Heart rhythm disturbances - Causes, symptoms and treatment. MF.

The heart of a person is a continuously running pump, performing about one hundred thousand cuts per day. Support the contractile function of the heart helps its conductive system. It includes a sinus node, where an electrical impulse is generated;an atrioventricular node that transmits a pulse to the bundle of the Hyis in the interventricular septum and the Purkinje fibers responsible for contraction of the ventricular muscle. Normally, the frequency of cuts is from 60 to 90 beats per minute.

The heart rhythm is sinus and correct. Sinus rhythm means that every pulse that causes a contraction of the heart muscle originates from the sinus node and is transmitted further downward. Correct rhythm - regular contractions of the heart with the same periodicity.

Deviations from normal heart rhythm are called disturbances of rhythm and conduction, or arrhythmias. The frequency of contractions may then increase or decrease, and the rhythm must be sinusoidal and correct or not. Some rhythm disturbances are not dangerous to humans and can occur even in a young healthy body, and some threaten health and life and require long-term treatment.

The rhythm disorders are divided into the following types:

1. Impairment of pulse formation. If impulses are formed in the sinus node, but too often, sinus tachycardia develops( heart rate over 90 per minute), if seldom is a sinus bradycardia( heart rate less than 60 per min).Another type of violations include sinus( respiratory) arrhythmia.

If the impulses arise from the lower parts of the conducting system, an ectopic( located in the wrong place) source of excitation is formed. Such a focus can be located in the atria, atrioventricular node or in the ventricles, and can send pulses both above and below its location. This type of rhythm disturbance includes slow, slipping and accelerated ectopic( non-paroxysmal tachycardia) rhythms, extrasystole and paroxysmal tachycardia. Each of these disorders can be atrial, atrioventricular and ventricular. Also, because of the existence of ectopic foci, fibrillation( fibrillation) and atrial flutter, fibrillation and flutter of the ventricles can develop.

2. Conduction abnormalities in the heart are called blockades. The impulse holding unit can occur on any part of the conductive system, so the sinoatrial, intracardiac, atrioventricular blockades, the bundle branch block are isolated. In addition, the same group includes Wolff-Parkinson-White syndrome( ERW syndrome), PQ shortened syndrome, ventricular asystole( cardiac arrest).

3. Combined species - parasystole, atrioventricular dissociation, ectopic rhythms with blockade output. These are the conditions in which an additional, ectopic pacemaker works parallel to the sinus rhythm driver, but they are separated by a blockade. In the heart there is a double rhythm formation, that is, the atria work in their rhythm, and the ventricles in their own.

Causes of heart rhythm disorder

What conditions can cause heart rhythm disturbances?

Not always the presence of abnormalities from a normal heart rhythm is a pathology. For example, people during a night's sleep experience a moderate slowing of the heart rhythm, that is, a bradycardia, due to the predominant vagal influences on the heart( the vagus nerve slows the heart rate, night - the "vagus kingdom").Also, during sleep often occur sinus arrhythmia, atrioventricular blockade of 1 degree, single atrial and ventricular extrasystoles. Bradycardia can also occur in athletes who are well trained not only in skeletal musculature, but also in the heart muscle.

With such conditions as psycho-emotional stress, stress, physical stress, tachycardia develops. This is due to the imbalance in the autonomic nervous system and the release of the stress hormone - adrenaline, which stimulates cardiac contractions to better supply blood to the muscles and brain. The use of large amounts of coffee, alcohol, nicotine can lead to the appearance of tachycardia, extrasystole. Malignant, daily abuse of alcoholic beverages can cause paroxysms of atrial fibrillation and supraventricular tachycardia.

Changes in the electrolyte blood composition( disbalance of sodium, potassium and magnesium balance), changes in blood viscosity cause deterioration in the work of the heart and blood vessels. Such changes can be caused by febrile conditions accompanying inflammatory processes in the body, overheating or hypothermia, food poisoning, anemia, blood loss, shock, collapse, dehydration due to vomiting or diarrhea.

The rhythm disorders that occur in the described states are usually transient, disappearing when the cause is eliminated, and no treatment is required.

More dangerous are rhythm abnormalities arising from drug overdose. For example, with frequent glycoside intoxication( digoxin, strophanthin, korglikon), overdose of antiarrhythmics( propafenone, etmozin), beta-adrenomimetics( salbutamol, berodual), frequent ventricular extrasystole, paroxysmal tachycardia can develop.

Risk factors for arrhythmia include elderly age, weighed heredity, overweight, bad habits.

Diseases that cause heart rhythm disorders

Rhythm disorders can occur due to many diseases not only of the heart, but also of other organs. All possible causes can be divided into the following groups.

1. cardiovascular diseases
- congenital and acquired defects
- cardiomyopathy
- myocardial infarction
- hypertension
- left ventricular hypertrophy
- endocarditis, myocarditis, pericarditis
- rheumatic heart disease
- postinfarction cardio, postmiokarditicheskogo genesis
- heartinsufficiency
2. Diseases of the nervous system
- vegetative dystonia
- neuroses, neurasthenia
- disorders of cerebral circulation( strokes, discsencephalopathy)
- brain tumors
- brain injury
3. Endocrine system diseases
- diabetes
- hypo- and hyperthyroidism - decrease or increase in activity of thyroid hormones
- pheochromocytoma - adrenal tumor
- menopause and premenstrualsyndrome in women
4. Diseases of the gastrointestinal tract
- hernia of the esophageal opening of the diaphragm
- cholecystitis
- pancreatitis

As a rule, in the rezuOut of the non-cardiac causes, sinus tachycardia and bradycardia develop, supraventricular tachycardia, atrial extrasitolia, rare and medium frequency ventricular extrasystole, atrioventricular blockade of 1-2 degrees, single-bundle blockade of the bundle.

Dangerous rhythm disturbances( frequent ventricular extrasystole, complete blockade, paroxysmal ventricular tachycardia, ventricular fibrillation) occur with severe organic damage to the heart.

First aid for heart rhythm disorders

The type of care for a particular rhythm disturbance depends on its type and the reason that led to it. In some cases, it is enough to drink a couple of tablets, and in some you will need hospitalization with a full examination and treatment.

Before giving first aid to a patient at home, you need to assess the complaints, the general condition and the need to call an ambulance team. Even if the patient as a whole feels satisfactory, an ambulance still needs to be called up for ECG recording and analysis by the doctor. If the general condition suffers, there are signs such as a drop in pressure, fainting, pale skin, speech and vision impairment, paralysis of the limbs, all the more necessary to call an ambulance as soon as possible by dialing the number "03" and describing all the symptoms to the dispatcher.

Common measures for rhythm disturbances are as follows:

- to calm and lay the patient by placing a pillow under his head with a rapid pulse and under the knees with a rare pulse( to reduce and increase the blood flow to the heart, respectively)
- open the window, unbutton the clothing for accessing oxygen
- measure blood pressure,
- call an ambulance
- the patient needs a sedative medication - tincture of valerian, corvalol, valoserdin, etc.
- if the attack has not developed for the first time, and the patient uses it for prescription appointed by the doctor( NOTmedications), take this medication
- if worried about heart pain, take nitroglycerin under the tongue of
- if signs of pulmonary edema occur( pronounced choking, bubbling breath, foamy sputum), drink furosemide or Lasix pill( if any)
- apply onefrom vagal samples with a rapid pulse. These include straining at a deep inspiration, pressing on the eyelids of closed eyes for 10 to 30 seconds, causing a cough or vomiting reflex. With a rare pulse,
can not be performed - if severe rhythm disturbances that caused cardiac arrest and clinical death( lack of consciousness, breathing and pulse on the carotid artery on the neck, no pupillary reaction to light) develop, begin cardiopulmonary resuscitation. Lay the patient on a firm surface on his back, throw his head back, put a cushion under his neck, begin an indirect heart massage and artificial mouth-to-mouth breathing. One cycle includes 15 quick pressing of two locked hands in the palm of the straightened hands on the lower part of the sternum and 2 inhalation of the air in the mouth, holding the patient's nose. After three cycles, assess the presence of a pulse on the carotid artery. If there is no pulse, continue resuscitation before the arrival of an ambulance, but no more than 30 minutes, since during this time, brain death develops.

The ambulance team, after making an ECG and evaluating the situation, can resort to medical methods of arrhythmia treatment, such as:
- with bradyarrhythmias - atropine 0.1% - 1 ml intravenously or slowly( daily dose not more than 4 ml), dopamine( dopamine, dopamine) 200 mg per 200 ml of saline intravenously drip, eufillin 2.4% - 5-10 ml intravenously stratified
- with paroxysm of atrial fibrillation - digoxin 0.025% 1-2 ml intravenously strontaneously, panangin 10 ml intravenously strontaneously, novocainamide 10% - 10ml intravenously slow
- with paroxysm of the supraventricularTachycardia - vagal tests, adenosine triphosphoric acid( ATP) 1% - 1 - 2 ml intravenously strontaneously, strophanthin( digoxin) 0.025% - 1 ml intravenously slowly, novocaineamide
- with paroxysm of ventricular tachycardia - lidocaine 2% - 6 ml intravenously strontaneously, novocainamide, mezaton 1% - 0.3 - 0.5 ml with reduced arterial pressure, cordarone( amiodarone) 5% - from 3 to 9 ml intravenously strontaneously, aimalin 2.5% - 2 ml intravenously slow or stratified
- in the absence of effect, temporary pacingwith the help ofa fibrillator( if the equipment allows)

To which doctor should I go for heart rhythm disturbances?

When the ambulance arrives, the doctor interprets the electrocardiogram, assesses the patient's condition and the need for admission to the therapy, cardiology or arrhythmology unit.

In the case of arresting complaints by vagal methods or medically, restoring the normal rhythm according to ECG data, the absence of the alleged complications, the patient can be left at home under the supervision of the attending physician. Sinus and supraventricular tachycardia, a rare extrasystole, incomplete blockades without loss of consciousness can be treated in a polyclinic at the place of residence, where the patient will be further examined on an outpatient basis. For this, the patient must immediately visit the therapist at the polyclinic, which will send him to the arrhythmologist and / or cardiologist.

Indications for restoring the rhythm in the hospital are:

- any rhythm disturbances, accompanied by the general severe condition of the patient, heart failure, pulmonary edema, symptoms of a heart attack, stroke and other formidable complications
- any rhythm disturbances with signs of myocardial ischemia on the ECG, asmay develop a myocardial infarction
- paroxysm of atrial fibrillation, frequent ventricular extrasystole, ventricular tachycardia, especially the first arising
- the first fully arisen left blockadeor remains persistent, but with pains in the heart or other uncharacteristic symptoms of
- a bradycardia accompanied by Morganya-Edessa-Stokes( loss of consciousness)

After discharge from the hospital, the patient is also observed with a cardiologist and arrhythmologist. If a patient suffers from rhythm disturbances for a long time and cardiosurgical treatment is planned, he is observed by a cardiac surgeon.

In any case, the patient was treated at the hospital or was left under the supervision of a doctor from a polyclinic, he must regularly visit a doctor, take prescribed medications and in no case to do self-diagnosis and self-medication, as this is dangerous for health and life.

Doctor therapist Sazykina O.Yu.