Ectopic activity of the heart - causes. Ectopic rhythms: diagnosis, symptoms and treatment

Proper work A healthy heart is normally in sinus rhythm. Its source is the main point of the conduction system - the sinoatrial node. But this doesn't always happen. If the center of automatism of the first level for some reason cannot fully perform its function, or it completely falls out of general scheme conducting pathways, another source of generation of contractile signals appears - ectopic. What is ectopic atrial rhythm? This is a situation in which electrical impulses begin to be produced by atypical cardiomyocytes. These muscle cells also have the ability to generate a wave of excitation. They are grouped into special foci called ectopic zones. If such areas are localized in the atria, then the sinus rhythm is replaced by the atrial rhythm.

Atrial rhythm is a type of ectopic contraction. Ectopia is an abnormal arrangement of something. That is, the source of excitation of the heart muscle does not appear where it is supposed to be. Such foci can form in any part of the myocardium, causing a disruption in the normal sequence and frequency of contractions of the organ. The ectopic rhythm of the heart is otherwise called a replacement rhythm, since it takes on the function of the main automatic center.

There are two possible atrial rhythm options: slow (it causes a decrease contractility myocardium) and accelerated (heart rate increases).

The first occurs when sinus node blockade causes weak impulse generation. The second is the result of increased pathological excitability of the ectopic centers; it overlaps the main rhythm of the heart.

Abnormal contractions are rare, then they are combined with sinus rhythm. Or the pre-sulfur rhythm becomes the leading one, and the participation of the first-order automatic driver is completely canceled. Such violations can be typical for different time periods: from a day to a month or more. Sometimes the heart works constantly under the start of ectopic foci.

What is inferior atrial rhythm? Active atypical connections of myocardial cells can be located both in the left and right atrium, and in the lower parts of these chambers. Accordingly, lower right atrial and left atrial rhythms are distinguished. But when making a diagnosis, there is no particular need to distinguish between these two types; it is only important to establish that the excitatory signals come from the atria.

The source of impulse generation can change its location within the myocardium. This phenomenon is called rhythm migration.

Causes of the disease

Inferior atrial ectopic rhythm occurs under the influence of various external and internal conditions. A similar conclusion can be given to patients of all age categories. Such a malfunction in the functioning of the heart muscle is not always considered a deviation. Physiological arrhythmia, as a variant of the norm, does not require treatment and goes away on its own.

Types of disorders caused by lower atrial rhythm:

• tachycardia of paroxysmal and chronic nature;
• extrasystoles;
• flutters and fibrillation.

Sometimes the right atrial rhythm is no different from the sinus rhythm and adequately organizes the work of the myocardium. Such a failure can be detected completely by accident using an ECG during the next routine medical examination. At the same time, the person is completely unaware of the existing pathology.

The main reasons for the development of ectopic inferior atrial rhythm:

• myocarditis;
• weakness of the sinus node;
• increased arterial pressure;

• myocardial ischemia;
• sclerotic processes in muscle tissue;
• cardiomyopathy;
• rheumatism;
• heart defect;
• exposure to nicotine and ethanol;
• poisoning carbon monoxide;
• side effects of medications;
• congenital feature;
• vegetative-vascular dystonia;
• diabetes.

Inferior atrial rhythm in children can be either congenital or acquired. In the first case, the child is already born with the presence of ectopic foci. This is the result oxygen starvation during childbirth or as a consequence of intrauterine developmental anomalies. Functional immaturity of cardio-vascular system, especially in premature babies, is also the cause of the formation of an ectopic rhythm. Such disorders can normalize on their own with age. However, such babies need medical supervision.

Another situation is adolescence. During this period, boys and girls experience major changes in organism,
hormonal background is disrupted, the sinus heart rhythm may be temporarily replaced by the atrial one. With the end of puberty, all health problems usually end. In adults, hormonal problems may be associated with aging (for example, menopause in women), which also affects the appearance of ectopic heart rhythms.

Professional sports can also be considered as a cause of the development of atrial rhythm. This symptom is a consequence of degenerative processes in the myocardium that occur under the influence of excessive stress in athletes.

Symptoms

Inferior atrial abnormal rhythm may develop asymptomatically. If signs of cardiac dysfunction are present, they will reflect the disease that caused this condition.

• A person begins to feel contractions of the myocardium and “hear” its tremors.
• The number of minute beats of the organ is growing.
• The heart seems to “freeze” for a while.
• There is increased sweat production.
• A dark, continuous veil appears before your eyes.
• My head suddenly began to spin.
• The skin became pale, a blue tint appeared on the lips and fingertips.
• It became difficult to breathe.
• Pain appeared in the chest area.

• Frequent urination bothers me.
• A person experiences strong fear in all my life.
• Nausea or vomiting may occur.
• Operational disruptions gastrointestinal tract.
• Fainting develops.

Short attacks take the patient by surprise, but end as quickly as they begin. Often such rhythm disturbances occur at night during sleep. A person wakes up in panic, feeling tachycardia, chest pain or heat in the head.

Diagnostics

The presence of atrial rhythm can be detected based on data obtained during an ultrasound of the heart or an electrocardiogram.

Since the pathology can manifest itself from time to time, and often this happens at night, Holter ECG monitoring is used to obtain a more complete clinical picture. Special sensors are attached to the patient’s body and record changes occurring in the heart chambers around the clock. Based on the results of such a study, the doctor draws up a protocol for monitoring the state of the myocardium, which makes it possible to detect both daytime and nighttime paroxysms of rhythm disturbances.

Transesophageal electrophysiological examination, coronary angiography, and ECG recording under stress are also used. A standard analysis is required biological fluids body: general and biochemical research blood and urine.

Signs on the electrocardiogram

An ECG is an accessible, simple and fairly informative way to obtain data on various heart rhythm disorders. What does the doctor evaluate on the cardiogram?

1. The state of the P wave, reflecting the process of depolarization (appearance of an electrical impulse) in the atria.
2. The P-Q region demonstrates the features of the excitation wave traveling from the atria to the ventricles.
3. The Q wave marks initial stage ventricular excitation.
4. The R element displays the maximum level of ventricular depolarization.
5. The S tooth indicates final stage propagation of an electrical signal.
6. The QRS complex is called the ventricular complex; it shows all stages of the development of excitation in these sections.
7. The T element registers the phase of decline in electrical activity (repolarization).

Using the available information, the specialist determines the characteristics of the heart rhythm (frequency and periodicity of contractions), the source of impulse generation, the location electrical axis heart (EOS).

The presence of atrial rhythm is indicated following signs on ECG:

• negative P wave with unchanged ventricular complexes;
• the right atrial rhythm is reflected by the deformation of the P wave and its amplitude in additional leads V1-V4, the left atrial rhythm - in leads V5-V6;
• teeth and intervals have increased duration.

EOS displays electrical parameters of cardiac activity. The position of the heart as an organ with a three-dimensional volumetric structure can be represented in a virtual coordinate system. To do this, the data obtained by the electrodes during the ECG is projected onto a coordinate grid to calculate the direction and angle of the electrical axis. These parameters correspond to the localization of the excitation source.

Normally, it has a vertical (from +70 to +90 degrees), horizontal (from 0 to +30 degrees), intermediate (from +30 to + 70 degrees) position. A deviation of the EOS to the right (over +90 degrees) indicates the development of an ectopic abnormal right atrial rhythm; a deviation to the left (up to -30 degrees and beyond) is an indicator of a left atrial rhythm.

Treatment

Treatment measures will not be required if the adult or child does not experience any discomfort when an anomaly has developed, and they have not been diagnosed with heart or other diseases. The occurrence of atrial rhythm in this situation is not dangerous to health.

Otherwise, the therapeutic effect is carried out in the following directions:

1. Accelerated pathological atrial rhythm is treated with beta blockers (Propranalol, Anaprilin) ​​and other drugs that reduce heart rate.
2. For bradycardia, medications are prescribed that can accelerate the slow rhythm: drugs based on atropine, sodium caffeine benzoate, and plant extracts (Eleutherococcus, ginseng).
3. Vegetative-vascular disorders that cause ectopic rhythm require the use of sedatives “Novopassit”, “Valocordin”, motherwort tincture, valerian.
4. To prevent heart attack, it is proposed to use Panangin.
5. In addition to antiarrhythmic drugs (Novocainamide, Verapamil), with irregular rhythm appointed specific treatment upon establishing the specific cause of the violations that have developed.
6. IN severe cases, not amenable to standard drug treatment, cardioversion and installation of an artificial pacemaker are used.

Traditional methods

Atrial rhythm, as one of the types of cardiac disorders, requires constant monitoring by a doctor. Even the absence alarming symptoms– there is no reason to be negligent about such a condition. If the development of ectopic contractions is caused by diseases, it is imperative to find out the cause of the pathology and treat it with all seriousness. Launched severe forms atrial arrhythmias can threaten human life.

Atrial rhythm is a contraction of the heart, during which the activity of the sinus node weakens and the underlying parts of the conduction system become the focus of electrical impulses. The heart rate in this case is much weaker. On average, there are from 90 to 160 beats per minute.

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Etiology of the disease

Atrial rhythm can appear at any age. This condition can last from several days to several months. However, in medical practice atrial rhythm is still a temporary condition.

In some cases this pathology may be congenital. The reasons for this phenomenon are due to neuroendocrine factors and changes in the myocardium in the womb. Therefore, the born child has ectopic lesions in the atria in the heart. However, such violations are quite rare.

The heart rate in children may deviate from normal due to infection with the virus. The patient's condition in this case is considered serious. Attacks of atrial rhythm worsen when changing body position or in the morning.

Heart rate may change when:

• rheumatism;
• diabetes mellitus;
• heart defects;
• increased heart pressure;
• ischemic disease;
• neurocirculatory dystonia.



In some cases, ectopic atrial rhythm is diagnosed in completely healthy people. The cause of this condition is external stimuli.

If the source of atrial impulses moves along the atrium, then the impulses come from different parts of the organ. This state of affairs clinical practice called rhythm migration. Depending on the location of the source, the amplitude on the ECG also changes.

Atrial fibrillation is characterized by chaotic movement of the source of impulses. In this case, the heart rate can vary from 350 to 500 beats per minute. This condition is considered critical. Without treatment, the patient may develop a myocardial infarction or stroke.



Characteristic manifestations

Symptoms of atrial rhythm depend on the cause and concomitant disease. As such, there are no specific manifestations of ectopic atrial rhythm. However, you can identify the main signs, the appearance of which should consult a doctor.



An attack of abnormal heart rate may occur unexpectedly. If this condition lasts for several hours, the patient may experience dizziness, chest pain and shortness of breath. In addition, the patient experiences a feeling of fear and anxiety. During a prolonged attack, a person tries to find a position that will make him feel better. If the attack does not go away, the patient's condition worsens. His hands begin to tremble profuse sweating, darkening of the eyes and bloating.

In some cases, the patient may experience nausea. Appear frequent urge for emptying Bladder. Such urges appear regardless of how much liquid a person drinks. The patient is forced to visit the toilet every 15-20 minutes. The urine produced is light and transparent. The urge to urinate stops after the attack.

IN in rare cases During an attack, a person may experience the urge to have a bowel movement.

Short-term attacks can appear at night. An abnormal heart rhythm can be caused by a bad dream. After an attack, a person may feel a slight sinking of the heart. As a rule, the heartbeat then returns to normal. A brief attack may be accompanied by painful sensations and a feeling of heat in the throat.



Ectopic atrial rhythm in children may manifest as weakness, pale skin, abdominal pain, anxiety, cyanosis and shortness of breath.



Diagnosis of pathology

If heart rhythm disturbances occur, you should consult a doctor. Diagnosis of ectopic atrial rhythm is carried out using an ECG. If there are abnormalities on the electrocardiogram, deformation of the P wave and a change in its amplitude are observed.



IN chest leads The P wave can be expressed in a positive or negative type. Right atrial rhythm is observed if the P wave on the ECG is of a negative type. IN in this case it appears in leads V1,2,3,4. The lower atrial rhythm on the ECG tape is determined negative type P waves in leads V1, 2 and VF.

In the left atrium, deviations of the P wave appear in chest leads V2, 3, 4, 5 and 6. And in lead V1, the wave is of a positive type. This form in medical practice is called a shield and sword.

With a left atrial rhythm, unlike a right atrial rhythm, no changes in the PQ interval are observed on the ECG tape. The duration of the interval is 0.12 seconds.



This diagnostic method is carried out at any age. Changes in the direction and amplitude of the P wave during atrial rhythm will also be clearly visible in children.



Medical therapy

If the ECG tape reveals signs of atrial rhythm, then doctors prescribe treatment depending on the provoking factor. If the underlying disease is associated with vegetative-vascular disorders, then therapy is carried out sedatives. In this case, the patient is prescribed Atropine and Belladonna. For palpitations, treatment is carried out with Propranolol, Obzidan and Anaprilin.



For ectopic atrial rhythm, doctors prescribe antiarrhythmic drugs. This group of drugs includes Novocainamide and Aymalin. To avoid the development of myocardial infarction, a course of treatment with Panangin is carried out.

To normalize the heart rate, massage of the carotid sinus can be performed. The duration of the massage is 15-20 seconds. Pressure is applied in the abdominal area and on eyeballs. If such manipulations do not bring relief, the doctor prescribes beta-blockers, namely Novocainamide or Verapamil.

During a prolonged attack, the patient is given electrical impulse therapy, which consists of defibrillation, cardioversion and temporary cardiac pacing. The impulse allows you to restore sinus rhythm and prevent the development of myocardial infarction. If therapy is ineffective, the pulse power may increase.



Traditional methods

For ectopic atrial rhythm, the main treatment can be combined with folk ways. In this case, the drugs should be selected depending on the cause that provoked the heart rhythm disturbance. You should also consult your doctor before using them.



If you have an atrial rhythm, you can prepare an infusion of calendula. Pour in 2 tsp. flowers 200 ml boiling water. The infusion should stand for 1-1.5 hours. Take ½ cup twice a day.

During attacks, you can drink cornflower infusion. To prepare it, you will need to pour 200 ml of boiling water with 1/3 tbsp. l. flowers and leaves of cornflower. Strain the finished infusion and take ½ glass in the morning and evening. In just a week general state will improve significantly.

For high heart pressure, a herbal mixture of hawthorn, calendula, rose hips, sweet clover, mint and foxglove is considered useful. Mix all ingredients in equal proportions. Pour 1 tbsp. l. herbal mixture 250 ml water. Place the container on the stove and bring the broth to a boil. Divide the contents into two portions. Drink the decoction twice a day, morning and evening.

No less effective is a decoction of burdock, mint, motherwort, blackberry, dried cucumber and coltsfoot. Combine all components in equal parts. Pour 2 tbsp. l. herbal collection 300 ml water. Boil the broth for 5-7 minutes over low heat. Take 100 ml three times a day.



For coronary heart disease, you can prepare a mixture of valerian, mint, caraway, fennel and chamomile. Pour 1 tbsp. l. collecting 400 ml of boiling water. Leave the infusion under the closed lid for two hours. Drink the product in small portions throughout the day. You can add 1 tsp to the finished infusion. honey

During treatment it is necessary to avoid stressful conditions and emotional disorders which can provoke an attack. Doctors recommend keeping healthy image life and quit smoking and drinking alcoholic drinks. Also useful is breathing exercises, which provides restorative effect. If you consult a doctor in a timely manner and follow all recommendations, the heart will work smoothly and clearly again.

What can you eat?

Heart rhythm disturbances are easier to avoid than to treat. An unhealthy diet can also trigger atrial rhythm. What you can and cannot use if you have a disorder heart rate?



The juice of carrots, beets and radishes is considered beneficial. You can drink juices every day for a month. If a short-term attack occurs, it is necessary to minimize the consumption of sugar and salt. Animal fats and foods containing cholesterol, such as caviar, should be excluded from the diet. egg yolk and meat. Strong coffee, tea and alcoholic drinks are prohibited.

You are allowed to eat foods that contain calcium and other beneficial microelements, such as beans, cabbage, carrots, celery, dairy products, honey, berries, seafood and fresh fruits. Porridge must be present in the diet. Include garlic, horseradish and onions in your menu. Coffee should be replaced with rosehip decoction, compote or herbal tea.

The peculiarity of the heart muscle is that it has its own automatic function, which is not subject to anyone else. This means that there are certain cells in the heart that are grouped into centers of automaticity.

The cells that produce impulses that make the heart beat are called the conduction system. Thanks to these centers, an impulse is generated, which is transmitted to the underlying centers.

The heart contracts as fast as the impulses occur. The most important center of first-order automatism is the sinus or sinoatrial node. It is located in the right atrium. It is there, in healthy heart an impulse occurs, leading to contraction of the atria and then the ventricles. But situations arise when the work of the sinus node stops or is disrupted. Then other atypical cells of the heart are activated, which are also capable of producing impulses, but are inactive when normal operation sinus node.

These cells or groups of cells are called ectopic centers. They set the pace for the heart. If the function of the pacemaker is taken over by the cells of the atria, then the ectopic rhythm that they produce is called atrial. That is, the source of impulse are special cells of the atria, which became active and began to produce ectopic rhythms as a result of disruption or cessation of the work of the center of first-order automaticity - the sinus node.

1 Causes of occurrence

Why does atrial rhythm occur? Due to suppression of work or cessation of the production of impulses in the sinus node. This can occur with organic heart lesions (coronary heart disease, arterial hypertension, cardiomyopathies, sick sinus syndrome, myocarditis, cardiosclerosis), heart defects, rheumatism, electrolyte imbalance in the body, autonomic dysfunction nervous system, intoxication with alcohol, nicotine, carbon monoxide, and some medications.

Atrial rhythm may accompany endocrine disorders(diabetes mellitus), chest injuries, may occur in children at birth. It can also be found in healthy person as an accidental finding on an ECG during a medical examination. It should be noted that atrial ectopic contractions can be either single with most contractions from the sinus node, or only atrial contractions can be observed if the sinus node is completely blocked. The atrial rhythm may be constant or may occur for a longer or shorter period of time.

2 Differences between atrial rhythm and sinus rhythm

Atrial rhythms can be slow, substitutive. They occur when the function of the sinus node is suppressed. With such rhythms, the heart rate is less than normal. And accelerated ones can be observed, when there is an increase in the pathological activity of the ectopic centers of atrial automaticity. In this case, the heart rate will be higher than normal. Depending on where the activity of the ectopic centers is observed, a right atrial or left atrial rhythm is distinguished. But it is not necessary for a doctor to know from which atrium the impulse originates; it is enough to simply diagnose the rhythm from the atria.

• ventricular contractions are correct, R-R intervals identical, heart rate 45-60 beats per minute;
• each ventricular complex is preceded by a P wave, but it is deformed or negative;
• the P-Q interval is shortened or of normal duration;

ECG signs of atrial accelerated rhythm:

• Heart rate 120-130 per minute, R-R intervals are the same
• each ventricular complex is preceded by a P wave, but it is deformed, biphasic or negative, jagged or reduced
• P-Q interval may be prolonged
• ventricular complexes are not changed.

These are the main differences between atrial rhythm and sinus rhythm on the ECG.

3 Symptoms of atrial rhythm

The atrial rhythm may not manifest itself clinically and is detected accidentally during an ECG. There are no specific complaints or symptoms. More often, symptoms are associated with the manifestation of the underlying disease. Complaints may include a feeling of palpitations, interruptions in heart function, or cardiac arrest. I am concerned about general weakness and fatigue. If the heart is damaged, there may be an increase in shortness of breath, pain in chest varying severity and duration, swelling. It should be noted that if the patient has no complaints, no diseases of the heart or other organs are detected, then the atrial rhythm should be considered as a normal variant.

4 Children and atrial rhythm

In a newborn child, the conduction system of the heart is not perfect, as is the regulation of the autonomic nervous system. This leads to the fact that the child at birth, or in young children, may experience an atrial rhythm. This may be a variant of the norm and when the centers of automatism mature, as well as when adjusting the balance of the autonomic nervous system, the atrial rhythm can be replaced by the sinus one.

Atrial rhythm can be observed in children with minor anomalies of cardiac development - the presence of an accessory chord, prolapse mitral valve. But sometimes the atrial rhythm in a newborn baby or in infants childhood may not be a harmless symptom, but evidence of more serious problems with the heart - heart defects, infectious lesions heart muscle, intoxication, hypoxia. In this case, we can talk about pathology.

It is observed in newborns who have had infections in utero, who have been exposed to nicotine or alcohol intoxication by the mother, in premature babies, with an unfavorable course of pregnancy, or complications during childbirth. Children diagnosed with atrial rhythm must be examined and consulted with a cardiologist. Very often the rhythm from the atria is functional character and accompanies disorders of the autonomic nervous system.

With an imbalance of the autonomic nervous system, a predominance may be observed sympathetic division- sympathicotonia, or parasympathetic department - vagotonia. With sympathicotonia, there will be complaints of rapid heartbeat, pallor skin, chills, headache, anxiety. ECG signs of atrial rhythm with a predominance of the sympathetic part of the ANS: the R-R intervals are the same, the heart rate depends on the age of the child, there is an increase in heart rate relative to the norm, high P waves, a shortening of the P-Q interval.

With vagotonia, children may complain of interruptions in heart function, dizziness, nausea, and may experience fainting states, sweating, disturbances in the gastrointestinal tract, blood pressure may decrease. ECG signs with a predominance of the parasympathetic part of the ANS: normal ventricular contractions, heart rate less than normal, flattened P waves, prolongation of the P-Q interval.

To determine the cause of rhythm disturbances, pediatricians or cardiologists conduct functional tests that allow them to determine the nature of the disturbances - functional (imbalance of the autonomic nervous system) or organic (heart damage). If the disorders are functional, then tests with physical activity, orthostatic, and atropine will be positive.

Whatever the cause of heart rhythm disturbances in children, it requires active examination and consultation with a doctor.

5 Diagnostics

The most accessible instrumental method is conducting an ECG. ECG included mandatory list examinations during medical examination. Allows you to evaluate the work of the heart and identify the source of disturbances, the state of the myocardium, and assess conductivity. For more accurate diagnosis use:

• 24-hour Holter ECG monitoring,
• transesophageal electrophysiological study.

6 Treatment of atrial rhythm

If the atrial rhythm is not accompanied by any other pathology of the cardiovascular system or other organs and systems, the patient feels well and is completely healthy - this is the norm, and no treatment is required. In all other cases, the underlying disease is treated. If disorders of the autonomic nervous system have occurred, they may be prescribed sedatives, adaptogens.

If the patient has tachycardia, the doctor may prescribe drugs that reduce heart rate, for example, b-blockers. If you have a tendency to slow your heart rate - medicines, capable of increasing heart contractions: atropine preparations, tincture of Eleutherococcus, ginseng, sodium caffeine benzoate. You must remember that you cannot self-medicate. Treatment for both adults and children should be prescribed only by a specialist, after full examination and establishing an accurate diagnosis, taking into account contraindications and concomitant pathologies.

Atrial rhythm is a condition in which the function of sinus contraction is weakened. In this case, the lower atrial center acts as a source of impulses. There is a weakened heart rate, with heart beats ranging from 90–160 per minute. This article explains how atrial rhythm is determined on an ECG.

What are we talking about?

Many people who are diagnosed with atrial rhythm do not understand what this means. A healthy person has a single path for the transmission of electrical impulses that cause sequential excitation of all parts of the heart. Due to this, a productive contraction occurs, leading to a satisfactory blood release into the arteries.

This route originates in the right atrium. After which it passes to the most distant ventricular tissues through the conduction system. However, due to various reasons, the sinus node loses the ability to generate the electricity necessary to release impulses to distant parts.

There is a change in the process of transmission of cardiac excitation. A replacement contraction is formed. It turns out that the impulse arises out of place. For information, atrial rhythm is the appearance of much-needed excitation anywhere in the heart, only in the non-location of the sinus node.

How does atrial rhythm occur?

Outside the border of the sinus node, an extraneous impulse appears, exciting the heart before the signal emanating from the main one. This situation indicates an advance of the secondary atrial contraction. Based on the reentry theory, there is no parallel excitation. This is affected by local blocking nerve impulses. During activation, this area experiences an extra extraordinary contraction, which disrupts the main cardiac impulse.

Diagnostics allows you to determine the presence of pathologies of the heart muscle

According to some theories, the endocrine, vegetative nature of the formation of the precardiac impulse is assumed. Usually this situation occurs in a child who is in adolescence or in an adult suffering from hormonal changes, which may occur due to age or pathological manifestations.

In addition, there is a theory of the occurrence of an impulse formed by the atria as a result of hypoxic, inflammatory processes occurring in the myocardium. This pathology can occur with regular inflammatory diseases. It has been noted that in children suffering from influenza and tonsillitis, the likelihood of myocarditis with further changes in atrial contraction increases.

The heart, which is the main muscle of the body, has a special property. It has the ability to contract regardless of the nerve impulse emanating from the main organ of the central nervous system. Since it is he who controls the activity of the neurohumoral system. The correct route originates in the region of the right atrium. Then spread along the septum occurs. Impulses that do not pass along this route are called ectopic.

Types of atrial contraction

Based on the unevenness of the intervals, atrial rhythm is of the following types:

• Extrasystole is characterized by extraordinary contractions that occur during normal heart rhythm. This condition does not always have a clinical picture. It happens that a healthy person, for one reason or another, experiences extrasystole. In this case, sometimes there is no need to contact a cardiologist. It manifests itself as fear, tingling in the area of ​​the heart and stomach.
• For atrial fibrillation heartbeats can reach up to 600 per minute. The atrial muscles are characterized by a lack of rhythm, flickering appears, with characteristic chaotic behavior. As a result, the ventricles of the heart completely go out of rhythm. This condition is quite serious and can lead to a heart attack. With this pathology, the patient suffers from shortness of breath, panic, dizziness, sweating, and fear of death. Loss of consciousness may occur.
• During pacemaker migration the source of contractions seems to move through the atria. There is a manifestation of successive impulses emanating from different atrial sections. The patient experiences tremors, fear, and stomach emptiness.
• Atrial flutter characterized by frequent regular contractions of the atria, systematic ventricular contractions. At this state more than 200 beats per minute occur. It is more easily tolerated by the patient than flickering, since it has a less pronounced circulatory disorder. Manifested by rapid heartbeat, swollen neck veins, excessive sweating, lack of strength.

is a cardiologist who obvious signs confirms or denies the presence of extrasystoles

How to distinguish atrial rhythm from sinus rhythm

The atrial rhythm is slow, replacing. It occurs during suppression of the sinus node. Usually, with this arrangement, the heart contracts less than normal. In addition, there are accelerated impulses, during which the pathological activity of the center of atrial automation increases. In this situation, the heart rate is higher than the heart rate.

Based on where the activity of the ectopic center occurs, left atrial and right atrial contractions are distinguished. To alleviate the patient’s condition, electrocardiography does not necessarily have to determine which atrium is producing the pathological impulse. The doctor will need to diagnose the altered contractions.

The atrial rhythm on a replacement ECG has the following signs:

• correct contraction of the ventricles at regular intervals;
• contraction frequency varies from 45 to 60 per minute;
• each ventricular complex has a deformed, negative wave;
• intervals are characterized by shortness or normal duration;
• the ventricular complex is not changed.

Accelerated atrial rhythm has the following signs on the ECG:

• cardiac impulses range from 120 to 130 per minute;
• each ventricular contraction has a deformed, biphasic, negative, jagged wave;
• intervals are lengthened;
• the ventricular complex is unchanged.

Atrial extrasystole is determined by a premature, extraordinary contraction. Ventricular extrasystole is characterized by a change in the contractile complex followed by a compensatory pause.

Features of atrial and ventricular rhythm that should be differentiated from each other

Signs on ECG

On an electrocardiogram, the doctor judges the atrial rhythm by the presence of deformation of the P wave. Diagnostics records the disturbed amplitude and its direction in comparison with the normal impulse. Usually this tooth is shortened. Right atrial contraction appears negative on the ECG. The left atrial rhythm has a positive wave and a rather bizarre shape. It looks like a shield with a sword.

Important! With an atrial rhythm, the P wave can be either negative or positive.

If the patient suffers from migration of the driving rhythm, then the electrocardiogram shows a changed wave shape and a longer P Q segment. Moreover, this change is cyclical. Atrial fibrillation characterized complete absence tooth Which is explained by the inferiority of systole.

However, the ECG shows an F wave, characterized by uneven amplitude. Using these waves, ectopic contractions are determined. There are cases when the atrial rhythm is asymptomatic, appearing only on the ECG. However, if a patient has this pathology, he requires specialist supervision.

Higher education:

Kuban State medical University(KubSMU, KubSMA, KubSMI)

Level of education - Specialist

Additional education:

“Cardiology”, “Course on magnetic resonance imaging of the cardiovascular system”

Research Institute of Cardiology named after. A.L. Myasnikova

"Course on functional diagnostics"

NTsSSKh them. A. N. Bakuleva

"Course in Clinical Pharmacology"

Russian medical Academy postgraduate education

"Emergency Cardiology"

Cantonal Hospital of Geneva, Geneva (Switzerland)

"Therapy course"

Russian state medical institute Roszdrav

The heart, being one of the main muscles in the human body, has a number of special properties. It can contract regardless of nerve impulses coming from the brain and taking part in the control of the neurohumoral system. The correct route for transmitting information in the heart muscle begins in the area of ​​the right atrium (sinus node), continues in the area of ​​the atrioventricular node and then spreads across the entire area of ​​the septum. All other contractions that do not follow this route are considered an ectopic rhythm.

How do atrial rhythms appear?

An ectopic impulse, appearing outside the sinus node, is formed and excites the heart muscle before the signal is transmitted from the main pacemaker. Similar situations allow us to say that the accelerated atrial rhythm appears due to the “advance” of the main rhythm by a secondary contraction of the ectopic type.

The theoretical basis for the ectopic rhythm is the re-entry theory, according to which a certain area of ​​the atrium is not excited in parallel with others due to the fact that there is a local blocking of the propagation of the nerve impulse. At the time of its activation, this area experiences an additional contraction - thus, it goes out of turn and thereby disrupts the overall rhythm of the heart.

Some theories suggest the autonomic and endocrine nature of the occurrence of atrial rhythms. As a rule, such phenomena occur in children in puberty or in adults with certain hormonal changes (age-related or resulting from pathologies).

There is also a version of the following type: hypoxic and inflammatory processes in the myocardium during cardiopathy and inflammatory diseases can cause atrial rhythms. Thus, in children who suffer from a sore throat or flu, there is a risk of myocarditis with a subsequent change in atrial rhythm.

The heart, being one of the main muscles in the human body, is endowed with special properties. It can contract regardless of the nerve impulses coming from the brain, which control the neurohumoral system. The correct route for receiving information in the heart muscle begins in the area of ​​the right atrium (sinus node), passes in the area of ​​the atrioventricular node and then spreads along the septum. All other beats that do not follow this route are called ectopic rhythm.

Etiology of atrial rhythm

As noted above, the reasons for changes in atrial rhythm are changes that take place in the sinus node. All changes are divided into ischemic, inflammatory and sclerotic. Non-sinus rhythms that appear as a result of such changes appear in the following forms:

1. Supraventricular ectopic rhythm;

Accelerated atrial rhythm usually occurs in people who suffer from rheumatic diseases, various diseases heart disease, dystonia, diabetes, coronary disease or hypertension. In some cases, atrial rhythm can appear even in healthy adults and children, and can also be congenital in nature.

Impulses can come from different parts of the heart, since the source of the emerging impulses moves through the atrium. In medical practice similar phenomenon is called the migrating rhythm. When measuring such an atrial rhythm, the amplitude on the ECG changes according to the source of the location of the impulses.

Clinical picture

Atrial rhythm has a direct relationship with the specific disease that caused it. It means that specific symptoms absent. Clinical picture directly caused by the pathological picture in the patient’s body. This rule applies only to short-term attacks of rhythm disturbance. With prolonged attacks, the following symptoms are possible:

• Initially there is a feeling of anxiety and fear. The person tries to take the most comfortable position that would stop the further development of the attack.
• The next stage is accompanied by severe tremor (shaking) in the limbs, and in some cases, dizziness.
• The next step is the appearance of pronounced symptoms - increased sweating, dyspeptic disorders, manifested in the form of bloating and nausea, frequent urge to urinate.

Short attacks may be accompanied by an increase in heart rate and shortness of breath, after which the heart stops for a moment and a noticeable jolt is felt. A similar impulse in the heart indicates that sinus rhythm has been restored - this can also be confirmed by minor painful sensations in the chest and heart area.

The change in atrial rhythm resembles paroxysmal tachycardia. Patients themselves can determine that they have an abnormal heart rhythm. If the heart rate is high, these changes will not be noticeable. An ECG examination helps to accurately determine this condition. In the case of atrial fibrillation, patients may complain of chest pain characteristic of angina pectoris.

Long-term attacks of atrial rhythm disturbance are dangerous for a person - at this moment, blood clots can form in the heart muscle, which, if they enter the blood vessels, can cause a heart attack or stroke. The danger also lies in the fact that when the disease is latent, patients may ignore the above symptoms, and therefore are not able to determine its further development.

Diagnosis of atrial rhythm

The main method for studying atrial rhythm is ECG. A cardiogram allows you to accurately determine where the rhythm disturbance occurs, as well as accurately determine the nature of such a rhythm. An ECG allows you to determine the following types of atrial escape rhythm:

• Left atrial rhythm: aVL is negative, aVF, PII, III are positive, PI, in some cases, smoothed. PV1/PV2 are positive, and PV5-6 are negative. According to Mirovski et al., the P wave in left atrial rhythm consists of two parts: the first has a low-voltage and dome-shaped rise (affected by depolarization of the left atrium), the second part is characterized by a narrow and high peak (the right atrium is depolarized).
• Right atrial rhythm: characterized by a negative P wave in the area of ​​the third standard branch, in the first and second - positive. This phenomenon is characteristic of a mid-lateral right atrial rhythm. The lower rhythm of this form is characterized by the indication of the P wave, negative in the second and third branches, as well as aVF, smoothed in the 5-6 thoracic.

• The lower atrial rhythm is characterized by a shortening of the PQ interval, in which its value is less than 0.12 seconds, and the P wave is negative in branches II, III and aVF.

The following conclusion can be drawn: based on electrocardiogram data, the doctor can determine a change in atrial rhythm based on changes in the P wave, which has a different physiological norm amplitude and polarity.

Note that to determine the right atrial rhythm, a specialist must have extensive experience, since ECG data with such a rhythm are blurry and difficult to differentiate. In view of this, Holter monitoring can be used to form the most complete and accurate picture of cardiac activity.

Treatment of pathology

Since the change in rhythm is directly determined by the presence of pathologies in the human body (in particular, circulatory system and heart), treatment is aimed at identifying and eliminating the underlying causes. So, for vegetative-vascular disorders they can prescribe sedatives, in case of strengthening of the vagus, drugs based on atropine or belladonna are prescribed. If there is a predisposition to tachycardia, beta-blockers are used - the most popular are isoptin and cordarone. In case of polytopic extrasystoles and ventricular fibrillation, potassium preparations, panangin, and lidocaine are used.

In situations where the above methods do not allow you to get rid of diseases, causing change heart rhythm, the doctor may prescribe the use of special therapy - preventive procedures aimed at promoting health, as well as the use of electrical pulse therapy.