Atrial fibrillation - Causes, Symptoms and Treatment .MF .
Causes of atrial fibrillation
Symptoms Diagnosis Treatment
and way of life
Possible complications and prognosis
Peter and Paul Fortress person is able to generate and conduct electrical impulses, this ability is realized by the cardiac conduction system.In a normally functioning heart pulses occur at the same frequency and a frequency of 60 to 90 per minute, providing the correct heart rhythm.If you have certain heart diseases occur rhythm and conduction disturbances, leading to a reduction nonsynchronous infarction and causing discomfort.One such arrhythmia is atrial fibrillation.
Atrial fibrillation - a disease resulting from a chaotic contraction of individual muscle fibers of the atria characterized by the appearance of a regular (regular) or wrong rhythm and leads to myocardial wear with the development of heart failure.With the development of this type of arrhythmias decreases each fiber individually, which hinders pushing out the full blood into the ventricles, and thus into the aorta and
According to electrophysiological criteria, atrial fibrillation is subdivided into flicker (fibrillation) and atrial flutter.These two types differ in that the frequency of the atrial fibrillation rate exceeds 400 beats per minute (usually 600 - 800 per minute), the rhythm is not correct, i.e. ventricles at varying intervals.When atrial flutter frequency rate of less than 400 ppm (240 - 300), and the rhythm can be correct, ie, ventricles with the same frequency in response to every second, third or fourth atrial contraction.With both types of atrial fibrillation, ventricular rate (respectively, heart rate) is less than the frequency of atrial contraction as the atrioventricular node due to the physiological characteristics can conduct impulses from the atria to the ventricles at a frequency of 200 - 220 per minute.
often one and the same patient flicker and flutter occur sequentially, one after another, so from the perspective of clinical terminology, the term atrial fibrillation equate to the term atrial fibrillation that is not entirely accurate.
There are paroxysmal (paroxysmal) and permanent atrial fibrillation.Paroxysms considered the origin and cupping (or self medication) during the first seven days, in the absence of further restore normal rhythm atrial fibrillation is considered permanent.The difference between these forms is patient management tactics - when a paroxysm of atrial fibrillation or (for the first time or re-arisen) the rhythm you want to recover, while at constant rhythm shape recovery is fraught with the development of thromboembolic complications.
depending on heart rate distinguished tahisitolichesky (heart rate over 90 minute) normosistolichesky (60 - 90 per minute) and bradisistolichesky (less than 60 min) the types of atrial arrhythmia.
Causes of atrial fibrillation
in the development of the disease is dominated by processes that cause re-entry of the electric field on the same muscle fiber, which manifests the occurrence of atrial fibrillation (literally - muscle twitching).Such repeated waves of circulation occur if the surrounding fibers do not have the ability to conduct an impulse that seems to revert back.
most common cause of myocardial process data are acquired heart diseases, as the blood of the atria overflow leads to stretching of the walls, a pressure increase intraatrial and malnutrition muscle fibers so they can not fully conduct impulses.
Have patient Cardiosclerosis (replacement heart muscle scar tissue) also provokes the above mechanism improper transfer of momentum, because scar tissue is not able to conduct electrical signals.By forming Cardiosclerosis can cause diseases such as coronary heart disease, myocardial infarction, myocarditis (inflammation of heart muscle disease - viral or rheumatic).
separate item should be allocated endocrine disease, due to the fact that some hormones have effects on the heart muscle with an increase rate, for example, thyroid hormones and adrenal glands (epinephrine, norepinephrine).When excess content of constant stimulation of the heart muscle develops in the blood of these hormones, which sooner or later will fail and will lead to chaotic work atrial fibers.Such diseases include hyperthyroidism and pheochromocytoma.
In addition, irregularities in the synchronous reduction may occur in cases of poisoning organism toxic substances - alcohol, carbon monoxide and other toxic gases.
Symptoms of atrial fibrillation
Sometimes the disease is asymptomatic and detected only on scheduled scans.But in most cases, the patients are concerned the following complaints:
- a sense of palpitations, stops and interruptions in the work of the heart;
- weakness, dizziness, sweating;
- pain in the heart;
- shortness of breath, difficulty breathing.
When a permanent form of atrial fibrillation clinical signs of a worn, as patients adapt to sickness and get used to the subjective feelings of the disruptions.When a long-term permanent form (for many years), the heart muscle will eventually wear out, resulting in chronic heart failure is formed.This pathology is characterized by stagnation of blood in the lungs, liver and other organs and manifests shortness of breath (when walking, climbing stairs, alone), episodes of "heart" of asthma or pulmonary edema (usually at night), edema of the lower extremities, increases the stomach and painsin the right upper quadrant (due to increased blood supply to the liver).
With the development of complications of the clinical picture is complemented by the characteristic symptoms - choking with choking breath, unconsciousness, paralyze parts of the body, a sharp decrease in blood pressure, collapse, respiratory arrest and cardiac activity.
diagnosis of atrial fibrillation
diagnosis of atrial fibrillation may be suspected on the basis of the complaints already.On examination, the patient is felt spasmodic rapid pulse is usually less than the heart rate (pulse deficit is due to the fact that not every contraction of the ventricles can lead to a full cardiac output).When listening (auscultation) of the heart and lungs are determined by spasmodic contraction of the heart, pulmonary edema can be wet gurgling wheeze.Tonometry may show as high as normal or even lower blood pressure.
main method of diagnosis is electrocardiogram .When atrial fibrillation on ECG revealed the absence of P wave (which means that the heart rate is set not from the sinus node as normal, but from the very muscle fibers or atrioventricular node) and different distances between the ventricular complexes (abnormal rhythm, a heart rate, which mightreach 200-220 beats per minute, due to the "bandwidth" of the atrioventricular node capacity).Instead contours marked small wave fibrillation (f).When atrial flutter also notes the absence of P wave, big wave flutter (F) and the same frequency of ventricular contraction.
can be identified signs of myocardial ischemia, since the heart muscle, decreasing at a rapid pace, requires more oxygen, and coronary vessels can not cope with this.
It looks like atrial fibrillation on ECG
Daily Holter ECG monitoring reveals short runs of atrial fibrillation or flutter, able to pass on their own, if the standard ECG rhythm disturbances recorded were not, and the patient presents specific complaints.Additionally, estimated arrhythmia connection with the load, for which the patient should keep a diary for a day, which indicates the detail psycho-emotional and physical stress.
Transesophageal ECG can be displayed at a standard electrocardiogram uninformative.
During the echocardiography determined myocardial contractility, ejection fraction, stroke volume.It can also be identified thrombus in the heart cavity (often formed in the left atrial appendage).
Chest X-ray is assigned to identify stagnant processes in the lung tissue, pulmonary edema, signs of pulmonary embolism, changes in the configuration of the heart due to the expansion of its departments.
In some cases, indications can be assigned MRI (magnetic - resonance imaging) and MSCT (multislice computed tomography) heart for better visualization of it.
Treatment of atrial fibrillation
The treatment of paroxysmal and persistent forms differ.The goal of therapy
paroxysmal is to restore sinus rhythm.If more than two days from the inception of the paroxysm, this issue is resolved strictly individually after three - four weeks of continuous use of warfarin and its analogs ( "thinning" the blood of drugs), because there is a risk of thromboembolic complications.All therapeutic measures for a given form requires stationary surveillance.To restore the rhythm using the following methods:
- drug treatment - intravenous appointed kordaron, procainamide, strofantin, Korglikon, polarizing mixture (potassium chloride, glucose and insulin in diabetes - potassium chloride and saline.).Inside kordaron accepted under the scheme established by a physician.
- except for drugs that restore rhythm to the continuous reception appointed agents, slows heart rate (beta-blockers - carvedilol, bisoprolol, nebilet, calcium channel antagonists - verapamil, diltiazem, etc.), antiarrhythmics (propanorm, VFS), antiplatelet agents (agents that preventformation of blood clots in the vessels and the heart - aspirin Cardio, cardiomagnil, tromboAss etc.).
- cardioversion is used after failure of medical treatment and held in the coronary care department with intravenous anesthesia.The method consists in the fact that the electric discharge a certain power "restart" the heart and cause it to contract properly.
With frequently occurring attacks addressed the issue of the transfer or paroxysmal in permanent form (that is, doctors do not restore the rhythm and treat atrial fibrillation as a constant), or to conduct cardiac surgery treatment.
At a constant form of treatment pursues the purpose slowing abnormal heart rhythm and maintain it at the highest level of comfort for the patient.To do this, constantly taking digoxin, beta-blockers, antiplatelet agents and anticoagulants (warfarin regularly monitor the performance of blood clotting, such as INR)
cardiac surgical treatment of atrial fibrillation
This type of treatment is carried out with the ineffectiveness of drugs and cardioversion, as well as expressedclinical manifestations of the disease.There are two types of operations:
1) radiofrequency ablation of pulmonary veins is to carry a catheter through a peripheral artery to the left atrium and "cauterization" lesions excitation, resulting in the patient set the right rhythm of heartbeats.
The figure shows the RFA pulmonary veins
2) radiofrequency ablation of the atrioventricular connection with the installation of the pacemaker is a complete break of the connection between the atria and ventricles, and the atrium are reduced at their own pace, and ventricle to the rhythm, given a stimulant.
Lifestyle in atrial fibrillation
Patients with atrial fibrillation should regularly take medications prescribed by the doctor not only to improve the quality of life, but also for the prevention of complications.It is necessary to adjust work and rest, to observe the principles of healthy eating, completely eliminate alcohol, as often this factor provoking "failures" rhythm.You should also exclude significant physical activity, and, if possible to limit the occurrence of stressful situations.
Pregnancy in atrial fibrillation is not contraindicated, but the possibility of carrying a child is determined by the underlying disease that led to the development of arrhythmias.
Complications of atrial fibrillation
The most frequently occurring complications include thromboembolic - increased formation of blood clots in the heart and the movement of the bloodstream into the brain vessels with ischemic stroke, a heart filled with myocardial infarction, hepatic vessels, limbs, intestines.Elevated blood clots due to the fact that the blood in the "flickering" or "flutter" atria whipped as in the mixer, whereby the injured blood cells adhere to each other, forming a clot.Prevention of complications is chronic administration of antiplatelet agents and anticoagulants.
other complications are acute heart failure, pulmonary edema, shock arrhythmogenic.
diseases If all the doctor's recommendations forecast uncomplicated atrial fibrillation favorable.But keep in mind that the forecast will depend on the underlying disease that caused the atrial fibrillation, and for the development of stroke, heart failure and other complications and their severity as well.
therapists Sazykina OJ