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Arrhythmia paroxysmal at children

Arrhythmia paroxysmal — the disturbance of a cordial rhythm arising in the form of attacks and which is expressed in considerable increase of cordial reductions (over 180 — 200 in a minute) at their normal sequence. At a Bouveret's disease heart is reduced from the ectopic center of excitement. Depending on the place of emergence of an impulse distinguish supraventricular (atrial, atrioventricular) and ventricular forms. The Bouveret's disease can arise at cardiac pathology (myocarditis, heart disease), against an acute infectious disease At 50% of children of the explicit pathological center it is not possible to define its emergence is caused by a vegetodistoniya. The long attack of tachycardia (within several hours) leads to development of a circulatory unefficiency
Symptoms. At the beginning of an attack children complain of unpleasant feelings of pain in heart, weakness, dizziness, heartbeat. Babies at the beginning of an attack are uneasy, then become sluggish, there are short wind, cold sweat, spasms are possible. Number of cordial reductions during an attack at children of advanced age — over 150 — 200 in a minute, at chest — to 250 in a minute. Attack duration — of minutes till several o'clock and days. Attacks can repeat repeatedly within a day. At a long attack pallor, cyanosis, short wind appear. A low pulse, arterial pressure it is reduced, increase of urinations.
For confirmation of the diagnosis of a Bouveret's disease and definition of its form the ECG needs research.
At a supraventricular form on an ECG: the changed tooth P precedes the QRS complex or the tooth P is absent before a ventricular complex, the QRS complex has the usual form, the number of cordial reductions exceeds 200 in a minute at children of preschool and school age.
At a ventricular Bouveret's disease the QRS complex is changed and widened. Frequency of ventricular reductions — from 150 to 250 in a minute. If the frequency of ventricular reductions less than 130 — 140 in a minute, then is not a Bouveret's disease and if more than 250, are a trembling of ventricles which is observed at a critical condition and has to be considered as a harbinger of sudden death of the child.
Acute management. The child needs to be laid, calmed. At supraventricular forms at children of school age it is possible to gain a positive effect from use of the receptions directed to excitement of a vagus nerve: a natuzhivaniye at the closed nose during a breath, swallowing of firm pieces of bread, drink small drinks of cold water, calling of vomiting (pressure upon a language root). It is possible to give inside potassium drugs (5% solution of chloride potassium in a dose of 80 — 100 mg/kg in three steps bucketed 20 — 30 min.), sedative drugs or valocordin (it is so much drops on reception, how many to the child of years), either Tinctura Valerianae, or Sibazonum (Seduxenum) in the average daily dose of 4 — 10 mg divided into 2 — 3 receptions, 1 mg/kg of Isoptinum 3 times inside. At lowering of arterial pressure and sokratitelny ability of a myocardium it is possible to apply cardiac glycosides to children of chest age: strophanthin, kortikon (see. circulatory unefficiency). Cardiac glycosides at a ventricular form of a Bouveret's disease are contraindicated.
In the absence of effect use antiarrhytmic drugs: novokainamid at supraventricular and ventricular forms. Appoint it intravenously in a dose of 0,15 — 02 ml/kg of 10% of solution (no more than 10 ml) for 10 — 15 ml of 10% of solution of glucose, also introduction of a novokainamid in oil in a dose of 02 ml/kg of 10% of solution for an injection is possible. After stopping of an attack novokainamid appoint inside in a dose 0,01 — 0,05 g/kg a day in 4 — 6 receptions. At use of a novokainamid lowering of arterial pressure it can be contraindicated at the expressed circulatory unefficiency
At a supraventricular form apply Isoptinum (verapamil. which enter intravenously in a single dose of 0,1 — 02 mg/kg on 15 — 20 ml of 10% of solution of glucose. In the absence of effect in 30 min. introduction of Isoptinum can be repeated. Action of Isoptinum is incontinuous (40 — 60 min.) therefore along with it in/in introduction it is reasonable to appoint reception of Isoptinum inside in a single dose of 0,0001 — 0,0005 g/kg 3 — 4 times a day (Isoptinum in ampoules on 2 ml of 0,25% of solution and in tablets on 0,04 and 0,08 g is issued). Isoptinum can be combined with introduction of Seduxenum — ODES of mg for a year of life.
In cases with firmness of the proceeding attack of a Bouveret's disease intravenously quickly without cultivation enter 0,5 — 1 ml of 1% of ATP solution.
At a ventricular Bouveret's disease introduction of 1% of solution of lidocaine in a dose of 1 mg/kg is shown.
Hospitalization: at not stopped attack of a Bouveret's disease, the repeating attacks and attacks which arose against cardiac pathology.

 
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