Scientific editor: OA Strokina practicing therapist, doctor of functional diagnostics.
August 2018.
Arrhythmia - a violation of cardiac conduction, as well as the frequency and regularity of its contractions, leading eventually to the malfunction of the heart and subjectively unpleasant symptoms.
Under arrhythmias understand any changes in the heart, that as a result of violating the right of its reduction - both in speed and in the synchronous operation of its departments. Normally, the heart beats in a certain rhythm, having in its cycle sequential contraction and relaxation of the atria and ventricles. This is ensured by the coordinated cardiac conduction mechanism, which is formed by:
- automaticity (the ability to generate pulses irrespective of our will)
- excitability (the ability of its muscles to actively respond to the pulse)
- contractility (ability of muscle to contract under the action of pulses),
- conduction of the heart (the ability to freely carry out a signal to all parts of the heart).
If you violate any of these mechanisms may develop arrhythmia. It is normal sinus rhythm, all deviations from it are essentially arrhythmias. Arrhythmias can be both independent of heart disease, and complications arise in the form of other heart problems - heart attacks, ischemia, myocarditis. In 15% of cardiac deaths is arrhythmia blame.
Causes
According to the basic mechanisms of arrhythmias can be divided into:
- caused by organic heart lesions (usually blockade)
- caused by functional heart disorders (disorders in the contraction frequency, beats).
Arrhythmias due to organic causes (when the heart muscle is damaged) can occur when:
- myocarditis,
- coronary heart disease,
- infarctions,
- cardiomyopathies,
- malformations,
- traumas and wounds of the heart, including the operative,
- heart failure,
- cardiosclerosis.
Functional arrhythmias are the result of:
- neurogenic effects, which include activation of the autonomic nervous system, the impact of stress, emotions, mental or physical work, psychostimulants (nicotine, alcohol, coffee, tea), neurosis, power components (acute, salty, spicy).
- electrolyte metabolism disorders, important for the heart (potassium, magnesium, sodium, calcium).
- iatrogenic interventions (treatment-induced), which include diuretics, beta-blockers, cardiac glycosides, agonists.
- hormonal influences, such as adrenaline and noradrenaline, thyroid hormone excess, ACTH (Adrenocorticotropic hormone) cortisol.
- disease states, such as fever, intoxication, hypoxia and anemia.
- idiopathic disorders (with unknown cause).
When organic arrhythmia occurs the formation of defects in the cardiac muscle, which is why it can not properly conduct impulses along nerves damaged twigs. If affected pacemaker - the sinus node, the pulses begin to be generated incorrectly.
When functional arrhythmia is a disturbance Incoming pulses to the heart due to external influences or inability of the heart shaped handle properly all the signals it receives.
Kinds
At present, there are many options for arrhythmia classification.
Anatomical classification:
- atrial localization of lesions in one or both atria,
- ventricular arrhythmia, localization of lesions in the ventricles,
- sinus problems in the sinus area,
- atrioventricular localization at the junction of the valves.
Classification of contraction frequency and regularity:
- tachycardia,
- bradycardia,
- irregular rhythm.
The most complete classification, which is based on electrophysiological parameters:
Arrhythmias due to violation pulses education
- nomotopnye (pulse generated in the sinus node), they include weakness sinus arrhythmia, bradycardia or tachy.
- ectopic (heterotopic - pulse is generated sinus node). They are passive and active.
Arrhythmias due to problems with the intracardiac pulse conductivity. These include:
- sinoatrial block,
- atrioventricular block,
- intraatrial blockade
- intraventricular blocks,
- premature ventricular irritability syndrome.
Arrhythmias combined type.
manifestations of arrhythmias
Symptoms of arrhythmias depends on the heart rate and regularity. It is important whether the arrhythmia affect blood flow to vital organs. May be clinically manifested arrhythmia, which are only detected on an electrocardiogram.
The main manifestations:
- disruptions in the heart,
- strong heart attacks, in violation of health,
- feeling a sinking heart,
- chest pain,
- dizziness,
- feeling of suffocation,
- fainting,
- weakness,
- the development of shock.
complications
Arrhythmias may be episodic or constant, aggravating the impact of negative factors. Particularly dangerous complications of arrhythmias. They are the most dangerous:
- atrial fibrillation or flutter,
- circulatory arrest,
- shortness of breath with pulmonary edema,
- attacks of Morgagni-Stokes (syncopal loss of consciousness due to a sharp violation of cerebral circulation)
- thromboembolism.
Diagnostics
Initially, the patient asked about complaints and examine, explore and listen to the heart pulse. Specialist necessarily pays attention to what drugs the patient receives at the moment. To determine the cause of the arrhythmia must first appoint:
- biochemical blood analysis: potassium, glucoseThyroid hormones and others. (Available as increased and reduced performance);
- blood test coagulabilityIncluding INR - mandatory survey to select the correct dosage of drugs that prevent blood clots.
But to clarify the type of arrhythmia and the degree of severity of injury should:
- holding a 12-lead ECG and daily Holter monitoring ECG - to identify the very fact of arrhythmia,
- Ultrasound of the heart (echocardiography) At rest and with the measured physical and pharmacological stress (stress tests) - to assess the structural changes of the heart, which may be the cause of the conduction disturbances and detection of functional disorders and the body at rest and during load
- transesophageal echocardiography reveals near those structures kotroye poorly visible during ultrasound through the chest wall, e.g., blood clots (thrombi) in the left atrial appendage, which are most often the cause of major complications of atrial fibrillation - ischemic strokes
- transesophageal electrical stimulation of the heart is used to determine the nature and mechanisms of specific conductance disturbances.
arrhythmia treatment
Treatment of arrhythmias involved cardiologists. Carry underlying disease therapy and simultaneous correction of cardiac rhythm.
Depending on severity of the disease and neglect tactics used conservative (use of drugs) or surgical.
In the treatment of arrhythmias following drugs are used:
- cell membrane stabilizing agents (procainamide, trimekain, propafenone),
- blockers (atenolol, nadolol), but lately preference is given to drugs like Concor, egilok, carvedilol, sotalol;
- potassium channel blockers (amiodarone)
- calcium channel blockers (verapamil).
But the danger is not so much an arrhythmia how many complications, such as thrombosis and thromboembolism. Therefore, the therapy added to medicines that prevent their appearance:
- vitamin K antagonists (warfarin);
- antiplatelet agents (acetylsalicylic acid);
- New oral anticoagulants (ksarelto, pradaksa) - today are the most advanced because of greatly simplify its use, since it is not necessary on a monthly basis to monitor coagulation parameters blood.
It is important to understand that by using traditional medicine, it is imperative to inform them using a doctor, because the probability of an overdose of certain substances that may aggravate situation.
Among other methods prescribed:
- Electrical cardioversion (way to restore heart rhythm using a special mode defibrillator);
- transesophageal atrial electrical stimulation;
- implantation of pacemakers,
- RF ablation (pathological blanking pulse method).
Prognosis of arrhythmias depends on the type and severity of violations.
Play an important role, and co-morbidities. Thus, each person is different and each needs its own approach and treatment, which should determine the cardiologist.
sources:
- Atrial fibrillation and flutter in adults. Clinical guidelines of the Ministry of Health of the Russian Federation, 2016.
- Ventricular arrhythmias in adults. Clinical guidelines of the Ministry of Health of the Russian Federation, 2016.
