Cardiac arrhythmias - Causes, Symptoms and Treatment .MF .
human heart - a continuously operating pump, carrying out the order of a hundred thousand cuts per day.Maintain the contractile function of the heart makes its conduction system.It includes the sinus node, which originates an electrical impulse;atrioventricular node, bundle branch block of the momentum transfer in the interventricular septum and the Purkinje fibers that are responsible for muscle contraction of the ventricles.Normally, the frequency rate of from 60 to 90 beats per minute.
Heart rhythm is sinus and right.Sinus rhythm means that each pulse that causes contraction of the heart muscle, comes from the sinus node and is transmitted on a downward path.The right rhythm - regular contractions of the heart with the same frequency.
Deviations from the normal heart rhythm disturbances called arrhythmias and conduction, or arrhythmias.rate cuts there may be increased or decreased, and the rhythm and sinus be correct or not.Some arrhythmias are not dangerous to humans, and can occur even in young h
Arrhythmias are divided into the following types:
1. Violations pulse formation. If the pulses generated in the sinus node, but all too often, developing sinus tachycardia (heart rate over 90 per minute), if rarely - sinus bradycardia (heart rate less than 60 minutes).Even in this type of violations include sinus (respiratory) arrhythmia.
If impulses arise from the downstream sections of the conducting system, formed ectopic (located in the wrong place) center field.Such a focus is located in the atria, the atrioventricular node or the ventricles, and can send pulses are both above and below their locations.For this type of arrhythmia are slow fly-out and accelerated ectopic (neparoksizmalnaya tachycardia) rhythms, beats and paroxysmal tachycardia.Each of these disorders can be atrial, ventricular and atrioventricular.Also, due to the existence of ectopic foci may develop flicker (atrial fibrillation) and atrial flutter, ventricular flutter and shimmer.
2. conduction abnormalities to the heart are called the blockades.Block pulse conduct may occur in any part of the vascular system, so release sinoatrialnuyu, intraatrial, atrioventricular block, bundle branch block.In addition, this group also includes Wolff - Parkinson - White (ERW - syndrome), shortened the PQ syndrome, ventricular asystole (cardiac arrest).
3. Combination - parasystole, atrioventricular dissociation, ectopic rhythms with a blockade release.This is a condition in which an additional, ectopic pacemaker operates in parallel sinus pacemaker, but they are divided between a blockade.In the heart there is a double ritmoobrazovanie, ie atrial work at their own pace and in its ventricles.
Causes of cardiac arrhythmias
What conditions may be the cause of cardiac arrhythmias?
not always the presence of deviations from normal heart rate is a pathology.For example, in humans during the night there is a moderate slowing of heart rate, ie, bradycardia, due to the prevailing vagal influences on the heart (vagus nerve slows the heart rate, night - "the kingdom of vagus").Also during sleep are common sinus arrhythmia, atrioventricular block of 1 degree, isolated atrial and ventricular premature beats.Bradycardia can occur in athletes and distinguished good trenirovannostju not only skeletal muscle but also the heart muscle.
When conditions such as psycho-emotional stress, stress, exercise, develop tachycardia.This is due to the imbalance of the autonomic nervous system and releasing the blood stress hormones - epinephrine stimulates cardiac contraction for better blood supply to muscle and brain.The use of large amounts of coffee, alcohol and nicotine may cause tachycardia, arrhythmia.Persistent, daily alcohol abuse can cause paroxysms of atrial fibrillation and supraventricular tachycardia.
changes of blood electrolytes (sodium balance disorders, potassium and magnesium), blood viscosity changes cause deterioration of the heart and blood vessels.Such changes may result in fevers accompanying inflammatory processes in the body, overheating or hypothermia, food poisoning, anemia, blood loss, shock, collapse, dehydration due to vomiting or diarrhea.
Arrhythmias arising in the conditions described, as a rule, are transient, disappearing with the elimination of the causes of, and do not require treatment.
are more dangerous arrhythmias arising from an overdose of drugs.For example, when the glycoside intoxication (digoxin, strofantin, Korglikon), overdose antiarrhythmics (propafenone, etmozin), beta - agonists (salbutamol, Flomax) may develop frequent ventricular premature beats, paroxysmal tachycardia.
arrhythmia risk factors include older age, family history, overweight, bad habits.
diseases, leading to disruption of cardiac rhythm
Arrhythmias can occur due to many diseases not only hearts, but also other organs.All possible causes can be divided into the following groups.
1. cardiovascular diseases
- congenital and acquired defects
cardiomyopathy - myocardial infarction
- left ventricular hypertrophy
- endocarditis, myocarditis, pericarditis
- rheumatic heart disease
- postinfarction cardio, postmiokarditicheskogo genesis
- heart failure
Diseases of the nervous system - dystonia
- neurosis, neurasthenia
- cerebrovascular accident (stroke, encephalopathy)
- brain tumor
- brain injury
3. endocrine diseases
- hypo- and hyperthyroidism - a reduction or increase in the activity of thyroid hormones
- pheochromocytoma -
adrenal tumor - menopause and premenstrual syndrome in women
4. gastro - intestinal tract
- hiatal hernia diaphragm
As a rule, as a result of extracardiac causes of sinus tachy and develop bradycardia, supraventricular tachycardia, atrial ekstrasisitoliya, rare and the average frequency of ventricular premature beats, atrioventricular block 1-2 degrees, single-beam bundle branch block.
Dangerous arrhythmias (frequent ventricular premature beats, full blockade, paroxysmal ventricular tachycardia, ventricular fibrillation) occur in severe organic heart disease.
First aid rhythm disturbances of the heart
view assist with this or that violation rate depends on the type and the cause that led to it.In some cases it is enough to drink a couple of pills, and some require hospitalization with full examination and treatment.
Before rendering first aid to the patient at home, you need to evaluate the complaint, the general condition and the need to call the brigade ambulance.Even if a patient feels generally satisfactory, an ambulance will still need to call for ECG recording and analysis of her doctor.If you suffer from a common condition, there are features such as pressure drop, fainting, pale skin, impaired speech and vision, paralysis of limbs, then all the more necessary as soon as possible to call an ambulance by dialing "03" and described all the symptoms to the dispatcher.
General measures for violations of rhythm are as follows:
- soothe and put the patient by placing a pillow under his head for a racing pulse and below the knees with a rare heart rate (increase or decrease the blood flow to the heart, respectively)
- open the window, open collarclothing for oxygen
- to measure blood pressure, count
pulse - call an ambulance
- patient drink a sedative drug - tincture of valerian, Corvalol, valoserdin etc.
-. if the attack has developed not for the first time, and the patient uses for its relief prescribed by the doctor (NOT alone) drugs, take the medicine
- if worried about the pain in my heart, take nitroglycerin under
language - if any signs of pulmonary edema (pronounced choking, bubbling breath, frothy sputum), take a pill furosemide, or Lasix (if any)
- applyone of the vagal samples for a racing pulse.They are straining to deep breathing, pressure on the eyelids eyes closed for 10 - 30 seconds, induction of cough or gag reflex.In rare perform pulse tests can not
- if developed severe rhythm disturbance that caused the cardiac arrest and clinical death (absence of consciousness, breathing and pulse in the carotid artery in the neck, there is no reaction of pupils to light), start cardiopulmonary resuscitation.Place the patient on a hard surface on the back, throw back his head back under the neck to put a roller, begin chest compressions and artificial respiration mouth to mouth.One cycle includes 15 quick taps two clasped hands in the lock extension of the arms at the lower part of the sternum and 2 breathing air into his mouth, holding the patient's nose.After three cycles to assess the presence of the carotid pulse.If no pulse, continue resuscitation before the arrival of the ambulance, but no more than 30 minutes, as during this time the developing brain death.
ambulance, making ECG and assessing the situation, may resort to drug therapy of arrhythmia, such as:
- when bradyarrhythmia - atropine 0.1% - 1 ml intravenous bolus or slow (daily dose of no more than 4 ml), dopamine (dopamine, dopmin) 200 mg per 200 ml of saline intravenously, eufillin 2.4% - 5.10 ml intravenous bolus
- when a paroxysm of atrial fibrillation - digoxin 0.025% 1-2 ml intravenously, Pananginum 10 ml intravenously, novokainamid 10% -10ml slow intravenous
- when a paroxysm of supraventricular tachycardia - vagal sample, adenosine triphosphate (ATP) 1% - 1 - 2 ml intravenously, strofantin (digoxin) 0.025% - 1 ml by slow intravenous injection, novokainamid
- when a paroxysm of ventricular tachycardia - lidocaine 2% - 6 ml intravenously, procainamide hydrochloride, phenylephrine 1% - 0.3 - 0.5 ml at lowering blood pressure, Cordarone (amiodarone) 5% - from 3 to 9 ml intravenously, aymalin 2.5% - 2 ml by slow intravenous or bolus
- atno effect can be carried out, if necessary, temporary pacing using the defibrillator (if equipment allows)
To which the doctor ask for cardiac arrhythmias?
Upon arrival, the ambulance doctor interprets electrocardiogram, assesses the patient's condition and the need for hospitalization in the department of therapy, cardiology or arrhythmology.
If cupping complaints vagal techniques or medikametozno, restore normal rhythm by ECG, the alleged absence of complications the patient may be left at home under the supervision of the attending physician.Sinus and supraventricular tachycardia, a rare arrythmia, incomplete blockade without loss of consciousness can be treated in a clinic in the community, where the patient is ambulatory doobsledovan.To do this, the patient must immediately visit a therapist in the clinic, which will send it to arrhythmology and / or cardiologist.
indications for recovery rate in a hospital setting are:
- any rhythm disturbances accompanied by severe general condition of the patient, heart failure, pulmonary edema, symptoms of heart attack, stroke and other serious complications
- any violation of rhythm with signs of myocardial ischemia on ECG,as can develop myocardial
infarction - a paroxysm of atrial fibrillation, frequent ventricular arrhythmia, ventricular tachycardia, especially for the first time emerged
- first emerged complete left bundle branch block or a long-term, but with pain in the heart or other uncharacteristic symptoms
- bradycardia, accompanied by attacksMorgagni - Edemsa - Stokes (loss of consciousness)
After discharge from the hospital the patient is also observed at the cardiologist and arrhythmology.If the patient suffers from prolonged cardiac arrhythmias, and he planned cardiac surgery treatment, it is observed in cardiac surgery.
In any case, the patient was treated at the hospital or had been left under the supervision of the doctor from the clinic, he should regularly visit the doctor, take medication as prescribed and in any case not engaged in self-diagnosis and self-treatment, since it is dangerous to health and life.
therapists Sazykina OJ