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  • Arrhythmia of the heart - Causes, symptoms and treatment. MF.

    Cardiac arrhythmia is any disturbance of the heart rhythm characterized by a change in the frequency, regularity and sequence of heartbeats as a result of the violation of the cardiac functions of the heart: automatism, excitability and conductivity.

    Causes of cardiac arrhythmia

    Arrhythmias are detected with organic damage of the heart: myocardial infarction, heart defects, etc., when the function of the autonomic nervous system is disturbed, the water-salt balance changes, intoxications. Arrhythmias can be observed even in completely healthy people against the background of severe fatigue, with a cold, after drinking alcohol.

    Many heart rhythm disturbances may not be felt by the patient and do not lead to any consequences( sinus tachycardia, atrial extrasystole), and more often indicate any non-cardiac pathology( eg, increased thyroid function).The most dangerous are ventricular tachycardia, which can be the immediate cause of sudden cardiac death( in 83% of cases).No less dangerous for life can be bradycardia, especially, AV blockade, accompanied by sudden short-term loss of consciousness. According to statistics, they cause sudden cardiac death in 17% of cases.

    What provides a normal heart rhythm

    The normal rhythm is provided by the cardiac conduction system. This is a consistent network of "power stations"( assemblies) - accumulations of highly specialized cells capable of creating and conducting electrical impulses along certain bundles and fibers, which in turn cause excitation and contraction of the heart muscle( myocardium).

    Although all elements of the conductive system are capable of generating electrical pulses, the main power plant is the sinus node located at the top of the right atrium. He sets the necessary frequency of the heart( at a state of rest 60-80 beats per minute, with physical exertion - more, during sleep - less).The impulses, "born" in the sinus node, spread out in all directions, like the sun's rays. Part of the pulses causes excitation and contraction of the atria, and the other - through special pathways of the conducting system - is directed to the atrioventricular node( more often to the AV node) - the next "power station".In the AV node, the movement of the pulse slows down( the atria must be shortened and the blood transferred to the ventricles).Further, the pulses propagate to the bundle of the Gis, which, in turn, is divided into two legs. The right leg of the beam with the help of Purkinje fibers conducts impulses to the right ventricle of the heart, left, respectively, to the left ventricle, causing their excitation and contraction. This is how the rhythmic work of our heart is ensured.

    There are two problems in the conductive heart system:

    1. impairment of the formation of a pulse in one of the "power plants".
    2. violation of the impulse in one of the sections of the described system.

    In both cases, the function of the main pacemaker is taken over by the chain "power station".However, the heart rate is less.

    Thus, the conduction system of the heart has multilevel protection against sudden cardiac arrest. But violations in her work are possible. They lead to arrhythmia.

    Arrhythmia Arrangements

    Arrhythmias are cardiac arrhythmias that are accompanied by:

    • by less than 60 beats per minute.
    • more frequent( more than 100 per minute).
    • or irregular heartbeat.

    Decrease in the rhythm of the heart is called bradycardia( bradi - rare), frequent - tachycardia( tahi - frequent).

    There are dozens of types of arrhythmias. Here, we will give you an idea of ​​the mechanisms of the most typical and common ones. These include:

    1. The main types of bradycardia:

    • Syndrome of weakness of the sinus node.
    • Atrioventricular blockade( often referred to as AV blockade).

    2. irregular rhythm:

    • Extrasystoles.

    3. Major types of tachycardia:

    • Supraventricular( supraventricular) tachycardia.
    • Atrial fibrillation( atrial fibrillation).
    • Ventricular tachycardia.

    Depending on the location of the "focus," tachycardia is divided into supraventricular, or supraventricular( with its localization in the atria or area of ​​the AV node), and ventricular.

    Depending on the duration, tachycardia is divided into paroxysmal and persistent. Paroxysmal tachycardia is a sudden sharp increase in the heart rate, lasting from a few seconds to several days, which also stops suddenly, as it begins( often without outside interference).Permanent tachycardia - a prolonged( more than 6 months) frequency of heart rhythm, resistant to drug and electrotherapy( electrical cardioversion).

    Syndrome of weakness of the sinus node is due to impaired pulse formation in the sinus node or impaired conduction of the "out" pulse from the sinus node upon contact with the atrial tissue. This pathology can be accompanied by a stable bradycardia or recurrent pauses in the work of the heart, caused by the so-called sinoatrial blockade.

    Sinus bradycardia can be observed in healthy, well-trained people or be a sign of the development of a pathological condition. For example, hypothyroidism( decreased thyroid function), increased intracranial pressure, some infectious diseases( typhoid fever), general asthenia with prolonged starvation.

    The atrioventricular blockade of is a violation of the "throughput" of the AV node. With AB blockade of the 1st degree, the impulse through the AV node slows down, at the 2nd - only every second or third pulse coming from the sinus node spreads to the ventricles, at the 3rd degree( complete transverse blockade) - conducting through ABThe node is completely blocked. In this case, the cardiac arrest does not occur, because, "the case comes in" the bundle of the Guiss or the underlying structures of the conduction system of the heart, but this is accompanied by a rare heart rhythm, approximately 20-40 beats per minute.

    Extrasystoles are premature contractions of the heart( extra - over).We already know that all the structural links in the conducting system of the heart are able to generate electrical impulses. Normally, the main "power plant" is a sinus node, because it is the one that can generate the pulses with the greatest frequency. However, under the influence of various factors( atherosclerosis, intoxications, etc.), the pathological( increased) activity of one of the structures of the conduction system of the heart can result, which leads to an extraordinary cardiac contraction, after which a compensatory pause may follow. This is one of the most frequent types of arrhythmias. Depending on the place of origin, the extrasystoles are divided into supraventricular( supraventricular) and ventricular. Single extrasystoles( up to 5 per minute) are not life threatening, whereas frequent, paired and group ventriculars are an unfavorable sign.

    Supraventricular( supraventricular) tachycardia. This type of tachycardia is characterized by an increase in the rhythm of up to 140-180 beats per minute, due to individual features of the structure of the AV node or pathological( increased) activity of one of the links of the conducting heart system at the level of the atria. This type of tachycardia includes Wolf-Parkinson-White syndrome( WPW syndrome), caused by the presence of an innate additional route of administration. With this pathology, the pulse from the atrium through the AV node spreads to the ventricles, but, after their excitation, instantaneously, along an additional path, returns to the atria, causes them to re-energize and again, through the AV node, is performed on the ventricles. The movement of the pulse can also occur in the opposite direction( downwards to the ventricles - through an additional path, upward to the atrium via the AV node).Such a pulse circulation can take an infinitely long time and is accompanied by a high heart rate( more than 200 beats per minute).

    Atrial fibrillation( atrial fibrillation) is the most common form of supraventricular arrhythmia, characterized by a chaotic contraction of individual atrial muscle fibers with a frequency of 400-600 per minute. It is important to note here that the AV node in the heart performs not only the function of the "power station" and the "conductor", but also the role of the filter of the frequency of the pulses transmitted to the ventricles( normally the AB node can hold up to 140-200 pulses per minute).Therefore, with atrial fibrillation, only a part of these impulses reach the ventricles, and their reduction occurs quite chaotically, resembling fibrillation( hence the name atrial fibrillation).The sinus node at the same time loses its function as a pacemaker.

    Ventricular tachycardia is a severe rhythm disturbance, manifested by contraction of the ventricles of the heart with a frequency of 150-200 per minute. In this case, the "focus" of excitation is located directly in one of the ventricles of the heart. At a young age, this arrhythmia is more often caused by structural changes in the right ventricle, in the elderly - more often after a previous myocardial infarction. The danger of this rhythm disturbance is determined by the high probability of its transition to fibrillation( flickering) of the ventricles, which, without the provision of emergency medical care, can lead to a sudden death of the patient. The severity of these types of arrhythmias is due to the lack of full-scale reduction of the ventricles of the heart and, as a consequence, the lack of adequate blood supply to vital organs( primarily the brain).

    Atrioventricular blockade of

    What is atrioventricular blockade?

    Atrioventricular blockade - is a violation of the "throughput" of the AV node - which is the "connecting link" between the atria and ventricles. With AB-blockade of the 1st degree, the impulse through the AV-node slows down, at the 2nd - only every second or third pulse coming from the sinus node is carried to the ventricles, with AB blockade of the third degree( complete transverse blockade)the impulse from the atria to the ventricles stops completely. At the same time, cardiac arrest does not occur, because, as the main "power station", a bundle of His or other structures of the conduction system of the heart enters the case. This is accompanied by a rare heart rhythm, approximately 20-40 beats per minute.

    What are the clinical manifestations of atrioventricular blockade?

    In this type of disturbance of conduction of the heart is usually disturbed:

    • general weakness;
    • dizziness;
    • shortness of breath;
    • fast fatigue.

    With severe bradycardia,

    • episodes of darkening in the eyes appear;
    • condition, close to loss of consciousness( "I want to grab for something, so as not to fall").

    WARNING!The extreme manifestations of bradycardia are short-term attacks of loss of consciousness( seconds) - "walked-went - came to the senses lying on the floor."This may be preceded by a feeling of "hot flush in the head".

    Long-term loss of consciousness( 5-10 minutes or more) is not characteristic of bradycardia.

    What are the methods for diagnosing atrioventricular blockade?

    The primary diagnosis can be the presence of clinical manifestations of cardiovascular disease.

    The next step is to register the electrocardiogram.

    Often there is a need for a round-the-clock recording of an electrocardiogram( Holter monitoring) in the usual mode of the patient's life. It is possible that during the 24-hour monitoring, the arrhythmia will also not be recorded. In this case, a tilt test is carried out.

    What are the methods for treating atrioventricular blockade?

    Implantation of the permanent pacemaker is the only method of treatment of severe bradycardia. This device restores the normal heart rate. At the same time, the volume of blood coming to the organs is normalized, and the symptoms of bradycardia are eliminated.

    The main indications for the implantation of a permanent pacemaker with atrioventricular blockade are:

    • the presence of clinical manifestations of bradycardia( dyspnea, dizziness, fainting);
    • pauses in the heart for more than 3 seconds.

    Sudden cardiac death

    What is sudden cardiac death?

    By sudden cardiac death is understood a natural death due to cardiac pathology, which was preceded by a sudden loss of consciousness within an hour after the onset of acute symptoms, when the previous heart disease may be known, but the time and way of death are unexpected.

    Cardiovascular disease continues to be the leading cause of death. After myocardial infarction, sudden cardiac death( BCC) is the second most common cause of cardiovascular mortality. Approximately 83% of SCD is associated with ischemic heart disease, not diagnosed at the time of death.

    What are the risk factors for sudden cardiac death?

    There are well-known risk factors for SCD: history of BCC, ventricular tachycardia, myocardial infarction, coronary artery disease, SCD cases or sudden unexplained death in the family, decreased left ventricular function, hypertrophic cardiomyopathy, heart failure, Brugada syndrome and QT syndrome andother

    Patients with sudden cardiovascular collapse during ECG recording have been shown that ventricular fibrillation and ventricular tachycardia are noted in 75-80% of cases, while bradyritmii seem to make an insignificant contribution to the development of ARIA.Approximately 5-10% of cases of SCD occur without the presence of coronary heart disease or congestive heart failure.

    The frequency of SCD observed in Western countries is approximately the same and varies from 0.36 to 1.28 per 1000 inhabitants per year.

    What are the methods of preventing sudden cardiac death?

    Treatment of patients with ventricular arrhythmias is aimed at preventing or arresting arrhythmia. Treatment options for today include:

    • therapy with antiarrhythmic drugs( AAP) class III;
    • radiofrequency ablation of cardiac pathways;
    • implantation of implantable cardioverter-defibrillators( ICDs).

    The role of amiodarone and other antiarrhythmic drugs of the III class is to prevent arrhythmia. However, if an episode of a ventricular tachycardia or fibrillation of the ventricles has developed during the administration of AAP, the drug is not able to arrest arrhythmia. Only an implanted cardioverter defibrillator or using an external defibrillator by resuscitation physicians can kill a life threatening tachycardia.

    Thus, the only treatment method that can prevent sudden cardiac death in life-threatening arrhythmia is therapy with implantable cardioverter-defibrillators. It is shown that ICDs are effective at 99% in stopping life-threatening arrhythmias and, thereby, in preventing sudden cardiac death.

    It has been shown that ICD reduces overall mortality( for all causes) by 31% among patients who underwent myocardial infarction and have an ejection fraction

    WARNING!If you suddenly lost consciousness before your eyes, while there is no independent breathing and the pulsation of the main arteries( on the neck, in the inguinal fold) is not determined, urgently begin resuscitation measures:

    Correctly lay the reanimated, providing airway patency. To do this:

    • patient must be laid on a flat solid surface and the maximum throw back to him.
    • to improve the patency of the airways from the mouth, you need to remove removable dentures or other foreign bodies. In case of vomiting, turn the patient's head to the side, and remove the contents from the mouth and pharynx with a tampon( or improvised means).

    Check for self-contained breathing.

    If there is no independent breath, start artificial ventilation. The patient should lie in the previously described posture on his back with a head thrown back sharply. The pose can be provided by placing under the shoulders of the roller. You can hold your head with your hands. The lower jaw must be pushed forward. The assisting person takes a deep breath, opens his mouth, quickly brings it closer to the patient's mouth and, pressing his lips tightly to his mouth, makes a deep exhale, i.e.as if blowing air into his lungs and inflating them. To the air does not go through the nose reanimiruemogo, pinch his nose with your fingers. Then the relief man leans back and takes a deep breath again. During this time, the chest of the patient falls down - there is a passive exhalation. Then the caretaker again blows air into the patient's mouth. For hygienic reasons, the patient's face can be covered with a handkerchief before blowing air.

    If there is no pulse on the carotid artery, artificial ventilation of the lungs must necessarily be combined with indirect heart massage. For an indirect massage, place your hands on one another so that the base of the palm resting on the sternum is strictly on the median line and 2 fingers above the xiphoid process. Without bending hands and using your own body weight, for 4-5 cm smoothly move the sternum to the spine. At this displacement, compression( compression) of the chest occurs. Massage so that the duration of the compression is equal to the interval between them. The frequency of compression should be about 80 per minute. In pauses, leave your hands on the sternum of the patient. If you are carrying out intensive care alone, after 15 compressions of the thorax, make two air inlets in succession. Then, repeat an indirect massage in combination with artificial ventilation.

    Do not forget to constantly monitor the effectiveness of your resuscitation. Resuscitation is effective if the patient has pink skin and mucous membranes, pupils have narrowed and a response to light has appeared, spontaneous breathing has resumed or improved, a pulse appeared on the carotid artery.

    Continue resuscitation before the ambulance crew arrives.

    Atrial fibrillation( atrial fibrillation)

    What is atrial fibrillation( atrial fibrillation)?

    Atrial fibrillation( atrial fibrillation) is the most common form of supraventricular arrhythmia, in which the atria contract chaotically at a frequency of 400-600 per minute without coordination with the ventricles of the heart. The role of the frequency filter performed to the ventricles of the pulses is performed by the AV node( normally the atrioventricular node is able to hold up to 140-200 pulses per minute).Therefore, with atrial fibrillation, only a part of the impulses reach the ventricles, while their reduction occurs irregularly, resembling fibrillation( hence the name atrial fibrillation).The sinus node at the same time loses its function as a pacemaker.

    Most people with atrial fibrillation( especially if the duration of atrial fibrillation exceeds 48 hours) have an increased risk of developing blood clots, which, due to their mobility, can contribute to the development of a stroke. Transition of the paroxysmal form of atrial fibrillation into a permanent form can promote the development or progression of chronic heart failure.

    How does the patient experience the appearance of atrial fibrillation?

    The appearance of atrial fibrillation is accompanied by a sharp increase in the heart rate, which can be accompanied by a sudden palpitation, cardiac disruptions, general weakness, lack of air, shortness of breath, a sense of fear, and chest pains. Sometimes this attack passes quickly( within a few seconds or minutes), without taking medication or other medical measures. However, very often heart palpitations do not pass by themselves, can last long enough( hours, days) and require treatment for medical help.

    What are the risk factors for atrial fibrillation?

    • Age. With age, electrical and structural changes in the atria can occur, which contributes to the development of atrial fibrillation.
    • Organic heart diseases, including heart defects, surgery on the open heart, increase the risk of atrial fibrillation.
    • Other chronic diseases. Diseases of the thyroid gland, arterial hypertension and other pathologies can promote atrial fibrillation.
    • Alcohol is a known "starter" of attacks of atrial fibrillation.

    What are the methods for diagnosing atrial fibrillation?

    1. Registration of an electrocardiogram.
    2. Holter monitoring - round-the-clock recording of the electrocardiogram at the usual mode of the patient's life.
    3. Recording of paroxysms of atrial fibrillation in on-line mode( real time) - a kind of Holter monitoring is a portable device that allows to transmit on the phone electrocardiogram signals at the time of an attack.
    4. Echocardiography is an ultrasound study that can determine the size of the heart cavities, its contractility, the condition of the valvular apparatus of the heart.

    What are the methods for treating atrial fibrillation( atrial fibrillation)?

    Atrial fibrillation can be paroxysmal( paroxysmal) and permanent.

    If you develop a persistent attack of atrial fibrillation, you should try to stop it( especially if this is the first occurrence of arrhythmia in your life).For this, medical or electrical methods for restoring rhythm are used. Tactics is determined by the duration, severity of clinical manifestations of arrhythmia, organic pathology of the heart, the alleged cause of arrhythmia.

    If you have developed a permanent form of atrial fibrillation( that is, all attempts at arresting the arrhythmia have been unsuccessful or maintaining a normal sinus rhythm unpromisingly), you need constant medication to control heart rate and prevent stroke.

    What are the methods of arresting( stopping) atrial fibrillation?

    The most effective drugs for stopping attacks of atrial fibrillation are Novokainamide( inside and intravenously) and Quinidine( inside).The use of them is possible only according to the doctor's prescription under the control of the electrocardiogram and the level of arterial pressure. Cordarone( inside and intravenously) and Propanorm( inside) are also used.

    The use of Anaprilin, Digoxin and Verapamil for relief of atrial fibrillation is less effective, but by reducing the heart rate, they improve the health of patients( reduction of shortness of breath, general weakness, palpitation).

    The most effective method of arresting atrial fibrillation is electrical cardioversion( about 90%).However, due to the need for short-term general anesthesia( anesthesia), it is resorted to when the patient's condition worsens against the background of arrhythmia progressively, the positive effect of drug therapy is absent or not expected( for example, because of the duration of the arrhythmia).

    ATTENTION!If you develop a persistent attack of atrial fibrillation, seek medical help urgently, since it is advisable to stop this arrhythmia within the next 48 hours( !). After this period, the risk of intracardiac formation of thrombi and related complications( stroke) increases sharply. Therefore, if atrial fibrillation lasts more than two days, it is necessary to take Warfarin( to reduce blood clotting) for 3-4 weeks and only then you can try to stop it. If successful outcome, taking Warfarin should be continued for another 4 weeks, while maintaining atrial fibrillation, it will have to be taken continuously.

    After successful recovery of the sinus rhythm, antiarrhythmic drugs are usually prescribed( Allapinin, Propanorm, Sotalex, Cordarone) to prevent repeated attacks of atrial fibrillation.

    What therapeutic measures are taken with a permanent form of atrial fibrillation?

    If you have a permanent form of atrial fibrillation( that is, all attempts at arresting the arrhythmia were unsuccessful) it is important to perform two tasks: to control the heart rate( approximately 70-80 beats per minute at rest) and prevent the formation of blood clots. The first task will help to decide the constant intake of Digoxin, adrenoblockers( Egilok, Atenolol, Concor), calcium antagonists( Verapamil, Diltiazem) or their combination. The second solution ensures a constant intake of Warfarin under the control of the state of the blood coagulation system( prothrombin index or INR).

    Are there methods for the radical elimination of atrial fibrillation( atrial fibrillation)?

    The only method of radical elimination of atrial fibrillation is radiofrequency isolation of pulmonary veins. Due to complexity and high cost, this catheter operation is still conducted only in large federal centers. Its efficiency is 50-70%.

    Also, with frequent paroxysms of atrial fibrillation and a permanent form of atrial fibrillation, it is possible to carry out RF-ablation of the AV node, at which an artificial complete transverse blockade( AV-blockade of the third degree) is created and a permanent pacemaker is implanted. In fact, atrial fibrillation remains, but the person does not feel it.

    Syndrome of weakness of the sinus node

    What is caused by the syndrome of weakness of the sinus node?

    Syndrome of weakness of sinus node is caused by impaired formation of a pulse in the sinus node - the main "power station" of the heart - or a violation of excitation in the atria. At the same time there is a rare rhythm or pause in the work of the heart.

    Note . Sinus bradycardia can be observed in healthy, well-trained people or be a sign of hypothyroidism( decrease in thyroid function), increased intracranial pressure, certain infectious diseases( typhoid fever), general asthenia with prolonged starvation.

    What are the clinical manifestations of the sinus node weakness syndrome?

    At this kind of heart rhythm disturbance is usually disturbed:

    • general weakness;
    • dizziness;
    • shortness of breath;
    • fast fatigue.

    With severe bradycardia,

    • episodes of darkening in the eyes appear;
    • condition, close to the loss of consciousness( "I want to grab for something, so as not to fall").

    ATTENTION!The extreme manifestations of bradycardia are short-term attacks of loss of consciousness( seconds) - "walked-went - came to the senses lying on the floor."This may be preceded by a feeling of "hot flush in the head".

    Long-term loss of consciousness( 5-10 minutes or more) is not characteristic for bradycardia.

    What are the methods for diagnosing the sinus node weakness syndrome?

    The primary diagnosis can be the presence of clinical manifestations of cardiovascular diseases.

    The next step is to register the electrocardiogram.

    Often there is a need for a round-the-clock recording of an electrocardiogram( Holter monitoring) in the usual mode of the patient's life. It is possible that during the 24-hour monitoring, the arrhythmia will also not be recorded.

    In this case, special studies are conducted, which allow provoking the appearance of pauses in the work of the heart. These include:

    • Transesophageal heart stimulation
    • tilt test.

    What are the methods of treating sinus node weakness syndrome?

    Implantation of a permanent pacemaker is the only method of treatment of severe bradycardia. This device restores the normal heart rate. At the same time, the volume of blood coming to the organs is normalized, and the symptoms of bradycardia are eliminated.

    The main indications for the implantation of a permanent pacemaker in the syndrome of weakness of the sinus node are:

    • the presence of clinical manifestations of bradycardia( dyspnea, dizziness, fainting);
    • heart rate & lt;40 beats per minute in waking state;
    • pauses( stopping the sinus node) for more than 3 seconds.

    Extrasystoles

    Extrasystoles are premature contractions of the heart( extra - "above").It is known that all the structural links of the conducting system of the heart are able to generate electrical impulses. Normally, the main "power plant" is a sinus node, because it is the one that can generate the pulses with the greatest frequency. However, under the influence of various factors( atherosclerosis, intoxications, etc.), the pathological( increased) activity of one of the structures of the conduction system of the heart can result, which leads to an extraordinary cardiac contraction, after which a compensatory pause may follow. This is one of the most frequent types of arrhythmias. Depending on the place of origin, the extrasystoles are divided into supraventricular( supraventricular) and ventricular. Single extrasystoles( up to 5 per minute) are not life threatening, whereas frequent, paired and group ventriculars are an unfavorable sign.

    Treatment of patients with extrasystole, primarily aimed at treating the underlying disease or condition that led to its development( treatment of myocardial infarction, correction of water-salt metabolism, etc.).In many cases, extrasystole can be eliminated by changing the patient's lifestyle: limiting or stopping the use of caffeine-containing beverages, quitting smoking, limiting alcohol consumption and stressful situations. A rare extrasystole, accidentally detected during examination and not accompanied by clinical manifestations, does not require medical treatment( !).However, if the extrasystole, especially the ventricular, is very frequent( more than 50 extrasystoles per hour), it is of a group nature, and it is also hard for patients, it is necessary to take special antiarrhythmic drugs( Atenolol, Allapinin, Propanorm, Etatsizin, Sotaleks, Kordaron).

    WARNING!Prolonged intake of Allapinin, Etatsizina and Propanorm is dangerous for patients who underwent myocardial infarction.

    Frequent ventricular extrasystole can also be eliminated by radiofrequency ablation of the cardiac pathways.

    Symptoms of arrhythmia

    There are certain differences between the symptoms of bradycardia( rare rhythm) and tachycardia( frequent rhythm).

    What are the symptoms of bradycardia?

    With a rare heart rhythm, the following symptoms are observed;

    • general weakness;
    • dizziness;
    • shortness of breath;
    • darkening in eyes;
    • fast fatigue;
    • state is close to loss of consciousness( "I want to grab something to avoid falling").

    ATTENTION!The extreme manifestations of bradycardia are short-term attacks of loss of consciousness( seconds) - "walked-went - came to the senses lying on the floor."This may be preceded by a feeling of "hot flush in the head".

    Prolonged loss of consciousness( 5-10 minutes or more) is not characteristic for bradycardia.

    What are the symptoms of tachycardia?

    With frequent heart rhythm, the following symptoms are observed:

    • Sensation of rapid heartbeat;
    • Shortness of breath;
    • General weakness;
    • Fast fatigue.

    ATTENTION!Some types of tachycardia( ventricular tachycardia, ventricular fibrillation) can lead to clinical death and require immediate resuscitation( defibrillation).

    Reasons for arrhythmia

    Arrhythmias in our heart can be caused by:

    1. endocrine disorders: increase in the level of thyroid hormone( thyrotoxicosis) hormones and adrenal glands( adrenaline), blood sugar level drop.
    2. violation of water-salt metabolism( change in the level of potassium, sodium, calcium, magnesium in the blood).
    3. violation of acid-base balance( changes in the level of oxygen and carbon dioxide in the blood).
    4. intoxication( alcohol, smoking, drugs, side effects of drugs).
    5. atherosclerosis( manifested in the narrowing of the vessels, which leads to a violation of blood supply to the organs and heart).
    6. heart defects
    7. heart failure

    Reasons for arrhythmia

    In the orderly operation of the conduction system of the heart, the following problems can arise:

    1. impairment of the formation of a pulse in one of the "links" of the conduction system of the heart: excessive( pathological) activity is extrasystole, some supraventricular or ventricular tachycardias.
    2. impairment or features of impulse conduction in one of the sites of the conduction system of the heart: atrioventricular block, atrial flutter.

    Arrhythmia prevention

    Arrhythmias are most often a symptom or complication of the underlying disease, so primary prevention is the adequate and timely treatment of existing acute or chronic diseases.

    Secondary prophylaxis( when a specific type of arrhythmia is established).

    Secondary prophylaxis is not performed with bradycardia.

    As a secondary prophylaxis for tachycardia, a number of antiarrhythmic drugs are used:

    • Adrenoblockers( Anaprilin, Egilok, Atenolol, Concor);
    • Calcium antagonists( Verapamil, Diltiazem);
    • Cardarone;
    • Sotaleks;
    • Allapinin;Propanorm and others.

    ATTENTION!Drugs that have antiarrhythmic action are strictly forbidden to take without the appointment of a doctor, as against the background of their reception, life-threatening conditions may arise, including aggravation of the course or appearance of a new type of arrhythmia.

    Complications of arrhythmia

    Some cardiac arrhythmias( atrial fibrillation, atrial flutter, ventricular tachycardia) can be accompanied by acute cardiac insufficiency( a sharp fall in blood pressure, pulmonary edema), chronic heart failure( general weakness, fatigue, dyspnea, swelling of the lowerextremities), other arrhythmias( complete AV block, ventricular fibrillation) can lead to cardiac arrest and the state of clinical death.

    Arrhythmias are most often a complication of a disease. However, having appeared, they can sharply aggravate its clinical course. Not all arrhythmias are equally dangerous and significant for the prognosis of the disease and life of the patient:

    Insignificant for course and prognosis of affection

    Significant for the course and prognosis of the disease

    Dangerous for life

    Sinus tachycardia

    Sinus bradycardia

    AB blockade of the 1st degree

    Block block

    Single extrasystoles

    Atrial fibrillation( ciliary arrhythmia) with a heart rate of less than 110 per minute

    Paroxysmal supraventricular( supraventricular) tachyardia

    AV blockade of the second degree

    Ventricular extrasystoles( frequent, paired)

    Atrial fibrillation( ciliary arrhythmia) with a heart rate of more than 110 per minute

    Paroxysmal ventricular tachycardia

    Ventricular fibrillation

    Ventricular flutter

    Complete AV blockade

    Danger to life is associated, first of all, with the risk of sudden cardiac death as a result of cardiac arrest.

    Diagnosis of arrhythmia

    The primary diagnosis of arrhythmia can be the presence of your clinical manifestations, characteristic of heart rhythm disturbances.

    The next step is to register your electrocardiogram.

    However, on an electrocardiogram, arrhythmia can be detected immediately only if it is permanent or persistent. Since many arrhythmias are temporary( paroxysmal), it often requires a round-the-clock recording of an electrocardiogram( Holter monitoring).In this case, sensors are installed on the patient's body connected to a compact device( the size of a camera), which constantly records an electrocardiogram in the usual mode of the patient's vital activity. It is possible that during the 24-hour monitoring, the arrhythmia will also not be recorded.

    In this case, special studies are carried out to provoke arrhythmia and determine its mechanism. These include:

    • transesophageal heart stimulation.
    • tilt test.
    • intracardiac( invasive) electrophysiological study.

    If you have frequent( rhythmic or irregular) heart contractions, irregular heartbeats or short-term episodes of darkening in the eyes, seek medical advice. It is extremely important to register the arrhythmia on an electrocardiogram to determine its mechanism, because you can cure only if and only if you know what you are treating( ?).

    Treatment of arrhythmia

    Treatment of bradycardia

    The only method of treatment of bradycardia, accompanied by known clinical manifestations is the implantation of a permanent pacemaker.

    The main indications for permanent cardiac pacemaker implantation are:

    Atrioventricular blockade of II and III degree, which are accompanied by clinical manifestations of bradycardia( dyspnea, dizziness, fainting) or pauses for more than 3 seconds, especially in patients with chronic heart failure.

    Syndrome of sinus node weakness with clinical manifestations of bradycardia , primarily in patients with a heart rate & lt;40 beats per minute in waking state.

    Note . If bradycardia does not have clinical manifestations, then the need for specialized treatment is usually absent.

    Treatment of atrial fibrillation

    Atrial fibrillation can be paroxysmal( paroxysmal) and permanent.

    If we are dealing with an attack of atrial fibrillation, it should be attempted to stop( especially if this is the first occurrence of arrhythmia in your life).

    If you have a permanent form of atrial fibrillation, you need a constant intake of drugs to control heart rate and prevent stroke.

    What are the methods for stopping atrial fibrillation?

    The most effective drugs for stopping attacks of atrial fibrillation are Novokainamide( inside and intravenously) and quinidine( inside).The use of them is possible only according to the doctor's prescription under the control of the electrocardiogram and the level of arterial pressure. Cordarone( inside and intravenously) and Propanorm( inside) are also used.

    The use of Anaprilin, Digoxin and Verapamil for relief of atrial fibrillation is less effective, but by decreasing the heart rate, they improve the health of patients( reduction in dyspnea, general weakness, palpitation).

    The most effective method of arresting atrial fibrillation is electrical cardioversion( about 90%).However, due to the need for short-term general anesthesia( anesthesia), it is resorted to when the patient's condition worsens against the background of arrhythmia progressively, the positive effect of drug therapy is absent or not expected( for example, because of the duration of the arrhythmia).

    WARNING!If you develop an attack of atrial fibrillation, seek medical help urgently, since it is advisable to stop this arrhythmia within the next 48 hours( !).After this period, there is a sharp increase in the risk of intracardiac blood clots and related complications( stroke).Therefore, if atrial fibrillation lasts more than two days, it is necessary to take Warfarin( to reduce blood clotting) for 3-4 weeks and only then you can try to stop it. If successful outcome, taking Warfarin should be continued for another 4 weeks, while maintaining atrial fibrillation, it will have to be taken continuously.

    After successful recovery of the sinus rhythm, antiarrhythmic drugs are usually prescribed( Allapinin, Propanorm, Sotalex, Kordaron) to prevent repeated attacks of atrial fibrillation.

    What therapeutic measures are taken with a permanent form of atrial fibrillation?

    If you have established a permanent form of atrial fibrillation( that is, all attempts at arresting the arrhythmia were unsuccessful) it is important to perform two tasks: to control the heart rate( approximately 70-80 beats per minute at rest) and prevent the formation of thrombi. The first task will help to solve the constant intake of Digoxin, adrenoblockers( Egilok, Atenolol, Concor), calcium antagonists( Verapamil, Diltiazem) or their combination. The second solution ensures a constant intake of Warfarin under the control of the state of the blood coagulation system( prothrombin index or INR).

    Are there methods for the radical elimination of atrial fibrillation( atrial fibrillation)?

    The only method of radical elimination of atrial fibrillation is radiofrequency isolation of pulmonary veins. Due to complexity and high cost, this catheter operation is still conducted only in large federal centers. Its efficiency is 50-70%.

    Also, with frequent paroxysms of atrial fibrillation and a permanent form of atrial fibrillation, it is possible to carry out RF-ablation of the AV node, at which an artificial complete transverse blockade( AV-blockade of the third degree) is created and a permanent pacemaker is implanted. In fact, atrial fibrillation remains, but the person does not feel it.

    Treatment of extrasystole

    Treatment of patients with extrasystole, primarily aimed at treating the underlying disease or condition that led to its development( treatment of myocardial infarction, correction of water-salt metabolism, etc.).In many cases, extrasystole can be eliminated by changing the lifestyle of the patient: limiting or stopping the use of caffeine-containing beverages, quitting smoking, limiting the use of alcohol and stressful situations. A rare extrasystole, accidentally detected during examination and not accompanied by clinical manifestations, does not require medical treatment( !).However, if the extrasystole, especially the ventricular, is very frequent( more than 50 extrasystoles per hour), is of a group nature, and is also hard for the patient, it is necessary to take special antiarrhythmic drugs( Atenolol, Allapinin, Propanorm, Etatsizin, Sotaleks, Kordaron) ATTENTION!!!Prolonged administration of Allepinin, Etatsizina and Propanorm is dangerous for patients who underwent myocardial infarction.

    Treatment of supraventricular tachycardia

    When an attack of rapid heartbeat occurs, specific samples are used first:

    • Valsalva test - strong straining at the height of inspiration with closed mouth and clamped nose.
    • Ashner's test - pressing on the closed eyeballs for 4-10 seconds in a prone position.

    These techniques can reduce tachycardia, and in some cases, interrupt it.

    ATTENTION!These samples are dangerous for elderly patients with severe heart failure or cerebral circulatory insufficiency.

    If tachycardia continues, use short( but quick!) Drugs( Anaprilin, Verapamil).

    Successful cessation of tachycardia does not guarantee the absence of her attacks in the future. Rather, on the contrary, the appearance of tachycardia indicates that in your heart there are conditions( or causes) for its appearance, only the cause( starter) is missing.

    If tachycardia attacks are very rare, easily transferred and quickly discontinued, there is no need for continuous preventive medication.

    With frequent, persistent attacks of tachycardia, a constant intake of antiarrhythmic drugs is necessary( Atenolol, Concor, Verapamil, Allapinin, Propanorm, Sotalex).

    Radical treatment of all types of supraventricular tachycardias is the radiofrequency ablation of the cardiac pathways, during which an isolated burn injury of the "focus" of arrhythmia or pathological junction( an additional pathway with WPW syndrome) is performed with the catheter. The effectiveness of this technique exceeds 90%.

    Treatment of ventricular tachycardia

    At the time of this life-threatening tachycardia, urgent medical attention should be urgently requested, and, in the event that ventricular tachycardia leads to clinical death, be able to independently carry out resuscitation.

    WARNING!If you suddenly lose consciousness before your eyes, while there is no independent breathing and the pulsation of the main arteries( on the neck, in the inguinal fold) is not determined, urgently begin resuscitation measures:

    Correctly lay the reanimated, ensuring the patency of the airways. To do this:

    • patient must be laid on a flat solid surface and the maximum throw back to him.
    • to improve the patency of the airways from the mouth, you need to remove removable dentures or other foreign bodies. In case of vomiting, turn the patient's head to the side, and remove the contents from the mouth and pharynx with a tampon( or improvised means).

    Check for self-contained breathing.

    If there is no independent breath, start artificial ventilation. The patient should lie in the previously described posture on his back with a head thrown back sharply. The pose can be provided by placing under the shoulders of the roller. You can hold your head with your hands. The lower jaw must be pushed forward. The assisting person takes a deep breath, opens his mouth, quickly brings it closer to the patient's mouth and, pressing his lips tightly to his mouth, makes a deep exhale, i.e.as if blowing air into his lungs and inflating them. To the air does not go through the nose reanimiruemogo, pinch his nose with your fingers. Then the relief man leans back and takes a deep breath again. During this time, the chest of the patient falls down - there is a passive exhalation. Then the caretaker again blows air into the patient's mouth. For hygienic reasons, the patient's face can be covered with a handkerchief before blowing air.

    If there is no pulse on the carotid artery, artificial ventilation of the lungs must necessarily be combined with indirect heart massage. For an indirect massage, place your hands on one another so that the base of the palm resting on the sternum is strictly on the median line and 2 fingers above the xiphoid process. Without bending hands and using your own body weight, for 4-5 cm smoothly move the sternum to the spine. At this displacement, compression( compression) of the chest occurs. Massage so that the duration of the compression is equal to the interval between them. The frequency of compression should be about 80 per minute. In pauses, leave your hands on the sternum of the patient. If you are carrying out intensive care alone, after 15 compressions of the thorax, make two air inlets in succession. Then, repeat an indirect massage in combination with artificial ventilation.

    Do not forget to constantly monitor the effectiveness of your resuscitation. Resuscitation is effective if the patient has pink skin and mucous membranes, pupils have narrowed and a response to light has appeared, spontaneous breathing has resumed or improved, a pulse appeared on the carotid artery.

    Continue resuscitation before the ambulance arrives.

    In the arsenal of emergency medical services, there is necessarily a defibrillator, an instrument with which a powerful electric discharge is needed to restore a normal rhythm during a life-threatening arrhythmia. In a number of cases, emergency medical doctors use intravenous antiarrhythmic drugs( Lidocaine, Cordarone) and deliver the patient to the intensive care unit, where intensive care and examination of the patient continues.

    Further treatment of ventricular tachycardia is determined by the pathology that caused this terrible arrhythmia and the peculiarities of the tachycardia itself( localization, stability, regularity of contractions, etc.).

    The appearance of ventricular tachycardia in childhood is more often associated with congenital( hereditary) disease( Brugada syndrome).In this case, a cardioverter-defibrillator is implanted - an extremely "smart" device that "senses"( arrives) the occurrence of a life-threatening arrhythmia and immediately inflicts a powerful electrical discharge to suppress it.

    In more mature age, the appearance of ventricular arrhythmias is often associated with, so-called, arrhythmogenic dysplasia( structural changes) of the right ventricle. In this case, radiofrequency ablation( burning out) of the "focus" of arrhythmia is carried out.

    If cardiomyopathy( structural change in the left ventricle) or coronary heart disease( previously suffered myocardial infarction) is based on the appearance of ventricular tachycardia( or ventricular fibrillation), a cardioverter defibrillator is implanted.

    Prophylactic medication for ventricular tachycardia, including in people with implanted cardioverter-defibrillator, is administered with antiarrhythmic drugs( Kordaron, Sotaleks, Etatsizin, Propanorm and others).

    ATTENTION!The administration of Etatsizina and Propanorm is contraindicated in patients who have suffered a myocardial infarction. Since most antiarrhythmic drugs can provoke the appearance or aggravation of arrhythmia, their appointment requires regular recording of an electrocardiogram and observation by a cardiologist.