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Bouveret’s disease: all about Bouveret’s tachycardia

Pathology of the heart rhythm, Bouveret’s disease is defined as the occurrence of heart palpitations that can be the cause of discomfort and anxiety. It is due to a defect in cardiac electrical conduction. Explanations.

What is Bouveret’s disease?

Bouveret’s disease is characterized by the presence of palpitations occurring in intermittent attacks in the form of a paroxysmal acceleration of the heart rate. The heart rate can reach 180 beats per minute which can last several minutes, even several tens of minutes, then suddenly normalize to the usual heart rate with an immediate feeling of well-being. These seizures can be triggered by an emotion or without a particular cause. It is still a mild disease that does not affect the heart’s functioning apart from its fast-paced repeating seizures (tachycardia). It does not present a vital risk. We talk about tachycardia when the heart beats more than 100 beats per minute. This disease is relatively common and affects more than one in 450 people, most often in young people.

What are the symptoms of Bouveret’s disease?

Beyond the sensations of chest palpitations, this disease is also a source of chest discomfort in the form of feelings of oppression and anxiety or even panic. 

Attacks of palpitations have an abrupt onset and end, caused by emotion, but often without an identified cause. 

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Urine emission is also common after the seizure and relieves the bladder. A feeling of dizziness, lightheadedness or faintness may also occur with brief unconsciousness. 

Anxiety depends on the patient’s degree to this tachycardia. An electrocardiogram shows regular tachycardia at 180-200 beats per minute while the usual heart rate ranges from 60 to 90. It is possible to calculate the heart rate by taking the pulse at the wrist, where the radial artery passes or by listening the heart with a stethoscope.

What assessment should be made in the event of suspicion of Bouveret’s disease?

In addition to the electrocardiogram which will seek to differentiate Bouveret’s disease from other heart rhythm disorders, a more in-depth assessment is sometimes necessary when the succession of tachycardia attacks is disabling on a daily basis and / or sometimes leads to dizziness, dizziness or dizziness. brief loss of consciousness. 

The cardiologist then records the electrical activity of the heart using a probe directly inserted into the heart. This exploration will trigger a tachycardia attack which will be recorded to visualize the nerve node in the wall of the heart that causes tachycardia. 

How to treat Bouveret’s disease?

When it is not very disabling and well tolerated, Bouveret’s disease can be treated by vagal maneuvers which stimulate the vagus nerve involved in the regulation of the heart rate (massage of the eyeballs, carotid arteries in the neck, drink a glass of cold water, induce a gag reflex, etc.). This vagus nerve stimulation will slow down the heart rate.

If these maneuvers are not sufficient to calm the crisis, antiarrhythmic drugs to be delivered punctually, in a specialized cadiological environment, may be injected. They aim to block the intracardiac node that causes tachycardia. 

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When this disease is poorly tolerated by the intensity and repetition of the attacks, a basic treatment is offered by antiarrhythmic drugs such as beta blockers or digitalis.

Finally, if the seizures are not controlled, are repeated and handicap the daily life of the patients, it is possible, during an exploration by a small probe which penetrates to the heart, to carry out an ablation shot. node causing radiofrequency tachycardia attacks. This gesture is carried out by specialized centers which have experience of this type of intervention. The efficiency of this method is 90% and it is indicated for young subjects or subjects who have a contraindication to taking anti-arrhythmic drugs such as digitalis.

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