home Audience 8 Pirouette-type ventricular tachycardia. Arrhythmia of the pirouette type: symptoms, diagnosis, treatment. What complications are possible

Pirouette-type ventricular tachycardia. Arrhythmia of the pirouette type: symptoms, diagnosis, treatment. What complications are possible

Often encountered in clinical practice and require careful examination of patients to determine the individual prognosis of these arrhythmias and the possible risk of ventricular fibrillation (VF) and sudden cardiac death. Frequent ventricular arrhythmias include: ventricular extrasystole (PV); ventricular tachycardia (VT); ventricular fibrillation (VF); accelerated idioventricular rhythm.

Ventricular extrasystole

Ventricular extrasystole (PV) is a premature excitation of the heart that occurs under the influence of impulses emanating from various parts of the ventricular conduction system. Single monomorphic PVCs can occur as a result of both the formation of a re-entry of the excitation wave (re-entry) and the functioning of the post-depolarization mechanism. Repetitive ectopic activity in the form of several successive PVCs is usually due to the re-entry mechanism. The source of PVCs in most cases are branches of the bundle of His and Purkinje fibers. During PVC, the sequence of repolarization changes, there is a shift of the RS-T segment above or below the isoline, the formation of an asymmetric negative or positive T wave. The shift of RS-T and the polarity of the T wave are discordant to the main wave of the ventricular complex, directed in the direction opposite to this wave.

An important sign of PVC is the absence of a P wave in front of the extrasystolic QRS complex, as well as the presence of a complete compensatory pause. During PVC, the SA node usually does not "discharge" because the ectopic impulse originating in the ventricles cannot pass retrograde through the AV node and reach the atria and SA node. In this case, the next sinus impulse freely excites the atria, passes through the AV node, but in most cases cannot cause another depolarization of the ventricles, since after PVC they are still in a state of refractoriness. With left ventricular ES, there is an increase in the interval of internal deviation in the right chest leads V1, V2 (more than 0.03 s), and with right ventricular ES - in the left chest leads V5, V6 (more than 0.05 s).

To assess the prognostic significance of PVCs, V. Lown and M. Wolf (1971) proposed a system of gradations. Based on the results of 24-hour Holter ECG monitoring, 6 classes of PVCs are distinguished: class 0 — no PVCs within 24 hours of monitoring; class 1 - less than 30 PVCs are recorded for any hour of monitoring; Grade 2 - more than 30 PVCs are registered for any hour of monitoring; Grade 3 - polymorphic PVCs are registered; class 4a — monomorphic paired PVCs; Grade 46 — polymorphic paired PVCs; Grade 5 - 3 or more PVCs in a row are registered within no more than 30 s. Class 2-5 PVCs are associated with a greater risk of ventricular fibrillation (VF) and sudden cardiac death.

In 65-70% of healthy people, separate, monomorphic isolated PVCs are registered, belonging to the 1st class according to the classification of V. Lown and M. Wolf, not accompanied by clinical and echocardiographic signs of organic heart disease. Therefore, they are called "functional PVCs". Functional PVCs are recorded in patients with hormonal profile disorders, cervical osteochondrosis, NCD, with the use of aminophylline, glucocorticoids, antidepressants, diuretics, and vagotonics.

In individuals with increased activity of the parasympathetic system, the PVC system disappears during physical activity.

Organic PVCs are characterized by a serious prognosis; they occur in patients with coronary artery disease, myocardial infarction, postinfarction cardiosclerosis, hypertension, heart defects, MVP, myocarditis, pericarditis, DCM, HCM, CHF. More often, polytopic, polymorphic, paired PVCs and even short episodes (“jogging”) of unstable VT are recorded. The presence of "organic" extrasystole does not exclude a certain role of neurohormonal disorders in the occurrence of arrhythmias. Patients in whom organic PVCs have been identified undergo: a biochemical blood test (K+, Mg2+ and other parameters); 24-hour Holter ECG monitoring; EchoCG with the definition of EF, diastolic dysfunction; study of heart rate variability. These studies make it possible to estimate the possible risk of VF and sudden cardiac death, to determine the tactics of treating patients.

Ventricular tachycardia

Ventricular tachycardia (VT) is a sudden onset and just as suddenly ending attack of increased ventricular contractions up to 150-180 bpm. (less often - more than 200 beats or within 100-120 beats per minute), usually while maintaining the correct regular heart rate). Mechanisms of VT paroxysms: re-entry of the excitation wave (re-entry), localized in the conduction system or the working myocardium of the ventricles; ectopic focus of increased automatism; ectopic focus of trigger activity.

In most cases, VT in adults develop by the reentry mechanism and are reciprocal. Reciprocal VT is characterized by a sudden acute onset immediately after the PVC that induces the onset of an attack. Focal automatic VT is not induced by extrasystoles and often develops against the background of an increase in heart rate caused by exercise and an increase in the content of catecholamines. Trigger VT also occurs after a PVC or an increase in heart rate. Automatic and triggered VT are characterized by tachycardia with a gradual achievement of a rhythm rate at which sustained VT is maintained.

There are streets with cardiac pathology (acute myocardial infarction, postinfarction aneurysm, DCMP, HCM, arrhythmogenic pancreatic dysplasia, heart defects, MVP, digitalis intoxication). In 85% of cases, VT develops in patients with coronary artery disease, and in men 2 times more often than in women. ECG signs: 1. A sudden onset and just as suddenly ending attack of increased heart rate up to 140-150 beats per minute (less often - more than 200 or within 100-120 beats per minute) while maintaining the correct rhythm. 2. Deformation and expansion of the QRS complex more than 0.12 by its discordant location of the RS-T segment and the T wave. 3. The presence of AV dissociation - complete separation of the frequent ventricular rhythm (PU complexes) and normal atrial sinus rhythm (P waves).

Differential diagnosis of VT and supraventricular PT with wide QRS complexes is of paramount importance, since the treatment of these two rhythm disorders is based on different principles, and the prognosis of VT is much more serious than that of supraventricular PT. A reliable sign of this or that form of PT is the presence of VT or the absence of AV dissociation with periodic "captures" of the ventricles. This in most cases requires intracardiac or transesophageal registration of P waves of the ECG. However, already during a routine clinical examination of a patient with paroxysmal tachycardia, when examining the veins of the neck and auscultation of the heart, it is possible to identify signs characteristic of each type of PT. With supraventricular tachycardia with AV conduction of 1:1, there is a coincidence in the frequency of arterial and venous pulses. Moreover, the pulsation of the cervical veins is of the same type and has the character of a negative venous pulse, and the volume of the first tone remains the same in different cardiac cycles. Only in the atrial form of supraventricular PT is there an episodic loss of the arterial pulse associated with transient second-degree AV block.

Figure 30.

Ventricular tachycardia

(M.L. Kachkovsky)

There are three clinical variants of VT: 1. Paroxysmal non-sustained VT is characterized by the appearance of three or more ectopic QRS complexes in a row, which are recorded during an ECG monitor recording within no more than 30 s. Such paroxysms increase the risk of VF and sudden cardiac death. 2. Paroxysmal sustained VT lasting more than 30 s. It is characterized by a high risk of sudden cardiac death and significant changes in hemodynamics. 3. Chronic or continuously recurrent VT - long-term recurring relatively short tachycardic "jogs" that are separated from each other by one or more sinus complexes. This variant of VT increases the risk of sudden cardiac death and leads to a gradual increase in hemodynamic disturbances.

Polymorphic ventricular tachycardia tina "pirouette"

A special form of paroxysmal VT is polymorphic VT (pirouette - torsade de pointes), which is characterized by an unstable, constantly changing form of the QRS complex and develops against the background of a prolonged QT interval. It is believed that bidirectional fusiform VT is based on a significant prolongation of the Q-T interval, which is accompanied by a slowdown and asynchronism of the repolarization process in the ventricular myocardium, which creates conditions for the re-entry of the excitation wave (reentry) or the appearance of foci of triggered activity. In some cases, bidirectional VT can develop against the background of a normal QT interval.

The most characteristic for VT of the "pirouette" type is a constant change in the amplitude and polarity of ventricular tachycardia complexes: positive QRS complexes can quickly transform into negative ones and vice versa. This type of VT is caused by the existence of at least two independent but interacting reentry circuits or multiple foci of trigger activity. There are congenital and acquired forms of VT of the "pirouette" type.

The morphological substrate of this VT is inherited - long QT interval syndrome, which in some cases (with an autosomal recessive type of inheritance) is combined with congenital deafness. The acquired form is much more common than the hereditary form. It develops against the background of a prolonged Q-T interval and pronounced asynchronism of ventricular repolarization.

ECG signs of VT: 1. The frequency of the ventricular rhythm is 150-250 per minute, the rhythm is irregular with fluctuations in R-R intervals within 0.2-0.3 s. 2. QRS complexes of large amplitude, their duration exceeds 0.12 s. 3. The amplitude and polarity of the ventricular complexes changes within a short time. 4. In cases where P waves are recorded on the ECG, a dissociation of the atrial and ventricular rhythm (AV dissociation) can be observed. 5. VT paroxysm usually lasts a few seconds, stopping spontaneously, but there is a pronounced tendency to multiple recurrence of seizures. 6. Attacks of VT are provoked by PVC. 7. Outside the attack of VT on the ECG, a significant lengthening of the QT interval is recorded. Since the duration of each attack of VT of the "pirouette" type is short, the diagnosis is more often established on the basis of the results of Holter monitoring and assessment of the duration of the QT interval in the period between attacks.

Figure 31.

Ventricular tachycardia type "pirouette"

(M.A. Kachkovsky)

Flutter and ventricular fibrillation

Ventricular flutter (VT) is a frequent (200-300 per minute) and rhythmic excitation and contraction. Ventricular fibrillation (flicker) is equally frequent (200-500 per minute), but erratic, irregular excitation and contraction of individual muscle fibers, leading to the cessation of ventricular systole (ventricular asystole). The main ECG signs: 1. With ventricular flutter - frequent (200-300 per minute), regular and identical in shape and amplitude flutter waves, resembling a sinusoidal curve. 2. With fibrillation (flicker) of the ventricles - frequent (200-500 per minute), but irregular random waves that differ from each other in different shapes and amplitudes.

The main mechanism of VT is the rapid and rhythmic circular movement of the excitation wave along the ventricular myocardium (re-entry) along the perimeter of the infarcted zone or the area of LV aneurysm. VF is based on the occurrence of multiple random micro-re-entry waves, which are formed as a result of pronounced electrical inhomogeneity of the ventricular myocardium.

The causes of TG and VF are severe organic lesions of the ventricular myocardium (acute myocardial infarction, chronic ischemic heart disease, postinfarction cardiosclerosis, hypertensive heart, myocarditis, cardiomyopathy, aortic heart disease).

Figure 32.

ventricular flutter

(M.A. Kachkovsky)

Distinguish between primary and secondary VF. Primary fibrillation is associated with acutely developing electrical myocardial instability in patients who do not have fatal circulatory disorders, severe heart failure, or cardiogenic shock. The causes of primary VF can be acute coronary insufficiency (MI, unstable angina pectoris), myocardial reperfusion after effective revascularization of the heart muscle, surgical manipulations on the heart.

Primary VF is successfully treated with electrical cardioversion in most cases, although patients remain at high risk of recurrent VF later in life. Secondary VF is a mechanism of death in patients with severe organic pathology: cardiogenic shock, CHF, postinfarction cardiosclerosis, DCMP, heart defects. Secondary VF is usually very difficult to treat and in most cases ends in the death of the patient.

Polymorphic ventricular tachycardia with prolongation of the Q-T interval (pirouette type)

polymorphic ventricular tachycardia with prolongation of the Q-T interval (pirouette type)

Ventricular tachycardia of the "pirouette" type is associated with an increase in the duration of cardiomyocyte repolarization, is determined on the ECG by a prolongation of the Q-T interval (congenital or acquired), and its immediate triggering factor is a slowing of the heart rate, which leads to a sharp prolongation of the interval.

Diagnostic criteria there are such ECG signs (Fig. 58):

1) cyclic changes in the direction of the QT complex vector in the range of 180 ° with a frequency of 10-15 complexes on average

2) connection of the occurrence of ventricular tachycardia with a decrease in heart rate. Ventricular tachycardia is often preceded by severe sinus bradycardia, complete atrioventricular block

3) prolongation of the Q-T interval in sinus rhythm complexes immediately preceding ventricular tachycardia.

The frequency of the ventricular rhythm in paroxysmal ventricular tachycardia of the "pirouette" type ranges from 150-250 per 1 min.

Clinical picture and course. Most attacks end spontaneously and are asymptomatic or accompanied by dizziness and temporary loss of consciousness. However, in such patients, the risk of transformation of ventricular tachycardia into ventricular fibrillation and sudden death is significantly increased.

Treatment and secondary prevention. The method of choice is temporary electron rocardiostimulation, preferably atrial, with a heart rate of 90-100 per 1 min, which allows to reduce the duration of the QT interval. The class IV antiarrhythmic drugs lidocaine and mexiletine have the same ability. Even in the absence of hypomagnesemia, iatrogenic ventricular tachycardia of the "pirouette" type can be suppressed by the administration of magnesium sulfate at a dose of 2-3 g, which is associated with the elimination of trigger activity due to blockade of calcium channels. A good effect is also given by intravenous administration of potassium salts. In the event of a prolonged attack, they resort to electrical defibrillation, which, however, gives an unstable effect.

To prevent recurrence of polymorphic ventricular tachycardia, the “culprit drug” should be discontinued. Subsequently, the appointment of other drugs that cause prolongation of the QT interval should be excluded. It is also important to prevent the development of hypokalemia and hypomagnesemia.

Pirouette type tachycardia

The concept of "pirouette-type tachycardia" was introduced by Dessertenne in 1966. It denotes rapid ventricular tachycardia with a repetitive change of QRS complexes around the isoline every 5-10 complexes. Most often, pirouette-type tachycardia is observed in the syndrome of prolongation of the QT interval (Schwartz, 1985). In this case, it is pathognomonic along with prolongation of the QTC interval. It can also be observed on the basis of other arrhythmogenic substrates.

(!) Pirouette-type tachycardia can stop spontaneously or turn into ventricular fibrillation. It should always be regarded as a life-threatening condition.

Therapy. Based on the following principles. Emergency treatment depending on the clinical condition of the patient. With unstable hemodynamic parameters - resuscitation measures. Ventricular arrhythmias should be treated as quickly as possible by cardioversion or defibrillation. Up to this point, it is necessary to maintain blood circulation through chest compressions. With slow and satisfactorily tolerated by the patient, arrhythmias can begin with pharmacological therapy. If relief does not occur, the next step is intracardiac overstimulation or cardioversion. Long-term therapy: pharmacological therapy is indicated if the child is too young for radiofrequency ablation, or if the arrhythmia is rapid, to reduce the frequency

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The rhythm of the human heart is usually 60-80 organ beats per 1 minute, and with certain deviations, the indicator can change significantly. What is pirouette type arrhythmia? This is a fairly common form of pathology, in which not only the rhythm changes, but also the strength of the shocks. An arrhythmia can either increase the heartbeat or decrease it. The second option is called bradycardia.

Pirouette arrhythmia is a disease in which the ECG results form wavy and uneven outlines, which influenced the name of the pathology. There are many varieties of this disease, on which the severity of the course of the disease and its prognosis depend.

sinus arrhythmia;
sinus tachycardia;
sinus bradycardia;
paroxysmal arrhythmia;
pirouette type arrhythmia.

The sinus type of arrhythmia is characterized by an increase in the heartbeat in 1 minute to 180-190 beats. This form of the disease is considered the easiest and usually occurs against the background of physiological facts, emotional overload, excessive fatigue. Pathological causes can also provoke the appearance of the disease, so only a doctor should understand the situation.

Sinus tachycardia occurs when the heart rate increases, but the rhythm of the organ remains uniform. Manifestations usually begin slowly, gradually increasing the work of the heart. This condition rarely leads to serious consequences, but requires examination of the patient and the use of certain therapies.

Sinus bradycardia has a significant difference from other types of arrhythmia, since with this disease there is a decrease in the speed of the heartbeat. Indicators can be less than 60 strokes of the organ in 1 minute, which causes discomfort and severe complications. If such a condition is due to pathological influences, then the signs are intermittent.

The paroxysmal type of the disease is characterized by a sudden onset of an attack, when the heart muscle begins to contract sharply and rapidly. The atrium also increases its activity, which leads to an increase in heart rate up to 260 beats per 1 minute or more. Symptoms increase sharply and also suddenly disappear.

Arrhythmia of the pirouette type has a characteristic set of symptoms that can be very vivid.

This type of disease occurs as a result of a deficiency in the blood of potassium, as well as magnesium.

Pathology can be manifested by fluttering of the heart, during which the heart muscle touches the ventricular part of the organ and there is a violation of the supply of nutrients and oxygen to the atrium. This condition requires prompt medical attention, as it often provokes the next stage of complications in the form of fibrillation. The pirouette type of arrhythmia is characterized by a strong increase in the rate of contractions of the heart, while the regularity of this process is also upset, since the pulse rate is usually 250-350 beats of the organ in 1 minute.

The synchrony of the functioning of the heart muscle is disturbed, the ventricles begin to work incorrectly, which can provoke a complete stop of the organ and lead to death.

Causes

Pirouette-type ventricular tachycardia is a type of arrhythmia. This condition may arise due to the influence of physiological factors that affect the heart in this way. In addition, doctors divide the causes of the development of this disease into acquired and congenital. Understanding the situation is not easy, so you need to take these ECG indicators seriously.

Physiological factors:

emotional overload;
abuse of drinks containing caffeine and energy drinks;
excessive physical activity;
binge eating;
bad habits, alcoholism and nicotine addiction;
body dehydration.

Of the congenital causes of this disease, one can single out the syndrome of a long Q-T interval, which appears as a result of a mutation of some genes. The forms of such a state may be different. Such syndromes as Jervell-Lange-Nielsen and Roman-Ward are known. These pathologies are often accompanied by pirouette-type tachycardia and are inherited.

However, the disease is usually acquired. Some medications can cause torsades de pointes. Long-term use of a number of drugs negatively affects the functioning of the body and its entire system.
These are the drugs:

"Triplix", as well as "Normopress" are antihypertensive drugs. Despite their effectiveness, these medications can cause a lot of adverse reactions in the body, including torsades de pointes.
"Frenolone" is a drug of the antidepressant group, which often has negative effects in the form of an increase in the rate of heart contraction.
"Fluconazole", "Fluzamed" are prescribed in the form of antifungal drugs, but can disrupt the intensity of the main organ.
"Furosemide" or "Indapamide" are diuretics, but their side effects include heart rhythm failure.
"Erythromycin" and other antibiotics of the macrolide type are dangerous for their negative effect on the rhythm of the organ.
"Salbutamol", "Fenoterol" and other beta-agonists thus affect the rate of heartbeat.

In addition to these drugs, some antihistamines and antiarrhythmics can be noted, especially when they are taken for a long time. Means "Nerviplex-N" is often prescribed to patients with disorders of the nervous system. This medication has excellent characteristics, but it can negatively affect the heart, worsening its rate of contraction.
Certain ailments can also have a bad effect on the activity of the cardiovascular system, including causing pirouette-type arrhythmia, symptoms of the disease and its consequences.
Pathologies:

Alcoholism.
Electrolyte disorders.
Diseases of the central nervous system.
Endocrine disorders (diabetes mellitus, pheochromocytoma) and others.
Poisoning with toxic substances.
Diseases of the cardiovascular system (myocarditis, angina pectoris, cardiomyopathy, mitral valve prolapse) and other pathologies.
Anorexia of a non-genetic nature.
Hypothermia.
Surgical interventions on the neck or vagotomy.
Diet with low doses of protein and calories.
Addiction.

The specific cause that influenced the development of pirouette tachycardia depends on the method of treatment and the manifestation of the disease. It is possible to accurately establish such a provoking factor only after a thorough examination of the patient.

signs

The symptoms of this disease also appear in different ways, since the cause that caused the disease affects this. The intensity of the signs can be very pronounced, when a person is even threatened with a fatal outcome, and sometimes the patient's condition does not worsen significantly, only mild ailments occur.

Manifestations:

increased fatigue, complete loss of strength;
body weakness;
the heartbeat is felt strongly, periodically decreasing;
difficulty breathing, shortness of breath at rest;
pain in the sternum on the left side;
dizziness;
disturbance of consciousness;
fainting.

With a paroxysmal course of the disease, a person suffers from seizures that occur abruptly. With this manifestation, the pulse may

increase significantly, up to 150-250 organ beats in one minute. The patient's state of health deteriorates rapidly, up to loss of consciousness. If the symptoms of the disease begin to manifest more intensely, then the patient's condition threatens to turn into ventricular fibrillation, which is also fraught with death.

Diagnostics

At the first symptoms of such a disease, you should immediately contact a doctor who will explain what a pirouette-type arrhythmia is and prescribe the entire range of diagnostic measures. Only after examining the patient will it be possible to take the next step, which is to eliminate the problem. It is important to state in detail all the complaints, so that the doctor assesses the patient's condition correctly. The passage of doctors of various specializations is also necessary. A neuropathologist, an endocrinologist, a cardiologist and an internist are usually involved in additional diagnostics.

Methods:

monitoring of the heart by the Holter method;
echocardiography;
biochemical blood test;
general blood test;
Analysis of urine;
blood test for hormone levels;

Usually pa

tology is detected immediately after an ECG, and an additional examination will help determine the cause of the disease.

Treatment and prevention

The initial stages of pirouette-type arrhythmias often do not require treatment, but only lifestyle changes. The doctor may advise the patient to avoid emotional overload, eat right and not overdo it with physical activity. When attacks of the disease occur frequently, endangering the life of the patient, more serious therapy is required.

The treatment of pathology depends on the causes that caused it, and only by eliminating them, one can hope to improve the person's well-being. However, this is not always possible, so some patients have to take drugs to stabilize the activity of the heart for a long time or for life. First of all, the specialist studies the medical history, paying attention to the previously prescribed medications. Since many drugs are capable of provoking an organ rhythm failure, the doctor cancels all these drugs, prescribing others instead.

Medicines may need different, depending on the provoking factors. If the pathology was caused by neurological disorders, then some drugs are needed, and in case of violations in the endocrine system, other medicines will be needed. There are certain remedies that can calm the intensity of the heart.

What is assigned:

"Magnesium sulfate";
"Glucose" solution for intravenous administration;
"Potassium chloride";
"Sodium chloride";
drugs of the group of adrenoblockers.

When drug therapy is powerless, doctors decide to install a pacemaker for the patient, which takes on

a problem caused by an arrhythmia. The device recognizes incorrect signals that cause the heart to contract at an accelerated pace, and eliminates them. Sometimes it becomes necessary to perform surgery to remove such sources of atypical cardiac impulses.

Prevention of this pathology consists in the normalization of nutrition, the rejection of bad habits and a healthy lifestyle. Human food plays a crucial role in arrhythmias, it is necessary to exclude the consumption of certain foods that adversely affect the heart. You also need to replenish your diet with healthy food that improves the functioning of the body.

Junk food:

fried foods;
smoked meats;
fatty foods;
fast food;
drinks with caffeine.

The right diet includes vegetables, fruits, low-fat dairy products, lean meat. Physical activity should be present in the life of every person, but it is important not to allow severe overwork. During sports, blood circulates rapidly in the body, delivering nutrients and oxygen to all organs and tissues. This process prevents the formation of blood clots and helps all body systems to function normally, so adequate exercise should not be abandoned.

Arrhythmia of the pirouette type is a serious disease that requires timely and proper treatment. It will not work to cope with the disease on your own: it is dangerous and can lead to death. The attack of this disease must be stopped as soon as possible, until it led to fibrillation and cardiac arrest.

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Heart arrhythmia: symptoms and treatment with folk remedies

Pirouette type tachycardia is most often an acquired pathology. Its danger lies in the fact that paroxysms can turn into ventricular fibrillation - a life-threatening condition that requires emergency care.

General characteristics of the pathology

Pirouette tachycardia refers to ventricular arrhythmia, in which the frequency of their contraction reaches 250-300 beats / min, and an attack of palpitations (paroxysm) usually does not exceed a minute.

Such ventricular tachycardia is polymorphic. This means that several ectopic foci, which produce electrical impulses that increase the contraction of the ventricles, contribute to its occurrence.

The pathology got its name (according to the type of pirouette) because of the peculiar pattern on the cardiogram at the time of the paroxysm.

Several sources of impulses change the amplitude and shape of the ventricular complexes, as a result of which a wave-like and uneven curve relative to the isoline is displayed on the ECG film.

Causes

Arrhythmia of the pirouette type has the main diagnostic feature - prolongation of the Q-T interval. Such a pathology can be provoked by congenital anomalies, acquired diseases, as well as external factors.

Among the congenital anomalies that cause tachycardia, the following are distinguished:

Gene mutation - currently there are 6 genetic abnormalities that lead to lengthening of the Q-T interval;
Congenital pathologies - Romano-Ward syndrome and Jervell-Lange-Nielsen syndrome, which are inherited in an autosomal dominant and autosomal recessive manner, respectively.

The acquired form of tachycardia is based on asynchronous depolarization of the ventricles. The following pathologies contribute to this:

Diseases of the heart and blood vessels - acute myocarditis, cardiomyopathy, heart defects, mitral valve prolapse, Prinzmetal's angina;
Pathologies of the endocrine system - pheochromocytoma, diabetes mellitus in the stage of decompensation;
Diseases of the central nervous system - brain tumors, strokes, hemorrhages in the subarachnoid space;
Surgical interventions on the vagus nerve;
Violations of the water and electrolyte balance - lack of potassium, magnesium, sodium, calcium in the body;
Anorexia nervosa is an eating disorder in which a person deliberately refuses to eat.

External factors in the development of tachycardia include:

Frequent emotional overload, chronic stress;
The use of drugs (especially cocaine), alcohol;
Severe hypothermia with the development of general hypothermia;
Intoxication with chemicals (FOS, mercury).

Arrhythmia "pirouette" can be triggered by taking the following medications:

Antiarrhythmic drugs (Procainamide, Amiodarone);
Antibacterial agents from the group of macrolides (Erythromycin);
Psychotropic medications (neuroleptics, antidepressants);
antifungal medicines (ketoconazole, fluconazole);
Beta-agonists (Salbutamol, Fenoterol);
Diuretics (Indapamide, Furosemide);
Prokinetics ("Cerukal", Metoclopramide);
Antiallergic drugs (Astemizol, Torfenadine).

When using drugs, it is important to pay attention to side effects. If you experience palpitations, shortness of breath, dizziness, stop taking them and consult a specialist.

Clinical picture

At the beginning, the symptoms of arrhythmia such as pirouette are quite scarce. The development of tachycardia can be suspected by the periodically tormenting feeling of lack of air, which occurs as a result of gradually increasing hypoxia.

In the future, the signs begin to appear brighter. The resulting paroxysms disrupt hemodynamic processes - arterial tone and cardiac output decrease. This contributes to the following symptoms:

Feeling of heartbeat;
Decreased peripheral blood pressure;
Sharp weakness;
Weak filling of the pulse;
Autonomic disorders: sweating, hand tremor, feeling of fear.

Late diagnosis and treatment contribute to the progression of the disease. With frequent paroxysms, when the heart rate reaches 300 beats / min, loss of consciousness is observed.

A prolonged attack, accompanied by heart pain and shortness of breath, often turns into ventricular fibrillation, which can be fatal.

Romano-Ward syndrome is accompanied by severe paroxysms with frequent loss of consciousness.

Syncopal attacks are accompanied by pallor, rapid breathing with its subsequent stop, convulsive seizures. Children suffering from this syndrome are shown a protective regime: they are released from sports, emotional overload is prevented.

Jervell-Lange-Nielsen syndrome is accompanied by the same clinical picture as the previous one. However, pirouette tachycardia is more difficult for children - fainting occurs often and for a relatively long time (up to 10 minutes), after regaining consciousness, temporary disorientation is observed. Genetic pathology is accompanied by bilateral sensorineural deafness.

Diagnostics

Pirouette-type ventricular tachycardia is rarely diagnosed in the early stages due to the scarcity of the clinical picture. Usually a person seeks medical help when the arrhythmia progresses, when he begins to notice bouts of rapid heartbeat.

Diagnosis of pirouette tachycardia is complex. It includes clinical and complementary methods.

Clinical

Clinical diagnostics include the following methods:

Collection of complaints - a specialist identifies disturbing symptoms of the disease.
History taking - information is collected about hereditary predisposition, risk factors, the presence of organic diseases, taking any medications.
General examination - an assessment is made of the work of the main body systems - cardiovascular (measurement of blood pressure, pulse rate), respiratory (determination of the number of respiratory movements); auscultation of the heart.

After collecting the basic information, the specialist appoints laboratory and instrumental studies.

Additional

Additional diagnostics include the following studies:

Complete blood count - an assessment of the general condition of the body (the presence of an inflammatory process, anemia, etc.) is carried out.
A blood test for the level of thyroid hormones - the work of the thyroid gland is assessed (the likelihood of developing thyrotoxicosis).
Echocardiography is an ultrasound examination that allows you to evaluate the functional and morphological features of the heart.
An electrophysiological study (EPS) of the heart is an invasive study that evaluates the conduction system of the heart.
Holter monitoring - daily ECG recording with fixation of blood pressure, heart rate and rhythm disturbances.

The main diagnostic method of pirouette-type tachycardia is an electrocardiogram (ECG) - registration on a film of electric fields generated during the work of the heart muscle. In this study, the following indicators are observed during paroxysm:

Different amplitude of ventricular complexes, their direction relative to the isoline periodically changes, as if “dancing pirouette”;
The duration of the QRS complexes is more than 0.12 seconds;
AV dissociation - dissociation of the rhythm of the atria and ventricles (diagnosed if the P wave is determined);
R-R intervals are different.

Since the cardiogram can rarely be removed at the time of the paroxysm, the main diagnostic ECG sign of pirouette tachycardia is the prolongation of the Q-T interval outside the paroxysm.

Treatment

Therapy for pirouette-type tachycardia is complex and consists of lifestyle correction, medication; according to indications, surgical intervention is performed.

Lifestyle

Lifestyle correction is the main non-drug method of tachycardia. It includes:

Rational nutrition - first of all, the rejection of fried, salty, spicy foods; Meals should be frequent, contain small portions.

Refusal of addictions - smoking, alcohol and caffeinated drinks disrupt the cardiovascular system, worsen the course of the disease.
Avoidance of emotional overload - constant stress leads to the frequent occurrence of paroxysms, decompensation of concomitant pathologies.
Regular physical activity - morning exercises, walking, cardio training prevent the development of hypoxia, improve overall tone (if a paroxysm occurs, any exercise should be stopped).

It is recommended to change eating habits, to carry out any physical activity in conjunction with your doctor.

Often in the early stages, tachycardia is well corrected by the normalization of lifestyle.

Medical therapy

With the ineffectiveness of non-drug remedies and the frequent occurrence of paroxysms, the appointment of drugs is indicated.

In the treatment of pirouette tachycardia, the following medicines are used:

Magnesium sulfate. The drug is diluted in a dosage of 80 ml of a 25% solution in a dilution of 400 ml of isotonic sodium chloride solution. It is administered intravenously drip at a rate of 10-30 drops / sec.
Potassium chloride. It is used to restore the heart rhythm against the background of hypokalemia. The drug is administered 1-1.5 g intravenously several times a day, diluted in glucose (5%) or saline.
polarizing mixture. This mixture contains potassium, glucose and insulin. It is prepared as follows: 4 g of potassium chloride and 8 IU of short-acting insulin are injected into 250 ml of glucose. It is administered intravenously drip 1 r / day. Magnesium sulfate is added to the mixture according to indications in individual dosages.

To correct the pulse rate, drugs from the group of beta-blockers for intravenous administration (Esmolol) are used. Tablet forms are used less often.

Operation

In addition to conservative methods, surgical intervention can be used as a treatment for pirouette tachycardia. The indications for the operation are:

The ineffectiveness of drug therapy;
Often recurrent paroxysms;
Severe seizure tolerance;
Organic changes in the myocardium or heart valves;
High risk of complications.

In modern surgery, two main methods are used:

Ablation of the heart. The operation is performed under local anesthesia. The essence of the method is to conduct access to the heart through large vessels by installing a catheter and introducing special tubes. The process is controlled by X-ray equipment. After finding the pathological focus, it is amenable to ablation - the destruction of radio frequency energy. The minimally invasive procedure and the use of local anesthesia significantly reduces the risk of postoperative complications.
Implantation of a pacemaker. The installation of an electrocardiostimulator (EX) involves the creation of an artificial pacemaker. The essence of the EX is to prevent paroxysms by applying an electrical impulse, which inhibits the occurrence of premature deporialization. The device is implanted through a vein in the arm.

With organic lesions of the heart, an open operation is performed with excision of pathological areas that set the wrong rhythm. It is performed under general anesthesia with the transfer of the patient to artificial circulation.

Such a radical method has a higher risk of postoperative complications.

Emergency help during an attack

When an attack of paroxysm occurs, the following steps must be taken:

Transfer the patient to the supine position, in the absence of consciousness, turn the head to the side;
Provide access to fresh air;
Measure peripheral blood pressure and heart rate.

At the prehospital stage, the following drugs are administered:

Magnesium sulfate 25% - 50 mg / kg diluted with 10 ml of 0.9% sodium chloride or 5% glucose IV slowly.
Lidocaine 2% - 2 mg / kg diluted with 10 ml of isotonic NaCl solution IV slowly.
Verapamil or "Isoptin" at an initial dose of 5 mg (one ampoule) diluted per 10 ml of sodium chloride (0.9%) or glucose (5%) intravenously; in case of ineffectiveness, the dose is repeated.
Esmolol ("Breviblok") at an initial dose of 500 mcg / kg diluted in 10 ml of saline.

All drugs are administered under the control of blood pressure and pulse rate.

With the development of ventricular fibrillation, electrical defibrillation (EDS) of the heart is performed.

Further treatment is carried out in the intensive care unit (ICU) with continuous monitoring of vital signs.

Complications and prognosis

Pirouette tachycardia can be complicated by the following conditions:

Fainting is a loss of consciousness due to a short-term violation of the blood circulation of the brain.
Acute left ventricular failure is a condition in which venous congestion occurs in the pulmonary circulation. Accompanied by pallor of the skin, cyanosis of the lips, cough. Auscultatory marked moist rales in the lower parts of the lungs.
Ventricular fibrillation is a rhythm disorder in which dissociative contractions of various sections of myocardial muscle fibers occur.

If myocardial infarction occurs against the background of tachycardia, cardiogenic shock may develop, which is accompanied by a sharp decrease in myocardial contractility and a drop in blood pressure.

The prognosis of the disease is different. If tachycardia is accompanied by rare paroxysms without hemodynamic disturbances, then it is of little danger.

If the attacks are recurrent, fainting and a decrease in blood pressure occur, then the prognosis for life is unfavorable. Deteriorate prognostic data and the presence of organic diseases, congenital pathologies.

Bibliography

Grishkin Yu.N. - Differential diagnosis of arrhythmias, 2000.
Belenkov Yu.N., Oganov R.G. - Cardiology. National leadership, 2007.
Belyalov F.I. - Cardiac arrhythmias, 2011.
Latfullin I.A., Bogoyavlenskaya O.V., Akhmerova R.I. - Clinical arrhythmology, 2002.
Heart rate variability. Experience of practical application, 2000.

Pirouette type arrhythmia is a type of heart rhythm disorder in which the contraction of the heart increases or decreases and leads to the formation of a blockade. Normally, the pulse should not exceed 90 beats. If its increase occurs during physical exertion, then this is normal. Violation of indicators is called arrhythmia. Due to the fact that the ECG results show wavy and uneven outlines, this type was called pirouette arrhythmia.

The conduction system provides the work of the heart. It consists of the sinus or sinoatrial node. It is he who develops an impulse that causes atrial contraction and directs it to the ventricles, ensuring their activity. All components of the conduction system are neuromuscular cells. If their integrity is violated, the heart rhythm goes astray.

Arrhythmia must be treated, as it can cause serious malfunctions in the cardiovascular system.

Pathology of the pirouette type manifests itself in the form of a heartbeat, in which the heart muscle touches the left ventricle, which leads to insufficient oxygen supply to the atrium.

The contractions occur at the same time, but as a result of a rapid pulse, they are incorrect. The indicator can reach 350 beats per minute.

This causes a violation of the synchrony of the work of the heart muscle and reduces the contractile functions of the ventricles, which ends in cardiac arrest. In this condition, it is important to provide first aid to the patient.

Reasons for development

Such arrhythmia occurs under the influence of various factors. It can be physical activity, and serious pathological processes.

Most often, the heart rhythm is disturbed as a result of:

Stress. In this case, the release of adrenaline in the blood occurs, which affects the cardiovascular system, causing an increase in the rhythm.
Abuse of alcohol, energy drinks, coffee.
Lack of fluid in the body. In connection with this condition, in order to compensate for the lack of oxygen, vitamins and minerals, the heart begins to pump blood faster.
Constant consumption of large amounts of food. Because of this, the digestive system needs to work harder, which leads to increased blood flow to the organs.
Excessive physical activity. During sports, metabolic processes in tissues increase, they need more nutrients and oxygen, which leads to the development of tachycardia.

These factors contribute to the formation of arrhythmia in healthy people. If you reduce their influence, then the state will normalize by itself.

The development of arrhythmia of the pirouette type occurs if there is not enough potassium and magnesium in the blood plasma.

Also, pathology can occur when:

genetic predisposition;
anomalies of calcium and sodium channels;
the use of sedative, antibacterial, antiarrhythmic, diuretic drugs, antidepressants and other potent drugs;
imbalance of electrolytes in the blood;
frequent use of alcohol and drugs;
pathologies of the heart and endocrine system;
hypothermia;
long-term consumption of low-calorie, low-protein foods;
deviations in the work of the nervous system;
neurogenic anorexia;
surgical interventions on the neck;
ingestion of organophosphorus and mercury substances.

The disease poses a serious danger to human health and life and requires timely treatment.

Symptoms of arrhythmia type pirouette

At the initial stages of the development of pathology, the patient does not notice deviations. Changes in the work of the heart are insignificant and do not manifest themselves in any way. Gradually, a person notices the appearance of:

dizziness and tachycardia;
interruptions in the rhythm of the heart;
increased fatigue and lethargy;
intense fear and anxiety;
feelings of shortness of breath and shortness of breath;
causeless fear and anxiety;
pain in the chest;
periodic fainting.

It is the loss of consciousness that worries patients most often. This is due to hemodynamic disturbances. During an arrhythmic attack, the heart rate increases to three hundred beats.

At the same time, the brain and other organs suffer from a lack of oxygen due to impaired blood supply.

These are very dangerous symptoms.

Ventricular arrhythmia of the pirouette type is accompanied by negative consequences. Fluctuations of the heart and sudden excitation of the ventricles can lead to the cessation of the organ from performing its functions.

Diagnostics

If the first manifestations of the disease appear, it is necessary to visit a cardiologist. He will prescribe laboratory and instrumental studies to make a diagnosis. If necessary, you may need to consult highly specialized specialists.

In most cases, an electrocardiogram is enough to determine the problem. The device measures the rhythms of the heart and the passage of impulses. But it does not always show the exact result. To get a more complete picture of the patient's health status, they can prescribe:

general examination of blood and urine;
blood chemistry;
checking the level of hormones;
ultrasound examination of the heart;
organ monitoring by the Holter method.

After studying the results of these procedures, a diagnosis is made and therapy is prescribed.

Emergency care and treatment

Pirouette arrhythmia at the beginning of development does not require medical attention, since the increase in heart rate is insignificant. The patient at this stage is recommended to avoid physical and emotional stress, to lead a measured lifestyle.

With the development of the pathological process, the patient is disturbed by regular attacks. In these cases, treatment is carried out with magnesium sulfate preparations, which are injected into a vein.

During a severe attack, cardioversion with a defibrillator and the introduction of Magnesia, Atenolol, Lidocaine are necessary.

If there are sudden changes in the heart rhythm, the patient is prescribed beta-blockers.

In the event that the development of tachycardia occurred under the influence of medications, then they can not be used. Sorbents are used to cleanse the body. All other drugs with such an arrhythmia can aggravate the situation.

In severe cases, the attack can be eliminated only with the help of surgery. During treatment, the patient is placed on an automatic defibrillator. It is implanted in the upper part of the chest. Thanks to the device, automatic stimulation and defibrillation of the heart occurs.

Treatment of the disease with the help of drugs is carried out only under the supervision of a doctor and with regular cardiograms to control the rhythm.

In children, pathology is treated with medical, surgical and minimally invasive methods.

Drugs are used urgent, emergency and permanent, which allow you to eliminate chronic disorders.

The need for resuscitation occurs when seizures develop that can cause heart failure and cardiac arrest.

To determine which method to resuscitate the child, the doctor must feel the pulse, assess the hemodynamics and the cardiogram. With paroxysmal tachycardia, measures are taken to normalize the general condition and relieve an attack.

If it hurts in the chest, dizziness, consciousness is clouded and the rhythm increases to 200 or more per minute, help is provided using vagal tests.

They can also press their fingers on the eyeballs, but this method cannot be used for myopia.

Vagus tests include massage of the root of the tongue or solar plexus, a cold compress on the mouth and chin.

It is necessary to apply these methods within the first half hour, if the attack persists, then they try to stabilize the child's condition with the help of medications.

In addition to the prescribed drugs, children and adults should eat right. With this diagnosis, you should refuse:

bakery products;
salty and spicy dishes;
high cholesterol foods;
drinks containing caffeine;
alcohol.

The diet should be dominated by cereals and low-fat dairy products, boiled fish.

Possible complications and prevention

Pirouette-type arrhythmia is a dangerous problem in the form of cardiac arrest. At the first manifestations of an attack, you need to call an ambulance. This is a dangerous disease, so efforts should be made to prevent violations.

Preventive measures include:

Diet food. The food should be dominated by potassium, magnesium, calcium. There are many of these elements in raw vegetables, fruits, greens. It is good to eat a lot of seafood.
In order for the body to receive enough potassium, you should consume apple cider vinegar with honey three times a day. A spoonful of honey is added to half a glass of vinegar and drunk before meals.
Normal level of physical activity. Excessive activity and a sedentary lifestyle negatively affect the state of the whole organism.
Quitting smoking and drinking alcohol.
Regular walks in the fresh air.
Prevention of emotional stress.

These measures will help to avoid the development of arrhythmias.

Therapy of the disease is based on adherence to the principles of a healthy lifestyle, the use of prescribed drugs and the implementation of the medical recommendations of the doctor. It is impossible to try to cope with the problem on your own, since pathology can lead to death.

What is pirouette type arrhythmia

Each person has an individual heart rate. As a rule, the normal rate is from 60 to 90 beats per minute. In some people, the heart rate may be different from the average value depending on factors such as gender, age, weight, etc.

The pulse quickens during physical exertion, slows down at rest. However, the indicator always remains within acceptable limits.

Arrhythmia - a violation of the normal heart rhythm, interruptions in the contraction of the heart. There are different types of this disease.

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Arrhythmia, related to the type of "pirouette", got its name because of the uneven and wavy outline that is formed during the study of the ECG.

Physiology

The heart is a vital organ. Contracting, it carries blood containing oxygen and nutrients to all parts of the body. This ensures its normal functioning.

The heart is divided into 2 parts - right and left. Each of them has an atrium and a ventricle. Their coordinated work ensures the normal functioning of the human body. The atrium collects blood and sends it to the ventricle, which, in turn, sends it to the vessels.

In a healthy body, the work of the heart is provided by the conduction system. The process of contraction occurs due to electrical impulses.

The conduction system of the heart consists of the following elements:

Each of the structural elements consists of neuromuscular cells. If the integrity of the conduction system of the heart has been violated, failures in the heart rhythm appear.

The causes of cardiac arrhythmia are listed in this article.

conduction system of the heart

Doctors identify a wide range of causes that cause cardiac arrhythmia. Moreover, this condition can be caused by both excessive exercise during sports, and serious heart problems.

The most common causes of arrhythmias are:

The elimination of these causes serves as the basis for the termination of cardiac arrhythmia. This is the state of affairs for healthy people.

There are several types of arrhythmias. Their occurrence is due to different reasons. The most common ones have been discussed above.

Arrhythmia of the "pirouette" type develops with a deficiency in the body and blood plasma of the necessary elements, magnesium and potassium. It is found in the form of a heartbeat, in which the heart muscle touches the myocardium of the left ventricle and there is a dysfunction in the supply of oxygen to the atrium. The contraction is performed simultaneously, but incorrectly due to an increased heart rate (up to 350 beats per minute).

As a result - pathology in the synchrony of the functioning of the heart muscle, a decrease in the function of contraction of the ventricles. The result is cardiac arrest. A patient in this condition needs urgent medical attention.

Pirouette type arrhythmia is provoked by mental disorders, for example, vagotonia. Pathology can occur as a result of constant stress, lack of sleep, smoking, alcohol and coffee abuse.

Arrhythmia can develop against the background of the use of certain drugs, for example, cardiac glycosides, tranquilizers and antidepressants.

This type of disease may be hereditary.

Symptoms of arrhythmia type "pirouette"

The early stages of the development of the disease can proceed unnoticed by the patient. Changes in the body are minor and do not reveal themselves.

Pirouette tachycardia is manifested by the following symptoms:

dyspnea;
dizziness;
fainting;
interruptions and decrease in heart rate.

Ventricular arrhythmia of the "pirouette" type can lead to serious consequences - cardiac arrest due to heart fluctuations and sudden ventricular excitation syndrome

Diagnostics

The disease is diagnosed by standard procedures. The patient turns to the doctor with certain complaints, after which he is prescribed an ECG referral.

This device measures the heart rate. On the cardiogram, the doctor will be able to detect pathology.

It should be borne in mind that sometimes the device does not show the presence of tachycardia. A more detailed and truthful picture will be presented by ultrasound of this organ.

This research technique allows you to analyze the features of the work of the heart, which makes it possible to detect the localization of the occurrence of arrhythmia.

Arrhythmia in the initial stages with a slight increase in heart rate does not need therapy. Patients need to avoid stressful situations and lead a calm lifestyle. If the disease has passed into more severe stages and the patient has complaints of regular attacks, then patients are prescribed magnesium sulfate preparations intravenously.

If the disease constantly worries the patient, then he is prescribed a defibrillator to prevent blockage of blood vessels and the development of thrombophlebitis. Drugs with a beta-blocking effect are prescribed to patients with sudden changes in the heart rhythm.

Pirouette tachycardia can occur due to certain medications. In this case, the doctor cancels their intake completely and prescribes other medications to the patient. In order for the body to be cleansed of the drugs used, the patient is prescribed certain drugs that will remove them from the blood.

It is necessary to know that medications for this type of arrhythmia can have an adverse effect on the body of a sick person. For example, medical devices of group 1A, which help to increase the interval between atrial contractions. In this situation, it is necessary to stop taking or reduce the dosage of the drug.

Therapy with medications to get rid of arrhythmia is allowed only under the supervision of a doctor and with regular ECG to monitor the results of treatment.

Individual drugs have a large number of contraindications and side effects. So, antiarrhythmic drugs are prohibited for patients who have suffered a myocardial infarction, for patients suffering from ventricular arrhythmia. This is due to an increased risk of cardiac arrest as a result of taking medications.

Along with treatment with medications, doctors recommend dieting. Patients should avoid the following foods:

bakery products;
salty and spicy dishes;
foods high in cholesterol;
coffee, alcoholic drinks.

At the same time, you need to add cereals and low-fat dairy products, boiled fish to your diet. It is recommended to take a tincture of hawthorn and wild rose.

Prevention

Preventive measures for pirouette-type arrhythmias include dieting. In the menu, you need to add foods containing potassium, calcium and magnesium. For example, raw vegetables and fruits (apples, cranberries, currants, celery), as well as dried fruits (dried apricots, raisins). Seafood has a positive effect for preventive purposes.

Potassium deficiency can be prevented by drinking half a glass of apple cider vinegar 3 times a day with the addition of 1 tbsp. spoons of honey. This infusion is recommended to be taken before meals.

Simple physical exercises, giving up bad habits, minimizing stress, walking in the fresh air are effective preventive measures to prevent the development of pirouette-type arrhythmia.

What to do if a woman is often worried about arrhythmia during pregnancy - the answer is here.

About the causes of severe sinus arrhythmia in a child and methods of treatment - we will describe further.

Pirouette type arrhythmia

Malfunctions in the functioning of the heart with an increased heartbeat are called arrhythmias. The disease has several varieties and has a different character, which depends on many reasons. A special form of the disease is considered to be a pirouette-type arrhythmia, related to ventricular tachycardia. About how the disease manifests itself and what methods exist for its treatment, we will describe in this article.

What is pirouette tachycardia

This type of arrhythmia is paroxysmal ventricular tachycardia, which is expressed by a prolonged QT interval and polymorphism. Such tachycardia has a peculiar name in connection with a special pattern on the ECG, which displays rapid and uneven failures in the amplitude of the cardiac complexes. Also, pathology is often referred to as cardiac ballet.

Attacks of the disease appear suddenly and can quickly stop, but they also tend to develop into fibrillations, which are very dangerous to health and often end in death. Pirouette-type tachycardia is mostly due to a lack of potassium and magnesium, which are necessary for the normal functioning of the heart.

Against this background, a heartbeat appears, due to the involvement of the heart muscle of the myocardium of the left ventricle, which causes failures in the supply of oxygen to the atrium. Such violations are manifested by a rapid heartbeat, which can reach 350 beats.

Reasons for the development of pathology

There are many reasons for the development of this pathology. These include such physiological factors as regular stress, alcohol and strong coffee abuse, smoking, drug use, chemical intoxication. Also, this type of disease can be hereditary, and if close relatives suffered from pathology, there is a considerable risk of its occurrence. Often torsades de pointes can be the result of taking these medications, especially in high doses:

antiarrhythmic (quinidine, sotalol, amiodarone);
diuretics (indapamide, furosemide);
antihistamines (triplix, terfenadine);
antibiotics (erythromycin, macrolide agents);
beta-blockers (metoprolol, atenolol);
antidepressants.

Moreover, prolonged use of certain antifungal and antiviral drugs, such as fluzamed, fluconazole, ketoconazole, and some others, can affect the increased heart rate. Also, manifestations of tachycardia are possible after taking certain antihypertensive drugs: normoprex, metoprolol, etc.). Often they become a cause that provokes the growth of pathology, and such diseases:

disorders of the endocrine system;
diseases of the central nervous system (strokes, various kinds of tumors, infectious diseases);
cardiovascular diseases (myocarditis, bradycardia, angina pectoris, heart valve prolapse, etc.);
neurogenic anorexia;
vagotomy.

In children, the disease may be associated with congenital pathologies, for example, palpitations are often formed due to various kinds of congenital heart defects.

Violations in the initial stage may be practically not felt. An increase in the pathological condition leads to a lack of oxygen, which causes the appearance of such symptoms of arrhythmia of the "pirouette" type:

During outbreaks of tachycardia, the heart rate quickens, it reaches from 200 to 300 beats per minute, this often leads to loss of consciousness, since the body is not able to provide the necessary blood supply. If the patient is conscious, he feels a strong heartbeat, sometimes soreness in the chest.

Important! In case of excitation of the ventricles, cardiac arrest is possible. This condition poses a direct threat to the life of the patient, so he needs urgent medical care.

Diagnostics

The main method of establishing the diagnosis is a standard procedure - an electrocardiogram. A characteristic feature of the disease is considered to be an extended QT interval, which is fixed in the intervals between attacks. In certain cases, the device may not show the development of tachycardia, then the patient is prescribed an ultrasound of the heart. Thanks to this technique, the functioning of the organ is analyzed and the localization of the appearance of arrhythmia is detected. As an additional diagnostic, it is possible to use the following methods:

echocardiography;
magnetic resonance imaging of the heart;
electrophysiological study;
general analysis of blood and urine;
thyroid hormone testing.

Treatment of this type of arrhythmia

Pirouette-type tachycardia is a serious disease that should be treated by a qualified specialist.

Important! Since this type of tachycardia often occurs after taking medications, it is imperative that you tell your doctor if you are using any medications.

Therapy of the disease is divided into urgent and permanent. When attacks of pathology appear, immediate resuscitation assistance is necessary. In the event of a sharp drop in blood pressure, cardioversion is used, and medications such as magnesium sulfate, adrenoblockers, lidocaine, which shortens the intervals, are also introduced to stop the attack.

In cases where the appearance of paroxysm is associated with taking medications, their use is urgently stopped and additional treatment is prescribed to remove harmful substances from the body. When diagnosing a stable pirouette arrhythmia with altered areas in the ventricles of the heart, patients are indicated for surgical intervention. For this, an automatic defibrillator-cardioverter is implanted.

As a permanent treatment, antiarrhythmic drugs are prescribed under the strict supervision of a doctor and ECG monitoring, it is also possible to prescribe vitamin drugs (Nerviplex-N, Askorutin, Napravit, etc.).

In addition to drug therapy, it is very important for the patient to adhere to the right lifestyle, it is advisable not to overwork, both physically and mentally, to avoid nervous strain. Proper nutrition also plays an important role, experts recommend:

do not eat fried, spicy and salty;
do not abuse flour, sweets and coffee;
give up alcohol;
use lean meat, dairy products, cereals for cooking;
eat vegetables and fruits;
drink about 2 liters of water per day.

Complications

The most common complications of pirouette arrhythmia are:

All of these complications are extremely life-threatening, and if proper measures are not taken in time, they can lead to death. .

Attention! Therefore, with minor malfunctions in the work of the heart, you need to contact specialists to prevent the formation of such a dangerous disease as ventricular tachycardia.

Prevention

To prevent the development of this type of tachycardia, there are certain rules that must be followed in order to avoid manifestations of the disease:

Follow the correct diet.
Do not use flour and sweet, fatty foods, strong coffee.
Include more vegetables and fruits in your diet.
Stop drinking alcohol and tobacco.
Engage in challenging sports.
Spend time outdoors regularly.
Do not take medications without a doctor's prescription.
Treat comorbidities.
Refrain from stress and mental fatigue.

To avoid manifestations of the disease, since it carries a considerable danger to human life, it is recommended to visit a doctor on time. When a disease is detected, it is imperative to strictly follow all the instructions that will help overcome the disease.

Arrhythmia type pirouette symptoms

Pirouette type arrhythmia: what is it?

Physiology

sinus arrhythmia;
sinus tachycardia;
sinus bradycardia;
paroxysmal arrhythmia;
pirouette type arrhythmia.

Arrhythmia of the pirouette type has a characteristic set of symptoms that can be very vivid.

This type of disease occurs as a result of a deficiency in the blood of potassium, as well as magnesium.

The synchrony of the functioning of the heart muscle is disturbed, the ventricles begin to work incorrectly, which can provoke a complete stop of the organ and lead to death.

emotional overload;
abuse of drinks containing caffeine and energy drinks;
excessive physical activity;
binge eating;
bad habits, alcoholism and nicotine addiction;
body dehydration.

"Triplix", as well as "Normopress" are antihypertensive drugs. Despite their effectiveness, these medications can cause a lot of adverse reactions in the body, including torsades de pointes.
"Frenolone" is a drug of the antidepressant group, which often has negative effects in the form of an increase in the rate of heart contraction.
"Fluconazole", "Fluzamed" are prescribed in the form of antifungal drugs, but can disrupt the intensity of the main organ.
"Furosemide" or "Indapamide" are diuretics, but their side effects include heart rhythm failure.
"Erythromycin" and other antibiotics of the macrolide type are dangerous for their negative effect on the rhythm of the organ.
"Salbutamol", "Fenoterol" and other beta-agonists thus affect the rate of heartbeat.

Alcoholism.
Electrolyte disorders.
Diseases of the central nervous system.
Endocrine disorders (diabetes mellitus, pheochromocytoma) and others.
Poisoning with toxic substances.
Diseases of the cardiovascular system (myocarditis, angina pectoris, cardiomyopathy, mitral valve prolapse) and other pathologies.
Anorexia of a non-genetic nature.
Hypothermia.
Surgical interventions on the neck or vagotomy.
Diet with low doses of protein and calories.
Addiction.

increased fatigue, complete loss of strength;
body weakness;
the heartbeat is felt strongly, periodically decreasing;
difficulty breathing, shortness of breath at rest;
pain in the sternum on the left side;
dizziness;
disturbance of consciousness;
fainting.

With a paroxysmal course of the disease, a person suffers from seizures that occur abruptly. With this manifestation, the pulse may

Diagnostics

monitoring of the heart by the Holter method;
echocardiography;
biochemical blood test;
general blood test;
Analysis of urine;
blood test for hormone levels;
Uzi hearts.

tology is detected immediately after an ECG, and an additional examination will help determine the cause of the disease.

Treatment and prevention

"Magnesium sulfate";
"Glucose" solution for intravenous administration;
"Potassium chloride";
"Sodium chloride";
"Lidocaine";
drugs of the group of adrenoblockers.

When drug therapy is powerless, doctors decide to install a pacemaker for the patient, which takes on

fried foods;
smoked meats;
fatty foods;
fast food;
drinks with caffeine.

Causes, symptoms and treatments for ventricular tachycardia

How is this disease diagnosed?

You can determine the presence of the disease by carrying out simple procedures. When a person complains to a doctor about certain ailments, he is sent for an examination of possible ECG signs. With the help of a special device, the rhythm of the heart is measured. The cardiogram will immediately show whether there is tachycardia or not.

In rare cases, such an examination does not see pathology. For complete certainty, experts advise to undergo an ultrasound, which shows the work of the heart as a whole. At this stage, it is possible to detect areas in which arrhythmias appear.

How do doctors deal with illness?

It is not uncommon for physicians to prescribe antiarrhythmic drugs. In other cases, long-term treatment with removal of the cardioverter-defibrillator. And, for example, tachycardia with paroxysms (pirouettes) dictates mandatory outpatient treatment.

Treatment of ventricular tachycardia of an unstable type of pirouette can not be attributed to an emergency option. Only if the attacks were lengthened, the frequency of the beating of the organ increased. Then the doctor prescribes an antiarrhythmic drug.

The main duty of the attending physician is to prevent the death of the patient. The second most important is the elimination of arrhythmias. Implantation of a cardioverter-defibrillator is the optimal solution in serious situations.

Long-term treatment is inappropriate if the disease appeared as a result of a recent myocardial infarction. In other cases, patients need hospitalization.

What complications are possible?

An acute form of reduced blood circulation in the brain, followed by loss of consciousness with silent ventricular tachycardia. Such a complication often immerses the patient in a prolonged coma.
Heart failure with characteristic pulmonary edema. If the disease is not treated in a timely manner, the complication will become regular until death.
Cessation of blood circulation. The optimal solution here is to restart the organ with defibrillation and implant a pacemaker.

What preventive measures should be taken?

To prevent the disease, it is worth considering some especially important recommendations.

So, a person with a tendency to such a disease needs to worry less, avoid mental disorders and excessive physical exertion.

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Ventricular tachycardia requires proper nutrition - the exclusion of fatty foods, the rejection of any alcohol and cigarettes, and the reduction of coffee consumption. Medical advice - frequent walks in the fresh air, fruits and vegetables in the daily diet.

It is good if a sick person has the opportunity to live in an ecologically clean area. If this is not possible, it is worth visiting more often, for example, in holiday villages.

Regular follow-up with a doctor is a must.

It should also be noted that the main source of the appearance of the disease is daily stress. That is why both a sick patient and a healthy person should monitor their emotions and worry less about trifles.

Lokren (betaxolol)

Lokren (betaxolol) is a modern medicine from the group of beta-blockers for the treatment of hypertension and the prevention of angina attacks. The drug acts smoothly and for a long time. It can be taken only once a day, which is convenient for patients. If the patient accidentally forgets to take a pill, it is unlikely that he will experience a sharp jump in blood pressure or heart rhythm disturbances. Lokren - in general, a good beta-blocker, but by no means a panacea for the treatment of hypertension and the prevention of angina attacks. Dear patients! Do not take betaxolol (Locren) or other hypertension medicines on your own. Find a good doctor and consult with him. Only qualified treatment of hypertension will help you prolong your life and avoid its dangerous complications.

The best way to cure hypertension (fast, easy, healthy, without "chemical" drugs and dietary supplements)
Hypertension - a folk way to recover from it at stages 1 and 2
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Effective treatment of hypertension without drugs

Instructions for the drug Lokren (betaxolol)

This article consists of the official instructions for the drug Lokren and information from medical journals, domestic and English. If you want to read the instructions for lokren, you will find all the information you need here. We hope that we were able to present information about the drug betaxolol in a form that is convenient for practitioners and patients. Instructions for Lokren were last updated in 2012. We draw the readers' attention to the fact that a significant part of the information about the drug Lokren (betaxolol) is provided by the manufacturer - Sanofi-Avensis. The same company funds research that demonstrates the high efficacy of betaxolol in clinical practice.

Lokren: indications for use and contraindications

Indications for use of the drug Lokren:

arterial hypertension (hypertension, high blood pressure);
prevention of angina attacks.

chronic heart failure IIB-III stage;
cardiogenic shock;
AV block II and III degree (without connecting an artificial pacemaker);
Prinzmetal's angina;
sinus node weakness syndrome (including sinoatrial blockade);
severe bradycardia;
arterial hypotension;
cardiomegaly (without signs of heart failure);
simultaneous use with sultopride and floktafenin;
simultaneous reception of MAO inhibitors;
children and adolescents under 18 years of age (efficacy and safety have not been established);
hypersensitivity to betaxolol.

The composition of the drug Lokren (betaxolol) includes lactose. Therefore, it is contraindicated in congenital galactosemia, as well as if the patient has impaired glucose / galactose absorption or lactase enzyme deficiency. Caution must be exercised when using lokren in the following categories of patients:

with a history of allergic reactions,
with pheochromocytoma,
with metabolic acidosis
with obliterating diseases of peripheral vessels (intermittent claudication, Raynaud's syndrome),
with liver failure,
with chronic renal failure,
during hemodialysis,
with myasthenia
with depression (including history),
in the elderly,
with AV blockade of the 1st degree,
with chronic obstructive pulmonary disease (bronchial asthma, pulmonary emphysema),
in patients with psoriasis,
with chronic circulatory failure,
with thyrotoxicosis,
with diabetes.

The use of Lokren for the treatment of hypertension

Lokren can be considered as one of the most suitable beta-blockers for the treatment of hypertension. The excellent safety of the drug is determined by its characteristics such as high cardioselectivity, lack of internal sympathomimetic activity, lipophilicity, metabolic neutrality, and a balanced elimination profile (kidney + liver). An important property of betaxolol is the absence of a pronounced metabolism during the primary passage through the liver, as a result of which the individual variability in plasma concentrations of the drug is very low.

Betaxolol slightly binds to plasma proteins, therefore, the likelihood of its negative interaction with other drugs that the patient can take at the same time is reduced. This further provides good predictability of the therapeutic effect.

Dosage of Lokren tablets (betaxolol)

According to the official instructions, the initial dosage of Lokren is 20 mg, i.e. one tablet per day. In clinical practice, the starting dosage of Lokren 5-10 mg / day (1 / 4-1 / 2 tablets per day), and then maintenance - 20 mg / day (1 tablet per day) has proven itself well.

The drug is excreted from the body by 85% by the liver and by 15% by the kidneys. At the same time, violations of liver function do not affect, do not lead to the accumulation of beta-blocker in the body and increase its toxicity.

For patients with renal insufficiency with creatinine clearance> 20 ml / min, the dose of betaxolol can usually not be adjusted. However, at the start of treatment, it is recommended to conduct clinical observation until the equilibrium concentration of lokren in the blood plasma is reached (on average, 4-5 days).

For patients with severe renal insufficiency (creatinine clearance

The article was written based on materials from sites: kardiopuls.ru, serdce.hvatit-bolet.ru, ritmserdca.ru, lechenie-gipertoniya.ru.

Ventricular tachycardia - an attack of accelerated ventricular contractions of more than 140 per 1 min, while maintaining the correct regular heart rhythm.
Development mechanism.

In most cases, the basis is the re-entry mechanism (re-entry of the excitation wave with impulse recirculation in a “vicious circle”); less commonly, ventricular tachycardia may be due to trigger activity.

Symptoms

For ventricular tachycardia is characteristic:

palpitations that start and end suddenly;
general weakness, lethargy;
heaviness in the heart or chest pain;
shortness of breath, cough.

In other cases, symptoms associated with a deterioration in cerebral blood supply dominate:

"dark circles" before the eyes;
dizziness;
syncopal states.

During auscultation of the heart, the rhythm is regular, with a frequency of up to 100-220 per minute, periodic amplification of the first tone. Arterial pressure is reduced. Vagus tests do not eliminate the attack.

Causes

Ventricular tachycardia rarely occurs in the absence of an organic lesion of the heart muscle.

Most often, it is a complication of myocardial infarction, congenital and rheumatic heart defects, with glycoside intoxication, with long Q-T interval syndrome, cardiomyopathies and other organic heart diseases.

Some drugs contribute to the occurrence of "pirouette"-tachycardia: quinidine, cordarone (they lengthen the Q-T interval), antibiotics (macrolides, fluoroquinolones), antidepressants, antipsychotics - about 200 drugs in total, as well as cocaine use, hypokalemia, hypomagnesemia.

Kinds

Paroxysmal ventricular tachycardia is:

monotopic,
polytopic,
pirouette type.

Monotopic

Monotopic (unidirectional) ventricular tachycardia: in one of the ventricles there is one ectopic focus (re - entry), rhythmically generating impulses, the frequency of which significantly exceeds the sinus rhythm. Consequently, the patient has two pacemakers: normal sinus, and pathological ventricular with a high frequency of their contractions.

ECG - signs:

the QRS complex is greater than 0.12 s, the T wave is directed in the opposite direction to the QRS complex
in one lead, the shape of the ventricular complexes is the same (one focus)
the duration of the intervals R - R is the same
antrioventricular dissociation, i.e. complete dissociation of the function of the atria and ventricles: P waves in sinus rhythm are layered on the ventricular complex.

polytopic

Polytopic ventricular tachycardia may be the result of the formation of two or more foci of arrhythmogenesis. If the sources of impulses are located in different ventricles, bidirectional paroxysmal tachycardia occurs, in which cycles with high, widened and split R-waves alternate and cardiac cycles with low R-waves, but widened and deep S-waves.

With polytopic tachycardia, the intervals R - R can be of different duration.

Pirouette type

Ventricular tachycardia of the "pirouette" type appears due to trigger activity and is due to the coexistence in the ventricles of several ectopic foci that compete with each other.

The basis of its occurrence is a change in the duration of recovery of the excitability of various myocytes.

Therefore, the appearance of pirouette-type tachycardia is preceded by a prolongation of the Q-T interval. Lengthening of the electrical systole of the ventricles to 0.45 s or more can be congenital or acquired (myocardial infarction, toxic effects of quinidine, cordarone, cardiac glycosides).

Ventricular tachycardia of the "pirouette" type is considered a life-threatening arrhythmia. May be complicated by flutter or ventricular fibrillation.

ECG diagnostics:
Heart rate (HR) - up to 250 per minute. QRS complexes are greater than 0.12 s, their amplitude changes periodically, which in some cases resembles a spindle in shape. Positive teeth are replaced by negative ones.

It seems that the ventricular complexes "jump", turning around the longitudinal axis (isoelectric line), like a ballerina (hence the name "pirouette" - tachycardia).

Since the impulses come from different foci, each of which generates them in its own rhythm, the R-R intervals are different in duration. Therefore, when examining the pulse, an arrhythmia is determined that resembles atrial tachyarrhythmia.

Previously, such a ventricular arrhythmia was described as "intermittent large-wave ventricular fibrillation." Unlike ventricular fibrillation, ventricular complex waves can be identified on the ECG, and torsades de pointes often stop spontaneously.

Treatment

I stage. Lidocaine (dose calculation 1 mg / kg) is administered intravenously by the microfluidic method (an average of 4 ml of a 2% solution in 20 ml of solvent), at the same time, 10% lidocaine solution 4 ml must be administered intramuscularly, since intravenously administered lidocaine acts only 20-25 minutes.
II stage. Cordarone (amiodarone) 300-450 mg (two or three ampoules) is administered intravenously in drops on glucose.
III stage. Novocainamide 5-10 ml of a 10% solution and 200 ml of a solvent are infused intravenously under the control of blood pressure.
VI stage. Cardioversion.

With ventricular paroxysmal tachycardia (PT), cardiac glycosides are contraindicated. First, having a vagotropic effect, they are effective only in supraventricular PT. The action of the vagus does not extend to the ectopic centers in the ventricles, therefore, cardiac glycosides are not effective in ventricular PT.

Secondly, the accumulation of Na and Ca ions and the loss of K lead to an increase in the excitability of myocytes and contributes to the emergence of new foci of arrhythmogenesis in the ventricular myocardium, and this is a real danger of arrhythmia turning into ventricular fibrillation and death of the patient.

Urgent Care

I stage. Magnesium sulphate (10 mg of a 25% solution) is infused intravenously, administered slowly under the control of blood pressure. The effect comes almost instantly. In the case of recurring paroxysms - 80 mg of a 25% solution of magnesium sulfate in 400 ml of saline solution is injected intravenously (30 drops per minute).

Magnesia is the drug of choice, since there is hypomagnesemia with trigger activity. In addition, magnesium ions block slow calcium channels.

II stage. Lidocaine intravenously and intramuscularly.
III stage. Isoptin (finoptin) 5-10 mg in 20 ml of the solvent is injected intravenously under the control of blood pressure.
IV stage. Cardioversion.

If the sinus rhythm is restored, a drip injection of a “polarizing mixture” is prescribed, the duration of the Q-T interval is carefully monitored.

The defibrillator should be at the bedside of the patient, as paroxysms of the heartbeat can be repeated many times.

Complications

Treatment of patients should be carried out in the intensive care unit (ward) with constant monitoring of the ECG and frequent recording of the rhythmogram.

ECG changes are assessed in real time with correction of treatment methods taking into account the effectiveness of drugs.

The frequency of complications of PT and the prognosis depend primarily on the degree of myocardial damage, electrical instability of the heart and impairment of its contractile function. Very often, AT is complicated by pulmonary edema, thromboembolism, cardiogenic shock, and fatal cardiac arrhythmias.

If a patient with a high heart rate develops shortness of breath at rest, pallor of the skin with blue-purple spots on the neck and chest, barely noticeable cyanosis of the lips, congestive rales in the lower parts of the lungs, one should assume an acute development of left ventricular failure.

At the same time, the pulse is small, low pulse pressure (the difference between the maximum and minimum blood pressure).

In order to prevent pulmonary edema, it is necessary to avoid the use of AAPs (antiarrhythmic drugs) that reduce the inotropic function of the heart (AAP class I, except for lidocaine, beta-blockers, verapamil preparations). Cardioversion is urgently needed. If the sinus rhythm is restored, 4-6 ml of a 1% solution, a “polarizing mixture”, and oxygen inhalations are administered intravenously.

In arrhythmic cardiogenic shock in patients with acute myocardial ischemia, treatment can be carried out with lidocaine (with ventricular PT) or cordarone, monitoring blood pressure every 5 minutes.

In the absence of an antiarrhythmic effect, cardioversion is performed. Thromboembolic complications of PT are more often observed in patients with prolonged paroxysms and subacute heart failure with an increase in the volume of residual blood in the left atrium, especially with increased blood clotting. In this case, thrombi form in the left atrium, and there may be an embolism of the vessels of the systemic circulation.

It must be borne in mind that in case of cerebral embolism, intravenous administration of full doses of aminophylline and cavinton may increase heart rate or contribute to the appearance of AS (cardiac arrhythmias).

A great danger is the possibility of transformation of ventricular PT into ventricular fibrillation. This can be facilitated by the arrhythmogenic effects of quinidine, rhythmilene, cordarone, as well as the progressive course of the underlying disease. With the appearance of precursors of ventricular fibrillation, antifibrillator therapy is performed with readiness for resuscitation.

Forecasts

Forecasts for patients are divided into:

harmless - if there are no hemodynamic disturbances during attacks of ventricular tachycardia, patients do not suffer from organic heart disease;
possibly dangerous - if, during attacks of ventricular tachycardia, hemodynamics are not disturbed, but there is damage to the heart;
life-threatening - if hemodynamics are disturbed or fatal arrhythmias during attacks of ventricular tachycardia.

In conclusion, it should be noted that the effectiveness of the treatment of palpitations paroxysms depends on the accuracy of determining the clinical and pathogenic forms of paroxysmal arrhythmias, since only the differentiated use of electropulse therapy and antiarrhythmic drugs can give a positive therapeutic effect and prevent dangerous complications of PT.

Cordarone is the drug of choice in patients with acute myocardial ischemia complicated by arrhythmias.

Where can an EKG be done?

Do you often experience discomfort in the area of the heart (pain, tingling, squeezing)?
You may suddenly feel weak and tired...
Feeling high pressure all the time...
There is nothing to say about shortness of breath after the slightest physical exertion ...
And you have been taking a bunch of medications for a long time, dieting and watching your weight ...

Causes, symptoms and treatments for ventricular tachycardia

How is this disease diagnosed?

How do doctors deal with illness?

Long-term treatment is inappropriate if the disease appeared as a result of a recent myocardial infarction. In other cases, patients need hospitalization.

What complications are possible?

An acute form of reduced blood circulation in the brain, followed by loss of consciousness with silent ventricular tachycardia. Such a complication often immerses the patient in a prolonged coma.
Heart failure with characteristic pulmonary edema. If the disease is not treated in a timely manner, the complication will become regular until death.
Cessation of blood circulation. The optimal solution here is to restart the organ with defibrillation and implant a pacemaker.

What preventive measures should be taken?

To prevent the disease, it is worth considering some especially important recommendations.

So, a person with a tendency to such a disease needs to worry less, avoid mental disorders and excessive physical exertion.

It is good if a sick person has the opportunity to live in an ecologically clean area. If this is not possible, it is worth visiting more often, for example, in holiday villages.

Regular follow-up with a doctor is a must.