Tachycardia paroxysmal preaserana

Tachycardia paroxysmal preaserana

Paroxysmal atrial tachycardia (PPT) is a sudden onset and sudden cessation of tachycardia attacks resulting from the pathological activity of heterotopic foci of automatism located in the atrial myocardium. The pulse rate reaches 150-250 (traditionally 160-190) per minute.

Classification

• • Reciprocal (re-entry) atrial paroxysmal tachycardia
  • Chronic reciprocal (permanently recurrent) PPT
  • Focal (focal) PPT
  • Multifocal (multifocal) PPT. Etiology. PPT is the most common form among all paroxysmal tachycardias (80-90%), especially at the age of 20-40 years
  • In 50-75% of cases, PPT occurs in people with a healthy heart as a result of emotional stress, excessive consumption of coffee or tea, alcoholic beverages, marijuana, smoking, sleepless nights.
  • Wolff-Parkinson-White syndrome (up to 30% of all APTs)
  • Poisoning by cardiac glycosides and sympathomimetics
  • Cardiac changes in arterial hypertension
  • Hypokalemia
  • Hypoxia
  • ischemic heart disease
  • Myocarditis
  • Thyrotoxicosis
  • Anomalies in the development of the heart
  • Reflex irritations in diseases of internal organs (cholelithiasis, colitis, nephrolithiasis, peptic ulcer). Pathogenesis
  • Excitation circulation in the atrioventricular node (60% of APT cases), in the atria (5% of APT cases), foci (foci) of increased automatism in the atria (5% of APT cases)
  • In the bulk of cases, PPT is due to the re-entry mechanism (see Cardiac arrhythmias) – the so-called. reciprocal tachycardia. For their development, the existence of 2 independent pathways for impulse conduction will be necessary, which is likely in the following situations:
  • Electrical heterogeneity of parts of the heart muscle and its conduction system (IHD, myocarditis, etc.)
  • Anomalies of development (additional fast-conducting bundles of Kent, James, longitudinal functional dissociation of the atrioventricular node)
  • An attack of PPT does not always indicate heart disease. In 60-75% of cases, PPT occurs with a healthy heart muscle.

The clinical picture – see Paroxysmal supraventricular tachycardia.

ECG identification

• • Heart rate – 150-250 per minute
  • The P wave is located in front of the QRS and can be changed
  • Foci of increased automatism in the atria – the shape of the P waves depends on the location of the ectopic source
  • The initial part of the ventricular complex is not changed.

Treatment:

Tactics of conducting

• • It is necessary to relieve tension and anxiety in the patient, create conditions for reducing sympathetic influences, provide access to fresh air
  • Vagus nerve stimulation (reduces conduction of the atrioventricular junction) – carotid sinus massage, Valsalva maneuver, pressure on the eyeballs (Ashner’s reflex)
  • With the ineffectiveness of these measures, medical therapy
  • Indications for electropulse therapy are unstable hemodynamics, heart failure, progression of coronary artery disease.

Drug therapy – see Paroxysmal supraventricular tachycardia, Atrial fibrillation; verapamil, b-blockers, novocainamide or cardiac glycosides in / in.

Synonyms

• • Supraventricular paroxysmal tachycardia
  • Supraventricular paroxysmal tachycardia See also. Paroxysmal supraventricular tachycardia, Paroxysmal tachycardia from the atrioventricular junction, Paroxysmal ventricular tachycardia Contraction. PPT – atrial paroxysmal tachycardia of the ICD. 147 Paroxysmal tachycardia