Bouveret disease is a tachycardia that usually occurs in young adults. It is due to an abnormality of nerve impulses within the heart.
Definition: what is Bouveret’s disease?
Tachycardia or Bouveret’s disease takes its name from Dr Léon Bouveret who described it in 1889. “The term has entered common parlance but in cardiology we speak precisely of intranodal reentry tachycardia (INRT). This is a so-called tachycardia junctional with a rapid heart rate between 120 to 200 beats per minuteexplains Dr Clémence Docq, cardiologist at Lill University Hospital. This is’a benign heart disorder that most often occurs in a healthy heart.
At what age can Bouveret’s disease occur?
“It can occur at any age of life but generally begins in adolescents or young adults“, admits the cardiologist.
What are the causes of Bouveret’s disease?
Bouveret tachycardia is due to a cardiac electrical feature. “It corresponds to a short circuit in the middle of the heart, between the atria and the ventricles, in the atrioventricular node. Normally there is only one electrical path at this location. But in certain people, approximately 5 to 20% of the population, we observe a variant, i.e. two conduction pathways at the origin of the short circuit which can be responsible for the racing heart.“, develops Dr Clémence Docq.
“Seizures can last a few seconds to several hours”
Can stress be responsible for Bouveret’s disease?
“In a person who is not prone to attacks of tachycardia by intra-nodal reentry, there is nothing to indicate that stress or a strong emotion can be the cause of an attack. On the other hand, it has been described that seizures can occur duringeffort, stress or be favored by pregnancy in patients with TRIN“, explains our interlocutor.
What are the symptoms of Bouveret’s disease?
“This tachycardia does not cause serious symptoms” insists our expert. However, the disease, characterized by a racing heart rate, can be the cause of anguish for the patient. Bouveret’s disease comes on suddenly and stops suddenly. “The frequency and duration vary greatly. Seizures can be very occasional or daily and last from just a few seconds to several hours“explains the cardiologist.
How to treat Bouveret’s disease?
Treatment is not always necessary, it will depend on the frequency of the attacks, their duration and how well the patient tolerates them. “Drug treatment is based onare anti-arrhythmics, among whom we found bradycardic calcium channel blockers (Ditiazem or Verapamil). In the event of infrequent attacks, the patient may be offered a single dose treatment to stop the attack (‘pill in the pocket’). The patient can also choose to take the treatment daily, which aims to prevent recurrence of seizures.“, explains the cardiologist. slow down the electrical impulse at the atrioventricular nodethree vagal maneuvers can be performed by the patient at home:
► Drink a large glass of iced water
► Perform a 30-second compression on the sino-carotid glomuslocated at neck level under the jaw
► Perform the Valsalva maneuver : exhale and swallow with your nose pinched and your mouth closed.
“In the event of failure of vagal maneuvers, in a hospital environment only, an attack can be interrupted by the injection intravenous Striadyne. The drug will slow electrical conduction in the atrioventricular node and interrupt the circuit necessary to maintain tachycardia. adds Clémence Docq.
What does Bouveret’s disease surgery consist of?
In the event of symptomatic and recurrent attacks, a very specific operation can be carried out by a rhythmologist, the heart rhythm specialist. This is’ablation of the additional electrical pathway, called “the slow pathway”, which is aimed at patients who wish it and/or who suffer from symptoms that are increasingly difficult to bear, which may be the case when the patient ages or the tachycardia is associated with a heart disease. “Concretely it’s about cutting the short circuit in the heart, this excess pathway between the atrium and the ventricle. During the operation, several maneuvers will be carried out to trigger the tachycardia attack and identify the mechanism. Then the specialist practices ablation of the slow pathway ascending via the femoral vein a radiofrequency ablation catheternotes Clémence Docq. It works very well but it is a invasive technique therefore the patient must have been informed beforehand by the cardiologist the expected benefit on symptoms and the risks of the procedure“.
It is important to make a diagnosis quickly
“If Bouveret’s tachycardia is benign, it is important to quickly make a diagnosis to rule out other tachycardias potentially more serious“, warns the specialist. The occurrence of attacks being occasional, it is rare for them to be observed by a doctor. “The electrocardiogram is used to document palpitations. It is important to do an electrocardiogram at the time of the attack but if we cannot do this we can use a Holter ECG, an electrocardiogram recorder which can be kept with you for several days or even several weeks“, explains Clémence Docq. Indeed, the attacks being of unpredictable frequency and duration, it can be difficult to undergo an electrocardiogram at the time of the attack. If the patient has not been able to go to the emergency room or if it does not arrive in time, the Holter ECG will make it possible to make the diagnosis.
Can you play sports with Bouveret’s disease?
Tachycardia can occur at rest or during exercise and does not cause serious symptoms in the patient. There is therefore no no reason to contraindicate sports practice.
Thanks to Dr Clémence Docq, cardiologist at Lille University Hospital.