Heart rhythm disturbances are common. The causes of heart rhythm disturbances can be not only diseases of the heart, gastrointestinal tract, nervous and endocrine systems, but also some physiological conditions of the body.

Heart - central authority in the human body, its engine. The heart muscle pumps blood constantly, both day and night during sleep, like a pump. The person does not pay attention to this at all. It is what directs blood throughout the body. Sometimes there are problems with the heart. The rhythm by which it works smoothly is disrupted. If this failure occurs within physiological limits, there is no cause for concern. But sometimes attacks of arrhythmia are an indicator of serious disorders in the body and accompany many other cardiovascular disorders.

The heart consists of four chambers, represented by two ventricles and two atria, and has the unique ability within itself to generate a spontaneous electrical impulse. This feature is called automatism of the heart muscle. How is this impulse born? Between the right ventricle and the atrium there is a cluster of special muscle cells that can spontaneously contract, causing tissue excitation. Then this impulse spreads to other parts of the heart, thanks to certain intermediaries. This trigger point for muscle cells is called the sinus node. From it, an electrical impulse follows through the atrioventricular node, spreading to the His bundle and Purkinje fibers. This is how the entire heart contracts. From 60 to 90 conductions occur per minute. It should be noted that in children the number of heartbeats per minute is about 120, for them this is the norm. With the correct rhythm, the heart contracts evenly and periodically. If disturbances occur in any of these areas, an attack of arrhythmia occurs. Such disorders may manifest themselves as an increase or decrease in the number of contractions.

Characteristics of different types of cardiac arrhythmias

There are several types of heart rhythm disturbances:

Pathology of impulse formation

• Excitation impulses arising in the sinus node are called sinus rhythm. In this case, the increased production of the number of such rhythms is called sinus tachycardia. A decrease in the number of impulses – sinus bradycardia. With tachycardia, the heart rate is more than 90 per minute. With bradycardia, the heart rate is below 60 beats per minute. These are disturbances in the number of impulses produced by the heart.
• In some pathologies, nervous excitation does not occur in the sinus node, as it should normally occur, but in any other element of the conduction of nervous excitation in the heart. Such an atypical place of origin of the electrical impulse is called an ectopic focus of excitation. Spontaneous contraction of muscle cells can occur in the atrioventricular node, bundle of His, atria or ventricles. The impulse from them can spread not only through the underlying parts of the heart, but also go upward. Such disorders include extrasystole and paroxysmal arrhythmia. Atypical foci of excitation can also trigger the occurrence of ventricular or atrial fibrillation. These are violations of the source of origin nerve impulse.

Heart blocks

In this condition, disturbances in the conduction of nerve excitation occur inside the heart, in any of its areas:

• bundle branch block;
• sinoatrial block;
• atrioventricular block.

Mixed arrhythmic pathologies

Along with sinus rhythm, an ectopic focus of excitation appears in the heart. Both nerve impulses propagate separately due to a blockage between them. The atria contract according to one rhythm, and the ventricles - according to the second.

Causes of arrhythmias

The causes of heart rhythm disturbances are divided into two groups:

• Physiological disturbances in heart rhythm can occur several times per day. This should not be a cause for concern.
• Pathological rhythm disturbances go beyond physiological boundaries, which can be caused by several reasons.

The age-related characteristics of the body are such that over time, the heart muscle loses elasticity and firmness, pumping blood in the required volume becomes difficult, which leads to disruption of the organ.

Genetic predisposition is not the least risk factor for the occurrence of pathological rhythmic contractions. Presence in anamnesis of this disease increases the chances of heart rhythm disturbances in offspring.

Abnormalities in the development and structure of the heart can also cause repeated attacks of arrhythmia.

Natural causes of rhythm disturbances

The occurrence of heart rhythm disturbances does not always signal the presence of a disease. There are a number of normal physiological conditions when there is a change in rhythm. Among them are the following reasons:

1. During sleep, the heart rate decreases slightly, causing bradycardia.
2. Bradycardia is natural in people who play sports professionally. To better adapt to constant strong physical activity, the heart begins to work differently.
3. IN stressful situations or during unusual excessive physical exertion, increased production of adrenaline occurs, which leads to tachycardia.
4. Drinking alcohol and smoking cause physiological tachycardia. Long-term consumption of alcohol in large quantities can lead to heart rhythm pathology, manifested by paroxysmal atrial fibrillation.

Temporary changes in the functioning of the heart lead to:

• food poisoning,
• overheating in the sun and at high temperatures,
• inflammatory processes,
• feverish conditions,
• states of shock,
• hypothermia.

Diseases that cause arrhythmia

1. Diseases of the endocrine system: lack of the hormone insulin (diabetes mellitus), pathologies of the thyroid gland, menopause in women, some tumor processes in the adrenal glands (pheochromocytoma).

2. Diseases of the nervous system:

• brain tumors and injuries,
• neuroses,
• neurasthenia,
• cerebrovascular accidents, strokes,
• vegetative-vascular dystonia.
• Diseases of the heart and blood vessels:
• myocardial infarction,
• hypertension of any severity,
• endocarditis,
• myocarditis,
• heart defects, acquired defects,
• all types of heart failure.

3. Diseases of the stomach and intestines:

• cholecystitis,
• some types of hernias,
• pancreatitis.

How to relieve an attack of arrhythmia?

Symptoms of arrhythmias are quite diverse, sometimes they can be confused with manifestations of other pathologies. If symptoms such as spontaneous causeless shortness of breath, fainting and pre-fainting states, discomfort in the chest, dizziness, sudden fatigue, the appearance of unconscious fear, darkening in the eyes occur, you should immediately call an ambulance and provide Urgent measures to improve the patient's condition. If a person says that he began to feel his heart beating and changes in its work, an arrhythmia can be suspected, which requires some help for the patient. When such a condition occurs, many people become confused and panic because they do not know what to do in the event of an attack of heart rhythm failure.

How to relieve an attack of arrhythmia? Before the arrival of medical personnel, it is necessary to lay the person on a flat surface, loosen all constricting elements of clothing (tie, belt), provide fresh air by opening the windows in the room, and give sedatives to drink (a few drops of Corvalol or valerian tincture). When fainting, the patient should be laid on the floor, head thrown to the side and back to clear the airway. If a person has difficulty breathing despite all this and there is a suspicion of the development of pulmonary edema and atrial fibrillation, the patient must be helped to take a semi-sitting position.

The arriving medical assistance will perform an ECG, carry out therapeutic manipulations to relieve an acute attack of arrhythmia, and take the patient to the hospital for further monitoring of his condition.

Diagnosis and treatment

In order to confirm the diagnosis, the doctor carefully examines the patient, clarifies all symptoms, their duration and frequency of occurrence, and prescribes additional examination methods. These include:

• Blood, urine, stool tests - mandatory procedures when examining any pathology.
• Electrocardiogram.
• Ultrasound examination of the heart.
• Magnetic resonance imaging if necessary.
• Holter monitoring of the electrocardiogram. Monitoring is carried out throughout the day. To do this, the patient carries a special recorder with him in his purse, which records the electrocardiogram all day. Then the cardiologist deciphers the data obtained and characterizes the results of the study for the patient.

If a person has an attack of arrhythmia, they should not treat themselves. You need to seek qualified help, which will include several stages. Initially, it is necessary to eliminate the cause of the heart failure by taking anti-inflammatory, hormonal and other drugs (for non-cardiac etiology). Then various antiarrhythmic drugs are prescribed, which, if necessary, stimulate or, conversely, suppress the conduction of the nerve impulse. Some of these medications will have to be taken for a long time. For better effect Vitamins are used for treatment. Positive results for cardiac arrhythmias, the use of physiotherapeutic methods of treatment can be helpful. Among them is a low-frequency magnetic field.

According to indications, surgical treatment is prescribed. The introduction of a pacemaker or a special defibrillator into the body solves the problem of abnormal heart rhythm.

At the moment, heart rhythm disturbances can be successfully treated and do not become a serious problem for humans. Timely identification of the causes and diagnosis of the disease provides a great chance of success in treating the pathology.

Heart rhythm disturbances: types, causes, signs, treatment

Human heart in normal conditions beats evenly and regularly. The heart rate per minute ranges from 60 to 80 beats. This rhythm is set by the sinus node, which is also called the pacemaker. It contains pacemaker cells, from which excitation is transmitted further to other parts of the heart, namely to the atrioventricular node, and to the His bundle directly in the tissue of the ventricles.

This anatomical and functional division is important from the point of view of the type of a particular disorder, because a block in the conduction of impulses or acceleration of impulses can occur in any of these areas.

Heart rhythm disturbances are called and are conditions when the heart rate becomes less than normal (less than 60 per minute) or more than normal (more than 80 per minute). Arrhythmia is also a condition when the rhythm is irregular (irregular, or non-sinus), that is, it comes from any part of the conduction system, but not from the sinus node.

Different types of rhythm disturbances occur in different percentages:

• Thus, according to statistics, the lion's share of rhythm disturbances with the presence of underlying cardiac pathology are atrial and ventricular, which occur in 85% of cases in patients with coronary artery disease.
• In second place in frequency is the paroxysmal and permanent form of atrial fibrillation, which occurs in 5% of cases in people over 60 years of age and in 10% of cases in people over 80 years of age.

Nevertheless, Disturbances in the functioning of the sinus node are even more common, in particular, and those that arose without heart pathology. Probably every inhabitant of the planet has experienced stress caused by stress or emotions. Therefore, these types of physiological deviations do not have statistical significance.

Classification

All rhythm and conduction disorders are classified as follows:

1. Heart rhythm disturbances.
2. Conduction disorders in the heart.

In the first case, as a rule, there is an acceleration of the heart rate and/or irregular contraction of the heart muscle. In the second, the presence of blockades of varying degrees with or without slowing of the rhythm is noted.
Generally The first group includes disorders of the formation and conduction of impulses:

The second group of conduction disorders includes blocks () on the path of impulses, manifested by intraatrial block, 1, 2 and 3 degrees and bundle branch block.

Causes of heart rhythm disturbances

Rhythm disturbances can be caused not only by serious heart pathology, but also physiological characteristics body. For example, sinus tachycardia can develop during fast walking or running, as well as after playing sports or after strong emotions. Respiratory bradyarrhythmia is a variant of the norm and consists of an increase in contractions when inhaling and a decrease in heart rate when exhaling.

However, such rhythm disturbances, which are accompanied by atrial fibrillation (atrial fibrillation and flutter), extrasystole and paroxysmal types of tachycardia, in the vast majority of cases develop against the background of diseases of the heart or other organs.

Diseases that cause rhythm disturbances

Pathology of the cardiovascular system occurring against the background of:

• , including acute and transferred ones,
• , especially with frequent crises and long-term,
• (structural changes in the normal anatomy of the myocardium) due to the above diseases.

Non-cardiac diseases:

• Stomach and intestines, for example, gastric ulcers, chronic cholecystitis, etc.
• Acute poisoning,
• Active pathology of the thyroid gland, in particular hyperthyroidism (increased secretion of thyroid hormones into the blood),
• Dehydration and disturbances in blood electrolyte composition,
• Fever, severe hypothermia,
• Alcohol poisoning
• Pheochromocytoma is a tumor of the adrenal glands.

In addition, there are risk factors that contribute to the occurrence of rhythm disturbances:

1. Obesity,
2. Bad habits,
3. Age over 45 years,
4. Concomitant endocrine pathology.

Do cardiac arrhythmias manifest themselves in the same way?

All rhythm and conduction disorders clinically manifest themselves differently in different patients. Some patients do not feel any symptoms and learn about the pathology only after a scheduled ECG. This proportion of patients is insignificant, since in most cases patients note obvious symptoms.

Thus, rhythm disturbances accompanied by rapid heartbeat (from 100 to 200 per minute), especially paroxysmal forms, are characterized by a sharp sudden onset and interruptions in the heart, lack of air, pain syndrome in the sternum area.

Some conduction disorders, such as fascicular blocks, do not show any signs and are recognized only on an ECG. Sinoatrial and atrioventricular blockades of the first degree occur with a slight decrease in heart rate (50-55 per minute), which is why clinically they can manifest only slight weakness and increased fatigue.

Blockades of the 2nd and 3rd degrees are manifested by severe bradycardia (less than 30-40 per minute) and are characterized by short-term attacks of loss of consciousness, called MES attacks.

In addition, any of the listed conditions may be accompanied by a general severe condition with cold sweat, intense pain in the left half of the chest, decreased blood pressure, general weakness and loss of consciousness. These symptoms are caused by impaired cardiac hemodynamics and require close attention from an emergency physician or clinic.

How to diagnose pathology?

Establishing a diagnosis of rhythm disturbance is not difficult if the patient presents typical complaints. Before the initial examination by a doctor, the patient can independently count his pulse and evaluate certain symptoms.

However The type of rhythm disturbances can be determined only by a doctor after, since each species has its own signs on the electrocardiogram.
For example, extrasystoles are manifested by altered ventricular complexes, paroxysm of tachycardia - short intervals between complexes, atrial fibrillation - irregular rhythm and a heart rate of more than 100 per minute, sinoatrial block - by lengthening the P wave, reflecting the conduction of the impulse through the atria, atrioventricular block - by lengthening the interval between the atrial and ventricular complexes, etc.

In any case, only a cardiologist or therapist can correctly interpret changes in the ECG. Therefore, when the first symptoms of rhythm disturbance appear, the patient should seek medical help as soon as possible.

In addition to an ECG, which can be performed upon the arrival of an ambulance team at the patient’s home, additional examination methods may be needed. They are prescribed in the clinic, if the patient was not hospitalized, or in the cardiology (arrhythmology) department of the hospital, if the patient had indications for hospitalization. In most cases, patients are hospitalized because even a mild heart rhythm disorder can be a precursor to a more serious, life-threatening rhythm disorder. The exception is sinus tachycardia, since it is often treated with tablets at the prehospital stage, and generally does not pose a threat to life.

Additional diagnostic methods usually include the following:

1. during the day (according to Holter),
2. Samples from physical activity(walking on stairs, walking on a treadmill - treadmill test, cycling - ),
3. Transesophageal ECG to clarify the location of the rhythm disturbance,
4. in the case when a rhythm disturbance cannot be registered using a standard cardiogram, and it is necessary to stimulate the heart contractions and provoke a rhythm disturbance in order to find out its exact type.

In some cases, an MRI of the heart may be required, for example, if the patient is suspected of having a heart tumor, myocarditis, or a scar after a myocardial infarction that is not reflected in the cardiogram. A method such as is a mandatory research standard for patients with rhythm disturbances of any origin.

Treatment of rhythm disturbances

Treatment for rhythm and conduction disorders varies depending on the type and the cause that caused it.

For example, in the case of coronary heart disease, the patient receives nitroglycerin (thromboAss, aspirin cardio) and drugs to normalize high cholesterol levels in the blood (atorvastatin, rosuvastatin). For hypertension, the prescription of antihypertensive drugs (enalapril, losartan, etc.) is justified. In the presence of chronic heart failure, diuretics (Lasix, Diacarb, Diuver, Veroshpiron) and cardiac glycosides (digoxin) are prescribed. If a patient has a heart defect, surgical correction of the defect may be indicated.

Regardless of the cause, emergency care in the presence of rhythm disturbances in the form of atrial fibrillation or paroxysmal tachycardia consists of administering rhythm-restoring (antiarrhythmics) and rhythm-slowing drugs to the patient. The first group includes drugs such as panangin, asparkam, novocainamide, cordarone, strophanthin for intravenous administration.

For ventricular tachycardia, lidocaine is administered intravenously, and for extrasystole, betalocaine is administered in the form of a solution.

Sinus tachycardia can be stopped by taking anaprilin under the tongue or egilok (Concor, Coronal, etc.) orally in tablet form.

Bradycardia and blockades require completely different treatment. In particular, prednisolone, aminophylline, atropine are administered intravenously to the patient, and in case of low blood pressure, mesaton and dopamine along with adrenaline. These drugs “accelerate” the heart rate and make the heart beat faster and stronger.

Are there possible complications of heart rhythm disturbances?

Heart rhythm disturbances are dangerous not only because blood circulation throughout the body is disrupted due to improper functioning of the heart and decreased cardiac output, but also the development of sometimes dangerous complications.

Most often, patients develop against the background of one or another rhythm disturbance:

• Collapse. Manifests sharp drop blood pressure level (below 100 mm Hg), general severe weakness and pallor, pre-syncope or fainting. It can develop both as a result of a direct rhythm disturbance (for example, during an attack of MES), and as a result of the administration of antiarrhythmic drugs, for example, procainamide during atrial fibrillation. In the latter case, this condition is interpreted as drug-induced hypotension.
• Arrhythmogenic shock– occurs as a result of a sharp decrease in blood flow in the internal organs, in the brain and in the arterioles of the skin. It is characterized by the general severe condition of the patient, lack of consciousness, pallor or cyanosis of the skin, pressure below 60 mmHg, and a rare heartbeat. Without timely assistance, the patient may die.
• occurs due to increased thrombus formation in the heart cavity, since during paroxysmal tachycardias the blood in the heart “beats”, like in a mixer. Emerging blood clots may settle on inner surface heart (mural thrombi) or spread through the blood vessels to the brain, clogging their lumen and leading to severe ischemia of the brain substance. It manifests itself as sudden speech disturbances, unsteadiness of gait, complete or partial paralysis of the limbs.
• occurs for the same reason as a stroke, only as a result of blockage of the pulmonary artery by blood clots. Clinically manifested by severe shortness of breath and suffocation, as well as bluish discoloration of the skin of the face, neck and chest skin above the level of the nipples. When the pulmonary vessel is completely obstructed, the patient experiences sudden death.
• Acute myocardial infarction due to the fact that during an attack of tachyarrhythmia the heart beats at a very high frequency, and coronary arteries they are simply not able to provide the necessary blood flow to the heart muscle itself. Oxygen deficiency occurs in the cardiac tissues, and an area of ​​necrosis, or death of myocardial cells, forms. Manifested by sharp pain in the chest or in chest left.
• Ventricular fibrillation, and clinical death . More often they develop with paroxysm of ventricular tachycardia, which turns into ventricular fibrillation. In this case, the contractility of the myocardium is completely lost, and an adequate amount of blood does not enter the vessels. A few minutes after fibrillation, the heart stops and clinical death develops, which without timely assistance turns into biological death.

In a small number of cases, the patient immediately experiences a rhythm disturbance, any of the complications and death. This condition is included in the concept of sudden cardiac death.

Forecast

The prognosis for rhythm disturbances in the absence of complications and in the absence of organic heart pathology is favorable. Otherwise, the prognosis is determined by the degree and severity of the underlying pathology and the type of complications.

Acute cardiac arrhythmias can complicate the course of such serious diseases as myocardial infarction, cardiosclerosis, acute myocarditis, valvular rheumatic heart defects. They often require emergency care, as they themselves cause severe circulatory disorders and sometimes pose a threat to the patient’s life. The consequence of heart rhythm disturbances can be acute heart failure (for example, pulmonary edema), collapse or shock, an attack of angina, and cerebrovascular accident. A common complication of cardiac arrhythmias is thromboembolism. Let's look at what to do if there is a heart rhythm disorder.

Mechanism of heart rhythm disturbances

The main mechanisms of the occurrence of arrhythmias (heart rhythm disturbances) include dysfunction of automatism (changes in normal automatism in case of dysfunction of the sinus node, increased function of automatism of auxiliary pacemakers; the occurrence of pathological automatism in the myocardial cells of the atria and ventricles); conduction disorders (blockades - sinoauricular, atrioventricular, bundle branch blocks; reciprocal arrhythmias according to the “re-entry” mechanism, arising in the presence of several conduction paths, unidirectional blockade of conduction in one of the paths and slowdown of impulse conduction in the myocardium, so that the impulse passes retrogradely blockade and re-excites the myocardial area distal to the blockade site; the excitation seems to circulate in a circle).

Types of heart rhythm disorders

The classification of the main rhythm and conduction disorders in a simplified form can be presented as follows:

Supraventricular (supraventricular): sinus arrhythmias, extrasystole, paroxysmal supraventricular tachycardia, atrial fibrillation and flutter;

Ventricular: extrasystole, paroxysmal ventricular tachycardia, flutter and ventricular fibrillation;

Conduction disorders: sinoauricular block, AV block I, II and III degrees, bundle branch block.

Antiarrhythmic therapy is indicated for poor subjective tolerance of rhythm disturbances and for hemodynamically and prognostically significant arrhythmias. Sinus tachycardia, bradycardia and arrhythmia, constant normoform of atrial fibrillation and flutter without signs of decompensation, extrasystole (with the exception of ventricular acute heart attack myocardium), atrioventricular block of I and II degrees in persons without a history of myocardial infarction, bundle branch block in most cases does not require drug treatment. Emergency treatment of arrhythmias is carried out for paroxysmal supraventricular and ventricular tachycardia, the paroxysmal form of atrial fibrillation and for disturbances of atrioventricular conduction with the development of fainting (Morgagni-Adams-Stokes syndrome).

Heart rhythm disturbances: paroxysmal tachycardia

Paroxysmal tachycardia is an attack of palpitations with a heart rate exceeding 160 per minute while maintaining the correct sequence of contractions. In most cases, the cause of paroxysmal tachycardia is the circular movement of the impulse - the re-entry mechanism; less often it is caused by the activation of a heterogeneous pacemaker (an unusual focus of excitation located in the atria or ventricles). Paroxysmal tachycardia can occur with myocardial infarction, myocarditis, mitral stenosis, thyrotoxicosis. In the occurrence of attacks, disturbances at different levels of the nervous regulation of heart rhythm are of particular importance.

Clinical picture. The attack begins suddenly. In addition to palpitations, patients often experience a feeling of fear, sometimes shortness of breath and squeezing pain in the heart area. The attack lasts from several minutes to several days and stops just as suddenly. After this, the patient often experiences a feeling of pleasant relief, accompanied by a feeling of weakness, and polyuria is usually noted (distinguished a large number of clear urine).

Examination during an attack reveals pallor of the skin, a small pulse, rhythmic, but so frequent that it cannot be counted. Blood pressure decreases, heart sounds are loud, the pause between the second and first sounds is shortened. During a multi-hour attack of paroxysmal tachycardia, cyanosis develops, swelling of the neck veins, shortness of breath appear, blood pressure decreases significantly, pulse pressure decreases, and anginal pain is more often observed. The cause of the development of heart failure during prolonged paroxysmal tachycardia is hemodynamic disturbances with a shortening of diastole time, difficulty in blood flow to the ventricles of the heart, a decrease in stroke and cardiac output, and a resulting deterioration in peripheral and coronary circulation.

An ECG confirms the presence of paroxysmal tachycardia and makes it possible to establish the localization of the pathological pacemaker. Depending on its location, paroxysmal tachycardia is divided into supraventricular (supraventricular) and ventricular forms. With supraventricular tachycardia, the ECG in the vast majority of cases shows undeformed QRS complexes (sometimes their shape can change - take on an aberrant appearance due to impaired conduction of excitation), heart rate can be in the range of 150-250 per minute.

With ventricular tachycardia, the ECG reveals three or more consecutive wide (more than 0.12 s) QRS complexes with a frequency of 100-250 per minute with a displacement of the ST segment and T wave in the direction opposite to the main wave of the QRS complex. Ventricular tachycardia is more often observed with severe organic pathology of the heart and has a more serious prognosis.

What to do if your heart rhythm is abnormal: torsade de pointes

Torsade de pointes - bidirectional fusiform ventricular tachycardia - is observed when the QT interval is prolonged. The maximum duration of the QT interval is normally no more than 0.46 s for men and 0.47 s for women; its prolongation can be idiopathic - hereditary (Hervel-Lange-Nielsen syndrome - an autosomal recessive type of inheritance, accompanied by deafness; Romano-Nielsen syndrome). Ward - autosomal dominant inheritance without deafness) and acquired (due to hypokalemia, hypocalcemia, hypomagnesemia, the influence of quinidine, procainamide, cordarone, some second-generation antihistamines, phenothiazine neuroleptics, tricyclic antidepressants). During an attack of tachycardia, the ECG shows an abnormal rhythm with a heart rate of 150-250 per minute, wide polymorphic deformed QRS complexes. A sinusoidal pattern is characteristic - groups of two or more ventricular complexes with one direction are replaced by groups of ventricular complexes with the opposite direction. The attack is triggered by a ventricular extrasystole with a long coupling interval, the number of QRS complexes in each series ranges from 6 to 100. Torsade de pointes is self-limiting, often recurs and easily turns into ventricular fibrillation.

Paroxysm of ventricular tachycardia.

Paroxysm of ventricular tachycardia.

The diagnosis of paroxysmal tachycardia is usually made on the basis of the patient’s characteristic complaints, examination data revealing sharp tachycardia (over 160 beats per minute) with the correct heart rhythm, and the results of an electrocardiographic study.

What to do if there is a heart rhythm disorder: treatment of tachycardia

Treatment. Emergency care for an attack of supraventricular paroxysmal tachycardia should begin with an assessment of the patient’s hemodynamic parameters. A drop in blood pressure with the development of syncope, fainting, an attack of cardiac asthma or pulmonary edema, the development of a severe anginal attack against the background of tachycardia are indications for immediate electropulse therapy with a discharge of 100-200 J.

If the hemodynamics are stable, the patient’s consciousness is clear, then relief of paroxysm begins with techniques aimed at irritating the vagus nerve and slowing down conduction through the atrioventricular node. Sometimes it is possible to interrupt an attack by holding your breath, coughing, or suddenly straining after take a deep breath(Valsalva maneuver), artificial vomiting, swallowing a crust of bread, immersing the face in ice water. Previously recommended pressure on eyeballs currently not generally used. In blocks intensive care An increase in the tone of the vagus nerve in case of cardiac arrhythmia is achieved by massage of the carotid sinus. Under ECG control, the patient’s head is turned to the left and the area of ​​the bifurcation of the right carotid artery is carefully massaged with two to three fingers (just below the angle lower jaw) for 3-5 s. If there is no effect, massage the left sinus. You cannot massage both carotid sinuses at the same time; this manipulation is not indicated for patients with audible murmur over the carotid arteries; The method is contraindicated in case of glycoside intoxication, cerebrovascular diseases, sick sinus syndrome (tachy-brady syndrome), and neck injuries. These techniques do not always help; with atrial fibrillation and flutter they cause a transient decrease in heart rate, and with ventricular forms of paroxysmal tachycardia they are generally ineffective.

The lack of effect from reflex techniques requires the use of antiarrhythmic drugs. Therapy of paroxysmal supraventricular tachycardia begins with intravenous administration of adenosine (ATP), interrupting the circle of “re-entry”: 10-20 mg (1-2 ml of 1% solution) ATP is administered intravenously as a bolus for 5 - 10 s, if there is no effect after 2 – After 3 minutes, another 20 mg (2 ml of 1% solution) is reintroduced. The effectiveness of the drug in this type of cardiac arrhythmia is 90–100%; as a rule, it is possible to stop paroxysmal supraventricular tachycardia within 20–40 s after ATP administration. Intravenous administration of adenosine also makes it possible to differentiate atrial flutter with 1:1 conduction from supraventricular tachycardia - inhibition of AV conduction makes it possible to identify characteristic flutter waves on the ECG, but the rhythm is not restored.

If there is no effect from adenosine (or if it is short-lived), the use of the calcium antagonist verapamil (isoptin) is indicated, which also lengthens the refractory period of the AV node, but acts longer (up to 30 minutes) and is not so safe. The drug is administered intravenously in a bolus at a dose of 5–10 mg over 2 minutes under ECG and blood pressure monitoring (faster administration may cause collapse or severe bradycardia). Verapamil restores rhythm in paroxysmal supraventricular tachycardia in 70–90% of cases. Verapamil should only be used for heart rhythm disturbances with a “narrow” QRS complex. With a “wide” QRS complex and suspected Wolff-Parkinson-White (WPW) syndrome, this drug is contraindicated, as it improves conduction along accessory pathways and can cause an increase in heart rate, a drop in blood pressure and ventricular fibrillation. Diagnosis of WPW syndrome is possible with appropriate anamnestic indications, when assessing previous cardiograms with sinus rhythm (P - R interval less than 0.12 s, the QRS complex is widened, a delta wave is determined). In addition, verapamil is contraindicated in patients who have been administered any beta-blocker within the last two hours.

An alternative to verapamil can be procainamide; the drug can also be used if verapamil is ineffective, but not earlier than 15 minutes after administration of the latter. Procainamide, when the heart rhythm is disturbed, impairs conduction along additional pathways and is therefore effective for reciprocal tachycardia in patients with WPW syndrome. Novocainamide is prescribed as a 10% solution of 10 ml intravenously in a slow stream with 10 - 15 ml isotonic solution sodium chloride. The administration is carried out slowly, over 5–8 minutes, under the control of heart rate, blood pressure and ECG. At the moment of restoration of the normal rhythm, which often occurs during the infusion, “on the needle,” the administration of the drug should be stopped. Due to the possibility of lowering blood pressure, novocainamide should be administered in horizontal position patient, having mezaton ready. With initially low blood pressure, 0.10.3 ml of 1% mesatone solution is administered in the same syringe with novocainamide. An increase in blood pressure after mesaton administration causes a baroreceptor reflex, which promotes vagal inhibition of the AV node and restoration of sinus rhythm.

In the absence of ATP and verapamil, beta-blockers (propranolol) and cardiac glycosides (digoxin) can be used, but these drugs are effective only in half of the cases of paroxysmal supraventricular tachycardia. 20 mg of propranolol (anaprilin) ​​can be given under the tongue; intravenous administration Propranolol at a dose of 0.15 mg/kg at a rate of 1 mg/min should preferably be carried out under the control of an ECG monitor in a cardiac unit. Propranolol is highly effective for paroxysmal tachycardia caused by a re-entry circle in the sinus or AV node, and in other types of tachycardia its use can reduce heart rate.

Digoxin in an initial dose of 0.5-0.75 mg is effective for nodal reciprocal tachycardia, in other cases it reduces heart rate. The most appropriate use of cardiac glycosides is for paroxysmal supraventricular tachycardia, complicated by the development of congestive heart failure. Like verapamil, digoxin is contraindicated in WPW syndrome.

Prevention of paroxysms of supraventricular tachycardia is indicated for patients in whom paroxysms occur frequently or are accompanied by painful subjective sensations, angina pectoris, hypotension, and circulatory decompensation. For this purpose, calcium antagonists (verapamil, diltiazem) or beta-blockers are usually used.

The treatment strategy for paroxysmal ventricular tachycardia is also determined by hemodynamic stability. If the patient’s pulse cannot be detected or arterial hypotension, shortness of breath, acute heart failure, angina pectoris, or fainting have developed, emergency electrical pulse therapy is indicated - cardioversion with a discharge of 200 J, if ineffective - a repeated discharge of 360 J.

With stable hemodynamics, the drug of choice for stopping paroxysmal ventricular tachycardia is lidocaine, usually administered intravenously at a dose of 1–2 mg/kg (80–120 mg) for 3–4 minutes. Lidocaine is quickly destroyed and eliminated from the body, therefore, after intravenous jet administration, if the heart rhythm is disturbed, they switch to drip administration at a rate of 20 - 55 mcg/kg/min ( maximum speed 2 mg/min). If necessary, against the background of a drip infusion, the drug can be re-administered intravenously in a bolus at a dose of 40 mg 10–30 minutes after the first bolus. In order to prevent ventricular rhythm disturbances, it is possible in the future to switch to intramuscular administration of lidocaine at a dose of 2–4 mg/kg (160–200 mg, maximum 600 mg) every 4–6 hours. After stopping the paroxysm of ventricular tachycardia, lidocaine is administered prophylactically for another at least 24 hours

If lidocaine is ineffective, other antiarrhythmics are used only if cardioversion is impossible or if hemodynamics are stable and there is no adverse reactions to lidocaine (otherwise there is a high risk of collapse and potentiation of the arrhythmogenic effect of antiarrhythmic drugs).

The second most important drug in the treatment of paroxysmal ventricular tachycardia is procainamide. The drug is administered intravenously in a slow stream over 5–8 minutes in fractional doses of 100 mg until sinus rhythm is restored or until a saturating dose is reached (500–1000 mg). The effectiveness of procainamide for all paroxysmal cardiac arrhythmias makes it the drug of choice for the treatment of tachycardia of unknown origin with a wide QRS complex - ventricular or supraventricular with aberrant conduction or bundle branch block. If therapy with lidocaine and procainamide is ineffective, cardioversion is performed; if this is ineffective, repeated administration of antiarrhythmics and repeated cardioversion are indicated.

The drug of choice for ventricular tachycardia of the “pirouette” type and an additional drug for other types of ventricular tachycardia (including those resistant to lidocaine and procainamide therapy) may be magnesium sulfate (cormagnesin); 40-80 mg of magnesium (20-40 ml of 10% or 10-20 ml of 20% solution) is administered intravenously over 7-10 minutes. If there is no effect after 30 minutes, repeated administration is possible. After achieving the effect, drip administration is recommended at a rate of 3-20 mg/min for 2-5 hours (maximum daily dose 3600 mg of magnesium or 180 ml of 10% solution).

Paroxysm of tachycardia with a “wide QRS complex” (A); restoration of sinus rhythm after administration of procainamide (B).

For secondary prevention For paroxysms of ventricular tachycardia, cordarone is most often used (high efficiency, toxic effect with long-term use), class 1b antiarrhythmic mexiletine (allows one to achieve a good therapeutic effect in the absence of side effects in approximately every fourth case). Beta blockers prevent exercise-induced ventricular tachycardia (caused by catecholamines or myocardial ischemia) and torsade de pointes (shorten the QT interval).

Unstoppable paroxysm of supraventricular tachycardia and any paroxysmal ventricular rhythm disturbances, especially when symptoms of heart failure appear (swelling of the veins of the neck, shortness of breath, cyanosis, enlarged liver, drop in blood pressure), are an absolute indication for emergency hospitalization the patient to the cardiac intensive care unit, and after stabilization, to the cardiology department of the hospital for examination, clarification of the cause of rhythm disturbances and selection of effective antiarrhythmic therapy. Transportation must be carried out in ambulance transport, on a stretcher.

Heart rhythm disturbances: paroxysmal atrial fibrillation

With atrial fibrillation, or atrial fibrillation, as is known, there is no simultaneous contraction - atrial systole; erratic contractions of individual groups of muscle fibers of the atrial myocardium take place. The consequence of this is a violation of the work of the ventricles of the heart, coordinated with the contractions of the atria, the duration of diastole becomes unstable, the correct sequence of heart contractions and, accordingly, pulse waves are disrupted, which is defined as absolute arrhythmia.

Paroxysmal form Atrial fibrillation when the heart rhythm is disturbed most often complicates the course of severe organic heart diseases. It is most often observed in rheumatic mitral heart defects, cardiosclerosis, myocardial infarction, and thyrotoxicosis.

The clinical picture of paroxysmal atrial fibrillation resembles that of paroxysmal tachycardia. The attack begins suddenly and is accompanied by the same painful subjective sensations. An objective study reveals a sharp unevenness of the intervals between individual heart contractions, tachycardia with a contraction frequency of over 160 per minute. The frequency of pulse waves in the periphery is usually much less than the number of heart contractions, i.e., a pulse deficit is determined. Sometimes it is possible to distinguish paroxysmal atrial fibrillation from paroxysmal tachycardia only on the basis of an electrocardiographic study. On the ECG with atrial fibrillation there are no atrial complexes, the RR intervals are different.

Paroxysm of atrial fibrillation significantly worsens hemodynamics, increases the manifestations of heart failure, and is accompanied by a noticeable decrease in blood pressure. Frequently recurring paroxysms of atrial fibrillation usually precede the development of a persistent form of atrial fibrillation.

What to do with atrial fibrillation: treatment of the disorder

Treatment. Atrial fibrillation with a low heart rate does not require emergency therapy. In case of paroxysm of atrial fibrillation and unstable hemodynamics, cardioversion is performed (starting with a shock of 100 J). If high heart rate arrhythmia is well tolerated, drug therapy is indicated. Treatment begins with the slow intravenous administration of 10 ml of a 10% solution of novocainamide in 15-20 ml of isotonic sodium chloride solution. The effectiveness of novocainamide in cases of recent paroxysm of atrial fibrillation in patients without severe dilation of the left atrium reaches 90%. It must be taken into account that in damaged myocardium, novocainamide can cause potentially dangerous intraventricular conduction disturbances, manifested on the ECG by widening of the ventricular complexes and bundle branch blocks.

An alternative to procainamide can be intravenous infusion of verapamil. This drug does not always restore sinus rhythm, but it is effective in reducing heart rate by blocking the AV node. However, we must not forget that the use of verapamil is contraindicated for atrial fibrillation in patients with WPW syndrome.

If the administration of novocainamide or verapamil is ineffective in case of cardiac arrhythmia at the prehospital stage further treatment usually performed in a hospital setting. Patients with prolonged paroxysm of atrial fibrillation are subject to hospitalization in a therapeutic hospital on ambulance transport, on a stretcher.

In a hospital setting, a paroxysm that lasts less than 2 days is stopped immediately, and, according to some researchers, the effectiveness of antiarrhythmic therapy is inversely proportional to the duration of the arrhythmia. In order to relieve paroxysm, cardioversion or quinidine is most often used according to the regimen (200 mg of the drug orally every 2 hours until the rhythm is restored, usually up to a total dose of 2 g; the maximum daily dose should not exceed 4 g). A long-acting drug - quinidine-durules - contains 0.2 g of active substance per tablet and is prescribed in 2 doses (2-5 tablets in the morning and evening). The effectiveness of class 1a antiarrhythmics for paroxysmal atrial fibrillation lasting less than 2 days is 70-90% of cases.

In the case of longer paroxysms, due to the danger of thromboembolism, rhythm restoration (medical or cardioversion) is carried out in a hospital setting as planned after preliminary preparation with anticoagulants. For paroxysmal atrial fibrillation lasting more than 2 days, antiarrhythmic therapy is effective only in 20-30% of cases.

In elderly patients, with long-term atrial fibrillation (more than 6 months), as well as in cases where it is difficult to establish the timing of the onset of paroxysm (tachycardia cannot be excluded in a patient with a permanent form of atrial fibrillation), with cardiomegaly and significant dilatation of the left atrium (antero-posterior size according to data ultrasound examination exceeds 4.5 cm), in the presence of repeated thromboembolism of the branches of the pulmonary arteries in the anamnesis, with the activity of the rheumatic process, cardiac glycosides become the means of choice to reduce heart rate. At the prehospital stage, 0.25 mg - 1 ml of 0.025% digoxin solution is administered intravenously. In a hospital setting, in case of cardiac arrhythmia, digoxin saturation is continued (if rapid digitalization is necessary, up to 0.75-1.25 mg is administered - 3-5 ml of a 0.025% solution over 24-36 hours in several doses). If a high heart rate persists during glycoside therapy, small doses of short-acting beta-blockers (propranolol 10-20 mg orally 34 times a day) are added to slow down the rhythm. After the rhythm slows down, the patient is transferred to maintenance therapy with small doses of cardiac glycosides. An indication for the use of cardiac glycosides is also heart failure, which usually increases rapidly with atrial fibrillation. In WPW syndrome, digoxin is contraindicated (risk of developing ventricular fibrillation).

Prevention of paroxysms of atrial fibrillation is carried out for patients in whom paroxysms occur frequently or are accompanied by painful subjective sensations, the development of heart failure, hypotension, angina pectoris, but not a single drug prevents the recurrence of paroxysms of atrial fibrillation for sure. Antiarrhythmics of class 1a or 1c are used - quinidine, propafenone (effective in almost 70% of patients, do not prolong the patient’s life), cordarone (more effective than other antiarrhythmics, but the use is limited by the toxicity of the drug), calcium antagonists (verapamil, diltiazem). Considering the fact that atrial fibrillation paroxysm is often preceded by an increase in heart rate due to activation of the sympathoadrenal system (for example, during physical activity), beta-blockers are often used for prevention.

It should be taken into account that even short-term and well-stopped, but often recurring paroxysms of atrial fibrillation can be a manifestation of an exacerbation of the underlying disease (rheumatism, coronary artery disease), therefore such patients should also be sent to the hospital, although not on an emergency basis.

Heart rhythm disturbances: Morgagni–Adams–Stokes syndrome. Atrioventricular block

Violation of atrioventricular (AV) - from the atria to the ventricles - conduction is more common in patients with atherosclerotic cardiosclerosis, with inflammatory diseases heart - myocarditis of rheumatic or other etiology or with digitalis intoxication (poisoning with digitalis preparations), or with an overdose of other medicines, affecting conductivity. AV block requires emergency therapy with a heart rate of less than 40 beats per minute, with the appearance of ventricular extrasystole against the background of bradycardia and in the case of fainting (Morgagni-Adams-Stokes syndrome).

Sudden loss consciousness most often occurs in the following cases:

1. With AV block of the second degree, type II according to Mobitz. When the heart rhythm is disturbed, individual impulses from the sinus node do not reach the ventricles and only cause contraction of the atria; The ECG shows loss of the ventricular complex after the P wave with a normal or extended P–Q interval.

2. With the transition of incomplete atrioventricular block to complete. In this case, all impulses from the sinus node do not reach the ventricles, which have to develop their own rhythm; the ventricular rate is usually 20-40 beats per minute, which is not enough for adequate blood supply to the brain. On the ECG, complete transverse block is manifested by the correct rhythm of the atrial complexes - the P - P interval is the same, the absence of a stable P - Q interval, periodic layering of P waves on the QRS complex, a constant R - R interval, the QRS complex is not changed or widened.

With these conduction disturbances, some patients experience and spontaneously stop episodes of ventricular fibrillation during the pause between myocardial contractions, which further worsens the prognosis.

Clinical picture. Morgagni-Adams-Stokes syndrome is characterized by the appearance of sudden pallor, followed by loss of consciousness, swelling of the neck veins, acrocyanosis, twitching of the facial muscles, and then tonic generalized convulsions combined with periodic absence of pulse. Auscultation of the heart reveals rare muffled tones; at times, a loud first sound is heard, caused by the simultaneous contraction of the atria and ventricles. These symptoms are explained by the fact that the absence of ventricular contraction and blood flow into the aorta and pulmonary artery entails the development of acute cerebral ischemia and increasing hypoxia of body tissues. Attacks rarely last more than 2 minutes; after restoration of consciousness, skin hyperemia is observed. Morgagni-Adams-Stokes attacks, as a rule, do not lead to neurological complications; in some patients, confusion may persist for a long time.

However, such a detailed picture of an attack is not always observed. Often, when the heart rhythm is disturbed, reduced, abortive forms occur, expressed in short-term fainting, a feeling of failure with loss of consciousness literally for a moment. The duration of such attacks sometimes does not exceed 15-20 seconds. The appearance in a patient with cardiac pathology of complaints of frequent fainting and short-term loss of consciousness should always be alarming, since such symptoms may be a manifestation of Morgagni-Adams-Stokes syndrome.

Complete atrioventricular block.

The diagnosis of Morgagni-Adams-Stokes syndrome with a typical clinical picture is not difficult. It is based on the following main signs: sudden, without warning, the onset of an attack; loss of consciousness a few seconds after the pulse disappears; absence of pulse and heartbeat at the time of the attack; restoration of consciousness following the appearance of heart contractions and pulse waves; pallor, giving way to cyanosis as the attack deepens; absence of tongue biting and muscle twitching and clonic convulsions characteristic of epilepsy; short duration of the attack; absence of retrograde amnesia (the patient remembers the events preceding the attack). The diagnosis can be verified by electrocardiographic examination, and in the case of transient conduction disturbances, daily ECG monitoring.

What to do with atrioventricular block: treatment of the disorder

What to do if there is a heart rhythm disturbance in this case? Drug therapy for severe bradyarrhythmias, accompanied by clinical symptoms, is aimed mainly at increasing the frequency of ventricular contractions and comes down, first of all, to the prescription of m-anticholinergic blockers. Atropine in a dose of 0.5-1.0 mg is administered in case of heart rhythm disturbances intravenously every 3-5 minutes until an effect is obtained or until a total dose of 2 mg is achieved. We must not forget that in acute myocardial infarction, the administration of atropine requires especially careful monitoring, as it can increase myocardial ischemia and provoke ventricular arrhythmias. Atropine is contraindicated in chronic urinary retention and glaucoma. The drug is ineffective in patients with distal (at the level of the His-Purkinje system) AV block, acute development which can be observed with extensive anterior myocardial infarction and is a very unfavorable prognostic sign. In this situation, the ineffectiveness of atropine is, in fact, a direct indication for temporary cardiac pacing (PAC).

The heart is the most important organ the human body that performs the work of pumping blood. In a healthy person, the heart rhythm is always smooth and constant. Heart rhythm disturbances (ICD code 10 – I49) are also called arrhythmia. This disease is considered secondary and has its own features. Below are the symptoms accompanying heart rhythm disturbances, causes, and treatment of the pathology.

You can understand the mechanism of development of disorders if you carefully understand how the organ functions. In the sinus node (also called the pacemaker), a signal is generated, which in a split second reaches the atrioventricular node. During this period of time, the atria contract, and after further signal transmission, the ventricles. The coordinated work of all these parts is the basis for proper blood circulation.

The cerebral cortex is responsible for the number of contractions of the heart muscle over a certain period of time and their intensity. Slowing or speeding up the heartbeat is associated with various situations: excessive physical activity, stress, sleep. This happens under the influence of pituitary hormones and the vagus nerve.

In a normal state, the heart rate is in the range of 60-80 beats/min. At the same time, the heart beats evenly and calmly. The failure that arises in the described process can be expressed by a violation of the conductivity of the heart, the contractility of its muscles, and automatism. Sometimes these problems combine, leading to even worsening of the condition.

Increased or slowed heart rate caused by natural causes and returning to normal after some time is not a disease. Failures that arise as a result of deviations in the functioning of other organs and systems are considered pathological and require urgent medical intervention.

Classification of arrhythmias

All heart rhythm disturbances are classified according to the course of the disease, etiology of development and characteristic features. Highlight following forms pathologies:

In addition to slowing and increasing heart rate, there are three more types of rhythm disturbances:

1. Paroxysmal tachycardia. The disease is characterized by frequent attacks of a sharp increase in heart rate. Sometimes the pulse can reach 140-200 beats/min. and higher. Contractions of the heart muscle occur rhythmically without interruption.
2. Rhythm disturbances such as ventricular extrasystole. Extraordinary excitation of the heart muscle, provoked by an additionally formed node, which takes on the functions of a pacemaker. This formation is located on the walls of the ventricles or atria and causes the heart to perform unnecessary contractions. This type arrhythmias can occur as bigeminy - when every second contraction of the muscle is provoked by a non-sinus node, and as trigeminy - every third contraction.
3. Atrial fibrillation (atrial fibrillation). This condition is the most severe rhythm disorder. This type of arrhythmia occurs in the presence of chronic diseases of the cardiovascular system. The pathology is characterized by irregular and too frequent (rare) excitations of the heart muscle, its atria, and ventricles. At the same time, contractions are heterogeneous in strength and frequency, and the duration of the cycle fluctuates over large intervals. Depending on the heart rate, there are three types of atrial fibrillation: bradysystolic, normosystolic and tachysystolic.

Causes of pathology

The main factor provoking deterioration of cardiac activity is deviations in the electrolyte composition of the blood. An imbalance of the microelements magnesium, potassium and sodium as a result of the development of inflammation, hyperthermia, after overheating, hypothermia and many other conditions leads to one-time episodes of rhythm disturbances. After the underlying disease is eliminated, heart rate and rhythm return to normal.

The risk group for the development of arrhythmias are patients:

Severe forms of arrhythmia can occur against the background of certain concomitant diseases. This includes pathologies:

• cardiovascular system (heart attack, hypertension, heart failure, ischemia, cardiosclerosis, cardiomyopathy, endocarditis, myocarditis, heart defects);
• neurological nature (brain injuries, neuroses, VSD, circulatory disorders);
• endocrine glands (problems with the adrenal glands, diabetes, hyper-, hypothyroidism);
• gastrointestinal system (peptic ulcer, cholecystitis, pancreatitis).

If it is not possible to establish the cause of the arrhythmia, an idiopathic heart rhythm disturbance is diagnosed and symptomatic treatment is carried out aimed at eliminating the disruption.

Symptoms of heart rhythm disturbances

Quite often, arrhythmias are practically asymptomatic, and patients learn about abnormalities in the heart only after undergoing an electrocardiogram. Heart rhythm disturbances are accompanied by symptoms, which doctors divide into two large groups, depending on the effect of the pathology on cardiac activity: it speeds up or slows down the work of the heart muscle. Patients suffering from tachycardial arrhythmias talk about feelings of interruptions in the functioning of the heart, and when the contraction slows down, deviations in the circulatory system appear.

To make a diagnosis, pay attention to general signs all arrhythmias:

Depending on the type of disorder, all symptoms vary in severity and can occur in combination. The most dangerous condition is atrial fibrillation, since there is a high probability of cardiac arrest during an attack.

Diagnostics

The most common diagnostic method for detecting arrhythmias is an electrocardiogram. The graph clearly identifies deviations. In addition to the ECG, the patient may be prescribed other instrumental research methods:

In addition, cardiac ultrasound and magnetic resonance imaging may be required. These methods make it possible to identify abnormalities in the structure of the heart and diagnose tumor formations that cause arrhythmia.

Treatment

Only a doctor should treat all types of arrhythmias. According to the results of the inspection, detailed examination A treatment regimen is drawn up, which includes taking medications in combination with therapeutic exercises and diet. Exercising is the best way to increase endurance, improve the patient’s general condition, and strengthen the heart muscle.

If there are disturbances in the heart rhythm, nutritional correction is necessary. Fried, smoked, too fatty, and salty foods should be excluded from the diet. Food is best prepared by regular boiling or using a steamer. It is worth giving up confectionery products, and instead diversify your diet with vegetables and fruits.

You should not strain your body with excessive stress. Regular exercises and walks in the fresh air are the best option for patients with arrhythmia. Over time, the load can be gradually increased.

Drug treatment

Elimination of rhythm disturbances is carried out with special blockers. The principle of action of such drugs is to prevent the influence of certain factors on the blood vessels and muscle of the heart. Among the most effective, it is worth highlighting means that block:

Only a doctor should choose the appropriate medicine for heart rhythm disturbances and treat the pathology. Independent selection of antiarrhythmic drugs can lead to a deterioration in the patient’s condition and provoke the development of complications.

In addition, for arrhythmias, vitamin and mineral complexes are prescribed to restore the electrolyte balance of the blood, as well as cardiac glycosides. The action of the latter is aimed at reducing heart rate and restoring the rhythm of the sinus node.

Surgical intervention

If you restore normal work heart disease with the help of medications is not possible, then surgery will be required. Surgical intervention necessary to relieve arrhythmia and reduce the risk of death. Several different techniques can be used for this.

Average service life electronic device is 8-10 years, after which it requires checking and replacing the batteries. When a device becomes obsolete, it is replaced with a new one.

Traditional methods of treatment

Medicinal herbs can be an excellent addition to the main course of treatment for cardiac arrhythmias. However, they should not completely replace prescribed medications. The following plants are considered the most effective:

The drug course of therapy can last six months or more. Folk remedies used at the end of treatment for prophylaxis.

Features in children and adolescents

Heart rhythm disturbances in children can occur both due to congenital anomalies of heart development and acquired ones. Perinatal pathologies, diagnosed in newborns, occupy no more than 25% of the total number of diseases; in other cases, disorders develop due to the restructuring of the child’s body during growth.

Arrhythmias are almost always asymptomatic in children. They are usually identified during standard medical examinations. Typically, such arrhythmias are not accompanied by persistent disturbances in cardiac activity, and therefore are easily amenable to drug correction.

Arrhythmia can develop in the fetus during pregnancy. There can be many reasons for this: unbalanced diet, chronic diseases a woman has problems with metabolic processes, bad habits. Treatment in this case should only be prescribed by a doctor.

Complications

In the absence of necessary therapy against the background of arrhythmias, serious and dangerous consequences may develop:

• myocardial infarction due to lack of oxygen in the blood and tissues;
• ischemic stroke due to thrombosis in the cardiac cavity;
• thromboembolism of the main pulmonary artery;
• collapse (presyncope, sharp decrease in blood pressure);
• ventricular fibrillation (emergency care required).

Forecast

If pathological changes are absent in the structure of the heart, the prognosis for the life of patients with arrhythmia is quite favorable. Most rhythm disturbances respond well drug treatment. In other situations, the prognosis depends on the type, severity of the disease and the presence of concomitant pathologies. With an uncomplicated course, patients of military age are subject to recruitment into the army.

The human heart contracts with a certain rhythm; normally, a person should not feel heart contractions. The number of contractions of the heart muscle is individual for each person, but still they should not be less than 60 and more than 80 beats per minute. Chief's job muscular organ provides the conduction system in the event that this system fails and various types of arrhythmias occur. The causes of heart rhythm disturbances are quite varied, some of them can be very dangerous for human health and vital functions.

Causes of arrhythmias

Arrhythmia may occur due to organic damage heart muscle, the causes of which are:

1. Cardiac vascular ischemia.
2. Congenital and acquired heart defects.
3. Hypertension.
4. Heart failure.
5. Severe intoxication of the body when taking certain medications, alcohol and the influence of certain chemical compounds.
6. Violation of the hormonal balance of the body.
7. Infectious diseases.
8. Traumatization and surgical treatment of the heart muscle.

However, arrhythmia can also appear in a healthy person (it lasts short period time), this happens for the following reasons:

1. Severe stress.
2. Excessive physical activity.
3. Taking medications.
4. Large meals.
5. Constipation.
6. Wearing clothes that are too tight.
7. In women, heart rhythm disturbances may be a manifestation of premenstrual syndrome.

If the arrhythmia is physiological, then treatment is not required. It does not cause discomfort or disturb a person.

A number of risk factors contribute to the development of this pathology:

1. Genetic predisposition. People with congenital heart defects are more prone to developing heart rhythm problems.
2. Age. The older a person gets, the more likely he is to experience problems with the heart muscle. The heart wears out, and under the influence of various diseases the conduction system can fail.
3. Diseases of the heart muscle. Arrhythmia quite often occurs on the basis of existing diseases (with ischemic heart disease, after a myocardial infarction).

Types of heart rhythm disorders

There are two main groups of arrhythmias depending on the frequency of contractions of the heart muscle:

1. Tachyarrhythmias (increased heart rate).
2. Bradyarrhythmias (decreased heart rate).

Depending on the damage to parts of the conduction system, several types of arrhythmias are distinguished, here are their characteristics:

1. Sinus tachycardia occurs due to damage or weakness of the sinus node (this is the place where the electrical impulse is generated, without which contractions cannot occur). In this case, the heart rate is more than 80 beats per minute. The etiology of this heart rhythm disturbance is varied: general hyperthermia of the body, severe stress and increased physical activity. Quite rarely, the cause of this condition is heart disease. Symptoms of this condition may be completely absent or appear mild.
2. Sinus bradycardia, it is characterized by a decrease in the number of contractions of the heart muscle (less than 60 beats per minute). This type of heart rhythm disorder can occur in healthy people who exercise at rest or during a night's rest. This pathological condition most often occurs due to dysfunction of the thyroid gland, or rather, when it decreases. Patients complain of discomfort in the heart area, dizziness, increased fatigue and lethargy.
3. Sinus arrhythmia is manifested by alternating acceleration and deceleration of the heart rate. This condition is often observed in childhood and adolescence. Attacks of arrhythmia can be directly related to breathing, so when you inhale, the number of heart contractions increases, and when you exhale, on the contrary, it decreases. There are no symptoms of this condition, and the patient’s well-being does not suffer. Treatment in this case is not required.


4. Extrasystole is an additional heartbeat, which should not have been in this interval. Normally, a healthy person may experience isolated failures of this kind. This condition can be caused by diseases of the internal organs and the presence of bad habits at the patient. Extrasystoles are felt as strong tremors in the chest or as a sinking heart.
5. Paroxysmal tachycardia is characterized proper work heart muscle with rapid heartbeat. A rhythm with a frequency of more than 100 beats per minute is recorded. An attack of arrhythmia occurs and disappears suddenly, while the patient feels increased heartbeat and general weakness, and increased sweating is observed.
6. Atrial fibrillation or atrial fibrillation. This type of arrhythmia is characterized by uneven contraction of individual sections of the atrium and increased contractile movements of the ventricles (more than 100 beats per minute). This pathology appears in the presence of defects and diseases of the heart muscle and thyroid gland, as well as alcohol addiction. There may be no symptoms or the patient complains of difficulty breathing, pain and fluttering in the heart area.
7. Ventricular fibrillation and flutter is a very serious condition that occurs due to electrical injuries, serious illnesses heart and poisoning medicines. During an attack, the heart stops working, there is no pulse, convulsions and wheezing appear. How to relieve an attack? This condition requires emergency medical care and carrying out resuscitation measures.


8. Heart blocks are characterized by slowing down or stopping the conduction of electrical impulses through the heart muscle. There are incomplete and complete blockades. The most dangerous are complete blockades; they are characterized by the appearance of convulsions and fainting. For some types complete blockade Sudden death may occur.

Diagnostics

The diagnosis is made based on the patient’s complaints, examination and instrumental studies:

1. Electrocardiography. Using this diagnostic method, you can evaluate the rhythm and frequency of contractions of the heart muscle, as well as the condition of the myocardium and heart chambers.
2. Ultrasound examination of the heart. This diagnostic method allows you to detect heart disease that can cause arrhythmia. The condition of the heart and its contractile function, its size and the functioning of the valve apparatus are assessed.
3. Daily monitoring – continuous recording of an electrocardiogram throughout the day. This study helps to identify not only arrhythmia, but also to determine at what time it occurs and what it may be associated with.

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Causes of rhythm failure

The heart consists of two ventricles and the same number of atria. In the right atrium there is a sinus node, in which an electrical impulse is generated. Spreading through the atrioventricular node, His bundle, and Purkinje fibers, it initiates contraction of the organ. The norm assumes a frequency of such passages ranging from 60 to 90 times per minute. With the correct rhythm, the frequency of heart contractions is the same. If a disturbance occurs in any area of ​​the conduction system, the normal passage of the impulse is disrupted. Accordingly, the heart rhythm fails.

For example, a natural heart rhythm disorder in the form of moderate bradycardia (slight slowdown contractile abilities organ) occurs in humans at night. This is due to the predominance of vagal effects on the heart. In addition, during the rest period, sinus arrhythmia, extrasystole, and grade 1 atrioventricular conduction disturbance may be observed.

Under severe stress emotional stress During significant physical exertion, tachycardia may also be observed. This occurs due to disturbances in the functioning of the autonomic nervous system and the entry of adrenaline into the blood, which leads to an increase in heart rate. Similar symptom can cause a considerable amount of coffee, alcoholic drinks, and nicotine. Significant consumption of alcohol-containing beverages leads to the formation of a paroxysm of atrial fibrillation and supraventricular tachycardia.

In addition, changes in heart rate can be a consequence of changes in the electrolyte balance of the blood and in the viscosity of biological fluid.

Such atypical transformations can lead to:

• inflammatory processes occurring in the body;
• overheating or hypothermia;
• large blood loss;
• collapse;
• intoxication;
• clinical-hematological syndrome;
• dehydration.

All the above reasons are temporary. They do not require treatment and disappear after eliminating the factors that led to the arrhythmia.

But heart rhythm disturbances can also cause complex diseases. Moreover, a malfunction in the functioning of the organ can provoke pathological processes, occurring not only in the heart, but also in other organs.

So, the following ailments can lead to arrhythmia:

1. Cardiovascular diseases - defects, heart attack, cardiomyopathy, hypertension, endocarditis, cardiosclerosis, myocarditis, heart failure, pericarditis, rheumatic carditis.
2. Diseases of the nervous system - prolonged psychogenic disorders, VSD, stroke, brain injury, oncological processes.
3. Pathologies of the endocrine system - absolute or relative deficiency of the hormone insulin, increased or decreased activity of thyroid hormones, pheochromocytoma, menopause.
4. Diseases of the gastrointestinal system - hiatal hernia, inflammation of the gallbladder, pancreas.

Most often, as a result of such factors, sinus tachycardia, bradycardia, atrial and ventricular extrasystole, supraventricular tachycardia, atrioventricular and His bundle block occur.

Types of heart rhythm disturbances

In a healthy person, the heart rhythm is sinus and regular. This means that each impulse originates in the sinus node and then arrives with the same frequency. In the event of any failure in the passage of the heart rate, it can decrease or increase. Such dysfunctions can be of several types.

Violation of impulse appearance

With this pathology, the impulse is created either very often or too rarely. In the first case, sinus tachycardia is diagnosed (the heart beats at a frequency of more than 90 beats per minute).

In the second option, sinus bradycardia is stated (the organ contracts less than 60 times per minute).

When an impulse is formed in other areas of the conduction system, an ectopic focus of excitation occurs. It can be located in the atrial sections, atrioventricular node, or ventricles. As a result, slow, slipping, rapid ectopic rhythms, untimely depolarization and contraction of the organ or its individual chambers, paroxysmal tachycardia, and flutter appear.

Blockades

Combined types

This category includes dysfunctions in which another ectopic pacemaker operates simultaneously with the sinus one, but the deviations are separated by a blockade. In such a case, the ventricles contract at one frequency, and the atria at another.

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Heart rhythm disturbances are deviations from the norm in the rhythm, frequency and systematicity of contraction of its muscles. Any deviation in the functioning of the heart has a bad effect on the functioning of the entire body. After all, it is the heart, contracting and relaxing cyclically, making from 50 to 150 beats per minute, that throughout a person’s life supplies the body with oxygen and nutrients through the blood.

There are two phases of the heart:

• the systole phase, during which the heart muscles, by contracting, stimulate the flow of blood through the blood vessels of the whole body;
• the diastole phase, during which the heart muscles relax and allow the heart to rest.

And it is very important that each phase replaces each other at certain intervals. Changing the frequency will lead to:

• to disruption of the body’s nutrition with necessary substances, in the event of a reduction in the systole phase;
• to the accumulation of fatigue in the heart, in the event of a shortening of the diastole phase.

The main causes of heart rhythm disturbances are:

• functional disorders, that is, dysregulation of the nervous and endocrine systems;
• organic disorders, that is, deviations in the anatomical structure of the heart and its development.

Often, the heart rhythm is disturbed due to a combination of these two reasons. However, the full range of causes leading to disturbances in the functioning of the heart has not yet been fully studied.

In case of heart rhythm disturbances, the following can be diagnosed:

Sinus tachycardia. Characterized by an increase in the frequency of contraction of the heart muscles to more than 100 beats per minute. At the same time, the electrocardiogram (ECG) shows unchanged cardiac complexes, and muscle contraction remains full, but rapid. Sinus tachycardia may indicate heart failure, thyroid disease, poisoning of various types, but it can also be the result of physical activity or stress on a healthy person.

Sinus bradycardia. Characterized by a decrease in the frequency of contraction of the heart muscles below 60 beats per minute. At the same time, the ECG also shows unchanged cardiac complexes. Sinus bradycardia can occur in people with excellent physical fitness, that is, athletes, and may be evidence of the presence of health problems such as: brain tumor, thyroid disease, hypothermia, mushroom poisoning and others.

Also, disturbances in heart rhythm and conduction can often be characteristic complications of cardiovascular diseases. In most of these cases, heart rhythm disturbances such as:

• atrial fibrillation, characterized by a completely irregular rhythm;
• extrasystole, characterized by extraordinary contractions of the heart;
• paroxysmal tachycardia, characterized by a sharp acceleration of cardiac muscle contractions from 150 to 200 beats per minute.

All changes in heart rate make up a rather difficult classification. Based on it, depending on the source of blockades and arrhythmias in the conduction system of the heart, their type is determined.

The nature of the heart rhythm disturbance can also be determined by the patient’s sensations:

• With a noticeable heartbeat, that is, with an increase in heart rate or interruptions in the heart rhythm, we can talk about atrial fibrillation or extrasystole.
• If there is a noticeable slowdown in the heart rate, cardiac arrest, which causes fainting and dizziness, it is worth taking a closer look at the options for bradycardia, that is, a slowdown in the pulse, or blockade of the heart rhythm.

Any type of cardiac arrhythmia is already a reason for a complete medical examination. With its help, it will be possible to identify the cause of the arrhythmia and, if necessary, create a treatment program for heart rhythm disturbances.

Today, the main method for diagnosing heart rhythm disturbances is electrocardiogram analysis. Thanks to the ECG, the doctor can find out the type of arrhythmia. However, certain types of arrhythmia, due to their episodic nature, can be diagnosed using only Holter monitoring.

Holter monitoring is the recording of an ECG during long period time (from several hours to several days) and ECG analysis together with records of a diary specially kept by the patient. In the diary, during the examination period, the patient, leading his usual lifestyle, makes notes hourly about what he did: rested, slept or worked. Interpretation and comparison of ECG and diary recordings give doctors an idea of:

• time of occurrence, duration and frequency of arrhythmia;
• about the correspondence of the appearance of arrhythmia to certain actions.

Doctors also have the opportunity to examine symptoms of insufficient blood supply to the heart.

Heart rhythm can be disrupted by such causes and diseases as:

• Psychogenic disorders, also called functional changes in healthy heart. They accompany neuroses and corticovisceral changes that occur with viscerocardial reflexes, that is, with reflex influences from other bodies.
• Organic heart lesions, including: myocardiopathy, myocarditis, heart defects and all manifestations of coronary heart disease.
• Toxic damage, in most cases caused by drug overdose.
• Traumatic heart injuries.
• Hypothyroidism, thyrotoxicosis and pheochromocytoma, which are pathologies of the endocrine glands.
• Electrolyte shifts, failure of magnesium and potassium metabolism, including hypokalemia that occurs while taking saluretics, cardiac glycosides and similar drugs.
• Age-related changes, which include: decreased automatism of the sinus node, weakening of nervous influences on the heart, increased sensitivity to catecholamines. All this leads to the formation of ectopic foci.

The following specialists can diagnose and prescribe treatment for cardiac arrhythmias:

• cardiologist;
• arrhythmologist

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The human heart works throughout life. It contracts and relaxes 50 to 150 times per minute. During the systole phase, the heart contracts, ensuring blood flow and delivery of oxygen and nutrients throughout the body. During the diastole phase it rests. Therefore, it is very important that the heart contracts at regular intervals. If the systole period is shortened, the heart does not have time to fully provide the body with blood movement and oxygen. If the diastole period is shortened, the heart does not have time to rest.

Heart rhythm disturbance is a disturbance in the frequency, rhythm and sequence of contractions of the heart muscle.

Cardiac muscle - the myocardium consists of muscle fibers. There are two types of these fibers:
- working or contractile myocardium, providing contraction
- conductive myocardium that creates an impulse to contract the working myocardium and ensures the conduction of this impulse.

Contractions of the heart muscle are provided by electrical impulses arising in the sinoauricular or sinus node, which is located in the right atrium. Electrical impulses then travel along the conductive fibers of the atria to the atrioventricular node, located in the lower part of the right atrium. The bundle of His originates from the atrioventricular node. He goes to interventricular septum and is divided into two branches - the right and left branches of the bundle of His. The bundle branches are in turn divided into small fibers - Purkinje fibers - through which the electrical impulse reaches the muscle fibers. Muscle fibers contract under the influence of an electrical impulse in systole and relax in its absence in diastole. The frequency of the normal (sinus) contraction rhythm is from about 50 contractions during sleep, at rest, to 150-160 during physical and psycho-emotional stress, when exposed to high temperatures.

Regulatory influence on the activity of the sinus node is exerted by endocrine system, through the hormones contained in the blood and the autonomic nervous system - its sympathetic and parasympathetic divisions. An electrical impulse in the sinus node occurs due to the difference in the concentrations of electrolytes inside and outside the cell and their movement through cell membrane. The main participants in this process are potassium, calcium, chlorine and, to a lesser extent, sodium.

The causes of heart rhythm disturbances are not fully understood. It is believed that the main two reasons are changes in nervous and endocrine regulation or functional disorders, and abnormalities in the development of the heart and its anatomical structure - organic disorders. Often there are combinations of these underlying causes.

An increase in heart rate of more than 100 per minute is called sinus tachycardia. In this case, the full contractions of the heart muscle and the cardiac complexes on the electrocardiogram do not change, an increased rhythm is simply recorded. This can be a healthy person’s reaction to stress or physical activity, but it can also be a symptom of heart failure, various poisonings, and thyroid diseases.

A decrease in heart rate below 60 beats per minute is called sinus bradycardia. Cardiac complexes on the ECG also do not change. This condition can occur in well-trained physically people (athletes). Bradycardia is also accompanied by diseases of the thyroid gland, brain tumors, mushroom poisoning, hypothermia, etc.

Disorders of conduction and heart rhythm are very frequent complications cardiovascular diseases. The most common heart rhythm disturbances are:
- extrasystole (extraordinary contraction)
- atrial fibrillation (completely irregular rhythm)
- paroxysmal tachycardia (sharp increase in heart rate from 150 to 200 beats per minute).

The classification of rhythm disturbances is very complex. Arrhythmias and blockades can occur anywhere in the conduction system of the heart. Their type depends on the place of occurrence of arrhythmias or blockades.

Extrasystoles or atrial fibrillation are felt by the patient as palpitations, the heart beats faster than usual or there are interruptions in the heart.

If the patient feels fading, cardiac arrest, and at the same time he experiences dizziness and loss of consciousness, most likely the patient has a heart rhythm block or bradycardia (decreased heart rate).

If any heart rhythm disturbance is detected in a patient, it is necessary to conduct a full examination to determine the cause of the arrhythmia.

The main method for diagnosing heart rhythm disorders is an electrocardiogram. An ECG helps determine the type of arrhythmia.

But some arrhythmias occur sporadically. Therefore, Holter monitoring is used to diagnose them. This study provides an electrocardiogram recording over several hours or days. At the same time, the patient leads a normal lifestyle and keeps a diary, where he notes the actions he performs hourly (sleep, rest, physical activity). When interpreting the ECG, the electrocardiogram data is compared with the diary data. The frequency, duration, time of occurrence of arrhythmias and their connection with physical activity are determined, while signs of insufficiency of the blood supply to the heart are analyzed.