some more, others less dangerous.

The presented ventricular tachycardia is an acceleration of cardiac activity over 100 beats per minute, due to organic disorders of the myocardium, and less often from the endocrine system. The condition poses a huge threat to life and health. Among all types of arrhythmias, it is considered almost the most fatal for the patient., because it progresses rapidly, is difficult to treat and occurs suddenly.

According to statistics, between the manifestation of the first symptoms and the onset of death of the patient, it takes from a month to three years, subject to treatment. All because of the late start of therapy.

With the described form of the pathological process, there is a violation of the generation and conduction of an electrical impulse through cardiac structures and tissues. The heart does not work as it is required for normal life.

Therapy and diagnostics are strictly within the hospital for a week or more. Until stabilization of the condition and full compensation.

The process is characterized by the acceleration of the rhythm of the muscular organ up to 100 beats per minute and more.

The pathogenic process is formed relatively quickly. The impetus for the beginning of changes is trauma, violation of the integrity of the heart or other organic damage as a result of a heart attack, cardiosclerosis, infectious moments.

To understand how the problem appears, you need to turn to anatomy and normal physiology.

An adequate state of affairs is characterized by a full-fledged work of the heart. Contractions of the muscular organ occur autonomously under the control of the brain stem.

External factors can only slightly affect the work of the heart, but not change it dramatically.

Rhythmic beats are possible due to the generation of an electrical impulse by special bundles of cardiac cells - the so-called sinus node. From the driver (an alternative name for this formation), the signal is transmitted through the bundles of His to other tissues of the organ. This leads to muscle contraction. This is what happens all the time.

Ventricular tachycardia (VT) is characterized by pathological localization of electrical impulse generation. The rest of the cardiac structures should not participate in the creation of the signal, they are conductors and a kind of "pumps" that redirect blood in the right direction.

In this case, the ventricles join the signal generation.

It ends with disastrous consequences:

• The intensity of blood ejection decreases. Organs and systems receive less nutrients and oxygen. The deficit is significant. Hence hypoxia, which often ends fatally.
• Even if this does not lead to the death of the patient, the ventricles contract erratically. Hence the probability of cardiac arrest at one moment. The resumption of the activity of the body is possible after resuscitation, but the main process continues to flow. There is a high chance of relapse. When this will happen: this very minute, in an hour or a month - is not known. Such patients are referred to a cardiological hospital for urgent diagnosis and emergency treatment.

The myocardium of the left ventricle suffers most often due to the anatomical structure.

This kind of problem is never natural. This is a direct indication of the pathological process. With the manifestation of a pronounced clinical picture, there is almost no time left for diagnosis and treatment.

Classification

The pathological process can be typified for various reasons.

Depending on the intensity of the onset, the time of occurrence of the phenomenon:

Based on the severity of the current, we can name:

• paroxysmal form. It is observed in 55% of clinical cases. Corresponds to the early stage of the pathological process. Each paroxysm lasts from 2 minutes to several hours.
• permanent variety. All the same type of disease process, but the duration of the attacks is higher. 2-3 days is not the limit. The prevalence of the phenomenon - 20%
• Chronic type. For him, the constancy of violations of the heart rate is typical. However, the patient gets used to the condition and almost does not feel the problem, which complicates late diagnosis.

Finally, depending on the form, they distinguish:

• Monoform variety. 1 area of ​​pathological rhythm generation appears. Usually this is the left ventricle. Direct indication of organic damage to the heart.
• polymorphic type. There are 2 or more places where an electrical impulse is produced (not counting the sinus node). This is a consequence of non-cardiac factors, an overdose of psychoactive substances, including medications.

The ventricular variety of tachycardia is multifaceted. Since patients are relatively late in seeking care, especially in the absence of a normal screening program, there is not much time to thoroughly identify the underlying cause and form of the process.

Everything has to be done in emergency mode. Hence the high mortality: The drugs themselves, if used incorrectly, can aggravate the course of the disease. Conclusion: at the first suspicion of a malfunction in the work of the heart, you need to contact a cardiologist.

Characteristic changes on the ECG

Electrocardiography is the main method for diagnosing ventricular tachycardia at any stage.

Typical signs:

• Increase in heart rate up to 100-300 beats per minute. Even in a state of complete rest. After exercise tests, the heart rate may drop sharply.
• The width of the QRS complex is over 0.12-0.14 seconds.
• The axial value of the same complex in degrees is more than 30.
• There is ventricular capture, AB dissociation.
• The R wave is high, broadened, not split as in the supraventricular type.
• S serrated.

The ventricular form of tachycardia on the ECG is characterized by an increase in heart rate, peak deviation. It is relatively easy to delimit this form of the pathological process according to the cardiogram if you have qualifications.

Self-decryption is not possible. In case of doubtful results, it is recommended to obtain the opinion of another specialist.

Cardiac causes of development

As was said, always pathological. Mainly of cardiac origin. Among the likely phenomena that cause ventricular tachycardia:

• Dysplastic process in the ventricles of the heart. Simply put, the replacement of functional active tissue, cardiomyocyte cells with adipocytes.
• Myocardial infarction. It consists in acute malnutrition of the muscular structures of the organ. The result is muscle necrosis on scar tissue, which is not capable of either automatism or even contraction and acts as a kind of “filler”. The healing process ends with the formation of persistent cardiosclerosis. Ventricular tachycardia in this case is a strange adaptive mechanism that has nothing to do with the normal functioning of the system.

• Heart defects, both congenital and acquired. They go unnoticed in most cases. There are no symptoms, they are discovered by chance during a deeper examination of patients. However, this is not a guarantee either. There are many cases of diagnosis after the fact, when the patient died. This is due to screening errors and insufficient attention of people to their own health.
• Coronary artery disease. Chronic malnutrition of the myocardium in a certain area. This is a precursor to a heart attack. In the future, a couple of years of emergency will come. Qualified help is needed at an early stage.

• Rheumatism. Autoimmune damage to the muscular organ. It is not treated, it can only be corrected to a small extent. The task of therapy lies in the need to prevent the generation of pathological impulses.
• Inflammatory diseases of the heart. Usually infectious. Myocarditis and others. Without competent and urgent help, they lead to the total destruction of cardiac structures. In such a situation, tachycardia is not the biggest problem. There is a risk of cardiac arrest. In the case of successful treatment, cardiosclerosis is still likely with clear consequences.

• Aneurysm of a vessel located in the ventricle. Bulging of the wall of a large artery leads to malnutrition. The result may be a rupture and massive bleeding, fatal in 100% of cases.

Non-cardiac causes

Occur less frequently. Among them:

• Endocrine disorders associated with a deficiency of hormones of the adrenal cortex, thyroid gland or pituitary gland.
• Dehydration or excess water in the body.
• Genetic syndromes and deviations. Many congenital pathologies affect the work of the heart. In some cases, children do not live to see the diagnosis, the disease is determined after the fact.
• Lack of potassium and magnesium. Due to nutritional factor. Poor nutrition is another point of risk.
• Excessive consumption of drugs for the treatment of arterial hypertension, problems with the cardiovascular system.
• Intoxication with alcohol, caffeine, nicotine, psychoactive substances (cocaine and heroin), salts of heavy metals, compounds of toxic chemical elements.

In the absence of data for organic changes in the heart or other systems, they speak of an idiopathic form. Her treatment comes down to stopping the picture throughout her life.

Symptoms

Manifestations of ventricular tachycardia require a qualified assessment. Look out for the following signs of a possible problem:

• Increased heart rate. It is felt subjectively, but not for long.
• Panic attack. Characteristic of the paroxysmal course of the disease.
• Loss of orientation in space. Dizziness.
• Nausea.
• Vomiting (rare).
• Fainting state.
• Dyspnea. Caused by tissue hypoxia. This is an alarming manifestation, indicating the rapid progression of the process.
• Cyanosis of the nasolabial triangle. Blue area.
• Paleness of the skin.
• Increased sweating.
• Weakness.
• Pain in the chest.

These are typical manifestations of paroxysm or a long-term, but not yet chronic process. As we move forward, the clinical picture is smoothed out, the patient stops feeling anything. Life seems to be getting back to normal, but this is just an appearance. Underlying the problem continues to exist and progress. In the early stages, there are also no symptoms, or they are so weak that the person does not pay attention.

Complications of ventricular tachycardia occur in almost 70% of cases.

Emergency conditions are indicated by the following signs:

• Sharp headache for no apparent reason, in the neck or crown. Beats to the beat of the heart.
• Discomfort behind the sternum of a pressing nature. Doesn't let you breathe.
• Repeated loss of consciousness.
• Focal neurological disorders, from the side of vision, hearing or touch.
• Paralysis, paresis, sensation of numbness of the extremities.
• Distortion of the face.
• Inability to speak normally.

All these moments are inherent in two formidable conditions: a heart attack and a stroke. The second one is easier to recognize, there are simple tests available (raise your hands, smile, say a phrase, if at least one action is impossible, call an ambulance). The first is diagnosed only in the hospital.

Symptoms of ventricular tachycardia from the brain, nervous, cardiovascular systems are explained by a violation of hemodynamics at a general level, a decrease in the concentration of oxygen in the blood.

Emergency help during an attack

You need to act quickly.

• Measurement of blood pressure and frequency of organ contractions is carried out. With a low level of blood pressure (less than 90 to 60), you can immediately call an ambulance, you cannot help yourself. The probability of an arrhythmic collapse is great.
• Next, you should take a tablet of Anaprilin or Karvedilol.
• Drink motherwort, valerian (1-2 tab.).
• Provide fresh air to the room.
• Do not make sudden movements, get to bed as carefully as possible, lie down.
• Loosen pressing jewelry, wardrobe items. The neck must be free.
• After 20 minutes, check your blood pressure and heart rate again.

In the absence of effect, call an ambulance. Prior to arrival, maintain a stable physical position.

Attention:

In no case should you resort to a contrast shower, hot baths, the use of phytotherapeutic agents. This is dangerous and often fatal. Large dosages of drugs are also contraindicated. They can aggravate the course of an attack. No alcohol, glycosides, other means.

Diagnostics

Passes under the control of a cardiologist. External specialists are involved as necessary. However, the main "weight" falls on the specialized doctor.

Survey methods include:

• Questioning the patient. There are health complaints. A person should tell everything, even if the moment seems to be irrelevant to the question. The doctor himself will sort the information.
• Collection of anamnesis. Bad habits, lifestyle, heredity and family history of diseases. Here are just some of the important facts.
• Measurement of blood pressure and heart rate. Several times, with an interval of 5-15 minutes or more.
• 24 hour Holter monitoring. Better in an outpatient setting. So the data will be more accurate, the patient will be in a natural, familiar environment. Excluded stress, phobias. Physical activity at an adequate level. The dynamics of the process is detected accurately.
• Electrocardiography. Applied first. Specific data allow you to quickly make a diagnosis. It is important to correctly decipher the information.
• Echocardiography. Ultrasound study. Imaging is shown to detect organic changes.
• For a more detailed picture, an MRI or CT scan is used.

Full diagnostics is carried out within 2-4 days. Faster in stationary conditions. It's not worth the time. In the early stages there is no urgency, in the long run there will be deterioration.

Therapeutic course

Treatment of ventricular tachycardia is medical, surgical or mixed. Lifestyle changes, folk recipes, diet correction, all these methods of effect do not excite, since the cause of the process is organic damage to the heart.

Preparations:

• cardiac glycosides. They normalize work by weakening the generation of pathological signals. Digoxin and tincture of lily of the valley. In strictly controlled quantities.
• calcium antagonists. Verapamil or Diltiazem.
• Beta blockers. Carvedilol, Metroprolol, Anaprilin.
• Antiarrhythmic drugs. To restore normal heart rate. Amiodarone, Quindine and others.

Surgery is indicated in extreme cases. It consists in cauterization of a pathological bundle of heart cells (endovascular ablation), implantation of a cardioverter or an artificial pacemaker. When tissues are destroyed, prosthetics are indicated.

The ventricular form of tachycardia is treated mainly with medication using several groups of drugs. Often there is a life-long prescription of symptomatic drugs.

Prognosis and complications

Likely consequences include:

• Cardiac arrest due to ventricular fibrillation. It is almost impossible to restore the work of the body in this case. This is a death sentence.
• Cardiogenic shock. A sharp violation of the activity of cardiac structures. Lethality approaches 100%. Even survivors die in 80% of situations within the first 2-3 years. You don't need to bring it up.
• Heart failure or ischemic disease. With a long course of the pathological process.
• Pulmonary edema.

All this against the background of a significant decrease in the quality of life: in difficult situations, the patient cannot serve himself, physical activity of minimal intensity becomes a torment and a real problem. Not only sports, but even going to the store becomes a big challenge.

The forecasts are quite optimistic:

• With early treatment, the probability of fatal complications is no more than 10-15% within 5 years. Perhaps less.
• Late initiation of treatment increases the number to 30-40% of cases and this is at the initial stage.
• In the absence of therapy, any stage of the process is associated with almost 80% mortality.

Unfavorable factors:

• Poor response to treatment.
• The presence of heart failure.
• Decreased contractile function.

In all other situations, patients can expect a long, fulfilling life.

Ventricular tachycardia means an acceleration of the heart rate to 100 beats per minute or more, due to organic disorders. The condition is stopped under the supervision of a cardiologist. The prognosis is variable.

Diseases

Ventricular tachycardia is a life-threatening arrhythmia. A high heart rate in the lower chambers of the heart reduces the time interval required for sufficient filling of the chambers. As a result, the heart does not pump blood efficiently. The heart muscle, brain and other parts of the body do not receive the necessary amount of blood. Ventricular tachycardia leads to severe syncope and even death. Most sudden cardiac deaths are caused by ventricular tachycardia and account for about 300,000 deaths per year, or approximately half of the cardiac deaths.

Ventricular tachycardia is a fast, regular heart rhythm in the lower chambers of the heart. The pulse frequency exceeds 120 to 200 beats.

Ventricular tachycardia occurs most often in people with damaged heart muscle and coronary heart disease. Other possible causes are related to valvular changes or cardiomyopathy. Rarely, ventricular tachycardia develops in a structurally normal heart.

Treatment is with an implantable defibrillator. It is extremely effective in healing. Used to detect and stop ventricular tachycardia. This is an electronic device that is implanted under the skin just below the collarbone and controls the heart rate.

Ventricular tachycardia

In the broad sense of the word, arrhythmias- this is a change in the normal regularity, frequency, source of cardiac excitation, an impulse conduction disorder, as well as a violation of the sequence between the excitation of the ventricles and atria.

• abnormal coordination of contractions of sections of the myocardium, parts of the heart
• cardiac cycles of unequal duration
• an increase or decrease in heart rate

Ventricular tachycardia represents an attack of the heartbeat, in which the impulses are rhythmic and come from the ectopic focus. With it, there is a sharp increase in heart rate (more than 140 heartbeats per minute).

Causes of ventricular tachycardia

• Shifts in nervous, endocrine regulation that change the course of electrical processes in heart cells
• Diseases of the heart muscle (myocardium), its anomalies, hereditary and congenital defects with membrane damage, destruction of cellular structures
• Mixed functional-organic heart disease.

It is very important for the heart that the synchronism of the excitation of its structures, that is, electrical homogeneity, be present and maintained. Asynchronism of refractoriness (non-excitability) and excitability in certain areas of the myocardium- the most important factor in the development of arrhythmias, including ventricular tachycardia. Note that these areas of the myocardium appear against the background of myocardial infarction, myocarditis; they can also be foci of myocarditis, postinfarction cardiosclerosis, a hypertrophied heart chamber, abnormally located chords, a mitral valve with prolapse, and others.

The main mechanism for the implementation of most arrhythmias (for example, paroxysmal tachycardia) on such a pathological background- the mechanism of re-entry of excitation, or re-entry, when the same cardiac impulse begins a circular motion, returning to its place of origin, then causes re-excitation of the heart muscle. For example, in the wall of the right ventricle there is a focus of postinfarction cardiosclerosis. The excitability of this area is reduced, and its period of non-excitability is lengthened. Therefore, the wave of excitation covers healthy areas of the myocardium in the first place, bypassing such an area with reduced excitability. At this time, healthy parts of the heart muscle have time not only to become excited, but also to get out of the state of non-excitability, that is, refractoriness. And at this time, a belated impulse of the pathological part of the myocardium comes, causing extraordinary contractions of the ventricle. There will be an extrasystole.

In the heart, re-entry waves are formed at the confluence of the pulmonary veins into the left atrium, at the mouth of the vena cava, in the area of ​​the bundles of Wenckebach, Bachmann, Torel, in the presence of additional anomalous Kent and Maheim pathways. According to this mechanism, paroxysmal ventricular tachycardia occurs.

With ventricular tachycardia, excitation waves are formed according to the re-entry mechanism. In this case, the heterotopic focus becomes the pacemaker for some time. Ventricular tachycardia is a stream of extrasystoles rhythmically following one after another.

Symptoms of ventricular tachycardia

Complaints of patients are very different, depending on the nature of the underlying disease: worried about the heartbeat, which is accompanied by dizziness, weakness, shortness of breath, pain in the heart, interruptions, pauses in heart contractions, fainting, episodes of confusion.

The main place in the clinical picture of arrhythmias is occupied by hemodynamic disturbances of the ischemic or congestive type. They pose a threat of embolism of important organs, provoke the occurrence of more severe arrhythmias, for example, ventricular fibrillation, which is the main cause of death in patients with cardiomyopathies, coronary artery disease and other heart diseases.

The most typical for ventricular tachycardia:

• palpitations
• feeling of tightness in the chest
• general weakness
• pallor of the skin
• pulsation of the jugular veins
• when the attack is delayed, signs of heart failure appear (shortness of breath, cough, swelling, and others).

Diagnosis of ventricular tachycardia in Israel

At the bedside of the patient, the doctor has the opportunity both to detect arrhythmias and to clarify the nature of some of them, which is achieved by carefully collecting an anamnesis of life and illness, examination, palpation of the arterial pulse, and auscultation (listening) of the heart.

In most of the patients when taking anamnesis find various diseases of the myocardium. With an objective examination, the data depend on the form of arrhythmia. Greater information is given palpation of the pulse, auscultation of the heart :

• On auscultation strengthened at the apex of the heart I heart tone due to low filling of the ventricles, and II tone weakened over the aorta due to a decrease in blood pressure.

But the most important is ECG(electrocardiography):

• The electrocardiogram is a series of ventricular extrasystoles that follow with a high frequency (from 140 to 180 quantities per 1 min) one after another. In this case, there is no P wave, or it can periodically overlap the QRS complex, which is expanded, deformed, with the ST segment and the T wave discordantly located after it.

Of the additional methods used ECG with exercise tests(eg, transesophageal pacing, bicycle ergometry, drug testing). Of particular importance is Holter monitoring. that is, an ECG recording over a long period of time.

Treatment of ventricular tachycardia in Israel

Appointed antiarrhythmic drugs. the most effective of which are:

• Lidocaine
• Procainamide
• Mexelitin
• Amiodarone
• Magnesium sulfate
• Bretylium tosylate

The drugs are administered intravenously. In severe cases, it is necessary to electropulse therapy and cardiopulmonary resuscitation .

Prevention of ventricular tachycardia

Ventricular tachycardia

Ventricular tachycardia

Ventricular tachycardia is a rapid contraction of the ventricles that often comes on and off suddenly. This pathology is one of the most severe types of rhythm disturbance that occurs in acute myocardial infarction. Ventricular tachycardia can pose a threat to human life, and therefore requires immediate medical attention.

Causes

There can be many causes of ventricular tachycardia. With idiopathic ventricular tachycardia, the patient does not have any heart disease, and there is no genetic predisposition.

Known causes of ventricular tachycardia may include:

· coronary artery disease;

myocarditis;

· cardiomyopathy;

Congenital heart defects

arrhythmogenic dysplasia of the right ventricle;

a consequence of surgical operations on the heart;

taking certain medications. In particular, attacks of ventricular tachycardia can develop with an overdose of antiarrhythmic drugs, beta-blockers and glycosides;

electrolyte disturbances;

Symptoms

The main symptoms of ventricular tachycardia are:

Feeling of rapid heartbeat

sensation of a lump in the throat;

dizziness, severe weakness (up to loss of consciousness);

Feeling of fear

pallor of the skin.

Sometimes ventricular tachycardia is asymptomatic.

Diagnostics

At the first stage, the patient's complaints are analyzed and an anamnesis of the disease is collected. During a physical examination, the skin is examined, blood pressure and pulse are measured, and heart sounds are heard.

electrophysiological examination of the heart;

daily monitoring of the electrocardiogram;

load tests;

Multispiral computed tomography;

· Magnetic resonance imaging;

· radionuclide research methods;

coronary angiography;

Other research methods (at the discretion of the doctor).

Types of disease

Ventricular tachycardia is monomorphic and polymorphic. With monomorphic ventricular tachycardia, there is one source of palpitations. As a rule, this form of the disease develops in the presence of damage to the heart.

Polymorphic ventricular tachycardia is characterized by the presence of several sources of tachycardia. This form of the disease can occur with overdoses of certain drugs, as well as with some hereditary diseases.

Downstream, ventricular tachycardia is paroxysmal unstable, paroxysmal stable, and chronic.

Paroxysmal non-sustained ventricular tachycardias are characterized by a duration of attacks of less than 30 seconds. Such exacerbations (paroxysms) do not have a significant effect on hemodynamics, but increase the likelihood of developing fibrillation.

Paroxysmal sustained ventricular tachycardias are characterized by a duration of attacks of more than 30 seconds. With this form of ventricular tachycardia, there is a pronounced violation of hemodynamics.

Chronic ventricular tachycardia is characterized by repetitive, relatively short tachycardia attacks. With this variant of ventricular tachycardia, hemodynamic disturbances increase slowly.

Patient's actions

With this pathology, the patient needs to consult a cardiologist.

Treatment

The underlying disease needs to be treated. To restore the rhythm at the time of exacerbation, electrical impulse therapy is performed, the patient is prescribed antiarrhythmic drugs.

To prevent attacks of ventricular tachycardia, the patient may be prescribed beta-blockers, antiarrhythmic drugs, calcium channel blockers, omega-3 polyunsaturated acids.

Surgical treatment of ventricular tachycardia involves radiofrequency ablation (destruction of the source of tachycardia) or implantation of an cardioverter-defibrillator.

Complications

Fibrillation of the ventricles.

· Heart failure.

· Sudden cardiac death.

Prevention

Prevention of diseases that cause ventricular tachycardia.

Avoidance of stress.

Refusal of bad habits (smoking and drinking alcohol).

Ventricular tachycardia most often occurs with severe damage to the heart muscle (myocardium). The main symptom is an irregular heartbeat. The main danger is in violation of hemodynamics, which can even lead to death. For this reason, in the event of a rhythm failure, the source of which is the myocardium of the ventricle of the heart, medical assistance should be provided as quickly as possible.

The danger of ventricular tachycardia is exacerbated by the frequency of occurrence - about 85% of patients who are diagnosed. Men are diagnosed twice as often as women.

Particularly distinguished is ventricular tachycardia of the pirouette type, characterized by a constantly changing amplitude and polarity of tachycardia complexes (on the ECG you can see how the shape of the QRS complex changes). The heart will either freeze or beat faster.

There is still one form related to ventricular - ventricular tachycardia. This form is associated with the atrioventricular node, which is located between the atria and ventricles and passes impulses from it through itself with a frequency at which the heart contracts 50-80 times per minute. Failure in this node leads to ventricular tachycardia.

For reference. Ventricular tachycardia is a failure of the heart rhythm, provoked by the course of pathological processes in the myocardium. It is characterized by serious disturbances in the flow of blood through the vessels and the vascular cardiac system. This pathology is a serious threat to human health.

Tachycardia in the clinic is called any increase in heart rate over 80 heart beats per minute. At the same time, tachycardia is divided into physiological - after physical exertion, excessive excitement and pathological.

For example, tachycardia that occurs in the supraventricular region, or near the atrioventricular node, is dangerous to health, and such a person needs urgent medical attention. Ventricular tachycardia is the most dangerous increase in the heart rate, and medical attention should be provided without delay.

A normal physiological phenomenon is the gradual transmission of electrical impulses from to the atrioventricular and below, along the bundles of His and Purkinje fibers. Due to this flow of impulses, the atria contract first, and then the ventricles of the heart. In such a situation, the muscular membrane of the heart contracts evenly with a frequency of 60-80 beats per minute.

During pathological processes occurring in the muscular wall of the heart, a certain number of impulses are not able to reach the ventricles due to the fact that the affected tissue cannot contribute to the emergence of contact, because of this, the impulses seem to linger in one place.

Thus, several sections are formed, and groupings of electrical impulses force the ventricles to work in an accelerated mode. In this situation, the heart rate can be 150 beats per minute and much higher. This disease is called "paroxysmal tachycardia". It is divided into stable and unstable.

For reference. Sustained ventricular tachycardia manifests as an unexpected increase in heart rate that lasts over thirty seconds (read from the electrocardiogram) and is characterized by numerous modifications of the ventricular complexes.

This form of pathology can turn into ventricular fibrillation, which is extremely dangerous for the patient's life.

Unsustained ventricular tachycardia is not as dangerous as the previous one. On the electrocardiogram, usually about three or more modified ventricular complexes are recorded. Such a disease accompanies usually often detected extraordinary contractions of the ventricles (ventricular extrasystole).

Reasons for the development of ventricular tachycardia

In 98% of patients, ventricular tachycardia is a consequence of the presence of a person with any heart disease. In the rest
cases, the cause cannot be recognized, and such a pathology is called “idiopathic”.

The main reasons for the development of ventricular tachycardia:

• Acute form of myocardial infarction - causes ventricular tachycardia in most cases due to pronounced necrotic changes in the ventricular muscle tissue.
• Genetically determined diseases that disrupt the potassium and sodium channels. These pathologies lead to failures in the processes of de- and repolarization, which causes an accelerated contraction of the ventricles of the heart. Such diseases include Jervell-Lange-Nielsen syndrome, which is also accompanied by hearing loss, and Romano-Ward syndrome, in patients with normal hearing. In addition, ventricular tachycardia occurs in patients with Brugada syndrome, Wolff-Parkinson-White syndrome, and Clerk-Levy-Christesco syndrome.
• Excessive intake of antiarrhythmic drugs - amiodarone, quinidine, sotalol, beta-agonists or diuretics.
• Inflammatory processes in the muscular wall of the ventricles, heart defects or lesions that have arisen after myocardial infarction.
• Intoxication with alcohol or drugs.

For reference. These reasons only determine the predisposition of the body to the occurrence of ventricular tachycardia.

Factors that serve as a provocateur of the development of pathology:

If this method did not help to detect ventricular tachycardia, it can be specifically provoked with the help of physical activity - in other words, diagnosis by the method of stress tests (treadmill test) or an intracardiac electrophysiological study.

These diagnostic methods are most often used to detect the increase in heart rate, its registration and detailed study in order to assess its clinical significance and prognosis of the disease.

In addition, an ultrasound examination of the heart is performed to predict the ejection fraction and ventricular contractility. Magnetic resonance imaging of the heart is also performed to determine the disease that could provoke ventricular tachycardia.

For reference. In some situations, radionuclide methods are used to detect a zone in the heart muscle where a pathological process is taking place, there is ischemia, which provoke the development of ventricular tachycardia.

Types of ventricular tachycardia

There are several classifications of ventricular palpitations.
According to the time of occurrence, the pathology is divided into two types:

• Paroxysmal - an attack is formed unexpectedly, the heart rate starts from 130 beats per minute or more. The patient needs professional help without delay;
• Non-paroxysmal - expressed by group extraordinary contractions. The nature of the attacks is not peculiar to her.