Arrhythmia heart symptoms
About 98% of potassium in the body is distributed in cells and in fluids is only 2% of potassium.Especially large stocks contain potassium in the muscles and liver.During the day a person loses 1-1.5 mmol / kg potassium, which the kidneys (90%) is displayed in the main, and the rest (10%) with the sweat and feces.How to use folk remedies, see here for arrhythmia.
MRFIT According to research the use of hydrochlorothiazide at a dose of 50-100 mg / day, or chlorthalidone 50 mg / dayin patients with hypertension and minimal ECG changes increased frequency of sudden death.At the same time, other studies have not confirmed this connection.Currently, long-term treatment of hypertension recommend spending doses 12.5-25 mg / day.
potassium deficiency to determine the use of potassium deficiency assessment of potassium, which normally amounts to 3.5-
technical errors, such as the imposition of the harness when the vein puncture or
prolonged storage of blood, promotes potassium out of the red blood cells and
If pronounced potassium deficiency (hypokalemia & lt; 2,5 mmol / l)
appear, as shown in Table symptoms.The ECG recorded
increase in the amplitude and width of the P-wave, a slight increase of the interval PR, the expansion of the complex QRS (+20 ms), improving U-wave amplitude decrease of the T wave and the segment ST, lengthening of the QT interval.
Arrhythmias Atrial tachycardia,
VT, including bi-directionally-spindle,
ventricular and atrial premature beats.
spasm of the muscles of the legs,
weakness of the respiratory muscles,
apathy or irritability,
sensitivity to cold,
Despite the unreliability of determining the content of potassium in the body for potassium, this indicator is widely used to assess the severity of an estimated deficit of potassium.
believed that the potassium level 3 mmol / l potassium deficit is about 350 mM, at a level of 2.5 mmol / l - 470 mmol, and at the level of 2 mmol / l - 700 mmol.
What preparations need to correct the existing lack of potassium?
potassium content of the various preparations.
potassium drug potassium content
Panangin, asparkam 1 mmol in 1 tablet or pills,
2,5 mmol in 10 ml.
13.5 mmol Potassium chloride 1 g of powder,
5.3 mmoles in 10 ml of a 4% solution,
10 mmol in 10 ml of 7.5% solution,
13.2 mmol in 10 mL of a 10% solution.Potassium
normin 13.5 mmol in 1 tablet (1 g KCl).
frothy Potassium 15.9 mmol in 1 tablet (1.18 g KCl).
Note: 1 mM = 1 mEq = 39.1 mg elemental potassium.1 g = 26.5 mmol.
Note that potassium deficiency replenishment
should not be administered on the same day as this can lead to complications upon administration
large amounts of potassium chloride.If parenteral nutrition is carried out, it is necessary to take into account the daily loss of potassium in the 80-100 mM.
Through infusion of potassium chloride solution must be remembered about the local
cauterizing effect of the drug to the formation of phlebitis and sclerosing effect.the solution can be warmed up to 37% to reduce the side effects, to reduce the concentration and administered at different veins.The main danger of potassium treatment drugs is the ability of the concentrated solution of potassium cause asystole.
In asymptomatic or low-symptom of potassium deficiency apply
diet with a high content of potassium.
rich foods in potassium (& gt; 500 mg per 100 g)
apricots without stones (apricots)
Dry milk cow
dried Pears Potatoes Spinach
milk Chocolate Almonds sweet
Sorrel dried apples
used as salt substitutes containing potassium 7-14 mmol per 1 g (salt Valetek, where 30% of potassium chloride)potassium or drugs.The daily dose of the additional potassium is typically 30-60 mmol.potassium chloride powder should be washed down with a glass of water or fruit juice, since potassium chloride is an irritant.In case of intolerance to oral medications used
intravenous drip.When potassium
& gt; 2,5 mmol / l and the absence of changes in the ECG, a solution at a concentration of 30 mmol / l.For solution of such concentration must 7.5 ml 15% potassium chloride diluted in 485 ml of 5% glucose.potassium introduction rate is typically 10 mmoles (330 ml) per hour.Typically about 60-90 day administered mmol potassium (2.3 L).When potassium
2,5-2,0 mmol / l, the ECG changes and the presence of tachyarrhythmias, or other symptoms, due to the danger of the state recommended a more intensive corrective therapy.Apply elevated potassium concentration of the solution - 60 mg / dL.For solution of such concentration must 7.5 ml 30% potassium chloride diluted in 470 ml of 5% glucose.Concentrated potassium solutions are injected only into the peripheral vein in order to avoid cardiotoxic effect (asystole).The speed of potassium is 40-60 mM (660-990 ml) per hour.Requires continuous ECG monitoring and determination of the potassium content in plasma after 4 hours. Usually a day is administered 90-150 mmol of potassium (1.5-2.5 l).When
potassium & lt; 2,0 mmol / l or severe arrhythmia (bidirectionally-fusiform VT, VF) recommend increasing the rate of introduction of potassium
80-100 mmol / hr at a concentration of 60 mmol / l solution.However
in this case it is necessary to introduce 1.3-1.7 liters of solution per hour under the control
HPC that can be dangerous, especially when left ventricular failure.Apparently, it is possible to increase the concentration of potassium 90 mmol / l and accordingly to reduce the infusion of 0.9-1.1 l / h.In life-threatening potassium applied at the beginning of treatment in isotonic solution as a solvent instead of glucose.
potassium preparations, the potassium salt of penicillin.
Tissue catabolism (sepsis, trauma, fever, the collapse of the tumor, hemolysis, gastrointestinal bleeding).
deficiency of insulin.
Beta-blockers (diabetes, hemodialysis).
Drugs (NSAIDs, ACE inhibitors, heparin, cyclosporin, potassium-sparing diuretics).
Addison's disease.Primary hypoaldosteronism.
Renal tubular acidosis.
possible psevdogiperkaliemiya, such as blood clotting, leukocytosis (& gt; 70 * 109 / l), thrombocytosis (& gt; 1000 * 109 / l), a tight application of the harness, hemolysis when drawing blood through a thin needle, delaying blood analysis.
hyperkalemia symptoms usually appear when the potassium content in the plasma
& gt; 6,5 mmol / l.
The ECG is often recorded following the sequence of changes: first, when potassium 5.7-6.5 mmol / l, there are high and pointed T waves, and then may develop AV block of 1 degree.When potassium 6.5-7.5 mmol / l flattened P waves, and at the level of 7.0-8.0 widen QRS complexes and ST segment depression is observed.
speed of hyperkalemia symptoms can be different.
example, from the first electrocardiographic signs of hyperkalemia to asystole or ventricular fibrillation may take several minutes.
Symptoms of hyperkalemia
Arrhythmias sinus, asystole,
AV block (1-3 degrees),
Weakness, especially in the lower extremities,
necessary to identify the cause of hyperkalemia and fix it.Also, to protect the heart conduct specific treatment required urgently when potassium & gt; 7 mmol / L or appearance of electrocardiographic signs.Emergency Apply following means:
10 units of insulin in 60 ml of 40% glucose / in for 5 min.The effect develops in 30-60 minutes and lasts for several hours.
inhaled salbutamol nebulized
10 ml of 10% calcium gluconate / in for 2-5 minutes.Preparation action develops rapidly, however if there is no effect for 5 min, the dose should be repeated.The duration of action of the drug is about 1 hour.
drug is not indicated for the use of cardiac glycosides.
8.4% Sodium bicarbonate 40 ml is introduced into / in for 5 minutes, and in the case of saving the changes in the ECG, the dose was repeated after 10-15 minutes.If untreated multiple drugs, the use of calcium to sodium bicarbonate, or may develop seizures.Simultaneous administration of glucose.
Around 99% of magnesium in the body is distributed in cells.The greatest
magnesium reserves contained in bones (50-60%), muscle and soft tissues.
daily requirement of magnesium for an adult is 12-40 mmol.
Chronic alcoholism - the main reason.
Fasting.Rich in protein and calcium food.
deficiency of vitamin B6.
Diarrhoea, vomiting, stomach drainage.
polyuria (diuretics, acute renal failure).
Diabetic ketoacidosis, glycosuria.
Medications: antibiotics (aminoglycosides, ticarcillin, carbenicillin, amfotertsin B), cyclosporine, cardiac glycosides, diuretics (especially loop).
Proton pump inhibitors.
magnesium deficiency To evaluate magnesium deficiency in the body using an assessment magnesium concentration in blood plasma, which normally is 0,65-1,1 mg / dL.Approximately 25-30% magnesium bound to plasma proteins, so the total amount of magnesium hypoalbuminemia plasma (magniemiya) decreases and ionised magnesium content may not change.
physiologically more important is magnesium fraction is not associated with proteins
magnesium level in the plasma is not a reliable indicator of magnesium deficiency, as only 1% of magnesium is distributed extracellularly.Consequently, the normal magniemiya not exclude a lack of magnesium.
Note that 40% magnesium deficiency combined with potassium deficiency.
symptoms appearing only in severe magnesium deficiency,
shown below.The ECG recorded an increase in the PR interval broadening of the QRS (+20 ms), increase the interval QT, ST segment depression and T-wave amplitude decrease
manifestations of magnesium deficiency
Paroxysmal atrial tachycardia with AV block,
long QT syndrome,
politopnye ventricular arrythmia,
digitalis, alcoholic arrhythmia,
sinus tachycardia, hypertension.
increased neuromuscular excitability,
spasms of skeletal muscles, facial, hand obstetrician, tremor.
spasm of the sphincter of Oddi,
alternating diarrhea and constipation.
impairment of consciousness up to coma,
chronic fatigue syndrome,
eclampsia in pregnant women.
Despite the unreliability of the determination of magnesium in the body by the level magniemii, the latter figure is widely used for a rough estimation pronounced deficiency of magnesium (& lt; 0,5 mmol / l).Hypomagnesemia is registered only in severe deficiency of magnesium in the body.Therefore, in the case of obvious reasons for the loss of magnesium and symptoms, presumably associated with magnesium deficiency, usually start treatment despite normal magniemiyu.
Among the drugs noted the low magnesium content in
widespread preparations Pananginum and asparkam.
magnesium content of the various preparations
drug magnesium content of magnesium
Panangin 0.5 mmol (12 mg) in one tablet, dragee,
Asparkam 1.4 mmol (34 mg) in 10 ml.Magnesium sulfate
8 mmol in 1 g of powder,
20 mmol in 10 mL of a 25% solution.
Mag-Ox 10 mmol (240 mg) in 1 tablet.
Uro-Mag 3.5 mmol (84 mg) in 1 tablet.
Magne B6 2 mmol in 1 tablet.
Note: 1 = 2 meq mmol = 24 mg of elemental magnesium
If there oligosymptomatic asymptomatic or magnesium deficiency, the use
oral agents, such as magnesium oxide or chloride, in a dose of 10 mmol (240 mg) in 1.2 better reception.At the same time useful to assign locking means.
can help products containing large amounts of magnesium
rich foods with magnesium (& gt; 100 mg per 100 g)
buckwheat Groats oat milk powder
pitted apricots (dried apricots)
should be remembered that in renal failure dose of magnesium must be reduced about 2 times.
Transport Driving arrhythmia
According to reports medical problems, including arrhythmias,
very rarely lead to traffic accidents.Among the 3,000 accidents while driving personal vehicles only 0.84% was caused by arrhythmias.According to the European countries 0.1% of road accidents of commercial vehicles are connected with medical problems, of which only 10-25% due to cardiac disorders.
consider the risk of transient disturbance of consciousness at different
personal arrhythmias and restricting access to driving a vehicle on the basis of the recommendations of OC
AHA / NASPE Experts (1996) and ESC (1998).
note that studies on the evaluation of cardiac arrhythmias and conduction
driving transport highly enough, so
most of the recommendations based on the extrapolation of the available data and are empirical.
ventricular arrhythmia and unstable ventricular tachycardia without structural heart disease
are safe and are not a limitation for
transport driving.Heart diseases are eliminated after the test (echocardiogram, stress test).If there are doubts about the presence of coronary artery disease, particularly in men older than 36 years, is a coronary angiography.In heart disease, ventricular arrhythmias may increase the risk of sudden death.
Individuals with sustained VT or VF in commercial vehicle driving
not allowed.After successful treatment of sustained VT or VF in the background
antiarrhythmic treatment of recurrent ventricular tachyarrhythmias in
first year occur in 17% of cases, with the highest frequency of
occur in the first month, from 2 to 7 months the recurrence rate is moderate, and later greatly reduced.
Patients with ICDs for several years of observation in 70% of cases registered repetitive discharges, of which 10% were accompanied by syncope, and 10% predobmorokom.Unfortunately, no evidence of predicting the risk of fainting.
absence of fainting at the first ICD discharge, nor does it guarantee the absence of syncope during subsequent discharges.Since the maximum frequency of relapses occur within the first 6 months after discharge, the private vehicles should not be driven in this period.