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Paroxysmal supraventricular tachycardia elderly worry 4 (content expertise) to edit entries summary
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Is originated in the atria or the atrioventricular junction is due to reentrant tachycardia most of the excitement caused by the self-discipline to increase minority and triggered activity caused. ECG more than 3 consecutive supraventricular premature beat called paroxysmal supraventricular tachycardia, including atrial and junctional tachycardia, and sometimes difficult to distinguish between the two ECG is referred to as paroxysmal supraventricular tachycardia. Cause disease
(A) etiology
Coronary heart disease, myocardial infarction, hypoxic acidosis, hypokalemia, pre-excitation syndrome, heart failure, chronic obstructive pulmonary disease, other types of organic heart disease or those associated with atrial enlargement, digitalis or other drugs toxicity, infection, fever, hyperthyroidism, can also be found without any cause, or due to emotional, fatigue, smoking, alcohol induced.
(B) of the pathogenesis
Supraventricular and ventricular tachycardia most of the electrophysiological mechanisms for the exhumation. An anomaly or a small number of self-excited after depolarization


secondary. Supraventricular tachycardia, sinus node reentry can occur in and adjacent atrium, the atrium, atrioventricular nodal or atrioventricular (via the side beam.) Reentrant ventricular tachycardia ventricular ring are located. Bundle branch reentry rare. Fast pathway of atrioventricular junction and electrophysiological differences between the slow pathway, the former transmission speed, not a long period, while the latter slow conduction velocity, refractory period is short, as the circular movement between the two, or turn back basis. Scheduled to ring the direction of downstream from the slow pathway, retrograde fast pathway (slow - fast type) more common, whereas (fast - slow type) rare. Next to the beam and the normal AV conduction system, the differences between the electrophysiological properties of atrioventricular bundle are reentry by side basis. Common direction of the circular movement spfrom the ventricular compartment formed against the spalong the beam next to atrium, also under the beam transmitted by the ventricular side and then along the retrograde His bundle. Regional myocardial ischemia, necrosis, or fibrosis due to changes in electrophysiological properties of myocardial cells, and the differences between adjacent normal myocardium, the myocardium to form a favorable basis for micro-reentry. Atrial and (or) ventricular cardiac muscle cell lesions can corresponding decline in resting membrane potential, rapid response by the cells into cells with electrophysiological characteristics of slow response, the conduction of abnormal slow and self-discipline. Early after depolarization triggered by excitement increased extracellular calcium, catecholamines and other drugs cause; and delayed after depolarization may trigger emotional and digitalis poisoning. Edit this section | Back to the top of the symptoms of the disease
1. Heart rate faster, and more at 160 ~ 220 times / min, rhythm rule.
2. Palpitations or chest in a strong sense of heart.
3. Polyuria, sweating, shortness of breath.
4. Continue for a long time can cause severe circulatory disturbance, causing angina and significant ST segment depression, dizziness, syncope, or heart failure, shock.
5. A sudden onset of a sudden stop, the attack stopped, because of intermittent sinus rhythm is too long, those occasional syncope.
6. Stimulate the vagus nerve endings, can make 50% ~ 80% PSVT sudden halt.
7. Heart sounds the same absolute rule, there are no guns jugular vein waves. Small pulse rate, blood pressure can be reduced.
In recent years, progress in cardiac electrophysiology study, paroxysmal supraventricular tachycardia on the pathogenesis and classification, there are some new understanding. Generally based on location and mechanism of its occurrence were divided into six types, now features all types of ECG are listed in Table 1, a token of identification. If the surface ECG P wave is unclear who do esophageal lead electrocardiogram. Edit this section | Back to the top of the check tests
Caused by the tachycardia of hyperthyroidism, T3, T4 can be anomaly.
1. Electrocardiogram showed rapid emergence of 3 or more consecutive QRS wave, frequency 160 ~ 220 times / min. R-R interval equal.
2. 24h Holter heart rate, arrhythmia patients both qualitative and quantitative diagnostic significance. Edit this section | Back to the top of the differential diagnosis
Clinical need and sinus tachycardia, atrial flutter, paroxysmal tachycardia, non-differentiated. Edit this section | Back to the top of the hair disease
Tachycardia frequency of more than 200 times / min, can cause heart, brain and organ insufficiency, hypotension, syncope, seizure (Aspen condensation sign), and angina pectoris, heart failure and even sudden death. Edit this section | Back to the top of the preventive health care
Should first be taken to remove cause atrial premature factors, such as mental or emotional fluctuations, work fatigue, smoking, drinking and so on. Frequent atrial premature when there should be an active treatment. Be the first trial, such as -blockers such as propranolol or atenolol, may be invalid if the order of selection of verapamil, diltiazem, propafenone, amiodarone, or quinidine and so on. Digitalis for heart failure or determined to increase the cases of very effective, but it should be due to the room except for digitalis toxicity early. For refractory recurrent PSVT may consider combination therapy to prevent recurrence. Edit this section | Back to the top of the Therapeutic Use
(A) treatment
1. To stimulate the vagus nerve endings of the method, this method is more suitable for young people, old people do not. Please patients forced expiratory breath; stimulate the throat cause nausea; mean carotid sinus pressure or massage, first try the right side of 10s, such as invalid and try the left side of 10s, not both sides of the same pressure, so as not to cause brain Ischemia; acupressure eye, but also left right after the first, each no more than 10s, not too much force, otherwise the risk of retinal detachment caused. Self-discipline of atrial tachycardia vagus nerve stimulation method is invalid.
2. Verapamil (verapamil) is not within 2 weeks of intravenous patient with -blockers may be preferred, each 5mg plus 5% glucose soluti0 ~ 20ml, slow intravenous injection (5 ~ 10min ), blood pressure and electrocardiogram monitoring, ineffective, 30min after repeated use, the total does not exceed 20mg.
3. Lanatoside C (cedilanid) for PSVT with heart failure should be preferred, but the pre-excitation syndrome wide QRS wave were banned. 1 to 2 weeks without use of digitalis may increase to 0.4mg glucose 10 ~ 20ml, intravenous injection of 5 ~ 10min.
4. Pressor agent for PSVT with low blood pressure, but older people should not use. Common metaraminol (alamin) per 1.0 ~ 2.Omg or methoxy Ming (U.S. speed Kexin life) 5mg plus slow intravenous injection of glucose solution 20ml, can also be used phenylephrine (phenylephrine) 1.0mg plus glucose 20ml, slow intravenous injection of 10min, while monitoring blood pressure and electrocardiogram. When the systolic pressure is over 22.7kPa (170mmHg) to pause or slow injection vasopressor, PSVT, shall immediately after the cessation of withdrawal.
5. Amiodarone 150 ~ 300mg plus glucose 30 ~ 50ml, intravenous injection of 30min. Effect was lanatoside C (cedilanid) faster than verapamil (verapamil) slow, but has few side effects, because a considerable number (60% to 80%) of the Department of supraventricular tachycardia by atrioventricular node reentry, but the main role of intravenous amiodarone on the AV node, it can block the PSVT.
6. Three adenosine monophosphate (ATP) the drug on sinus node and atrioventricular node were significantly inhibited by the atrioventricular junction on the exhumation of PSVT effective. Three commonly used cAMP (ATP) 10 ~ 20mg rapid intravenous injection, 5s the end note. Drug half-life is very short, only 30s, so if the invalid, 3 ~ 5min after repeated intravenous injection. Stationary to prevent serious sinus, atrioventricular block, combined with intravenous injection of atropine 0.5mg. Sick sinus syndrome, elderly and disabled.
7. Speeding or match a variety of drug treatment ineffective pacing may be speeding through the esophagus or atrial pacing to terminate tachycardia or the onset of pairing.
8. Synchronized direct current cardioversion of emergency, such as acute heart failure, shock, and conditions are available direct current cardioversion. Generally start with 25J, invalid may be increased to 50 ~ 200J. Used digitalis drugs may start small dose of 10J.
9. Surgical treatment of various medical treatment fails or too frequent episodes of PSVT, atrioventricular junction can be used for electrical burns, postoperative cardiac necessary to install a permanent pacemaker. WPW with refractory PSVT for drug treatment ineffective, can be used for bypass surgery. In recent years, radiofrequency catheter ablation of atrioventricular bypass blocking, safe and effective with few complications.
(B) the prognosis
No obvious structural heart disease, and occasionally attack, each no more than a few minutes, nor obvious symptoms, prognosis good, also do not have special treatment. If structural heart disease, in particular, are prone to cause PSVT AMI complicated by heart failure, shock, after the more serious and should be actively controlled. Edit entry Open Category:
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