If the human heart always worked correctly and contracted with the same regularity, there would be no diseases such as arrhythmias, and there would not be a vast subsection of cardiology called arrhythmology. Thousands of patients around the world experience some type of arrhythmia caused by for various reasons. Arrhythmias have not been spared in very young patients, in whom registration of an irregular heart rhythm on a cardiogram is also quite common. One of the common types of arrhythmias are disorders such as ectopic rhythms.
the cardiac cycle is normal - the primary impulse comes ONLY from the sinus node
IN normal heart In humans, there is only one path for conducting an electrical impulse, leading to sequential excitation of different parts of the heart and to productive heart rate with sufficient release of blood into large vessels. This path begins in the right atrial appendage, where the sinus node (1st order pacemaker) is located, then passes through the atrial conduction system to the atrioventricular (atrioventricular) junction, and then through the His system and Purkinje fibers reaches the most distant fibers in the tissue of the ventricles.
But sometimes, due to the action of various reasons on the cardiac tissue, the cells of the sinus node are not able to generate electricity and release impulses to the underlying sections. Then the process of transmitting excitation through the heart changes - after all, in order for the heart not to stop completely, it should develop a compensatory, replacement system for generating and transmitting impulses. This is how ectopic or replacement rhythms arise.
So, ectopic rhythm is the occurrence of electrical excitation in any part of the conducting fibers of the myocardium, but not in the sinus node. Literally, ectopia means the appearance of something in the wrong place.
The ectopic rhythm can originate from the tissue of the atria (atrial ectopic rhythm), in the cells between the atria and the ventricles (rhythm from the AV junction), and also from the tissue of the ventricles (ventricular idioventricular rhythm).
Ectopic rhythm occurs due to a weakening of the rhythmic functioning of the sinus node, or a complete cessation of its activity.
In turn, complete or partial is the result various diseases and states:
since this may be due to congenital cardiomyopathy, congenital and acquired heart defects, rheumatic fever, viral myocarditis.In addition to pathology of the cardiovascular system, disorders can also lead to ectopic rhythm hormonal levels in the body - diabetes mellitus, pathology of the adrenal glands, thyroid gland, etc.
Symptoms of ectopic rhythm
The clinical picture of replacement heart rhythms can be clearly expressed or not manifested at all. Usually, the symptoms of the underlying disease come first in the clinical picture, for example, shortness of breath on exertion, seizures burning pain behind the sternum, swelling lower limbs etc. Depending on the nature of the ectopic rhythm, symptoms may be different:
- With ectopic atrial rhythm, when the source of impulse generation is located entirely in one of the atria, in most cases there are no symptoms, and disturbances are detected by a cardiogram.
- With rhythm from the AV connection a heart rate close to normal is observed - 60-80 beats per minute, or below normal. In the first case, no symptoms are observed, but in the second, attacks of dizziness, a feeling of lightheadedness and muscle weakness are noted.
- With extrasystole the patient notes a feeling of freezing, cardiac arrest, followed by a sharp jolt in the chest and a further lack of sensation in the chest. The more often or less frequently, the more varied the symptoms are in duration and intensity.
- With atrial bradycardia As a rule, the heart rate is not much lower than normal, within 50-55 per minute, as a result of which the patient may not notice any complaints. Sometimes he is bothered by attacks of weakness, sudden fatigue, which is due to reduced blood flow to the skeletal muscles and to brain cells.
- Paroxysmal tachycardia shows itself much more clearly. When the patient notices a sharp and sudden sensation of accelerated heartbeat. According to many patients, the heart flutters in the chest like a “hare’s tail.” The heart rate can reach 150 beats per minute. The pulse is rhythmic, and may remain around 100 per minute, due to the fact that not all heartbeats reach the peripheral arteries at the wrist. In addition, there is a feeling of lack of air and chest pain caused by insufficient oxygen supply to the heart muscle.
- Atrial fibrillation and flutter may have paroxysmal or permanent forms. The disease is based on chaotic, non-rhythmic contraction of different parts of the atrium tissue, and the heart rate in the paroxysmal form is more than 150 per minute. However, there are normo- and bradysystolic variants, in which the heart rate is within the normal range or less than 55 per minute. The symptoms of the paroxysmal form resemble an attack of tachycardia, only with an irregular pulse, as well as a feeling of irregular heartbeat and interruptions in heart function. The bradysystolic form may be accompanied by dizziness and lightheadedness. With a permanent form of arrhythmia, the symptoms of the underlying disease that led to it come to the fore.
- Idioventricular rhythmis almost always a sign of serious heart pathology, for example, severe acute. In most cases, symptoms are noted, since the myocardium in the ventricles is capable of generating electricity at a frequency of no more than 30-40 per minute. In this regard, the patient may experience episodes - attacks of loss of consciousness lasting several seconds, but no more than one or two minutes, since during this time the heart “turns on” compensatory mechanisms and begins to contract again. In such cases, they say that the patient is “massing.” Such conditions are very dangerous due to the possibility of complete cardiac arrest. Patients with idioventricular rhythm are at risk of developing sudden cardiac death.
Ectopic rhythms in children
In children, this type of arrhythmia can be congenital or acquired.
Thus, ectopic atrial rhythm occurs most often with vegetative-vascular dystonia, with hormonal changes during puberty (in adolescents), as well as with pathology of the thyroid gland.
In newborns and young children, a right atrial, left or lower atrial rhythm may be a consequence of prematurity, hypoxia or pathology during childbirth. In addition, the neurohumoral regulation of heart activity in very young children is immature, and As the baby grows, all heart rate indicators can return to normal.
If the child does not have any pathology of the heart or central nervous system, then the atrial rhythm should be considered a transient, functional disorder, but the baby should be regularly monitored by a cardiologist.
But the presence of more serious ectopic rhythms - paroxysmal tachycardia, atrial fibrillation, atrioventricular and ventricular rhythms - require more detailed diagnostics,
The leading diagnostic method is the electrocardiogram. If an ectopic rhythm is detected on the ECG, the doctor should prescribe a further examination plan, which includes (ECHO-CS) and daily ECG monitoring. In addition, patients with myocardial ischemia are prescribed coronary angiography (CAG), and patients with other arrhythmias are prescribed TPE.
ECG signs for different types of ectopic rhythm differ:
accelerated ectopic atrial rhythm
AV nodal rhythm
idioventricular (ventricular) ectopic rhythm
atrial and ventricular ectopia (extrasystoles) on the ECG
Treatment is not carried out in cases where the patient has an ectopic atrial rhythm that does not cause unpleasant symptoms, and pathologies of the heart, hormonal and nervous systems have not been identified.
In the case of moderate extrasystole, the appointment of sedatives and restorative drugs(adaptogens).
Therapy for bradycardia, for example, with an atrial rhythm with a low contraction frequency, with the bradyform of atrial fibrillation, consists of prescribing atropine, ginseng preparations, Eleutherococcus, Schisandra and other adaptogens. In severe cases, with a heart rate less than 40-50 per minute, with attacks of MES, implantation of an artificial pacemaker (pacemaker) is justified.
Accelerated ectopic rhythm, for example, paroxysms of tachycardia and atrial fibrillation-flutter require assistance emergency assistance, for example, administering a 4% solution of potassium chloride (panangin) intravenously, or a 10% solution of novocainamide intravenously. Subsequently, the patient is prescribed beta blockers or Concor, Coronal, verapamil, propanorm, digoxin, etc.
In both cases - both slow and accelerated rhythms, treatment is indicated underlying disease, if any.
The prognosis in the presence of an ectopic rhythm is determined by the presence and nature of the underlying disease. Eg, If the patient has an atrial rhythm recorded on the ECG, and no heart disease is detected, the prognosis is favorable. And here the appearance of paroxysmal accelerated rhythms against the background acute heart attack myocardium puts the prognostic value of ectopia in the category of relatively unfavorable.
In any case, the prognosis improves with timely consultation with a doctor, as well as with the fulfillment of all medical prescriptions in terms of examination and treatment. Sometimes medications have to be taken for the rest of your life, but this greatly improves the quality of life and increases its duration.
The only place where a normal rhythm of heart contractions is formed is the sinus node. It is located in the right atrium, from which the signal passes to the atrioventricular node, then along the branches of His and Purkinje fibers it reaches its target - the ventricles. Any other part of the myocardium that generates impulses is considered ectopic, that is, located outside the physiological zone.
Depending on the location of the pathological pacemaker, the symptoms of arrhythmia and its signs on the ECG change.
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If the sinus node is damaged, then the function passes to the atrioventricular one - a nodal rhythm occurs. Its descending part spreads in the right direction, and the impulses on the way to the atrium move retrograde. Also, an ectopic focus forms in the right atrium, less often in the left, in the ventricular myocardium.
The reasons for the loss of contraction control by the sinus node are:
There are also extracardiac factors that interfere with physiological functioning. muscle fibers sinus node. These include diabetes mellitus, diseases of the adrenal glands or thyroid gland.
The manifestations of ectopic heart rhythms depend entirely on how far the new pacemaker is located from the sinus node. If its localization is the cells of the atria, then there are often no symptoms, and the pathology is diagnosed only on.
Atrioventricular rhythm can be with a pulse rate close to normal - from 60 to 80 contractions per minute. In this case, it is not felt by the patient. At lower values, paroxysmal dizziness, fainting, and general weakness are observed.
Detects lower atrial rhythm mainly on ECG. The reasons lie in the VSD, so it can be diagnosed even in a child. Accelerated heartbeat requires treatment as a last resort, non-drug therapy is more often prescribed
Excitation of the heart does not come from the suture system, but from certain parts of the left or right atrium, therefore, with this rhythm disturbance, the P wave is deformed, of an unusual shape (P), and the QRS complex is not changed. V.N. Orlov (1983) highlights:
1) right atrial ectopic rhythms (RAER),
2) coronary sinus rhythm (CSR),
3) left atrial ectopic rhythms (LAER).
Electrocardiographic criteria for left atrial rhythm:
1) –Р in II, III, aVF and from V 3 to V 6;
2) Р in V 1 in the form of “shield and sword”;
3)PQ is normal;
4) QRST is not changed.
When the pacemaker is located in the lower parts of the right or left atria, the same picture is observed on the ECG, i.e. –P in II, III, aVF and +P in aVR. In such cases, we can talk about the lower atrial rhythm (Fig. 74).
Rice. 74. Inferior atrial rhythm.
Excitation of the heart comes from the AV junction. There are “upper”, “middle” and “lower” atrioventricular or nodal rhythms. The “upper” nodal rhythm is virtually indistinguishable from inferior atrial rhythm. Therefore, it is advisable to talk about only two options for nodal rhythm. In option I, the impulses come from the middle sections of the AV junction. As a result, the impulse to the atria goes retrograde, and they are excited simultaneously with the ventricles (Fig. 75). In option II, the impulses come from the lower parts of the AV junction, while the atria are excited retrogradely and later than the ventricles (Fig. 76).
Rice. 76. Inferior nodal rhythm: Heart rate = 46 per minute, at V = 25 mm/s RR = RR, Р(–) follows QRS.
Electrocardiographic criteria of AV rhythm (Fig. 75, 76):
1) heart rate 40–60 per minute, the distance between R–R is equal;
2) QRST is not changed;
3) Р is absent in option I and –Р follows after QRS in option II;
4) RP is equal to 0.1–0.2 s with option II.
With this rhythm, the excitation and contraction of the ventricles is carried out from a center located in the ventricles themselves. Most often, this center is localized in the interventricular septum, in one of the bundle branches or branches, and less often in Purkinje fibers.
Electrocardiographic criteria for ventricular rhythm (Fig. 77):
1) widened and sharply deformed (blocked) QRS. Moreover, the duration of this complex is more than 0.12 s;
2) heart rate 30–40 per 1 min, with a terminal rhythm less than 30 per 1 min;
3) R–R are equal, but may be different in the presence of several ectopic foci of excitation;
4) almost always the atrial rhythm does not depend on the ventricular rhythm, i.e. there is complete atrioventricular dissociation. Atrial rhythm can be sinus, ectopic, atrial fibrillation or flutter, atrial asystole; Retrograde excitation of the atria is extremely rare.
Rice. 77. Idioventricular rhythm: Heart rate = 36 per 1 min, with V = 25 mm/s QRS - wide; R - absent.
Just like slow rhythms, they can be atrial, from the AV junction (most often) and ventricular. This rhythm disturbance is compensatory and occurs against the background of a rare rhythm, periods of asystole, and therefore is also called passive.
Electrocardiographic criteria for escape complexes (Fig. 78):
1) the R–R interval before the jumping contraction is always longer than usual;
2) the R–R interval after the jump-out contraction is of normal duration or shorter.
Rice. 78. Slipping complexes.
As you know, arrhythmia is not a disease, but a group of cardiac diagnoses that are united by impaired conduction of impulses in the heart. One of the manifestations of a characteristic disease is lower atrial rhythm; a qualified cardiologist will tell you what it is.
Inferior atrial rhythm is an abnormal contraction of the myocardium, which is provoked by impaired activity of the sinus node. The appearance of so-called “replacement rhythms” is not difficult to determine, since they are noticeably shorter in frequency, which is listened to by a specialist during an individual consultation.
Etiology of pathology
If a doctor determines the presence of an abnormal heartbeat, then diagnosis and treatment alone are not enough to finally get rid of the health problem that has arisen. It is also necessary to find out what factors preceded this anomaly, and then permanently eliminate them from the life of a particular patient (if possible).
This disease progresses in adults whose bodies already have a number of chronic diagnoses. Most often this arterial hypertension, rheumatism, diabetes mellitus, coronary heart disease, myocardial defects, acute heart failure, myocarditis, neurocirculatory dystonia. Also, one should not exclude the fact that the problem may be congenital and cannot be completely cured.
Whatever the reasons, in such a situation a non-sinus regular or irregular rhythm is diagnosed with a normal or abnormal heart rate. Detect presence characteristic disease is not particularly difficult, but the ECG plays a decisive role.
Diagnostics
To make a correct diagnosis, the patient should first contact a cardiologist with characteristic complaints about his general health. Collecting medical history data allows you to carefully study the clinical picture and presumably identify several potential diagnoses.
Will allow you to narrow the circle clinical diagnosis and detailed laboratory research followed by a conclusion. The first step is to take a general and biochemical blood test, where the latter can show serious disturbances in the function of the thyroid gland and work endocrine system generally. A general urine test can also reveal the etiology of the pathological process, followed by diagnosis and medical prescription.
Early ventricular repolarization syndrome is determined by ECG, but in this case a clinical examination is carried out within 24 hours using a special portable device. The data obtained is ultimately collected in a table, and the doctor can determine heart rhythm disturbances with possible symptoms of the pathological process.
If certain difficulties arise in making a final diagnosis, then it would not hurt the patient to undergo an MRI, because this particular clinical diagnostic method is considered more informative and comprehensive. After the procedure, the attending physician will certainly not ask any additional questions; all that remains is to prescribe the most optimal treatment regimen.
Treatment
Effective treatment begins with eliminating the underlying causes that provoked the arrhythmia attack. If the underlying disease is finally healed, then the lower atrial rhythm will not disturb the typical patient.
Since the disease tends to be chronic, it is necessary to follow all the recommendations of the cardiologist in order to avoid frequent attacks and relapses. For this purpose it is prescribed therapeutic diet with limiting fatty and sweet foods, physiotherapy and even acupuncture.
But drug therapy is based on the systematic use antiarrhythmic drugs, which, after taking a single portion, regulate the speed and frequency of impulses conducted to the heart. The main medical drug is prescribed by the doctor, based on the diagnosis and specifics of the diseased organism.
If conservative treatment turned out to be ineffective, or there is a neglected clinical picture, then surgical intervention followed by a long rehabilitation period is indicated.
In general, patients with this diagnosis live well in a state of long-term remission, but only if they strictly follow all medical recommendations and do not violate the previously prescribed diet. If the disease reminds itself of itself with systematic attacks, the doctor recommends agreeing to surgery. Such radical measures are carried out in exceptional cases, but give the patient a real chance for a final recovery.
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FEATURES OF THE ELECTROCARDIOGRAM
IN CHILDREN WITH VEGETATIVE DYSFUNCTIONS
Associate Professor of the Department of Pediatrics Khrustaleva E.K.
An electrocardiogram (ECG) is a graphic recording of excitation processes occurring in the myocardium. The ECG reflects the state of all myocardial functions: automaticity, excitability, conductivity and contractility.
ECG plays an important role in identifying autonomic dysfunctions in children.
Orthostatic test. First, the child’s ECG is recorded in a horizontal position (after a 5-10 minute rest) in 12 generally accepted leads, then in vertical position(after 5-10 minutes of standing). Normally, in a vertical position of the body, a slight shortening of the R–R, PQ and Q–T intervals, as well as some flattening of the T wave, is observed on the ECG. A pronounced shortening of the R–R intervals (acceleration of the rhythm) by 1.5–2 times in a vertical position, accompanied by T wave inversion in some leads (III, aVF, V4–6) may indicate the presence of hypersympathicotonic autonomic reactivity in the child.
Exercise test. It is carried out on a bicycle ergometer (45 rpm, 1 W/kg body weight, for 3 minutes) or by squats (20-30 squats at a fast pace). An ECG is recorded before and after exercise. With a normal reaction to stress, only a slight acceleration of the rhythm is detected. With vegetative disorders, changes appear similar to those described during orthostatic test. The test also helps to identify vagodependent and sympathodependent extrasystoles. More indicative than an oral static test.
Sample with - adrenergic blockers. This test is used if there is reason to believe that the child has hypersympathicotonia, which is expressed on the ECG in the form of T wave inversion, downward displacement of the ST segment, or extrasystoles appearing after physical activity.
Atropine test. The administration of atropine causes a temporary depression of vagal tone. The test is used in children school age if there is a suspicion of a vagal nature of ECG changes (bradycardia, conduction disturbances, extrasystole). Atropine is administered subcutaneously at the rate of 0.1 ml per year of life, but not more than 1.0 ml. Registration of an ECG (12 leads) is carried out before giving atropine, immediately after it and every 5 minutes for half an hour. If, after a test with atropine, changes in the ECG temporarily disappear, it is regarded as positive and indicates an increase in the tone of the vagus nerve. Often, autonomic dysfunctions in children manifest themselves in the form of various disturbances of heart rhythm and conduction.
Heart rhythm disturbances, or arrhythmias, include any disturbance in the rhythmic and consistent activity of the heart. Children experience the same numerous heart rhythm disturbances as adults. However, the causes of their occurrence, course, prognosis and therapy in children have a number of features. Some arrhythmias manifest themselves with a clear clinical and auscultatory picture, while others are hidden and visible only on an ECG. Electrocardiography is an indispensable method for diagnosing various heart rhythm and conduction disorders. Electrocardiographic criteria for normal sinus rhythm are: 1/ regular, consistent row R-R(R-R); 2/ constant P wave morphology in each lead; 3/ the P wave precedes each QRST complex; 4/ positive P wave in leads I., II, aVF, V 2 - V 6 and negative in lead aVR. On auscultation, a normal heart melody is heard, i.e. the pause between the Ι and ΙΙ tones is shorter than the pause after the ΙΙ tone, and the heart rate (HR) corresponds to the age norm.
All deviations from normal sinus rhythm are classified as arrhythmias. The most acceptable for practitioners is the classification of arrhythmias, based on dividing them in accordance with violations of the basic functions of the heart - automaticity, excitability, conductivity and their combinations.
To arrhythmias associated with violation automation functions include the following: sinus tachycardia (accelerated sinus rhythm), sinus bradycardia (slow sinus rhythm), sinus arrhythmia (irregular sinus rhythm), pacemaker migration.
Sinus tachycardia, or accelerated sinus rhythm. Sinus tachycardia (ST) is understood as an increase in heart rate per minute compared to age norm, in which the pacemaker is the sinus (sinoatrial) node. On auscultation, a rapid rhythm is heard with a preserved heart melody. As a rule, children do not complain. Nevertheless, ST adversely affects general and cardiac hemodynamics: diastole is shortened (the heart has little rest), cardiac output decreases, and myocardial oxygen demand increases. A high degree of tachycardia also adversely affects coronary circulation. On the ECG with TS, all waves are present (P, Q, R, S, T), but the duration is shortened cardiac cycle due to the diastolic pause (TP segment).
The causes of TS are varied. School-age children have the most common cause TS is a syndrome of autonomic dysfunction (AVD) with sympathicotonia, while a flattened or negative T wave appears on the ECG , which is normalized after taking β-blockers (positive obsidan test).
The doctor's tactics should be determined by the cause of TS. For SVD with sympathicotonia it is used sedatives(Corvalol, valerian, tazepam), electrosleep, β-blockers (inderal, anaprilin, obzidan) in small doses (20–40 mg per day) or isoptin, potassium preparations (asparkam, panangin), cocarboxylase are indicated. In other cases, treatment of the underlying disease (anemia, arterial hypotension, thyrotoxicosis, etc.) is required.
Sinus bradycardia, or slow sinus rhythm. Sinus bradycardia (SB) is expressed as a slower heart rate compared to the age norm, with the sinus node being the pacemaker. Typically, children do not complain; with severe SB, weakness and dizziness may periodically appear. On auscultation, the heart melody is preserved, the pauses between tones are lengthened. All waves are present on the ECG, the diastolic pause is prolonged. Moderate SB does not cause hemodynamic disturbances.
The causes of SB are varied. Physiological bradycardia occurs in trained people, athletes, during sleep. The most common cause of WS in school-age children is SVD with vagotonia, which is confirmed by a functional ECG test with atropine.
SB can also be a manifestation of myocarditis and myocardial dystrophy. A significant decrease in heart rate is observed in children with food and medicinal poisonings or overdose of a number of medications: cardiac glycosides, antihypertensive drugs, potassium preparations, β – adrenergic blockers. Severe SB may be a manifestation of sick sinus syndrome. When the central nervous system is affected (meningoencephalitis, brain tumors, cerebral hemorrhages), SB is also observed. The doctor’s tactics for SB are determined by its cause.
Atrial rhythms. They come from pacemakers, which are located in the conduction tracts of the atria. They appear when the pacemakers of the sinus node do not work well. In children, a common cause of such arrhythmias is a violation of the autonomic supply of the sinus node. Various atrial rhythms are often observed in children with VDS. However, a decrease in the activity of automatism of the sinus node can occur both with inflammatory changes in the myocardium and with myocardial dystrophy. One of the causes of atrial rhythms may be a malnutrition of the sinus node (narrowing of the feeding artery, its sclerosis).
Atrial rhythms do not cause subjective sensations, children do not complain. This rhythm disturbance also has no auscultatory criteria, except for a slight slowdown in the rhythm, which often goes unnoticed. The diagnosis is made solely by electrocardiographic data. Electrocardiographic criteria for atrial rhythms are changes in the morphology of the P wave and relative bradycardia. There are upper, middle and lower atrial rhythms. With an upper atrial rhythm, the P wave is reduced and close to the ventricular complex, with a mid-atrial rhythm it is flattened, and with a lower atrial rhythm it is negative in many leads (retrograde conduction of the impulse to the atria) and is located in front of the QRS complex.
There is no specific treatment. Depending on the reason that caused the shift in the source of rhythm, appropriate therapy is carried out: anti-inflammatory drugs are prescribed for carditis, cardiotrophic drugs for myocardial dystrophy, and correction of autonomic disorders for SVD.
Migration of the source (driver) of the rhythm. It occurs due to weakening of the pacemaker activity of the sinus node. Any atrial rhythm can be replaced by pacemaker migration. Usually there are no subjective or clinical manifestations. The diagnosis is made on the basis of an ECG. An electrocardiographic criterion is the change in the morphology of the P wave in different cardiac cycles within one lead. It is clear that the source of the rhythm is alternately different pacemakers, located either in the sinus node or in different parts of the atria: the P wave is sometimes positive, sometimes flattened, sometimes negative within the same lead, and the R-R intervals are not the same.
Rhythm source migration is common in children with VDS. However, it can also be observed in myocardial dystrophy, carditis, as well as in children with a pathological athletic heart. ECG functional tests can help in making a diagnosis.
To violations excitability functions refers to a group of ectopic arrhythmias, in the occurrence of which the main role is played by ectopic pacemakers located outside the sinus node and having high electrical activity. Under the influence of various reasons, ectopic foci are activated, suppress the sinus node and become temporary pacemakers. In addition, the mechanism of development of ectopic arrhythmias recognizes the principle of reentry, or circular movement of excitation waves. Apparently, this mechanism operates in children with dysplasia syndrome connective tissue hearts that have additional conduction pathways, additional chords in the ventricles and valve prolapse.
Ectopic arrhythmias, which often occur against the background of autonomic disorders in children, include extrasystole, parasystole, and paroxysmal tachycardia.
Extrasystole – premature arousal and myocardial contraction under the influence of ectopic pacemakers, which occurs against the background of sinus rhythm. Exactly this frequent violation heart rhythm among ectopic arrhythmias. Depending on the location of the ectopic focus, atrial, atrioventricular and ventricular extrasystoles are distinguished. In the presence of one ectopic pacemaker, the extrasystoles are monotopic; with 2 or more, they are polytopic. 2-3 consecutive extrasystoles are called group.
Often children do not feel extrasystole, but some may complain of “interruptions” or “fading” in the heart. A premature tone and a pause after it are heard on auscultation. An accurate diagnosis of extrasystole can only be made using an ECG. The main electrocardiographic criteria are the shortening of diastole before the extrasystole and the compensatory pause after it. The shape of the ectopic complex depends on the location of the extrasystole.
Depending on the time of occurrence, they distinguish late, early and very early extrasystoles. If there is a small segment of diastole before the ectopic complex, then this is a late extrasystole. If an extrasystole occurs immediately after the T wave of the previous complex, it is considered early. Super early, or extrasystole “R to T”, appears on the unfinished T wave of the previous complex. Very early extrasystoles are very dangerous; they can cause sudden cardiac death, especially during physical overload.
On the ECG at atrial P wave is present in extrasystoles , but with a changed morphology: it can be reduced (upper atrial extrasystole), flattened (mid-atrial) or negative (inferior atrial). The ventricular complex, as a rule, is not changed. Sometimes it is deformed (aberrant complex) if intraventricular conduction is impaired. Atrial extrasystole may be blocked, this occurs when excitation covers only the atria and does not extend to the ventricles. In this case, only one premature P wave is recorded on the ECG and a long pause after it. This is typical for very early atrial extrasystoles, when the ventricular conduction system has not yet left the refractory period.
At atrioventricular extrasystoles, the focus of excitation (ectopic pacemaker) is located in the lower part of the AV junction or in the upper part of the trunk of the His bundle, since only in these sections there are cells of automatism. There may be several variants of atrioventricular extrasystoles in shape. Extrasystoles without a P wave with a slightly changed ventricular complex are more common. This form of extrasystole occurs if the excitation simultaneously reaches the atria and ventricles or does not reach the atria at all due to a violation of the retrograde conduction of the AV junction. If the excitation wave first came to the ventricles and then to the atria, a negative P wave is recorded on the ECG , located between the QRS complex and the T wave, or the P wave overlaps the T wave . Sometimes, with atrioventricular extrasystoles, as with atrial extrasystoles, there may be an aberrant QRST complex, which is associated with impaired intraventricular conduction.
At ventricular extrasystoles, the ectopic focus is located in the conduction system of the ventricles. They are characterized by the absence of a P wave on the ECG (the impulse does not reach the atria retrogradely) and severe deformation of the ventricular complex with a discordant location of the QRS and T waves .
An ECG can be used to determine where the ectopic focus is located. To do this, you need to fix the extrasystoles in leads V 1 and V 6. Right ventricular extrasystoles in lead V 1 look down, and in V6 look up, i.e. in lead V1 in the extrasystolic complex a widened QS wave and a positive T wave are observed, and in lead V 6 a high widened R wave is observed and a negative T wave. Left ventricular extrasystoles in lead V 1 are directed upward (their direction is always changed compared to the main sinus complex), and in V 6 - downward.
Group, frequent extrasystoles, against the background of prolongation of the QT interval, as well as early and very early ones, are considered prognostically unfavorable. Early and very early ventricular extrasystoles are especially dangerous. They should attract special attention from pediatricians and pediatric cardio-rheumatologists.
Many factors contribute to the occurrence of extrasystole in children. At school age, extrasystoles associated with autonomic disorders predominate (60%). These are mainly late right ventricular or supraventricular (atrial and atrioventricular extrasystoles). All extrasystoles of vegetative origin can be divided into three types. More often (in 47.5% of cases) there are so-called vagodependent extrasystoles caused by the increased influence of the vagus nerve on the myocardium. Usually they are heard in the supine position (they can be frequent, in an allorhythm, in groups), in an upright position their number sharply decreases, and after physical activity they disappear. After administration of atropine subcutaneously (0.1 ml per 1 year of life), such extrasystoles also temporarily disappear (positive atropine test).
Some children with SVD have sympathodependent extrasystoles associated with increased activity of sympathetic influences on the heart. Such extrasystoles are recorded against the background of sinus tachycardia, usually in a standing position; in a horizontal position their number decreases. In this case, a positive test with β is noted – adrenergic blockers: after giving obzidan (anaprilin, inderal) at a dose of 0.5 mg/kg body weight, after 60 minutes the number of extrasystoles sharply decreases or they temporarily disappear altogether.
In approximately 30% of cases there are co-dependent extrasystoles, mainly in children with a mixed form of SVD. Such extrasystoles can be heard and recorded on an ECG, regardless of the patient’s position and physical activity. From time to time they become similar either to vago-dependent or to sympathetic-dependent extrasystoles.
Myocardial dystrophy associated with foci of chronic infection or sports overload can also cause extrasystole. In young children, extrasystole may be a manifestation of late congenital carditis. Acquired carditis, dilated cardiomyopathy, congenital heart defects are often complicated by extrasystole, often left ventricular. Extrasystoles of a mechanical nature are known: after heart surgery, cardiac trauma, angiocardiography, catheterization. Extrasystole is often detected in children with connective tissue dysplasia of the heart in the form of additional conduction tracts, an additional chord of the left ventricle and mitral valve prolapse.
Treatment children with extrasystole is a very difficult task. To obtain the effect of therapy, great skill of the doctor is required. The approach to treatment should be differentiated, taking into account the cause of extrasystole, its type and shape.
At vagozavisnymi extrasystoles is indicated physical rehabilitation in the form of exercise therapy and dosed loads on a bicycle ergometer: 45 rpm, from 0.5 to 1 W/kg body weight for 5–10 minutes, then up to 15–20 minutes. in a day. For 2–3 weeks, medications that reduce vagal influences are prescribed, for example, amizil or bellataminal 1–2 mg 3–4 times a day. Calcium-containing preparations are used - calcium glycerophosphate, vitamins B 5 and B 15. If the extrasystoles are late, monotopic and single, antiarrhythmic drugs are not needed. In the presence of unfavorable extrasystoles, the drugs of choice are etacizin and etmozin. They have virtually no cardiodepressive effect and do not slow down the rhythm, which is important when treating patients with vagodependent extrasystoles. Before using these medications, it is recommended to conduct an acute drug test (ADT): 100–200 mg of the drug is given once, and an ECG is taken 2–3 hours later; if the number of extrasystoles decreases by 50%, the test is considered positive and treatment will be effective.
Children with sympathetically dependent Extrasystoles are prescribed sedatives (valerian, motherwort, tazepam, etc.), potassium preparations (panangin, asparkam) in age-specific dosages for 2–3 weeks. You can use electrosleep (5–7 sessions). Showing β – adrenergic blockers, which are preferably used after OLT, since there is individual sensitivity to various drugs of this series.
At combination-dependent extrasystoles, cardiotrophic therapy is carried out: potassium preparations, antioxidant complex, pyridoxal phosphate in age-appropriate dosages of 2–3 weeks. You can carry out a course of treatment with ATP and cocarboxylase for 30 days or prescribe Riboxin 1 tablet 2-3 times a day. For supraventricular extrasystoles, isoptin (finoptin, verapamil) in tablets is recommended for 2-3 weeks; for ventricular extrasystoles, etacizin, etmozin or prolecophen are recommended. Allapenin and Sotalex are effective for all types of extrasystole.
When treating patients with extrasystole against the background of myocardial dystrophy, sanitation of foci of chronic infection is important. Cardiotrophic drugs are prescribed, and, if necessary, antiarrhythmic drugs. In the treatment of extrasystoles against the background of carditis, anti-inflammatory drugs are of primary importance; antiarrhythmic drugs are often not needed. For extrasystoles of toxic origin, detoxification therapy is used in combination with cardiotrophic drugs.
Parasystole stands close to the extrasystole. Parasystoles do not differ in shape from extrasystoles; they are also atrial, atrioventricular and ventricular. During parasystole, there are two independent sources of rhythm in the heart: one is sinus, the other is ectopic, the so-called “paracenter”, located in one of the sections of the conduction system - in the atria, atrioventricular junction or ventricles. The paracenter produces impulses in a certain rhythm, from 10 to 200 impulses per minute. Basically, the paracenter works as if “behind the scenes”, hidden, impulses do not come out of it and parasystoles are not recorded. With various adverse effects on the myocardium and paracenter, parasystoles (ectopic impulses) are released, which can inhibit the impulses of the sinus node or work in parallel with them.
On auscultation, parasystoles are often heard as extrasystoles. The diagnosis is made by ECG. There are three main electrocardiographic criteria for parasystole. The first criterion is different pre-ectopic intervals before parasystoles, the difference between which exceeds 0.1 s, which is not typical for extrasystoles. The second criterion is the presence of drain complexes on the ECG, the formation of which is explained by the simultaneous excitation of the myocardium from the sinus pacemaker and the parasystolic one, as a result of which the complex becomes unusual, representing a cross between the shape of the sinus and parasystolic complexes. The third criterion is the multiplicity of the smallest R–R interval between parasystoles to the largest distance between them. This sign indirectly indicates the presence of a certain rhythm in the paracentre. To clearly establish parasystole, you need to take a long tape ECG and find all three diagnostic criteria.
In children, parasystole is often detected against the background of SVD. Just like extrasystole, it can be vagodependent, sympathodependent and combined dependent. Parasystole also occurs against the background of myocarditis and myocardial dystrophy. For parasystole, the same therapeutic principles, as with extrasystole.
Paroxysmal tachycardia (PT) – arrhythmia close to extrasystole. Increased electrical activity of ectopic pacemakers and the mechanism of circular motion of the impulse (reentry) also play a role in its occurrence. An attack of AT is characterized by a sudden increase in heart rate from 130 to 300 beats per minute, while the sinus node does not work, and the source of the rhythm is an ectopic pacemaker, which can be located in the atria, AV junction or ventricles. Depending on this, atrial, atrioventricular and ventricular forms of AT are distinguished. The heart rate remains constant during the entire attack and does not change with breathing, movement, or changes in body position, i.e. a rigid rhythm is observed. Embryocardia is heard on auscultation: an accelerated rhythm with equal pauses between tones. This is the difference between AT and sinus tachycardia, in which the melody of the heart is maintained at an increased rate. An attack of PT can last from a few seconds to several hours, rarely up to a day; it ends suddenly with a compensatory pause, after which normal sinus rhythm begins.
PT always has an adverse effect on hemodynamics and tires the heart muscle ( complete absence diastole, the moment of relaxation and nutrition of the heart). A prolonged attack of PT (more than 3 hours) often leads to acute heart failure.
During short attacks, the child may not have any complaints or subjective sensations. If the attack drags on, older children experience pain and discomfort in the heart area, palpitations, weakness, shortness of breath, and may experience abdominal pain.
In school-age children, the cause of an attack of AT is more often SVD, while AT is usually supraventricular (atrial or atrioventricular). Often, AT, especially atrioventricular, is observed in children with ventricular preexcitation syndromes (short PQ and WPW interval syndromes). The ventricular form of AT can occur in children with early ventricular repolarization syndrome.
It must be remembered that an attack of PT can also occur against the background of myocardial dystrophy, carditis and dilated cardiomyopathy. We observed the development of PT in children with connective tissue dysplasia syndrome of the heart in the form of an additional chord of the left ventricle and mitral valve prolapse.
The question of the form of PT can be resolved using an ECG recorded during an attack. Atrial form PT on the ECG looks like atrial extrasystoles, following each other at a fast pace, with no diastole. The morphology of the P wave is changed, sometimes the P wave is superimposed on the T wave of the previous complex, the ventricular complexes, as a rule, are not changed.
Atrioventricular form PT on the ECG differs from the atrial one in the absence of the P wave . The ventricular complexes are either unchanged or somewhat widened. When it is impossible to clearly distinguish the atrial form from the atrioventricular one, the term “supraventricular” or “supraventricular” is used. The AB form of AT is often found in children with ECG ventricular preexcitation syndromes.
At ventricular form The PT ECG shows a series of ventricular extrasystoles following one another. In this case, the P wave is absent, and the ventricular complex is sharply widened and deformed, the discordance of the QRS complex and the T wave is pronounced. The prognosis for ventricular AT is always serious, since it often develops against the background of damaged myocardium (myocarditis, cardiomyopathy).
Regardless of the reason that caused the PT, it is necessary first of all to stop the attack, and then carry out targeted therapy for the underlying disease against which the PT occurred. First, the patient must be reassured and given sedatives: valerian extract, Corvalol, valocardine or motherwort (20–30 drops), seduxen, etc. It is advisable to take an ECG and determine the form of PT.
At supraventricular form If the attack has recently begun, school-age children can undergo vagus nerve stimulation. This can be a massage of the carotid sinus area, pressing on eyeballs, causing a gag reflex or pressure on the abdominals. If these actions are ineffective, antiarrhythmic drugs are prescribed. The drug of choice in this situation is isoptin (finoptin, verapamil), which is administered intravenously slowly in the form of a 0.25% solution at the rate of 0.12 mg per 1 kg of body weight (no more than 2 ml per injection). Along with it, seduxen or relanium, cocarboxylase, and panangin are administered in an age-specific dosage in a 10% glucose solution. Instead of isoptin, Sotalex can be administered intravenously at a dose of 1 mg/kg body weight.
At ventricular form For PT, you can use lidocaine, which is administered intravenously at a rate of 1 mg/kg of a 1% solution per injection. To relieve an attack of ventricular tachycardia, etacizin or ethmozin is successfully used intramuscularly or intravenously at a dose of 1 mg per 1 kg of body weight.
Allapenin is administered to adult patients intramuscularly and intravenously for both supraventricular and ventricular forms of PT, 0.5 - 2 ml of 0.5% solution per injection. Sometimes, during a prolonged attack of PT, it is necessary to sequentially administer two antiarrhythmic drugs from different classes, for example, isoptin and etacizine or Sotalex and etacizine.
In the ventricular form of PT, it is undesirable to administer β-blockers and cardiac glycosides, as a complication may occur in the form of ventricular fibrillation. This is why, if the form of PT is unknown, therapy should never be started with these drugs.
After the attack of PT is relieved, the patient should be further examined and the cause of the arrhythmia should be determined.
Conduction function disorders (blockades) arise when cells of the 2nd and 3rd types, which ensure the transmission of impulses throughout the conduction system and to contractile myocardium. Based on localization, they distinguish sinoatrial (at the level of the atrial myocardium), atriventricular (at the level of the AV junction and the trunk of the His bundle) and intraventricular blockades (at the level of the legs and branches of the His bundle). Conduction disturbances can be observed simultaneously at different levels, reflecting widespread damage to the conduction system of the heart.
The blockade can be complete, when there is a complete interruption in the passage of the excitation wave, and incomplete, partial, when the conduction of impulses slows down or some impulses periodically do not pass through the affected area.
With autonomic dysfunctions (with increased tone of the vagus nerve), children may experience sinoatrial blockades and AV blockade of the first degree. Other conduction disorders have a more serious genesis (myocarditis, cardiosclerosis, cardiomyopathy, etc.).
At sinoatrial (SA) block there is a slowdown or cessation of impulse transmission from the sinus node to the atria. SA blockade can be transient or permanent.
With incomplete (partial) SA blockade, some impulses do not pass from the sinus node to the atria, which is accompanied by periods of asystole. If several ventricular contractions occur in a row, this is clinically manifested by dizziness or even fainting, “freezing” in the heart. Auscultation can be heard periodic loss of cardiac activity, i.e. temporary absence of heart sounds. In this case, the ECG records long diastolic pauses, after which escape contractions or rhythms may appear.
Incomplete SA block is almost impossible to distinguish from sinus node failure (sinus arrest), which is also expressed on the ECG by a long pause. Sinus node failure is often a manifestation of sick sinus syndrome and in this case is recorded against the background of severe bradycardia. In this situation, the sinus node temporarily loses the ability to generate impulses, which is often associated with a disruption in its power supply.
Complete SA blockade is characterized by the fact that not a single impulse reaches the atria; the excitation and contraction of the heart are carried out under the influence of underlying pacemakers (heterotopic rhythms), most often atrial ones.
SA blockade often occurs in school-age children against the background of SVD with vagotonia. In this case, the atropine test will be positive, i.e. the blockade will be temporarily lifted after the administration of atropine.
SA blockade may appear against the background of current myocarditis or myocardial dystrophy. In these cases, the atropine test will be negative.
Intoxication and poisoning with certain drugs (cardiac glycosides, β – adrenergic blockers, quinidine, cordarone) can also cause sinoatrial blockade.
For sinoatrial blockade of vagal origin, agents are used that reduce the tone of the vagus nerve. This can be amizil, bellataminal or beloid in age-specific dosages for 3 to 4 weeks. To reduce the degree of blockade, if fainting is frequent, use ephedrine, alupent. In severe cases, children should receive care in cardiac surgery departments for the treatment of cardiac arrhythmias, where they undergo cardiac pacing if necessary.
Atrioventricular (AV) block manifests itself as a violation of the conduction of impulses mainly through the AV connection.
Ι degree Diagnosed only by ECG. It has no auscultatory or clinical manifestations. On the ECG it is expressed by a lengthening of the PQ interval in comparison with the age norm (Fig. 18). With this blockade, all impulses pass through the affected area, but their conduction is slowed down. The cause of AV block of the 1st degree is often SVD with vagotonia, this is confirmed by a positive functional test with atropine. However, it must be remembered that such a blockade can occur in children with an ongoing inflammatory process in the area of the AV junction (rheumatic carditis, non-rheumatic myocarditis), in this case the PQ interval changes over time.
Persistent prolongation of the PQ interval is characteristic of post-myocardial cardiosclerosis. A temporary prolongation of the PQ interval can be observed with an overdose of potassium preparations, cardiac glycosides, and antiarrhythmic drugs. AV block of the 1st degree can be hereditary; in this case, it is registered from birth and is often detected in one of the parents.
There is no special treatment for 1st degree AV block. Treatment of the underlying disease is carried out, while drugs that slow down conduction (potassium, cardiac glycosides, β – adrenergic blockers).
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Non-sinus rhythms can occur due to changes occurring in the area of the sinus node, as well as in other conducting sections. These modifications can be:
Ectopic disorders are classified in different ways. There are several forms:
Changes occurring in the myocardium due to neuroendocrine influences can also occur in children. This means that in the child’s heart there are additional foci of excitation that function independently of each other. Such violations are divided into several forms:
Ventricular extrasystoles in childhood begin to develop in cases of cardiac organic pathology. Very rare, but there are cases when this type can be diagnosed in healthy child, even in a newborn.
Against the background of a viral infection, attacks of paroxysmal tachycardia occur at an early age, which can occur in a very severe form, called supraventricular. This is possible with congenital heart defects, atropine overdose and carditis. Attacks of this form often occur when the patient awakens and changes body position.
We have learned that non-sinus rhythms depend on the underlying disease and its causes. It means that specific symptoms not visible. Let's look at some signs that indicate that it is time to see a doctor yourself or together with your child if his condition worsens.
Let's take paroxysmal tachycardia as an example. Most often it begins as unexpectedly as it ends. At the same time, its precursors, such as dizziness, chest pain, and so on, are not observed. At the very beginning of the crisis there is usually no shortness of breath or heart pain, but these symptoms can appear during a prolonged attack. Initially, there arises: a feeling of anxiety and fear that something serious is happening to the heart, motor restlessness, in which a person wants to find a position in which the disturbing state will stop. Next, hand trembling, darkening of the eyes and dizziness may begin. Then it is observed:
Attacks of short duration may occur during sleep, and the patient may experience a sharply increased heart rate due to some kind of dream. After it ends, heart activity returns to normal, shortness of breath disappears; a person feels a “fading” of the heart, followed by a heartbeat, which indicates the beginning of a normal sinus rhythm. It happens that this impulse is accompanied by a painful sensation. However, this does not mean that the attack always ends so abruptly; sometimes heart contractions slow down gradually.
Separately, it is worth considering the symptoms that occur in children with the development of ectopic rhythm. Each mentioned form of disorder of this nature has its own symptoms.
Extrasystoles are characterized by:
However, there may be no symptoms at all. Vagotopic extrasystoles in children are accompanied by excess body weight and a hypersthenic constitution. Paroxysmal tachycardia at an early age has the following symptoms:
Diagnosis of the disease, in addition to the symptoms indicated by the patient, is based on ECG data. Some forms of ectopic rhythm disturbances have their own characteristics that are visible in this study.
The atrial rhythm is different in that the configuration of the R wave changes, its diagnostic signs are not clear. With a left atrial rhythm, there is no change in the PQ interval; it is also equal to 0.12 s or exceeds this level. The QRST complex does not differ, since excitation through the ventricles occurs in the usual way. If the pacemaker is located in lower parts left or right atrium, then the ECG will show the same picture as with coronary sinus rhythm, that is, positive PaVR and negative P in the third and second leads aVF. In this case, we are talking about the lower atrial rhythm, and it is very difficult to find out the exact localization of the ectopic focus. The right atrial rhythm is characterized by the fact that the source of automatism is P-cells, which are located in the right atrium.
In childhood, a thorough diagnosis is also carried out. Atrial extrasystoles are characterized by a modified P wave, as well as a shortened P-Q interval with an incomplete compensatory pause and a narrow ventricular complex. Extrasystoles of an atrioventricular connection differ from the atrial form in that there is no P wave in front of the ventricular complex. The right ventricular extrasystole is characterized by the fact that the main R wave has a standard upward lead, and the left ventricular one is distinguished by the downward lead of the same tooth.
With paroxysmal tachycardia, embryocardia is detected during the examination. In this case, the pulse has a small filling and is difficult to count. Reduced blood pressure is also observed. The ECG shows a rigid rhythm and ventricular aberrant complexes. In the period between attacks and with the supraventricular form, extrasystole is sometimes recorded, and during the crisis itself the picture is the same as with group extrasystole with a narrow QRS complex.
When diagnosing non-sinus rhythms, treatment is aimed at the underlying disease. Accordingly, it is very important to identify the cause of cardiac dysfunction. For vegetative-vascular disorders, sedatives are usually prescribed; for vagal strengthening, belladonna and atropine are prescribed. If there is a tendency to tachycardia, beta-blockers, for example, obzidan, anaprilin and propranolol, are considered effective. Known drugs are cordarone and isoptin.
Extrasystoles of organic origin are usually treated with panangin and potassium chloride. Sometimes antiarrhythmic drugs such as ajmaline and procainamide may be used. If extrasystole is accompanied by myocardial infarction, it is possible to use panangin together with lidocaine, which are administered by intravenous drip infusion.
Digitalis intoxication can lead to polytopic extrasystoles, which causes ventricular fibrillation. In this case, you need to urgently stop the drug, and use potassium preparations, Inderal, and lidocaine as treatment. To relieve intoxication associated with cardiac glycosides, the doctor may prescribe diuretics and unithiol.
With the supraventricular form, you can massage the carotid sinus on the left and right for about twenty seconds. Pressure is also applied to the abdominals and eyeballs. If these methods do not provide relief, your doctor may prescribe beta blockers, such as verapamil or procainamide. Drugs should be administered slowly while monitoring pulse and blood pressure. It is not recommended to alternate propanol and verapamil intravenously. Digitalis can be used only if it has not entered the patient’s body for the next few days before the attack.
If the patient's condition worsens, electropulse therapy is used. However, it cannot be used in case of intoxication with cardiac glycosides. Cardiac pacing can be used continuously if attacks are severe and frequent.
Complications may include heart problems, or rather their exacerbation. To avoid this, you should seek medical help in a timely manner and not neglect treatment of underlying diseases that provoke the development of ectopic rhythm. For clear and coordinated functioning of the heart, it is simply necessary to lead a healthy lifestyle and avoid stress.
cardio-life.ru
This type of cardiac arrhythmia is considered one of the most common in people with any cardiac pathology. And identifying the so-called “replacement rhythm” is quite simple, since its long duration is shorter, which can be easily heard by a professional when conducting an appropriate examination.
Since the etiology of this cardiac pathology presupposes the presence of physiological causes provoking this condition, as well as objective causes that can become provoking factors, to completely get rid of this type of cardiac arrhythmia, identifying the disease and treating it will not be enough. It is necessary to identify those predisposing factors that could cause the manifestation of the lower atrial rhythm.
Danger this state consists in the possibility of further deepening of symptoms, as well as in significant limitation of the capabilities of the sick person. There is also a danger to life, and this is especially true in the case of additional serious diseases.
Read on to find out what it is and whether ectopic, accelerated, transient lower atrial heart rhythm is dangerous.
There is a certain classification of this pathological condition of contractions of the heart muscle. In accordance with it, there are several main types of lower atrial rhythm:
Read below about the reasons for the appearance of lower atrial rhythm.
Most often, lower atrial rhythm is detected in people who are elderly: by this time they already have a number of chronic diseases, which can also cause the onset of various types of cardiac pathologies. The most common provoking causes of this type of arrhythmia include diseases such as:
However, when the disease is detected, it can be diagnosed this pathology as congenital; in this case, the disease cannot be completely cured.
With lower atrial rhythm, manifestations characteristic of any type of cardiac pathology are especially frequent. Symptoms of lower atrial rhythm include the following:
Abnormal rhythm and heart rate are the most common reason for visits to a cardiologist, as this causes a deterioration in the patient’s general condition.
Identification of this pathological condition begins with determining the patient’s subjective manifestations. Symptoms characteristic of lower atrial rhythm usually become the first manifestations of the disease, on the basis of which a preliminary diagnosis can be made by a cardiologist.
Subsequent studies of the lower atrial rhythm are based on an ECG. Using this procedure, it becomes possible to determine the presence of irregularities in the heart rate and heart rhythm. The doctor also prescribes general and biochemical analysis blood, with the help of which it becomes possible to determine the presence of serious disorders in the functioning of the thyroid gland, as well as the entire endocrine system in general.
The doctor may order a test for a more detailed examination. general analysis urine, its data helps determine the etiology of the disease, and will also make it possible to more correctly carry out treatment in each case.
Treatment of lower atrial rhythm can be carried out in several main directions.
Elimination of the root cause of the disease is mandatory drug treatment and preventive measures will help to completely stop pathological process and normalize the patient's condition.
Most important point in obtaining excellent results in treatment of this disease is to eliminate the causes that provoked the appearance of the lower atrial rhythm. Since many serious diseases can provoke this pathological condition, you should first eliminate the root cause of heart pathology. The final cure of chronic diseases is considered an important condition for the success of curing lower atrial rhythm.
As a treatment, when a lower atrial rhythm is detected, a cardiologist prescribes the use of antiarrhythmic drugs that stabilize the frequency and rhythm of heart contractions, as well as the speed of impulses that are transmitted from the heart.
Purpose of a certain medication carried out by a doctor, taking into account the specificity of the patient’s disease and the presence of chronic diseases.
In the absence of significant effectiveness of drug and therapeutic treatment methods, surgical intervention may be prescribed to help eliminate the problem. However, the operation requires a long recovery period.
Following a diet that limits the consumption of fatty, canned and excessively sweet or salty foods, as well as following the advice of a cardiologist, allows you to avoid disturbances in the functioning of the cardiac system, therefore, as preventive measures The following measures may be recommended:
In the absence of the necessary treatment, complications may occur that negatively affect the condition of the cardiac system as a whole. Relapses of the disease are likely - this is possible with incompletely cured diseases that provoked the disease.
Deterioration of the patient's condition, severe arrhythmia and increased symptoms of lower atrial rhythm (chest pain, weakness and lack of stability during physical activity) are the main manifestations of insufficient treatment of this pathological condition.
The survival rate when this cardiac pathology is detected is quite high. The main condition is its timely diagnosis.
At correct scheme treatment and the absence of advanced chronic diseases that can cause aggravation of the patient’s condition, the survival rate is about 89-96%. This is high rate and can become an incentive to start timely and adequate treatment when diagnosing lower atrial heart rhythm.
He will talk about some methods of treating various types of arrhythmias at home. next video. But remember: self-medication can be dangerous:Arrhythmia with normal pulse and pressure
When the sinus node loses the function of the main pacemaker, ectopic foci appear. When they are located in the lower parts of the atria, a lower atrial heart rhythm appears on the ECG. Clinical manifestations may be absent, and the ECG shows minor changes in the form of negative atrial waves.
Treatment is aimed at normalization autonomic regulation heart rate, therapy of the underlying disease. At normal frequency No medications are prescribed for heart rate.
Read in this article
Normally, a cardiac impulse should form only in the sinus node, and then spread through the conduction system of the heart. If for some reason the node loses its dominant role, then other areas of the myocardium may be the source of excitation waves.
If the ectopic (any other than the sinus node) focus is located in the lower part of the left or right atrium, then the rhythm generated by it is called inferior atrial. Since the new pacemaker is located not far from the main one, changes in the order of contractions of the heart parts are insignificant, they do not lead to severe circulatory disorders.
The appearance of an ectopic rhythm is possible in two cases:
The neonatal period is characterized by insufficient maturation of the fibers of the cardiac conduction system and autonomic rhythm regulation. Therefore, the appearance of an atrial rhythm is not regarded as a pathological condition. The activity of the sinus node in such a child is usually inconsistent - the normal rhythm alternates with the lower atrial one.
Often there is a combination of an ectopic focus in the atria and minor anomalies in the development of the heart - additional chords, trabeculae, valve prolapse.
Mitral regurgitation A more serious condition is arrhythmia in the presence of heart disease, intoxication during the period of intrauterine development, unfavorable pregnancy, complications of childbirth, and in premature infants. Therefore, if there is weakness, shortness of breath, cyanosis when crying or feeding, the child needs a thorough examination of the heart.
Expert opinion
Alena Ariko
Expert in Cardiology
There are no specific manifestations of the lower atrial rhythm, but since in the vast majority of cases it reflects an autonomic imbalance in the body, patients may have significant clinical symptoms.
Many complaints about heart function (interruptions, fading, palpitations) in this case does not reflect the severity of the changes. Characteristic feature is the variability of manifestations, improvement after taking sedatives.
If the patient has a predominant tone of the sympathetic nervous system, then the main signs of arrhythmia will be:
With vagotonia, the heart rate slows down, which is accompanied by dizziness, freezing of the heartbeat, sweating, lightheadedness, and falling blood pressure. Typically, such sharp manifestations are characteristic of the crisis course of vegetative-vascular dystonia, and in milder variants the symptoms are mild.
If the lower atrial rhythm occurs due to organic lesions of the heart (ischemia, inflammation, scar tissue), then the clinical picture is completely determined by the underlying disease.
Due to the fact that the appearance of a rhythm with a source of impulses in the lower atrium is often a variable phenomenon, it is not always possible to detect it during routine diagnostics. With a one-time registration, you can get a completely normal record.
Therefore, many patients require a long-term examination - monitoring throughout the day or even 2-3 days, as well as the use of stress tests, rhythmography, and electrophysiological studies.
Criteria for classifying heart rhythms as lower atrial:
| Heart rhythms | Description |
| Substitute | the configuration of the ventricular complex is normal, the atrial wave is located before each QRS, but it is deformed or the apex is directed downward, PQ is not changed or shortened, the contraction rate is less than 60 beats per minute; |
| Accelerated | P is located in front of an unchanged QRS, can be biphasic, jagged or negative, PQ is slightly lengthened, the contraction frequency exceeds 90 per minute; |
| From the right atrium | P changes in 2, 3, aVF, V1, V2; |
| From the left atrium | abnormal P in V1-V6, 2, 3, aVF, while in V1 there will be a special shape - a smooth, elongated first phase and a sharp peak in the second (“bow and arrow”, “shield and sword”, “dome with a spire”) . |
If the heart rate is normal, patients do not require antiarrhythmic medications. For bradycardia or palpitations, therapy is aimed at the cause of the lower atrial rhythm. Complex treatment for severe symptoms may include:
For functional arrhythmia (without myocardial disease), non-drug methods have a good effect - reflexology, massage of the thoracic spine, electrophoresis of magnesium or caffeine, baths with herbal extracts, circular showers, physical therapy.
Surgical treatment methods (and) for lower atrial heart rhythm are practically not used.
Watch the video about heart rhythm disturbances and arrhythmias:
Despite the fact that this rhythm disorder is characterized by a benign course, patients with ectopic foci of excitation in the myocardium should be under medical supervision. This is due to the fact that if concomitant pathology occurs or physical, psycho-emotional stress occurs, such arrhythmia can transform into more serious forms. Therefore they are shown:
For athletes and those with a professional risk of stress on the heart (pilots, electric locomotive drivers, truck drivers), restrictions on further activities or a ban on admission to sports sections or employment may be introduced.
Inferior atrial rhythm appears when the sinus node loses its role as the main source of impulses for heart contraction. This may be due to diseases of the heart muscle, a failure of autonomic regulation, or hormonal imbalance.
Specific symptoms are absent or mild. The diagnosis is made by examining an ECG, often in monitoring mode. Treatment is aimed at the cause of the occurrence, antiarrhythmic therapy is carried out only when signs of circulatory disorders appear.
Read also
An ectopic rhythm can occur in a child, teenager, and adult. The ECG readings will tell you which one it is - nodal, right atrial. An accelerated rhythm may also indicate the onset of another disease.
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