GENERAL
In the normal state for a minute a healthy heart performs about 70 cuts. Given rhythm is achieved by alternately equal to the contraction and relaxation of the atria and ventricles. When AI (atrial fibrillation) pulse transmission sequence between the atria and the ventricles is disturbed and normally no longer atria to contract. Instead of individual fibers in random processes observed contraction and excitation, the number of which may reach for 350-800 minutes. Unfortunately, modern medicine has not yet found an answer to the question of the mechanism of abnormal signals in the heart muscle.
Facts about atrial fibrillation (AF):
- The disease more susceptible to males, but women are diagnosed with AF higher probability of premature death.
- Around 5.5 million. people worldwide are living with a diagnosis of AF. Every year the number of patients increased by 720 thousand.
- Approximately half of the patients diagnosed with atrial fibrillation - people over the age of 60.
- According epidissledovaniya, in the Russian Federation MA prevalence is at least 6%, exceeding the similar foreign figures in half.
Quite often, atrial fibrillation occurs as a complication of acute forms of myocardial infarction, as well as open-heart surgery. MA is not an independent disease, which manifests itself in the background of another illness, and disappears after treatment of the underlying disease.
About that, what are the symptoms and treatment of atrial fibrillation, than it can be dangerous, what preventive measures need to be taken to prevent its development, will be discussed below.
CAUSES
Causes of atrial fibrillation are divided into two major groups: cardiac (directly related to the heart) and extracardiac.
Cardiac causes of MA:
- diseases of the coronary arteries;
- condition after surgery on the heart;
- congenital and acquired heart defects;
- hypertonic disease;
- cardiomyopathy.
Noncardiac causes of MA:
- obstructive pulmonary disease chronicity of the system;
- pathology of endocrine system (e.g., hyperthyroidism);
- surgery;
- diseases caused by viral infections;
- GI pathologies (diaphragmatic hernia, cholecystitis, etc.);
- CNS diseases.
Furthermore, approximately about 10 percent of cases of atrial fibrillation disease associated with a different order reasons: drug administration that violate electrolyte and metabolic balance in the body, chronic stress, excessive overvoltage, drinking large amounts of alcohol or caffeine-containing drinks.
The appearance of atrial fibrillation in young people may be the first sign of an existing disease - mitral valve prolapse, which usually takes place secretly and found out casually.
CLASSIFICATION
Atrial work violations can be classified according to several criteria.
The American Heart Association Classification:
- Parokzizmalnaya atrial fibrillation occurs more frequently than others. This attack of tachyarrhythmia, which is diagnosed for the first time. This form is very often accompanied by hypokalemia (a sharp decrease in the content of potassium in the blood). attack duration, usually not more than a day. In rare cases it can last up to five days.
- In persistent atrial fibrillation attack can last for 7-10 days, thus it is impossible to stop yourself. This form requires the mandatory medical and sometimes surgical treatment.
- The chronic form of flickering arrhythmia involves a permanent violation of the heart rate, which lasts at least a year. Complete restoration of normal heart rhythm in such form is no longer possible.
By the nature of ventricular rate:
- normosistolicheskaya MA (from 60 to 90 beats per minute);
- bradisistolicheskaya MA (less than 60 beats per minute);
- tachysystolic MA (greater than 90 beats per 60 seconds).
By the nature of contractions of the atria:
- fibrillation;
- "Flutter" or "flicker".
Clinical manifestations:
- clear atrial fibrillation;
- latent (asymptomatic) MA.
SYMPTOMS
Clinical manifestations of such arrhythmias are directly related to its shape and the views of the main pathologies, against which there is an arrhythmia. The strength of the severity of symptoms depends on the patient's individual characteristics (age, his cardiovascular system, etc.). Quite often, the symptoms of atrial fibrillation, blurred and therefore remain for a long time without proper attention. For example, a symptom like dizziness atrial arrhythmia occurs among other disease symptoms (Injury and brain tumors, inner ear pathologies and the like), and can also be a manifestation of stress or overwork.
The main symptoms of atrial fibrillation:
- pain and tingling in the chest;
- feeling the heartbeat;
- sudden weakness and excessive sweating;
- dyspnea;
- skin blanching;
- panic attacks;
- dizziness, faintness that ends.
An additional feature of atrial fibrillation in women is frequent urination that is not associated with abnormalities of the urogenital area, or pregnancy.
DIAGNOSTICS
About a quarter of patients atrial fibrillation occurs in an asymptomatic form, so many of them do not even know a certain point, what it is - an arrhythmia. Often atrial arrhythmia is detected at random, for example, by passing the planned inspection by a cardiologist, and at the time of diagnosis may already be present in the chronic stage, which cure at this stage impossible.
The main methods of diagnosing atrial fibrillation:
- Gathering medical history and complaints. The attending physician finds when it first appeared arrhythmia, whether there are at the same time pain in the chest, what diseases and patient underwent surgery in his life, whether he or the next of kin of chronic cardiovascular disease system.
- Physical examination reveals the disease, which caused the occurrence of atrial fibrillation. The doctor draws attention to the color and condition of the skin, listens to the lungs and heart.
- General blood and urine can detect comorbidities.
- Using biochemical analysis of blood cholesterol levels is determined, and the ratio of "good" and "bad" cholesterol, sugar and potassium.
- The study of the hormonal profile helps to prevent thyroid pathology as a possible cause of atrial fibrillation.
- ECG (electrocardiogram) allows to observe irregular heart rhythm, the absence of the P wave in atrial fibrillation, which reflects the synchronism reductions in rate.
- Chest X-ray is used to measure heart size (increased or not), changes in the lung tissue.
- Echocardiography helps to identify changes in cardiac structure (zone after myocardial infarction, cardiac wall thickening, etc.).
In some cases, the above methods of diagnosis of atrial fibrillation may be insufficient, and the cardiologist can apply additional.
Additional methods of diagnosing MA:
- HMEKG - ECG monitoring for 1-3 days Holter helps to identify periods of flickering arrhythmia occur without apparent symptoms, MA form, its duration and so on.
- Transesophageal echocardiography. Introduction of the probe with a sensor on the end of the esophagus to determine the blood clots in the atria location area or their ears.
- Load test, which is conducted via veloegometra (special simulator). The patient receives a physical activity that increases gradually. Changes in cardiac activity at the same time fixed by ECG. This test reveals the presence of coronary heart disease, and help correctly assign dosage of drugs in chronic AF.
TREATMENT
The methods by which carried out the treatment of atrial fibrillation of the heart, are divided into two groups: conservative and surgical. The tactics of therapy the physician determines, on the basis of clinical disease.
Therapeutic treatments MA:
- Drugs, antiarrhythmics appointed for the initial stages of the development of atrial fibrillation. Allow to quickly get rid of the symptoms and slow down the further development of the pathological process.
- Medicaments regulating heart rate, did not give the ventricles to contract faster than it should occur in normal (β-blockers, cardiac glycosides).
- Antiplatelet drugs are prescribed for the prevention of strokes and thrombus formation (desagregants blood thinning). The use of these drugs for the treatment of atrial fibrillation should be under the constant supervision of the physician, with regular monitoring of the state of blood tests.
- The control heart rate in order to keep it on the norm level (60 ppm) is performed by receiving beta-blockers, digitalis drugs, calcium antagonists and certain aritmikov. Improving the state of health after the application of this type of treatment is observed in 30-60% of patients. However, with prolonged use may decrease its effectiveness.
In some cases, conservative therapy does not give the desired results, so surgery can be assigned for the treatment of atrial fibrillation.
Indications for surgical treatment of AF:
- Lack of effect of drug use different kinds.
- Blood disorders (increased frequency of fainting, low blood pressure, feeling of weakness), observed during attacks.
Methods of surgical treatment of atrial fibrillation:
- Catheter ablation - a minimally invasive method to neutralize the heart cells that cause AF. Penetration to the heart muscle is achieved by introducing the catheter through the femoral artery, which carries out "opening" atrial fibers using cold, laser or chemical reagent or current pulse, thereby eliminating the source of occurrence of AF.
- Pacemaker implantation is carried out if unable to normalize the heart rhythm (frequency reduced to 60-90 beats per minute) with drugs.
- Operation with open chest is used as an opportunity cupping sources that cause fibrillation atrial, simultaneously with the elimination of a serious cardiac pathologies (e.g., during operations on coronary vessels).
According to medical statistics, the surgical treatment of atrial fibrillation offer the highest chance of getting rid of this disease - from 70 to 85%.
COMPLICATIONS
Atrial fibrillation is only at first glance it seems a simple disease. Patients with this diagnosis should be remembered that the flickering arrhythmia - is a pathology which is associated with a risk complications arising from lack of timely adequate treatment or transition into a chronic disease shape.
The most dangerous complications of MA:
- Development of cardioembolic stroke, which occurs due to the stagnation of blood in the atria.
- Thrombus formation, which the bloodstream can get into any organ, including the brain, triggering death of brain tissue (stroke).
- Cardiogenic shock, provoking a significant reduction in blood pressure, which resulted in the authorities and human tissue no longer receive the necessary nutrition, and irreversible processes begin in them.
- Development of thromboembolism due to thrombus formation in the chambers of the heart.
- Heart failure.
- The onset of sudden death due to cardiac arrest caused by blockage of its internal openings.
PREVENTION
Preventive measures largely depend on the form of atrial fibrillation, which is diagnosed in a patient. However, there are general guidelines that need to comply with all patients diagnosed with AF.
Preventive measures for atrial fibrillation:
- A balanced diet that provides the body with necessary vitamins and microelements. The basis of the diet should be foods rich in Mg and K (pumpkin, walnuts, apricots, zucchini). Also in the daily menu, we recommend the use of products containing large amounts of fiber. Nutrition should be a fraction, without periods of starvation and overeating.
- Complete rejection of alcohol and tobacco.
- Regular exercise: morning exercises, swimming, walking, jogging, etc.
- Timely therapy of thyroid disease (hyperthyroidism, hypothyroidism), respiratory (chronic obstructive bronchitis, bronchial asthma).
- Avoiding stressful situations and conflicts. If necessary - receiving sedative drugs row.
- Constant monitoring of blood pressure, prevention of hypertension.
- Retention body weight on the same level, without sharp jumps in the direction of decreasing or increasing.
It is important to remember that at the first sign of atrial fibrillation should consult a cardiologist for the purpose of therapy, the appropriate form MA.
FORECAST FOR RECOVERY
Paroxysmal and persistent atrial fibrillation in modern conditions respond well to therapy, the chances of recovery is high enough and provided timely appropriate treatment aimed at eliminating the causes of primary disease. Healing of chronic forms of MA is unfortunately impossible at this stage.
The least favorable prognosis for patients with serious heart disease (heart attack, cardio, congenital or acquired defects, etc.), and thromboembolic complications. Atrial fibrillation in these patients is the development of heart failure, which ranks third in the statistics of deaths.
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