Heart rhythm disturbances are the most difficult section in cardiology to study the functioning of the cardiovascular system.
Doctors always recommend calling an ambulance without delay. This is partly due to the fact that arrhythmia can only be correctly diagnosed with the help of an experienced cardiologist and a high-quality electrocardiogram. In addition, patients with similar symptoms may often need qualified emergency care, which is much more convenient and effective to provide in a hospital rather than at home without necessary medications and technology.
The heart is the engine human body. Every beat is like an impetus to life. On the 25th day after conception, the heart of a new person makes its first beat.
The heart does not stop beating until the last beat. It is very important that the heart contractions occur at the same duration. There are 2 phases of the heart, the first is diastole, when the heart rests. The second is systole - the period of time during which the heart contracts so that the blood flow delivers nutrients and oxygen to all places in the body. When the systole cycle decreases, the body is not fully supplied with oxygen and blood movements. If the diastole gap is stopped, the heart does not have time to rest.
A cardiac arrhythmia is a disorder in the rhythm, frequency, and sequence of heart muscle beats.
The heart muscle is the myocardium, consisting of muscle filaments. Muscle fibers are divided into 2 types:
As for the disease in children, there is no reliable information about the prevalence of heart rhythm disturbances in such age category No. According to the number of visits to clinics, about 30% are arrhythmia diseases in children. Sometimes diseases are detected even in a seemingly healthy child. Often, such rhythm disturbances are not life-threatening and can be treated and stopped.
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Depending on the severity of the course, cardiac arrhythmias can be permanent, transient, acute or chronic. To characterize the clinical course of pathological arrhythmias, the following terms are used: paroxysmal, recurrent and continuously recurrent.
It is quite difficult to classify rhythm disturbances. Blockades and arrhythmias occur independently anywhere in the conductor of the heart. The type of violations and blockades depends on their place of origin.
The patient feels the heart begin to beat faster than usual or with interruptions in its functioning, this is how atrial fibrillation and extrasystolic disorders manifest themselves.
If, on the contrary, the patient feels freezing, a delay in the beat, loses consciousness, or experiences attacks of dizziness, then most likely the patient has bradycardia or rhythm blockade.
Having discovered any type of heart rhythm disturbance in a patient, it is important to immediately carry out full course examinations of the entire cardiovascular system to confirm or refute any abnormalities.
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Indications for medical intervention in the treatment of rhythm disturbances, obvious hemodynamic disorders or subjective intolerance to extrasystole are used.
Arrhythmias that manifest themselves safely, asymptomatically or with little symptoms, and are easily tolerated, do not require special treatment.
IN similar cases The main method of treatment is rational psychotherapy.
Until now, medicine cannot answer the question of what is main reason the appearance of heart rhythm disturbances. It is assumed that the main reasons due to which restructuring occurs in the endocrine and nervous regulatory systems are abnormal processes in the heart muscles, and disturbances in the actions and anatomical structure- this is a flaw organic class. Often the above reasons are combined, creating a unique cause for the disease.
In addition to the main reasons, the functioning of the heart is quite strongly influenced by age, genetic predisposition, as well as previous infectious diseases, which together only aggravate the accumulated problems with functioning. For example, with age, the organ weakens and at any time can have an unfavorable failure; genetics also influences, especially in patients with congenital heart disease, defects or anomalies in muscle development. All of the above - fertile soil for the development of pathologies in the heart rhythm.
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At the first symptoms of arrhythmia, the patient should seek medical help. For the initial check, an electrocardiogram (ECG) is used, which helps determine the type of complication.
Electrocardiogram - the most important method diagnosing heart rhythm disorders. But this only applies to those species in which the symptoms are stable and frequent.
Further diagnosis is carried out using more serious methods. For episodic symptoms, Holter monitoring is used. Such a study allows you to provide a report of the work of the heart over several hours or days. In this case, the patient can lead a normal way of life, only noting in the diary the time of sleep, physical activity and rest. The electrocardiogram recording turns into a report, which will later be deciphered and explained by a cardiologist, comparing the diary data with the cardiogram indicators.
An experienced doctor will calculate the frequency, duration and time of occurrence of disorders and their relationship with physical activity, while simultaneously analyzing the symptoms of insufficient blood supply to the heart muscles.
Echocardiography identifies diseases that contribute to the occurrence of arrhythmia. Ultrasound examination allows you to obtain an image of the heart for further analysis of the heart's performance.
In addition to ECG, more are used modern methods research:
A transesophageal electrocardiogram is a test that can cause abnormal heart rhythms in a patient. This procedure is carried out with a thin electrode, which is inserted through the food canal to the level of the right atrium and activated to provoke an attack.
The procedure takes place under the full supervision of a doctor, who takes data from reports on the functioning of the heart using sensors specially attached to the patient’s body. This scheme helps to correctly diagnose and prescribe effective treatment.
The catheterization method is a method of inserting a catheter into the heart through large blood vessels using a radiopaque tube. This technique allows you to determine the pressure on different parts of the heart muscles and extract tissue samples for further analysis.
To confirm the results of diagnosing a disease of the cardiac system caused by disturbances in the rhythm of contractions of the heart muscle, catheterization is used.
For further research the reasons that caused the patient’s arrhythmia, the doctor may additionally prescribe laboratory tests.
The causes and treatment of heart rhythm disturbances are extremely important actions when removing a person from a serious and life-threatening condition.
The heart never rests. Therefore, as a person ages, problems most often arise with the heart. However, there is another opinion - the heart rests and does it regularly. It is not for nothing that it is divided into 4 chambers - 2 atria and 2 ventricles. While one part of the heart contracts, the other part rests. This is probably why a constant, measured rhythm of heartbeats is so important.
There is another muscle group that provides the body without interruption necessary substances. This is a set of muscles that provide respiratory movements. Respiratory and cardiac activity are 2 functions that cannot stop long enough a long period. All these muscles need rest, and therefore a adjusted rhythm of movements.
A regular heart rate is truly a guarantee of heart health, since this is the only way it can rest.
An imbalance of elements such as sodium, potassium and magnesium can lead to serious consequences. As a result of this imbalance, blood viscosity changes, which negatively affects the functioning of the heart and blood vessels. In addition, arrhythmia is possible in the following cases:
In these cases, arrhythmia is a quickly passing phenomenon that does not require special treatment.
However, poisoning, especially drug poisoning, poses a great danger.
Danger negative consequences arrhythmias increases significantly in old age, with overweight, heavy chronic diseases, alcoholism, drug addiction.
All human diseases in relation to the work of the heart can be divided into 2 parts: those that provoke arrhythmia and those that do not have a direct effect on the work of the heart.
Risk factors include the following:
This extensive list cannot be called complete. Any disease or injury that affects several functions of the body can change the rhythm of the heart. At chronic pathologies it is necessary to purposefully begin treatment of heart rhythm.
It is easier to prevent any disease than to treat it. This is especially true regarding cardiac arrhythmia. Moreover, treatment of arrhythmia is not just prevention serious illnesses, this is the preservation of life.
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All treatment of arrhythmia can be divided into the following parts:
However ambulance never arrives right away. Before her arrival, you must do the following:
If rhythm disturbances become increasingly acute, proceed to resuscitation actions in the hope that the ambulance team is about to arrive.
Heart rhythm disturbances are common. The causes of heart rhythm disturbances can be not only diseases of the heart, gastrointestinal tract, nervous and endocrine systems, but also some physiological conditions of the body.
Heart - central authority in the human body, its engine. The heart muscle pumps blood constantly, both day and night during sleep, like a pump. The person does not pay attention to this at all. It is what directs blood throughout the body. Sometimes there are problems with the heart. The rhythm by which it works smoothly is disrupted. If this failure occurs within physiological limits, there is no cause for concern. But sometimes attacks of arrhythmia are an indicator serious violations in the body, accompany many other cardiovascular disorders.
The heart consists of four chambers, represented by two ventricles and two atria, and has the unique ability within itself to generate a spontaneous electrical impulse. This feature is called automatism of the heart muscle. How is this impulse born? Between the right ventricle and the atrium there is a cluster of special muscle cells that can spontaneously contract, causing tissue excitation. Then this impulse spreads to other parts of the heart, thanks to certain intermediaries. This trigger point for muscle cells is called the sinus node. From it, an electrical impulse follows through the atrioventricular node, spreading to the His bundle and Purkinje fibers. This is how the entire heart contracts. From 60 to 90 conductions occur per minute. It should be noted that in children the number of heartbeats per minute is about 120, for them this is the norm. With the correct rhythm, the heart contracts evenly and periodically. If disturbances occur in any of these areas, an attack of arrhythmia occurs. Such disorders may manifest themselves as an increase or decrease in the number of contractions.
There are several types of heart rhythm disturbances:
In this condition, disturbances in the conduction of nerve excitation occur inside the heart, in any of its areas:
Along with sinus rhythm, an ectopic focus of excitation appears in the heart. Both nerve impulses propagate separately due to a blockage between them. The atria contract according to one rhythm, and the ventricles - according to the second.
The causes of heart rhythm disturbances are divided into two groups:
The age-related characteristics of the body are such that over time, the heart muscle loses elasticity and firmness, pumping blood in the required volume becomes difficult, which leads to disruption of the organ.
Genetic predisposition is not the least risk factor for the occurrence of pathological rhythmic contractions. A history of this disease increases the chances of heart rhythm disturbances in the offspring.
Abnormalities in the development and structure of the heart can also cause repeated attacks of arrhythmia.
The occurrence of heart rhythm disturbances does not always signal the presence of a disease. There are a number of normal physiological conditions when there is a change in rhythm. Among them are the following reasons:
Temporary changes in the functioning of the heart lead to:
1. Diseases endocrine system: lack of the hormone insulin (diabetes mellitus), pathology of the thyroid gland, menopause in women, some tumor processes in the adrenal glands (pheochromocytoma).
2. Diseases nervous system:
3. Diseases of the stomach and intestines:
Symptoms of arrhythmias are quite diverse, sometimes they can be confused with manifestations of other pathologies. If symptoms such as spontaneous causeless shortness of breath, fainting and pre-fainting states, discomfort in the chest, dizziness, sudden fatigue, the appearance of unconscious fear, darkening in the eyes occur, you should immediately call an ambulance and provide Urgent measures to improve the patient's condition. If a person says that he began to feel his heart beating and changes in its work, an arrhythmia can be suspected, which requires some help for the patient. When such a condition occurs, many people become confused and panic because they do not know what to do in the event of an attack of heart rhythm failure.
How to relieve an attack of arrhythmia? Before arrival medical personnel it is necessary to place the person on flat surface, loosen all constricting elements of clothing (tie, belt), provide fresh air by opening the windows in the room, give a drink sedatives(a few drops of Corvalol or valerian tincture). In case of fainting, the patient should be laid on the floor, head thrown to the side and back to free the airway. respiratory tract. If a person has difficulty breathing despite all this and there is a suspicion of the development of pulmonary edema and atrial fibrillation, the patient must be helped to take a semi-sitting position.
The arriving medical assistance will perform an ECG, carry out therapeutic manipulations to relieve an acute attack of arrhythmia, and take the patient to the hospital for further monitoring of his condition.
In order to confirm the diagnosis, the doctor carefully examines the patient, clarifies all symptoms, their duration and frequency of occurrence, and prescribes additional methods examinations. These include:
If a person has an attack of arrhythmia, they should not treat themselves. You need to seek qualified help, which will include several stages. Initially, it is necessary to eliminate the cause of the heart failure by taking anti-inflammatory, hormonal and other drugs (for non-cardiac etiology). Then various antiarrhythmic drugs are prescribed, which, if necessary, stimulate or, conversely, suppress the conduction of the nerve impulse. Some of these medications will have to be taken for a long time. For better effect Vitamins are used for treatment. Positive results for cardiac arrhythmias, the use of physiotherapeutic methods of treatment can be helpful. Among them is a low-frequency magnetic field.
Prescribed according to indications surgery. The introduction of a pacemaker or a special defibrillator into the body solves the problem of abnormal heart rhythm.
At the moment, heart rhythm disturbances can be successfully treated and do not become a serious problem for humans. Timely identification of the causes and diagnosis of the disease provides a great chance of success in treating the pathology.
Violation of cardiac rhythm and conduction is a fairly common diagnosis. Cardiac arrhythmias cause disorders in the cardiovascular system, which can lead to the development serious complications, such as thromboembolism, fatal rhythm disturbances with the development of an unstable condition, and even to sudden death. According to statistics, 75-80% of cases of sudden death are associated with the development of arrhythmias (so-called arrhythmogenic death).
Arrhythmias are a group of disturbances in the rhythm of the heart or the conduction of its impulses, manifested as a change in the frequency and strength of heart contractions. Arrhythmia is characterized by the occurrence of early or irregular contractions or changes in the order of excitation and contraction of the heart.
The causes of arrhythmias are changes in the main functions of the heart:
Violations occur for the following reasons:
Signs of cardiac arrhythmias are:
Arrhythmias are based on changes in electrophysiological mechanisms based on the principle of ectopic automatism and the so-called re-entry, that is, the reverse circular entry of impulse waves. Normally, cardiac activity is regulated by the sinus node. In case of heart rhythm disturbances, the node does not control individual parts of the myocardium. The table shows the types of rhythm disturbances and their symptoms:
| Type of rhythm disturbance | ICD 10 code | Signs of violations |
|---|---|---|
| Sinus tachycardia | I47. 1 | It is characterized by an increase in heart rate at rest of more than 90 beats per minute. This may be normal during physical activity, elevated temperature body, blood loss and in case of pathology - with hyperthyroidism, anemia, inflammatory processes in the myocardium, increased blood pressure, heart failure. Often this type of arrhythmia occurs in children and adolescents due to imperfect neuroregulatory systems (neurocirculatory dystonia) and does not require treatment in the absence of obvious symptoms |
| Sinus bradycardia | R00. 1 | In this condition, heart rate decreases to 59-40 beats per minute, which may be a consequence of decreased excitability of the sinus node. The causes of the condition may be decreased thyroid function, increased intracranial pressure, infectious diseases, n.vagus hypertonicity. However, this condition is observed normally in well-trained athletes in the cold. Bradycardia may not manifest clinically or, on the contrary, cause deterioration of health with dizziness and loss of consciousness |
| Sinus arrhythmia | I47. 1 and I49 | Common in adults and adolescents with neurocirculatory dystonia. Characterized by abnormal sinus rhythm with episodes of increased and decreased contractions: heart rate increases with inspiration and decreases with expiration |
| I49. 5 | It is characterized by a significant disruption of the functioning of the sinus node and manifests itself when about 10% of the cells that form the electrical impulse remain in it. For diagnosis, at least one of the criteria must be present: sinus bradycardia below 40 beats per minute and (or) sinus pauses more than 3 seconds during the daytime | |
| Extrasystoles | J49. 3 | Rhythm disturbances such as extrasystoles are extraordinary contractions of the heart. The causes of their occurrence may be stress, fear, overexcitation, smoking, drinking alcohol and caffeine-containing products, cardiopsychoneurosis, electrolyte disturbances, intoxication and so on. By origin, extrasystoles can be supraventricular and ventricular. Supraventricular extrasystoles can occur up to 5 times per minute and are not a pathology. Serious problem represent ventricular extrasystoles, including those of organic origin. Their appearance, especially polymorphic, paired, group (“runs”), early ones, indicates high probability sudden death |
| I48. 0 | Organic damage to the myocardium can manifest itself in the form of a pathological rhythm of the atria: flutter is recorded with regular contractions up to 400 per minute, fibrillation - with chaotic excitation of individual fibers with a frequency of up to 700 per minute and unproductive activity of the ventricles. Atrial fibrillation or atrial fibrillation is one of the main factors in the occurrence of thromboembolic events, and therefore requires careful treatment, including antiplatelet and antithrombotic therapy as indicated | |
| I49. | Ventricular flutter is their rhythmic excitation with a frequency of up to 200-300 beats per minute, occurring through a re-entry mechanism that arises and closes in the ventricles themselves. Often this condition develops into a more serious condition, characterized by an erratic contraction of up to 500 per minute in individual sections of the myocardium - ventricular fibrillation. No emergency medical care with such rhythm disturbances, patients quickly lose consciousness, cardiac arrest is recorded and clinical death is recorded | |
| Heart blocks | J45 | If the passage of an impulse is interrupted at any level of the conduction system of the heart, an incomplete heart block (with partial receipt of impulses in the underlying parts of the heart) or complete (with an absolute cessation of the receipt of impulses) occurs. With sinoatrial blockade, the conduction of impulses from the sinus node to the atria is impaired, intraatrial blockade - through the conduction system of the atria, AV blockade - from the atria to the ventricles, blockade of the legs and branches of the His bundle - respectively, one, two or three branches. The main diseases that cause the development of such disorders are myocardial infarction, post-infarction and atherosclerotic cardiosclerosis, myocarditis, rheumatism |
Symptoms of arrhythmias are varied, but most often they manifest themselves as a feeling of rapid or, conversely, rare heartbeat, interruptions in heart function, chest pain, shortness of breath, a feeling of lack of air, dizziness until loss of consciousness.
Diagnosis of rhythm disturbances is based on a thorough history, physical examination (measuring frequency and studying pulse parameters, measuring blood pressure) and objective electrocardiography (ECG) data in 12 leads (more leads are used, including intraesophageal ones, according to indications).
ECG signs of the main arrhythmias are presented in the table:
| Type of rhythm disturbance | ECG signs |
|---|---|
| Sinus tachycardia | Heart rate>90, shortening R-R intervals, correct sinus rhythm |
| Sinus bradycardia | Heart rate<60, удлинение интервалов R-R, правильный синусовый ритм |
| Sinus arrhythmia | Fluctuations in the duration of R-R intervals of more than 0.15 s associated with breathing, correct sinus rhythm |
| Sick sinus syndrome | Sinus bradycardia, periodic non-sinus rhythms, sinoatrial block, bradycardia-tachycardia syndrome |
| Supraventricular extrasystoles | Extraordinary appearance of the P wave and the following QRS complex, possible deformation of the P wave |
| Ventricular extrasystoles | Extraordinary appearance of a deformed QRS complex, absence of the P wave before the extrasystole |
| Ventricular flutter and fibrillation | Fluttering: regular waves of the same shape and size, similar to a sine wave, with a frequency of 200-300 beats per minute. Fibrillation: irregular, distinct waves with a frequency of 200-500 beats per minute. |
| Atrial flutter and fibrillation | Fluttering: F waves with a frequency of 200-400 beats per minute, sawtooth shape, the rhythm is correct, regular. Fibrillation: absence of P waves in all leads, presence of erratic f waves, irregular ventricular rhythm |
| Sinoatrial blockade | Periodic “loss” of the P wave and the QRS complex at the same time |
| Intraatrial block | P wave increase>0.11 s |
| Complete AV block | There is no relationship between P waves and QRS complexes |
| Left bundle branch block | Dilated, deformed ventricular complexes in leads V1, V2, III, aVF |
– any disturbance in the regularity or frequency of the normal heart rhythm, as well as in the electrical conduction of the heart. Arrhythmia may be asymptomatic or may be felt in the form of palpitations, freezing, or interruptions in heart function. Sometimes arrhythmias are accompanied by dizziness, fainting, pain in the heart, and a feeling of lack of air. Arrhythmias are recognized during physical and instrumental diagnostics(heart auscultation, ECG, TEE, Holter monitoring, stress tests). In treatment various types For arrhythmias, drug therapy and cardiac surgical methods (RFA, installation of a pacemaker, cardioverter-defibrillator) are used.
Rhythmic sequential contraction of the heart is ensured by special muscle fibers myocardium, forming the conduction system of the heart. In this system, the first-order pacemaker is the sinus node: it is here that excitation arises with a frequency of 60-80 times per minute. Through the myocardium of the right atrium, it spreads to the atrioventricular node, but it turns out to be less excitable and causes a delay, so the atria contract first and only then, as the excitation spreads through the His bundle and other parts of the conduction system, the ventricles. Thus, the conduction system provides a certain rhythm, frequency and sequence of contractions: first the atria and then the ventricles. Damage to the myocardial conduction system leads to the development of rhythm disturbances (arrhythmias), and of its individual parts (atrioventricular node, bundle or legs of His) to conduction disturbances (blockades). In this case, the coordinated work of the atria and ventricles can be dramatically disrupted.
The development of organic arrhythmias is based on damage (ischemic, inflammatory, morphological) to the heart muscle. They impede the normal propagation of an electrical impulse through the conduction system of the heart to its various parts. Sometimes damage also affects the sinus node, the main pacemaker. During the formation of cardiosclerosis, scar tissue interferes with the conductive function of the myocardium, which contributes to the emergence of arrhythmogenic foci and the development of conduction and rhythm disorders.
The group of functional arrhythmias includes neurogenic, diselectrolyte, iatrogenic, mechanical and idiopathic rhythm disturbances.
The development of sympathetic-dependent arrhythmias of neurogenic origin is facilitated by excessive activation of the tone of the sympathetic nervous system under the influence of stress, strong emotions, intense mental or physical work, smoking, drinking alcohol, strong tea and coffee, spicy food, neurosis, etc. Activation of sympathetic tone is also caused by diseases of the thyroid gland (thyrotoxicosis), intoxication, feverish conditions, blood diseases, viral and bacterial toxins, industrial and other intoxications, hypoxia. Women suffering from premenstrual syndrome may experience sympathodependent arrhythmias, heart pain, and sensations of suffocation.
Vague-dependent neurogenic arrhythmias are caused by activation of the parasympathetic system, in particular, vagus nerve. Vague-dependent rhythm disturbances usually develop at night and can be caused by diseases of the gallbladder, intestines, peptic ulcer of the duodenum and stomach, diseases Bladder, in which the activity of the vagus nerve increases.
Diselectrolyte arrhythmias develop when there are disturbances in electrolyte balance, especially magnesium, potassium, sodium and calcium in the blood and myocardium. Iatrogenic rhythm disturbances arise as a result of the arrhythmogenic effect of certain drugs (cardiac glycosides, β-blockers, sympathomimetics, diuretics, etc.).
The development of mechanical arrhythmias is facilitated by chest injuries, falls, blows, injuries electric shock etc. Idiopathic arrhythmias are rhythm disturbances without an established cause. Hereditary predisposition plays a role in the development of arrhythmias.
The etiological, pathogenetic, symptomatic and prognostic heterogeneity of arrhythmias gives rise to discussions regarding their unified classification. According to the anatomical principle, arrhythmias are divided into atrial, ventricular, sinus and atrioventricular. Taking into account the frequency and rhythm of heart contractions, it is proposed to distinguish three groups of rhythm disturbances: bradycardia, tachycardia and arrhythmias.
The most complete classification is based on the electrophysiological parameters of rhythm disturbances, according to which arrhythmias are distinguished:
This group of arrhythmias includes nomotopic and heterotopic (ectopic) rhythm disturbances.
Nomotopic arrhythmias are caused by dysfunction of the automatism of the sinus node and include sinus tachycardia, bradycardia and arrhythmia.
Separately in this group there is sick sinus syndrome (SSNS).
Heterotopic arrhythmias are characterized by the formation of passive and active ectopic myocardial excitation complexes located outside the sinus node.
In passive heterotopic arrhythmias, the occurrence of an ectopic impulse is caused by a slowdown or disruption of the conduction of the main impulse. Passive ectopic complexes and rhythms include atrial, ventricular, disturbances of the atrioventricular junction, migration of the supraventricular pacemaker, and jumping contractions.
With active heterotopias, the resulting ectopic impulse excites the myocardium before the impulse formed in the main pacemaker, and ectopic contractions “interrupt” the sinus rhythm of the heart. Active complexes and rhythms include: extrasystole (atrial, ventricular, emanating from the atrioventricular junction), paroxysmal and non-paroxysmal tachycardia (emanating from the atrioventricular junction, atrial and ventricular forms), flutter and fibrillation (fibrillation) of the atria and ventricles.
This group of arrhythmias occurs as a result of a decrease or cessation of impulse propagation through the conduction system. Conduction disorders include: sinoatrial, intraatrial, atrioventricular (I, II and III degree) blockades, syndromes premature arousal ventricles, intraventricular blockades of the bundle branches (one-, two- and three-bundle).
Arrhythmias that combine conduction and rhythm disturbances include ectopic rhythms with exit block, parasystole, atrioventricular dissociation.
Manifestations of arrhythmias can be very different and are determined by the frequency and rhythm of heart contractions, their effect on intracardiac, cerebral, renal hemodynamics, as well as the function of the left ventricular myocardium. There are so-called “silent” arrhythmias that do not manifest themselves clinically. They are usually detected by physical examination or electrocardiography.
The main manifestations of arrhythmias are palpitations or a feeling of interruptions, freezing when the heart works. The course of arrhythmias may be accompanied by suffocation, angina pectoris, dizziness, weakness, fainting, and the development of cardiogenic shock. Palpitations are usually associated with sinus tachycardia, attacks of dizziness and fainting are associated with sinus bradycardia or sick sinus syndrome, and cardiac arrest and discomfort in the cardiac region are associated with sinus arrhythmia.
With extrasystole, patients complain of sensations of freezing, jolting and interruptions in the heart. Paroxysmal tachycardia is characterized by suddenly developing and stopping attacks of heartbeat up to 140-220 beats. per minute Feelings of frequent, irregular heartbeat are observed with atrial fibrillation.
The course of any arrhythmia can be complicated by ventricular fibrillation and flutter, which is tantamount to circulatory arrest, and lead to the death of the patient. Already in the first seconds, dizziness and weakness develop, then loss of consciousness, involuntary urination and seizures. Blood pressure and pulse are not determined, breathing stops, the pupils dilate - a state of clinical death occurs. In patients with chronic failure blood circulation (angina pectoris, mitral stenosis), during paroxysms of tachyarrhythmia shortness of breath occurs and pulmonary edema may develop.
With complete atrioventricular block or asystole, syncope may develop (Morgagni-Adams-Stokes attacks, characterized by episodes of loss of consciousness) caused by sharp decline cardiac output and blood pressure and a decrease in blood supply to the brain. Thromboembolic complications in atrial fibrillation lead to cerebral stroke in every sixth case.
The primary stage of diagnosing arrhythmia can be carried out by a therapist or cardiologist. It includes the analysis of patient complaints and determination of peripheral pulses characteristic of cardiac arrhythmias. At the next stage, instrumental non-invasive (ECG, ECG monitoring) and invasive (TPE, VEI) research methods are carried out:
The electrocardiogram records the heart rhythm and frequency over several minutes, so the ECG detects only persistent, persistent arrhythmias. Rhythm disturbances that are paroxysmal (temporary) in nature are diagnosed using the Holter 24-hour ECG monitoring method, which records circadian rhythm hearts.
To identify organic reasons the occurrence of arrhythmia is carried out by Echo-KG and stress Echo-KG. Invasive methods diagnostics make it possible to artificially induce the development of arrhythmia and determine the mechanism of its occurrence. During an intracardiac electrophysiological study, catheter electrodes are applied to the heart, recording the endocardial electrogram in various parts of the heart. The endocardial ECG is compared with the result of a recording of an external electrocardiogram performed simultaneously.
In prognostic terms, arrhythmias are extremely ambiguous. Some of them (supraventricular extrasystoles, rare ventricular extrasystoles), not associated with organic heart pathology, do not pose a threat to health and life. Atrial fibrillation, on the contrary, can cause life-threatening complications: ischemic stroke, severe heart failure.
The most severe arrhythmias are flutter and ventricular fibrillation: they pose an immediate threat to life and require resuscitation measures.
The main direction of preventing arrhythmias is the treatment of cardiac pathology, which is almost always complicated by disturbances in the rhythm and conduction of the heart. It is also necessary to exclude extracardiac causes of arrhythmia (thyrotoxicosis, intoxication and febrile states, autonomic dysfunction, electrolyte imbalance, stress, etc.). It is recommended to limit the intake of stimulants (caffeine), avoid smoking and alcohol, and independently select antiarrhythmic and other medications.
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