Ventricular Bouveret's disease

Description:

The Ventricular Bouveret's Disease (VBD) — suddenly beginning and suddenly stopping tachycardia attacks caused by the pathological centers of automatism in a myocardium of ventricles. ChSS —> 100 in min. Localization of an aritmogenny zone is determined by rules of the topical diagnosis of ventricular extrasystoles (see Premature ventricular contraction ventricular). The prevailing floor — men's (69%).

Reasons of a ventricular Bouveret's disease:

Mechanisms: in most cases there is a roundabout of an excitation wave (re-entry) in the site of a sokratitelny myocardium or in the carrying-out system of ventricles. Ectopic ventricular impulses are not carried out retrogradno to auricles in this connection AV develops — dissociation (auricles are reduced irrespective of ventricles under the influence of normal sinus impulses).

Reasons: an acute myocardial infarction and a chronic ischemic heart disease (to 80% of all cases of FRIDAY) myocardites, a cardiomyopathy, heart diseases, prolapse of the mitral valve intoxication foxglove drugs.

Symptoms of a ventricular Bouveret's disease:

• It is caused by low cordial emission (pallor of integuments, low the ABP)
• Frequency of a cordial rhythm, usually regular — 100-200 in min. Most often — 150-180 in min.
ECG identification
• ChSS — 100-200 in min.
• Deformation and broadening of the QRS complex more than 0,14 with in 75% of cases, from 0,12 to 0,14 with — in 25% of cases of ZhPT.
• Lack of a tooth of River.
• The signs allowing to diagnose authentically ZhPT
• Emergence of the QRS complexes, normal on width, among the deformed ventricular complexes (total captures of ventricles) and/or drain complexes (the partial or combined captures of the ventricles) testimonial of passing to ventricles of a sinus impulse during the extra refractory period. Difficulties at identification: in most cases it is possible to register only at long, multiminute registration of chest assignments of V, V2, V3
• Identification of independent (slower) rhythm of auricles — atrioventricular dissociation (teeth P have no fixed connection with ventricular complexes). Difficulties at identification: in the majority
cases teeth P are completely hidden in the changed ventricular complexes.
• By results of an ECG allocate several ZhPT types
• Steady ZhPT with a frequency of 140-250 in min. and the same ventricular complexes
• The repeated episodes of ZhPT in the form of groups of 3-5-10 QRS complexes having the form of ventricular extrasystoles alternating with the periods of a sinoatrial rate
• Slow ZhPT with a frequency of 100-140 in min. duration of 20-30 with (about 30 QRS complexes).

Treatment of a ventricular Bouveret's disease:

— lidocaine of 80 — 120 ml. in/in struyno and 20,0 physical. solution,
— ATP 2,0 in/in struyno bolyusno without cultivation,
— новокаинамид 10,0 on 20,0 physical. solution in/in struyno under control of the ABP, if necessary + a phenylephine hydrochloride 0,3 — 0,5,
— кордарон 150 mg and 20,0 physical. solution in/in struyno.
At piruetny ventricular tachycardia — multidirectional wide complexes — magnesium sulfate of 2,4% — 10,0 on 20,0 physical. solution in/in, struyno, slowly.

The QRS complexes constantly change amplitude, as if rotating around the isoelectric line.
At inefficiency of medicinal therapy a countershock with category 100 power — 200 J with the minimum interval between them.