Bouveret's disease

Description:

Bouveret's disease is an ectopic tachycardia which has the form of attacks – suddenly begins and not less suddenly comes to an end.

Symptoms of the Bouveret's disease:

The paroxysm is usually felt as a heartbeat attack with the clear beginning and the termination, lasting from several seconds up to several days. Supraventricular tachycardia quite often is followed by other displays of vegetative dysfunction - perspiration, a plentiful urination at the end of an attack, increase in a vermicular movement of intestines, small fervescence. Long attacks can be followed by faints, weakness, unpleasant feelings in heart, stenocardia, emergence or increase of heart failure. Ventricular tachycardia is almost always connected with a heart disease and is regarded as heavier complication, and at unusually frequent rhythm (more than 180 in a minute) it can be a ventricular fibrillation harbinger.

Reasons of the Bouveret's disease:

These characteristics are identical that they are observed at premature ventricular contraction.

The Bouveret's disease differs in severe rhythm and pulse rate of 160-220 beats per minute. On an ECG it is possible to see ventricular complexes, and before them a little deformed R. Chasto's tooth is often observed the disease is followed by intra ventricular and (or) atrioventricular conductivity. At the same time most often – on the right leg of a ventriculonector.

Difference of atrioventricular tachycardia available a tooth P which or accumulates on the QRST complex, or is located before it.

At massage of a carotid sine the cordial rhythm is temporarily normalized. It concerns all forms of supraventricular tachycardia.

Ventricular tachycardia - tachycardia with a frequency of 130-180 beats per minute, with considerable deformation of the QRST complex. Auricles are excited irrespective of ventricles in the correct rhythm, but P it is difficult to distinguish a tooth. The form and amplitude of the QRST complex and a contour of the zero line slightly change from a cycle to a cycle. The rhythm often is not strictly correct.

Ventricular tachycardia - tachycardia with a frequency of 130-180 a minute, with considerable deformation of the QRST complex. Auricles are excited irrespective of ventricles in the correct rhythm, but P it is difficult to distinguish a tooth. The form and amplitude of the QRST complex and a contour of the zero line slightly change from a cycle to a cycle. The rhythm often is not strictly correct. Massage of a carotid sine does not change rhythm frequency. Sometimes within several days after a tachycardia paroxysm on an ECG negative teeth of T are registered, is more rare - with ST segment shift - a poyettakhikaralny syndrome: such patients demand careful observation and an exception of small focal myocardial infarction.

Treatment of the Bouveret's disease:

For treatment of a Bouveret's disease it is necessary to calm the patient,  apply sedatives, the termination of loadings. At supraventricular tachycardia the first minutes of attack stimulation of a vagus nerve - vigorous and persistent massage of area of a carotid sine, calling of gaggings, pressure upon eyeballs and upon a prelum abdominale is necessary. Quite often patient stops an attack breath holding, a certain turn of the head or other receptions. Sometimes 40 mg of propranolol accepted at the beginning of an attack stop it in 15 - 20 min. More effectively in / in introductions of Isoptinum (2 - 4 ml 0,25 solutions), a novokainamida (5 ml of the 10th solution). At considerable hypotonia previously enter subcutaneously or intramusculary a phenylephine hydrochloride. In the presence of a heart disease the antiarrhythmic effect renders strophanthin (if attack is not connected with overdose of a glycoside). Inefficiency of treatment as drugs and increase of cardiovascular insufficiency serve as the indication to electropulse treatments. If attacks frequent, then out of attacks with the preventive purpose it is necessary to appoint propranolol with delagil, digoxin, новокаинамид, dipheninum.