Tachykardie - zrychlení srdečního rytmu

7.4.2012 , Kamila Burdová

tachykardie.jpg - kopie
tachykardie.jpg - kopie
Tachykardie znamená zvýšení frekvence činnosti srdce nad 90 stahů za minutu. Tachykardie může být fyziologickou odpovědí organismu na nejrůznější stimuly jakož i příznakem mnoha chorob. Tachykardii zaznamenáváme jak při zvýšené fyzické zátěži, kdy je potřeba pumpovat do těla větší množství okysličené krve, tak při stresu v tom nejširším slova smyslu, tedy psychickém, při nemoci či zranění. Tachykardie může být způsobena také celou řadou chorob. Vyskytuje se při chudokrevnosti, onemocnění štítné žlázy nebo při některých vlastních nemocech srdce. Tachykardie může vyústit v poruchu srdečního rytmu, která může člověka ohrožovat přímo na životě.

Tachykardie

Tachykardie znamená zrychlení srdečního rytmu. Normální srdeční frekvence se pohybuje mezi 60 až 90 tepů za minutu. Z toho vyplývá, že při tachykardii se srdeční frekvence pohybuje nad 90 tepů za minutu. Za srdeční činnost je odpovědný tzv. sinoatriální uzel, který elektrické vzruchy tvořící se ve specializovaném shluku buněk rozvádí po celém srdci tak, aby došlo k srdečnímu stahu. Vedení vzruchu zajišťuje tzv. převodní systém srdeční. Sinusový uzel a tím srdeční frekvenci ovlivňuje nervový systém a některé hormony.

Příčiny vzniku tachykardie

Zrychlená srdeční akce, tachykardie, může být způsobena řadou příčin. Nejčastěji jde o zrychlenou tvorbou vzruchu, tvorbu vzruchu mimo sinusový uzel nebo z důvodu nervových a hormonálních regulací.

Zrychlená tvorba vzruchu

Pokud je za tachykardii zodpovědný sinusový uzel, který tvoří vzruchy příliš rychle, nazýváme ji sinusovou tachykardií. Srdce bije pravidelně, ale rychleji než za normálních okolností. Toto vzniká při fyzické aktivitě, kdy tělo potřebuje více kyslíku a živin, a krev proto musí proudit rychleji, aby tuto potřebu uspokojila. Nervový systém a vyplavené hormony povzbudí sinusový uzel v srdci a zrychlí pumpování krve do tělního oběhu. Ke stejné reakci dojde při stresu nebo rozrušení, jelikož dojde k vyplavení adrenalinu. Totožný vznik tachykardie doprovází rovněž infekce, horečku a závažné stavy, jako je krvácení, srdeční selhávání, šok.

Tvorba vzruchu mimo sinusový uzel

Za některých okolností vznikají v srdci místa, kde se začínají tvořit vzruchy vedoucí ke stahům srdeční svaloviny. Jde o nebezpečný stav se zrychleným a nepravidelným srdečním rytmem. Může jít o nadbytečné stahy v síních i komorách. Podle toho rozlišujeme:

  • Fibrilace síní, charakterizovaná chaotickou elektrickou aktivitou v síních, která se díky tomu chvěje. Nedochází tak ke vzniku kontrakcí síní.
  • Komorová tachykardie, u které nadbytečné stahy vznikají v komorové svalovině či v oblasti převodního systému.
  • Fibrilace komor představuje stav neslučitelný se životem. Dochází u něj k chaotickému uspořádání vzruchů, které vedou pouze ke chvění komory, nikoliv ke stahům. Tím není vypuzována krev z levé komory do těla.

Hormonální regulace

Dalším důvodem sinusové tachykardie je působení některých hormonů. Tachykardie bývá přítomna u onemocnění štítné žlázy. Při tzv. hyperfunkci štítné žlázy je tato stimulována k intenzivnější funkci, dochází tak ke zvýšené tvorbě a uvolňování hormonů štítné žlázy do krve. Tyto hormony působí na sinusový uzel, pokud je jich nadbytek, způsobí tachykardii.

Rizikové faktory tachykardie

Rizikovými faktory vzniku tachykardie jsou zátěžové situace, ve kterých se zvyšují nároky buněk na kyslík a srdce musí proto pracovat rychleji. Jsou to nejen sportovní aktivity ale i stres, infekce nebo úrazy. Tachykardii způsobují i hormony štítné žlázy při tzv. hypertyreóze , což je zvýšená činnost štítné žlázy. Tachykardie se objeví při anémii, tj. chudokrevnosti. Dalším rizikovým faktorem vzniku tachykardie jsou srdeční choroby, které poškozují srdeční buňky. Jde o infarkt myokardu, záněty srdečního svalu, vady chlopní nebo srdeční selhání.

Příznaky tachykardie

Sinusovou tachykardii nemusí způsobit srdeční nebo jiná choroba. Zcela běžně se vyskytuje při fyzické zátěži, při pohybu nebo psychickém rozrušení. Na druhou stranu mohou tachykardie provázet závažné stavy a ohrožovat život člověka. Tachykardie se projevují zrychlenou srdeční činností a pacient může pocítit i bušení srdce, tlak na hrudi a dušnost. Pacient může pro snížené prokrvení mozku pociťovat závratě, bolesti hlavy nebo na chvíli ztratit vědomí.

Diagnostika tachykardie

Diagnostika tachykardie spočívá ve fyzikálním vyšetřeni lékařem, který objeví zrychlenou činnost srdce nad 90 tepů za minutu. Dále se o tachykardii může přesvědčit poslechem srdeční činnosti pomocí fonendoskopu. V neposlední řadě je možné pro diagnózu použít elektrokardiografii. Jde o bezbolestné vyšetření, při kterém se snímá elektrická aktivita srdce pomocí elektrod připojených na končetiny a hrudník pacienta.

Léčba tachykardie

Léčba tachykardie spočívá především v léčbě příčiny tohoto stavu. V případě, že příčinou tachykardie je některý z druhů arytmií, tedy poruch srdečního rytmu, je nezbytné užívat antiarytmika. Tedy léky, které nepravidelný rytmus ruší. V případě jejich neúčinnosti je nutná elektrická kardioverze, při které se přiloží dvě elektrody potřené vodivým gelem a aplikuje se elektrický výboj, který navrátí přirozený rytmus srdce. Pokud ani tento ambulantně prováděný výkon není účinný, pak se přistupuje k implantaci kardioverter-defibrilátoru pod kůži pacienta, který funguje stejným způsobem. Pokud je příčinou tachykardií onemocnění štítné žlázy, pak je nutné tuto korigovat léky.

Prevence tachykardie

Prevence vzniku zrychleného srdečního rytmu, tedy tachykardie, je pravidelná fyzická aktivita. Srdce se při pohybu přizpůsobí větší zátěži a přestane na ni reagovat překotným zrychlením. Doporučuje se vyhýbat se stresovým situacím. Je vhodné dodržovat zásady zdravého životního stylu, tedy nekouřit, mít dostatek aktivního odpočinku a spánku. V rámci diety je vhodné omezit tuky a zvýšit příjem zeleniny a ovoce. Důležité je rovněž nezanedbávat pravidelné preventivní prohlídky u praktického lékaře. Prohlídka odhalí i dosud skryté poruchy srdeční činnosti, které by mohly vyústit v síňové a komorové tachykardie a následně fibrilace.

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