Causes, symptoms and treatment of ectopic atrial rhythm. Why can an inferior atrial rhythm be detected on an electrocardiogram?

The heart is the most important human organ that does not stop for a minute. Its reduction is ensured thanks to complex system nerve impulses transmitted first from the region of the sinus node in the right atrium, spreading to the atrioventricular node and the entire area of ​​the septum. This process is considered normal and is called sinus rhythm. Sometimes under the influence various reasons Patients experience an atrial rhythm on the ECG. In the article we will look at what this means and what the possible reasons for such a violation may be.

Development mechanism

Any cardiac conduction route that does not follow the path described above is called an ectopic rhythm. In this case, an electrical impulse that occurs not in the sinus node, but outside it, excites the heart before the signal is transmitted from the normal pacemaker, that is, the sinus node. In simple words, atrial rhythm is a condition in which it contracts faster due to the advance of a healthy impulse by a pathological (minor) one.

Often this violation occurs due to various blockades caused by congenital or acquired reasons. In this case, a separate part of the heart cannot be excited due to blocking of propagation nerve impulse. When activation occurs, an additional contraction is noted, which disrupts the sequence of heart and atrium impulses. This causes the so-called atrial rhythm.

According to some scientists, pathological condition may develop as a result of hypoxia or inflammatory myocardial diseases. Cases of ectopic rhythm occurring after influenza, sore throat and other infectious diseases have been reported.

Important! Regardless of the cause of cardiac conduction disturbances, it is necessary to promptly identify the pathological condition and take measures to treat it.

How does it show up on an ECG?

Pathological conduction of the heart can be determined using an electrocardiogram. This instrumental diagnostic technique allows you to identify the localization of rhythm disturbances and the cause of the deviation. Using an ECG, a specialist can determine one of the types of ectopia:

• left atrial rhythm– in this case, deviations such as a P wave of two parts are noted, when the first of them has a dome-shaped appearance, and the second looks like a high and narrow peak. In addition, PI can be smoothed, and PV 1 and 2 are positive, PV 5 and 6 are negative;
• right atrial– in the area of ​​the third lead, a negative P wave is observed, while in the first and second leads it is positive. This is characteristic of a mid-lateral right atrial rhythm. The lower type of this disorder is characterized by a negative P wave in the second and third leads, as well as a smoothed one, and VF in chest leads– 5 and 6;
• inferior atrial rhythm– on the electrocardiogram, it appears as a shortening of the PQ interval, a negative P wave in the first, third and aVF leads.

Electrocardiography allows for accurate diagnosis

Based on this, we can say that a specialist determines the conductivity of the heart by assessing the P wave, which, with an ectopic rhythm, is characterized by pathological amplitude and polarity. An experienced doctor should diagnose the condition, since it can be quite difficult to determine the pathology on an ECG due to the vagueness of the signs. Holter monitoring is often used to make an accurate diagnosis.

What diseases can cause rhythm disturbances?

Atrial rhythm on the ECG can appear in patients regardless of age, gender and region of residence. Often the pathology is temporary and is caused by certain physiological reasons. In such cases, the duration of conduction disturbance lasts no more than several hours or days.

The situation is different with the development of certain diseases that can provoke an ectopic rhythm. These include myocardial inflammatory processes, ischemic disorders, and sclerotic changes. Let's look at the most common of them.

Myocarditis is an inflammatory process of the myocardium. The causes of the pathology are damage to the heart muscle by viruses, bacteria or toxins. Often the disease develops due to allergic reaction or autoimmune disorder. Doctors note that myocarditis can act as an independent pathology or be provoked by other diseases. The course of inflammation can be chronic or acute. The latter form often develops into cardiomyopathy.

Myocarditis – common reason violations normal rhythm

Common symptoms of myocarditis are atrial rhythm, chronic fatigue, dizziness, rapid heartbeat, pain in chest and other. If the pathology is diagnosed in a timely manner and the necessary treatment is carried out, the prognosis for the patient is quite favorable.

Cardiomyopathy

A group of diseases that unite pathological changes in myocardial tissues are called cardiomyopathies. As a result of these disorders, disruptions in the functioning of the heart occur. The disease develops both under the influence of cardiac and non-cardiac factors. That is, there are a lot of reasons that can provoke cardiomyopathy. The disorder is primary or secondary in nature and is almost always accompanied by an extracardiac rhythm.

Rheumatism

Rheumatism is a disease accompanied by inflammatory process connective tissue and cardiac muscle. It mainly affects children under 15 years of age. The main cause of inflammation is an attack of the body streptococcal infection, which provokes diseases such as tonsillitis, tonsillitis, pharyngitis, etc. Rheumatism occurs as a complication, leading to impaired contractility of the heart, increased temperature, joint and heart pain and the development of other symptoms in the patient.

Heart defects

Heart defects are congenital or acquired. The concept of “defect” implies a deviation in the structure or structure of an organ, as a result of which electrical conductivity or blood flow in it is disrupted. In addition to the congenital or acquired type, doctors classify the disease into combined or isolated, as well as the presence of a symptom such as cyanosis (bluish tint of the skin) or its absence.

Sick sinus syndrome

A dangerous condition that carries the risk of sudden cardiac arrest. The causes of this disorder are congenital or acquired. These include ischemic disease heart disease, cardiomyopathy, injury to the heart muscle, cancer in this area, defects, toxic damage to the organ and much more.

A person suffers from arrhythmia, decreased heart rate, weakness, headaches, paresis, decreased vision, hearing, and memory. Without necessary treatment the pathology is often accompanied by death.

Cardiac ischemia

IHD is a very common disease that is accompanied by many disruptions in the functioning of vital important body. Pathology is provoked by many factors, the most common of which are smoking, anatomical aging of the body, genetic predisposition, diabetes, hypertension and so on. The atrial rhythm is shown on the cardiogram of many people with this deviation. In addition, signs such as shortness of breath, headache, chest discomfort, chronic fatigue.

Vegetovascular dystonia

VSD is a set of disorders functional nature, which is caused by a violation of the regulation of vascular tone by the autonomic nervous system. In this case, an ectopic rhythm is formed, the patient experiences periodic or permanent violation heart rate, excessive sweating, frequent headaches, cold extremities, lightheadedness or fainting.

Important! Vegetative-vascular dystonia often provokes a persistent increase in blood pressure and nervousness, significantly reducing the patient’s quality of life.

Other reasons

In addition to various diseases that lead to the development of ectopic heart rhythm, other causes can be identified. These include:

• persistent increase in blood pressure;
• smoking and drinking alcoholic beverages;
• carbon monoxide intoxication;
• taking certain medications;
• frequent stress;
• hormonal disorders;
• regular physical activity;
• professional sports.

Arrhythmia often occurs during heavy physical exertion.

These and other changes in the body can lead to intra-atrial conduction, which causes the development of many unpleasant symptoms.

Features of the patient's symptoms

Often, cardiac conduction disturbance occurs without visible symptoms, but more often the following clinical picture is observed:

• attacks of heartbeat sensations. The patient seems to feel tremors in the chest;
• the average number of heartbeats increases;
• depending on the pathology that provoked outside heartbeat, a slowdown in organ contractions can be diagnosed;
• sometimes the heart freezes for a few seconds. In this case, the patient may feel panic, fear, and a feeling of excitement;
• sweat production often increases;
• headaches and dizziness occur;
• due to shortness of breath, breathing is impaired;
• discomfort and pain, burning or tingling sensation are observed in the chest area;
• the skin of the face acquires a bluish tint, cyanosis may spread to the fingertips.

In addition, patients complain of the appearance of a veil before the eyes, difficulty breathing, and bouts of fever. IN difficult situations Nausea occurs, often accompanied by vomiting and abdominal pain. There is a malfunction digestive system, which entails belching, heartburn, hiccups, flatulence, and bowel dysfunction. Common sign illnesses – pre-fainting or fainting states.

Tachycardia – common symptom atrial rhythm

People with this pathology are characterized by an increase in heart rate. Signs atrial tachycardia consist in strong heartbeat, shortness of breath, panic, increased sweating, redness of the face. Attacks occur mainly at night. Their duration is usually short, lasting from several minutes to several hours. At the same time, the patient experiences panic and fear for his life.

Atrial rhythm in children

The regulation of the autonomic nervous system and the cardiac conduction system in newborns differs from that in adults. They do not function fully due to insufficient formation. This triggers the development of atrial rhythm in infants and children preschool age. Normally, such a rhythm is independently transformed into a sinus rhythm; the condition does not require additional methods treatment.

Cardiac conduction disorders in children often develop when minor anomalies organ. For example, with prolapse mitral valve or additional chord. But this does not mean that you should not pay attention to this symptom, because often a deviation can indicate serious heart defects, infectious lesions myocardium, hypoxia, intoxication and other conditions.

The risk group includes children who have had an intrauterine infection or prolonged intoxication with alcohol or nicotine, as well as severe course pregnancy and childbirth. Such patients should undergo a thorough examination after birth to ensure timely detection of various diseases and prevent the development of severe complications.

Types of ectopic disorders

Ectopic arrhythmias include various disorders that develop in the area of ​​the ventricles and atria. According to research, it turned out that often the right atrial rhythm, which does not manifest itself on the electrocardiogram, does not come from the sinus node. That is, an electrical impulse is provoked in neighboring areas of the organ.

Most dangerous looking atrial fibrillation is considered a disorder

Types of atrial rhythm:

• extrasystole - occurs quite often (about 60% of people), this condition consists of untimely contraction of the heart muscle or its individual parts;
• paroxysmal tachycardia – separate species atrial rhythm, accompanied periodic attacks accelerated heartbeat. In this case, the number of strokes can reach 220 per minute. Paroxysms replace the normal heart rhythm and have a sudden onset and end. Electrical impulses are generated in the atria, atrioventricular node or ventricles. The duration of the attack varies;
• ectopic accelerated rhythms - attacks of accelerated heartbeat, in which the heart rate increases to 130 beats. In this case, electrical impulses are generated in the atria, ventricles or atrioventricular junction. During an ECG, a non-sinus pacemaker is recorded in the P–QRS–T complex;
• atrial fibrillation or atrial fibrillation - frequent excitation of the atria or individual muscle fibers chaotic in nature. IN in some cases Heart rate reaches 600 beats per minute. The prolonged course of such an attack significantly increases the risk of blood clots and the development of ischemic stroke. If left untreated, acute heart failure occurs.

Important! Therapy for any type of ectopic rhythm should be carried out immediately, regardless of the severity and symptoms of the patient.

Treatment methods

The atrial rhythm may be hidden and not manifest itself in any way. If the patient does not feel any unpleasant symptoms and abnormal pacemakers were identified by chance, most often special treatment not required. It is enough for such people to undergo a thorough medical examination to exclude serious anomalies in the structure of the heart and other organs. If no deviations are detected, the ectopic rhythm is considered safe for health.

Treatment methods are determined depending on the diagnosis and symptoms of the patient

When a patient has complaints from of cardio-vascular system and any pathologies are detected, drug therapy. The group of drugs includes the following:

• beta blockers and other drugs intended to lower blood pressure (Nadolol, Metoprolol, Carvedilol);
• medications that accelerate the rhythm during bradycardia. These include Atropine, Isoprenaline, Eufillin. Extracts are often recommended for plant based– ginseng, eleutherococcus;
• sedatives are prescribed to patients who develop vegetative-vascular dystonia. Popular remedies include tincture of motherwort, valerian, as well as Novopassit, Fitosed, Dormiplant;
• Preventive medications are used to prevent strokes, heart attacks and other dangerous complications. For this, Panangin and Cardiomagnyl are prescribed.

Treatment tactics always depend on the disease that acts as a factor provoking arrhythmia. Based on the data received during instrumental diagnostics and based on the patient’s medical history, the doctor selects the necessary medications.

In particularly difficult situations, when conservative therapy turned out to be useless, the patient is given an artificial pacemaker (cardioversion). This method is often effective when atrial fibrillation and other dangerous conditions.

Folk recipes

Healthy lifestyle and proper nutrition help patients prevent many dangerous complications. They are especially indicated for patients with developed atrial rhythm. Refusal bad habits and saturating your diet with plenty of vitamins and minerals is an important step towards health. Some have proven themselves to be effective in the fight against heart disorders. folk recipes. Here are some of them:

• mix 200 ml grapefruit juice with three teaspoons olive oil. Take half a glass of the drink in the morning and evening for one month;
• combine chopped figs and walnuts, season the resulting mass with honey and refrigerate for a day. Take a teaspoon of the mixture twice a day. The course of treatment is at least 60 days;
• To restore rhythm, a decoction of calendula flowers is often used. To do this, brew a spoonful of herbs with a glass of boiling water and let the medicine brew for at least 2 hours. Take a quarter glass twice a day for a month;
• A decoction of hawthorn and lemon balm has a beneficial effect on heart health. To prepare it, combine a tablespoon of raw material, pour a liter of boiling water over the mixture, and simmer over low heat for 10 minutes. After this, the medicine should infuse for 40 minutes. Take the drink instead of tea several times a day.

Folk recipes – great way maintaining the heart

Important! Any folk remedies should only be used after consultation with a specialist. Self-treatment can be extremely hazardous to health.

Prognosis for the patient

The patient's atrial rhythm should not be ignored, as it often indicates various diseases. People with this pathology need constant medical control and appropriate treatment. If the deviation is not accompanied by severe anomalies in the structure of the heart, it proceeds without acute symptoms, the prognosis for a person is often favorable. Severe forms of ectopia and lack of treatment are often accompanied by death.

Ectopic atrial rhythm, what is it? This term refers to contractions of the heart fibers that appear automatically, but not in the sinus node, but in the myocardium or conduction system. Literally, ectopia is translated as the appearance of something in the wrong place.

Ectopic atrial rhythm, what is it? Description of the phenomenon

Ectopic heart rhythm, also called replacement rhythm, since it “turns on” if the sinus node constantly or periodically fails to cope with its “ functional responsibility" The frequency of the ectopic rhythm is much lower and is considered non-sinus. It should be noted that the further the fibers that are the source sending the electrical pulse are concentrated, the less reproducible it is.

At normal operation heart, the electrical impulse originates in the appendage of the right atrium, because it is there that the sinus node is located, which is considered a first-order driver, in medical literature it is also called the Kisa-Flaca knot. Next, the impulse moves along the conduction system, heading to the atrioventricular node. Having reached the atrioventricular junction, it is distributed through the Purkinje fibers and the His system to all the muscles of the ventricles.

With ectopic heart rhythm, due to the influence of certain factors, the tissues in the Kisa-Flaca node do not emit an electrical impulse, which is sent to the lower parts of the heart. Due to the instability of the first order driver, replacement rhythms arise.

Why does ectopic heart rhythm occur? Causes of pathology

First-order driver disruptions may occur due to changes of the following nature:

1. Ischemic.
2. Sclerotic.
3. Inflammatory.

Let's take a closer look at each of these deviations in the functioning of the sinus node.

If the cause is ischemia

In acute or chronic cardiac ischemia, dysfunction of the sinus node is observed. This happens due to insufficient oxygen supply to the myocardial cells. “Hungry” cells are not able to work at full capacity. Therefore, myocardial ischemia is a leading disease that causes disruption of normal rhythms.

If the cause is sclerotic

These include: cardiosclerosis, heart attacks, myocarditis. After crisis attacks, during the recovery process, myocardial cells are replaced by growing scar tissue. Since scar tissue does not have the corresponding nerve fibers, then the transmission of the electrical impulse does not occur in full or is absent altogether.

If inflammation is the cause

The inflammatory course of the disease, which occurs in the cardiac tissues, can also affect the muscle fibers of the Kisa-Flaca node. As a consequence of this spread of infection, the cellular ability to issue and conduct electrical impulses generated in the sinus node is disrupted. Escape rhythms begin to appear in the cells of the atria, sending them to the atrioventricular node. The frequency of such contractions differs significantly from the usual ones, up or down.

When is ectopic heart rhythm found in children?

Ectopic atrial rhythm in children is extremely rare and can be congenital or acquired. Most often, this pathology appears when:

• hormonal changes, adolescence;
• vegetative-vascular dystonia;
• pathologies associated with the thyroid gland.

As for newborns, ectopic atrial rhythm is often detected in premature babies or in newborns with birth pathology, including hypoxia. Usually, with age, the neurohumoral regulation of the activity of the heart muscles in children becomes more mature and the replacement rhythms disappear, and the heart begins to distribute electrical impulses from the sinus node.

Therefore, if, when an ectopic atrial rhythm is detected in children, there are no pathologies associated with the work of the heart, and there are no disorders of the central nervous system, then such a disorder is called age-related, which goes away as the child grows up. Required condition For such children, regular monitoring by a cardiologist is necessary.

If a child is found to have atrial fibrillation, atrioventricular rhythm or paroxysmal tachycardia, then an immediate examination should be performed, since such abnormalities can be caused by congenital cardiomyopathy, heart defects, which can be congenital or acquired, rheumatic fever or viral myocarditis.

Methods for treating ectopic atrial rhythm

If disturbances in the functioning of the heart muscles are detected, which are asymptomatic and not caused by hormonal imbalances, heart or neuralgic diseases, the following treatment is carried out.

1. At a low frequency of ectopic contractions (bradyform of atrial fibrillation), adaptogens (natural - ginseng, Eleutherococcus, mumiyo) are prescribed.
2. If the manifestation of the disease is moderate, then restorative and sedatives.
3. At severe cases Doctors advise resorting to implantation of an artificial pacemaker.

Some patients are prescribed drugs instead of an electronic implant that must be taken for the rest of their life, thereby increasing its duration.

Timely consultation with a doctor increases the chances of full recovery, especially if the ectopic atrial rhythm is not accompanied by an underlying heart disease.

Ectopic, also characterized as replacement, rhythms are contractions of the heart caused by automaticity manifested in other parts of the myocardium or conduction system. Arise if the activity of the sinus node is stopped or weakened, which can happen either permanently or temporarily. The further away the source of the non-sinus rhythm is (we will apply this name to rhythms ectopic in nature), the frequency is usually lower and the pulses of the sinus node are less frequent.

Reasons for rhythm changes

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:

• sclerotic;
• ischemic;
• inflammatory.

Ectopic disorders are classified in different ways. There are several forms:

1. Supraventricular rhythm of ectopic nature. Its causes are an overdose of cardiac glycosides, as well as autonomic dystonia. It rarely happens that this form due to increased automaticity of the ectopic focus. In this case, the heart rate will be higher than with an accelerated or replacement rhythm of an ectopic nature.
2. Ventricular rhythm. Typically, this form indicates that significant changes have occurred in the myocardium. If the ventricular rate is very low, ischemia may occur, affecting important organs.
3. Atrial rhythm. Occurs often in the presence of rheumatism, heart disease, hypertension, diabetes mellitus, ischemia, neurocirculatory dystonia, also even healthy people. As a rule, it is present temporarily, but sometimes it lasts for a long period. It happens that atrial rhythm is congenital.

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:

• active: and extrasystole;
• accelerated: atrial fibrillation.

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 in early age seizures occur paroxysmal tachycardia, 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.

Symptoms of the disease

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:

• increased sweating;
• nausea;
• bloating;
• the urge to urinate, even if the person has not consumed much liquid, occurs every fifteen or ten minutes, and about 250 ml of light, transparent urine is released each time; this feature persists even after an attack, then gradually disappears;
• urge to defecate; this symptom It is not observed often and occurs after the onset of a seizure.

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 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:

• interruptions in cardiac function;
• a feeling of “fading” of the heart;
• feeling of heat in the throat and heart.

However, there may be no symptoms at all. Vagotopic extrasystoles in children are accompanied by overweight body and hypersthenic constitution. Paroxysmal tachycardia at an early age has following signs:

• fainting;
• feeling of tension and anxiety;
• dizziness;
• pallor;
• dyspnea;
• stomach ache.

Diagnosis of the disease

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. There is also a decreased arterial pressure. 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.

Treatment methods

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.

Intoxication with digitalis can lead to the occurrence of polytopic extrasystoles, which is why it occurs. 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 abdominal press 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 apply for timely medical care and do not start treatment of underlying diseases that provoke the development of ectopic rhythm. For clear and coordinated work of the heart, it is simply necessary to maintain healthy image life and avoid stress.

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.

Read in this article

Reasons for the development of nodal, right atrial ectopic rhythm

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:

• , especially of viral origin. Ectopic atrial lesions produce signals whose frequency is higher or lower than normal.
• Ischemic processes disrupt the functioning of the conduction system due to lack of oxygen.
• Cardiosclerosis leads to the replacement of functioning muscle cells with rough inert tissue, incapable of generating impulses.

There are also extracardiac factors that interfere with the physiological work of the muscle fibers of the sinus node. These include diabetes mellitus, diseases of the adrenal glands or thyroid gland.

Symptoms of a slow or fast heartbeat

Manifestations ectopic rhythms hearts are completely dependent on how far from the sinus node the new pacemaker is located. 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 SU, 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 QRS complex 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)PQ 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.

Ectopic av-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 the lower 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.

Ectopic ventricular (idioventricular) rhythm

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.

Escaped (jumping, replacing) complexes or contractions

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.