Health

Reasons to be careful with tachyarrhythmias – VnExpress


Tired breathing, dizziness, low blood pressure, weakness, paralysis of limbs, fainting… are some symptoms of tachycardia, which can be life-threatening if not handled promptly.

Th.S.BS Nguyen Khiem Thao – Deputy Department of Electrophysiology and Arrhythmia, Cardiology Center, Tam Anh General Hospital in Ho Chi Minh City, said that some arrhythmias can impair heart function over time. time, or cause life-threatening symptoms. Common types of tachyarrhythmias include:

Paroxysmal supraventricular tachycardia

Paroxysmal supraventricular tachycardia is the most common type of tachycardia, occurring at any age. The origin of the tachycardia comes from the supra-atrial arrhythmia, the atrioventricular accessory pathway, or from the atrioventricular nodal region.

Tachycardia can appear suddenly, even when the patient is resting or sleeping. The heart rate during tachycardia ranges from 150-210 beats per minute and the heart rate is usually regular. During an episode of tachycardia, patients usually have only mild symptoms such as palpitations, chest discomfort, feeling tired, short of breath, and weak. However, some other cases have more severe symptoms such as dizziness, lightheadedness, low blood pressure, and fatigue.

Usually, paroxysmal supraventricular tachycardia does not affect the general health, because it is rare, and resolves on its own within a few hours. But in some cases, the tachycardia occurs more often, lasts longer, causing symptoms, so it is necessary to treat arrhythmia specialists. The method of treatment depends on the type of tachycardia, the level of symptoms, the frequency of occurrence of the tachycardia, the general health of the patient, the desire for radical treatment (intervention and arrhythmia ablation). or take a controller medication to reduce the tachycardia.

Crazy ear

This is a type of tachycardia in the atria of the heart, caused by one or more loops of re-entry. In atrial flutter, the atria contract rapidly and evenly with a frequency of about 240-340 beats/minute. The atria contract very rapidly, but the impulse conduction through the atrioventricular node is reduced before being transmitted to the two inferior ventricles. This is a physiological property of the atrioventricular node to protect the ventricles from being affected by atrial arrhythmias.

Symptoms of atrial flutter are similar to those of other supraventricular tachyarrhythmias: palpitations, chest rales, dyspnea, weakness, dizziness. In fact, it is rare that atrial flutter causes a patient to present with syncope or near syncope. However, in some cases, patients have symptoms of stroke (weakness in arms and legs, slurred speech, loss of consciousness) due to thromboembolism. After experiencing a stroke event, these patients are screened for the cause, detected atrial flutter, atrial fibrillation.

Some factors that increase the risk of atrial flutter are: being elderly, obese, drinking alcohol or having heart valve disease, congenital heart disease, previous heart surgery.

Prevent overweight – obesity has a high risk of atrial flutter. Image: Shutterstock

There are two approaches to treating atrial flutter: medication to control the rate of ventricular beats too quickly, or interventional investigation to absolve the atrial re-entry loops. Depending on the patient’s condition, the arrhythmic specialist will recommend the appropriate treatment.

In addition, when the patient has atrial flutter, it will lead to the risk of forming blood clots in the heart, which is the cause of stroke because the thrombus moves to block blood vessels in the brain. Therefore, the doctor will assess the risk of blood clots, anticoagulation treatment when needed.

Atrial fibrillation

According to Dr. Nguyen Khiem Thao, atrial fibrillation is one of the most complex arrhythmias in the atrium of the heart. In atrial fibrillation, the atria are activated asynchronously in many different regions with rapid, irregular, and chaotic impulses that spread throughout the atria. The result is a fast and completely irregular heartbeat.

Atrial fibrillation can appear in transient episodes, causing no obvious symptoms. But as the disease progresses, atrial fibrillation will persist, become persistent, and degrade cardiac function over time. The symptoms of atrial fibrillation are similar to those of atrial flutter.

Factors that contribute to an increased risk of atrial fibrillation include: high blood pressure, coronary artery disease, heart valve disease, congenital heart disease, thyroid disease, metabolic disorder (diabetes), syndrome Sinus node failure, chronic obstructive pulmonary disease, sleep apnea syndrome, after heart surgery, old age, obesity…

Like atrial flutter, atrial fibrillation carries a risk of creating a blood clot in the heart, leading to a stroke caused by a blood clot that blocks a blood vessel in the brain. Therefore, doctors also need to assess risk and treat anticoagulation (if necessary) to prevent stroke. This is one of the important steps in addition to palliative treatment of atrial fibrillation, controlling the ventricular rate not to beat too fast in atrial fibrillation.

The treatment of atrial fibrillation includes two main directions: rhythm control and heart rate control. In the direction of rhythm control, the doctor will treat the patient to maintain a normal rhythm (sinus rhythm) with drugs or intervention to investigate and destroy atrial fibrillation, minimizing the recurrence of atrial fibrillation. In contrast, in the direction of rate control, the physician focuses mainly on keeping the ventricular rate from beating too fast regardless of when atrial fibrillation recurs.

According to Dr. Thao, the choice of treatment direction for atrial fibrillation depends on many factors and each specific patient, there is no general formula. Therefore, when atrial fibrillation is detected, patients need to be examined by an arrhythmic specialist to have appropriate treatment, minimizing the risk of disease progression.

Ventricular tachycardia

This is a type of tachyarrhythmia of arrhythmic origin in the ventricles. In general, ventricular tachycardia is an arrhythmia that requires special attention, even when initially detected. Because ventricular tachycardia itself has a risk, the ability to damage health is much more than normal paroxysmal supraventricular tachycardias. In addition, ventricular tachycardia is also a sign of some other dangerous cardiovascular diseases that the patient has not been examined and detected. Due to the complicated and dangerous nature of ventricular tachycardia, when there are abnormal signs, the patient should see an arrhythmia specialist immediately to be treated to prevent dangerous complications.

Ventricular tachycardia may appear transient, not clear enough, or the patient has only vague symptoms such as feeling light-headed, palpitations, unwell. However, Dr. Thao emphasized, when the condition worsens, most patients will have symptoms ranging from mild to severe such as palpitations, dizziness, heavy chest rales, shortness of breath, dizziness, low blood pressure, near fainting and fainting. faint.

Ventricular tachycardia can be caused by causes such as: ischemic cardiomyopathy (coronary artery disease), cardiomyopathy (hypertrophic cardiomyopathy, dilated cardiomyopathy), hereditary arrhythmias (hypertrophic cardiomyopathy). Long QT interval, catecholamine-related ventricular tachycardia), electrolyte disturbances, side effects of medications, narcotic drugs (cocaine or methamphetamine), idiopathic ventricular tachycardia…

Coronary artery disease is one of the risk factors for ventricular tachycardia.  Photo: Shutterstock

Coronary artery disease is one of the risk factors for ventricular tachycardia. Image: Shutterstock

“Vatrial tachycardia requires careful treatment and monitoring of response to specialist treatment, especially when the patient has severe, recurrent symptoms. Screening and correction of underlying causes (if any) cause them.” ventricular tachycardia also plays an important role.Patients may consider drug treatment or ablation of ventricular tachycardia depending on the severity of the ventricular tachycardia, severity of accompanying symptoms, and general condition. patient, nature and underlying cause of ventricular tachycardia, said Dr. Thao.

In many cases, the option of interventional ablation of ventricular tachycardia is preferred and is more effective than medication, which only reduces the number of episodes of ventricular tachycardia. Some cases of malignant, refractory, recurrent, worsening ventricular tachycardia will require the doctor to perform additional surgery to place a defibrillator implanted under the skin so that the patient’s life is not threatened during the attack. dangerous ventricular tachycardia.

Ventricular fibrillation

According to doctor Nguyen Khiem Thao, ventricular fibrillation is a dangerous arrhythmia in tachyarrhythmias. The disease can be a direct and immediate threat to the patient’s life, so it should be treated immediately. In ventricular fibrillation, the heart’s ventricles contract very rapidly, chaotically, completely out of sync, and the heart’s ability to pump blood and maintain circulation is no longer available. Therefore, in ventricular fibrillation, if the patient is not treated promptly, the probability of death is very high, almost death, or if the treatment is slow, it will lead to permanent brain damage.

Symptoms of ventricular fibrillation develop rapidly over time from the onset of the disease. Patients with transient ventricular fibrillation for a few seconds often experience dizziness, lightheadedness, dark eyes, and a feeling of lightheadedness. If the ventricular fibrillation lasts for nearly 10 seconds, the patient will have a transient loss of consciousness. As the ventricular fibrillation lasts longer, the person will faint and organs sensitive to ischemia such as the brain begin to suffer. At this time, if the patient is not given emergency treatment, the ventricular fibrillation continues, the possibility of death is very high.

Risk factors for ventricular fibrillation: acute myocardial infarction, cardiomyopathy, hereditary severe ventricular arrhythmias (Brugada syndrome, long QT syndrome), acute myocardial injury or inflammation, electrical disturbances severe resolution, drug overdose (especially cocaine and methamphetamine), idiopathic ventricular fibrillation.

Cardiology patient at Tam Anh General Hospital.  Photo: Provided by the hospital

Cardiology patient at Tam Anh General Hospital. Image: Hospital provides

The treatment of ventricular fibrillation is a medical emergency. Besides, it is necessary to quickly find and correct the underlying causes to help the patient stabilize and stop the recurrence of ventricular fibrillation. With the exception of ventricular fibrillation due to acute causes, which can be treated with complete recovery, the prevention of sudden death from recurrent ventricular fibrillation is always a top priority. In this respect, the placement of a defibrillator is the only treatment to prevent sudden death in the patient. This is not a treatment to reduce or stop ventricular fibrillation, but a measure to cut off ventricular fibrillation to protect the patient’s life.

Tachyarrhythmias need to be treated as soon as possible to prevent complications such as heart failure, stroke, myocardial infarction… Therefore, when there are abnormalities, you need to go to a specialized medical facility to be checked by a doctor on duty. Follow-up examination, blood tests, electrocardiograms, echocardiograms to find the most exact cause, appropriate and effective treatment.

Ha Vu

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