Left atrial rhythm on ecg. What is an ectopic rhythm and why is it dangerous?

This type of heart defect manifests itself against the background of problems in the sinus node. If its activity is weakened or completely stopped, then an ectopic rhythm occurs. This type of contraction is due to automatic processes that occur under the influence of disturbances in other parts of the heart. In simple words One can characterize such rhythm as a process of a substitutive nature. The dependence of the frequency of ectopic rhythms is directly related to the distance of rhythms in other cardiac regions.

Atrial rhythm disturbance

Types of atrial arrhythmia

Since the manifestations of ectopic rhythms are a direct derivative of disturbances in the functioning of the sinus node, their occurrence occurs under the influence of changes in the rhythm of cardiac impulses or myocardial rhythm. The following diseases are common causes of ectopic rhythm:

• Cardiac ischemia.
• Inflammatory processes.
• Diabetes.
• High pressure in the heart area.
• Rheumatism.
• Neurocircular dystonia.
• Sclerosis and its manifestations.

Other heart defects, such as hypertension, can also trigger the development of the disease. A strange pattern of occurrence of ectopic right atrial rhythms appears in people with excellent health. The disease is transient, but there are cases congenital pathology.

Pain in the heart area

Among the features of the ectopic rhythm, a characteristic heart rate is noted. In people with this defect, during diagnosis they reveal increased performance heartbeats.

With routine blood pressure measurements, it is easy to confuse ectopic atrial rhythm with an increase in heart rate due to high temperature, at inflammatory diseases or normal tachycardia.

If the arrhythmia does not go away long time, talk about the persistence of the violation. Paroxysmal disturbances of accelerated atrial rhythm are noted as a separate item. A feature of this type of disease is its sudden development, the pulse can reach 150-200 per minute.

A feature of such ectopic rhythms is the sudden onset of an attack and unexpected termination. Most often occurs with atrial tachycardia.

On the cardiogram, such contractions are reflected at regular intervals, but some forms of ectopia look different. The question: is this normal or pathological can be answered by studying different types of deviations.

There are two types of uneven changes in the intervals between atrial rhythms:

• Extrasystole is an extraordinary atrial contraction against the background of a normal heart rhythm. The patient can physically feel a pause in the rhythm that occurs against the background of myocarditis, nervous breakdown or bad habits. There are cases of manifestations of causeless extrasystole. Healthy man can feel up to 1500 extrasystoles per day without harm to health, contact for medical assistance not required.

Extrasystole on ECG

• Atrial fibrillation is one of the cyclic stages of the heart. There may be no symptoms at all. The atrium muscles stop contracting rhythmically, and chaotic flicker occurs. The ventricles, under the influence of flickering, are knocked out of rhythm.

Atrial fibrillation

The danger of developing an atrial rhythm exists regardless of age and can occur in a child. Knowing that this abnormality can occur over a period of days or months will make it easier to identify. Although medicine treats such deviations as a temporary manifestation of an illness.

IN childhood the appearance of ectopic atrial rhythm may occur under the influence of a virus. This is the most dangerous form of the disease, usually the patient is in serious condition, and exacerbations of atrial heart rhythm in children can occur even with changes in body position.

Symptoms of atrial rhythm

External manifestations of the disease appear only against the background of arrhythmia and another complication. The ectopic rhythm itself does not have characteristic symptoms. Although it is possible to pay attention to long-term disturbances in the rhythm of heart contractions. If you discover such a deviation, you should immediately consult a doctor.

Among indirect symptoms, indicating heart problems, can be noted:

• Frequent attacks of shortness of breath.
• Dizziness.
• Chest pain.
• Increased feeling of anxiety and panic.

Important! A characteristic sign of the onset of an attack of ectopic rhythm is the patient’s desire to take a body position in which the discomfort will go away.

Dizziness

In cases where the attack does not go away for a long time, it may begin copious discharge sweat, blurred vision, bloating, hands will begin to shake.

There are deviations in heart rate that cause problems with the digestive system, sudden vomiting and the desire to urinate. Urges to empty bladder occur every 15-20 minutes, regardless of the amount of liquid drunk. As soon as the attack stops, the urge will stop and your overall health will improve.

An attack of extrasystole can occur at night and be provoked by a dream. As soon as it is completed, the heart may freeze, after which its operation will return to normal. Symptoms may occur during sleep elevated temperature and burning sensation in the throat.

Diagnostic techniques

Identification is made based on data obtained during the anamnesis. After this, the patient is sent to an electrocardiogram to detail the obtained data. Based on the patient’s internal feelings, one can draw conclusions about the nature of the disease.

Ectopic rhythm on ECG

With the help of an ECG, the features of the disease are revealed; with ectopic heart rhythm, they are of a specific nature. Characteristic signs are manifested by changes in readings on the “P” wave; they can be positive or negative depending on the lesion.

The presence of atrial rhythm on an ECG can be determined based on the following indicators:

1. The compensatory pause does not have a full form.
2. The P-Q interval is shorter than it should be.
3. The “P” wave configuration is uncharacteristic.
4. The ventricular complex is excessively narrow.

Treatment of ectopic rhythm

To select an appropriate treatment, an accurate diagnosis of the abnormality must be established. Nizhne atrial rhythm maybe in varying degrees influence heart diseases, which changes treatment tactics.

Sedatives are prescribed to combat vegetative-vascular disorders. Increased heart rate suggests the use of beta-blockers. To stop extrasystoles, Panalgin and Potassium chloride are used.

Manifestations of atrial fibrillation are determined by the prescription of drugs that stop the manifestation of arrhythmia during attacks. Controlling the contraction of cardiac impulses with medications depends on the age group of the patient.

Massage carotid sinus located nearby carotid artery, is necessary after diagnosing the supraventricular form of heart rhythm disorder. To carry out the massage, apply gentle pressure in the neck area on the carotid artery for 20 seconds. Remove development unpleasant symptoms At the time of an attack, rotational movements of the drills on the eyeballs will help.

Eyeball massage

If the attacks are not stopped by massage of the carotid artery and pressure on eyeballs, a specialist may prescribe medication treatment.

Important! Repetition of attacks 4 times in a row or more, severe deterioration of the patient’s condition can lead to serious consequences. Therefore, to restore normal heart function, the doctor uses electromagnetic therapy.

Although the extrasystole defect can be irregular, the appearance of ectopic arrhythmia is a dangerous form of development of heart damage, as it entails serious complications. To avoid becoming a victim of unforeseen attacks that result in an abnormal heart rhythm, you should undergo regular examinations and work diagnostics of cardio-vascular system. Adherence to this approach allows you to avoid the development of dangerous diseases.

Excitation of the heart does not come from the suture system, but from certain parts of the left or right atrium, therefore, with this rhythm disturbance, the P wave is deformed, of an unusual shape (P), and the QRS complex is not changed. V.N. Orlov (1983) highlights:

1) right atrial ectopic rhythms (RAER),

2) coronary sinus rhythm (CSR),

3) left atrial ectopic rhythms (LAER).

Electrocardiographic criteria for left atrial rhythm:

1) –Р in II, III, aVF and from V 3 to V 6;

2) Р in V 1 in the form of “shield and sword”;

3)PQ is normal;

4) QRST is not changed.

When the pacemaker is located in the lower parts of the right or left atria, the same picture is observed on the ECG, i.e. –P in II, III, aVF and +P in aVR. In such cases, we can talk about the lower atrial rhythm (Fig. 74).

Rice. 74. Inferior atrial rhythm.

Ectopic av-rhythm

Excitation of the heart comes from the AV junction. There are “upper”, “middle” and “lower” atrioventricular or nodal rhythms. The “upper” nodal rhythm is virtually indistinguishable from the lower atrial rhythm. Therefore, it is advisable to talk about only two options nodal rhythm. In option I, the impulses come from the middle sections of the AV junction. As a result, the impulse to the atria goes retrograde, and they are excited simultaneously with the ventricles (Fig. 75). In option II, the impulses come from the lower parts of the AV junction, while the atria are excited retrogradely and later than the ventricles (Fig. 76).

Rice. 76. Inferior nodal rhythm: Heart rate = 46 per minute, at V = 25 mm/s RR = RR, Р(–) follows QRS.

Electrocardiographic criteria of AV rhythm (Fig. 75, 76):

1) heart rate 40–60 per minute, the distance between R–R is equal;

2) QRST is not changed;

3) Р is absent in option I and –Р follows after QRS in option II;

4) RP is equal to 0.1–0.2 s with option II.

Ectopic ventricular (idioventricular) rhythm

With this rhythm, the excitation and contraction of the ventricles is carried out from a center located in the ventricles themselves. Most often, this center is localized in the interventricular septum, in one of the bundle branches or branches, and less often in Purkinje fibers.

Electrocardiographic criteria for ventricular rhythm (Fig. 77):

1) widened and sharply deformed (blocked) QRS. Moreover, the duration of this complex is more than 0.12 s;

2) heart rate 30–40 per 1 min, with a terminal rhythm less than 30 per 1 min;

3) R–R are equal, but may be different in the presence of several ectopic foci of excitation;

4) almost always the atrial rhythm does not depend on the ventricular rhythm, i.e. there is complete atrioventricular dissociation. Atrial rhythm can be sinus, ectopic, atrial fibrillation or flutter, atrial asystole; Retrograde atrial excitation is extremely rare.

Rice. 77. Idioventricular rhythm: Heart rate = 36 per 1 min, with V = 25 mm/s QRS - wide; R - absent.

Escaped (jumping, replacing) complexes or contractions

Just like slow rhythms, they can be atrial, from the AV junction (most often) and ventricular. This rhythm disturbance is compensatory and occurs against the background of a rare rhythm, periods of asystole, and therefore is also called passive.

Electrocardiographic criteria for escape complexes (Fig. 78):

1) the R–R interval before the jumping contraction is always longer than usual;

2) the R–R interval after the jump-out contraction is of normal duration or shorter.

Rice. 78. Slipping complexes.

The heart is the most important human organ that does not stop for a minute. Its contraction is ensured thanks to a complex system of nerve impulses transmitted first from the sinus node in the right atrium, spreading to the atrioventricular node and the entire area of ​​the septum. This process is considered normal and is called sinus rhythm. Sometimes under the influence various reasons Patients experience an atrial rhythm on the ECG. In the article we will look at what this means and what the possible reasons for such a violation may be.

Development mechanism

Any cardiac conduction route that does not follow the path described above is called an ectopic rhythm. In this case, an electrical impulse that occurs not in the sinus node, but outside it, excites the heart before the signal is transmitted from the normal pacemaker, that is, the sinus node. In simple words, atrial rhythm is a condition in which it contracts faster due to the advance of a healthy impulse by a pathological (minor) one.

Often such a violation occurs due to various blockades due to congenital or acquired causes. In this case, a separate part of the heart cannot be excited due to blocking the propagation of the nerve impulse. When activation occurs, an additional contraction is noted, which disrupts the sequence of heart and atrium impulses. This causes the so-called atrial rhythm.

According to some scientists, pathological condition may develop as a result of hypoxia or inflammatory myocardial diseases. Cases of ectopic rhythm occurring after influenza, sore throat and other infectious diseases have been reported.

Important! Regardless of the cause of cardiac conduction disturbances, it is necessary to promptly identify the pathological condition and take measures to treat it.

How does it show up on an ECG?

Pathological conduction of the heart can be determined using an electrocardiogram. This instrumental diagnostic technique allows you to identify the localization of rhythm disturbances and the cause of the deviation. Using an ECG, a specialist can determine one of the types of ectopia:

• left atrial rhythm– in this case, such deviations as a P wave of two parts are noted, when the first of them has a dome-shaped appearance, and the second looks like a high and narrow peak. In addition, PI can be smoothed, and PV 1 and 2 are positive, PV 5 and 6 are negative;
• right atrial– in the area of ​​the third lead, a negative P wave is observed, while in the first and second leads it is positive. This is characteristic of a mid-lateral right atrial rhythm. The lower type of this disorder is characterized by a negative P wave in the second and third leads, as well as a smoothed one, and aVF in the chest leads - 5 and 6;
• inferior atrial rhythm– on the electrocardiogram, it appears as a shortening of the PQ interval, a negative P wave in the first, third and aVF leads.

Electrocardiography allows for accurate diagnosis

Based on this, we can say that a specialist determines the conductivity of the heart by assessing the P wave, which, with an ectopic rhythm, is characterized by pathological amplitude and polarity. The condition must be diagnosed experienced doctor, since it can be quite difficult to determine the pathology on an ECG due to the vagueness of the signs. Holter monitoring is often used to make an accurate diagnosis.

What diseases can cause rhythm disturbances?

Atrial rhythm on the ECG can appear in patients regardless of age, gender and region of residence. Often the pathology is temporary and is caused by certain physiological reasons. In such cases, the duration of conduction disturbance lasts no more than several hours or days.

The situation is different with the development of certain diseases that can provoke an ectopic rhythm. These include inflammatory processes myocardium, ischemic disorders, sclerotic changes. Let's look at the most common of them.

Myocarditis is an inflammatory process of the myocardium. The causes of the pathology are damage to the heart muscle by viruses, bacteria or toxins. Often the disease develops due to an allergic reaction or an autoimmune disorder. Doctors note that myocarditis can act as an independent pathology or be provoked by other diseases. The course of inflammation can be chronic or acute. The latter form often develops into cardiomyopathy.

Myocarditis is a common cause of normal rhythm

Common symptoms of myocarditis are atrial rhythm, chronic fatigue, dizziness, rapid heartbeat, pain in chest and other. If the pathology is diagnosed in a timely manner and the necessary treatment is carried out, the prognosis for the patient is quite favorable.

Cardiomyopathy

A group of diseases that unite pathological changes in myocardial tissues are called cardiomyopathies. As a result of these disorders, disruptions in the functioning of the heart occur. The disease develops both under the influence of cardiac and non-cardiac factors. That is, there are a lot of reasons that can provoke cardiomyopathy. The disorder is primary or secondary in nature and is almost always accompanied by an extracardiac rhythm.

Rheumatism

Rheumatism is a disease accompanied by an inflammatory process of connective tissues and heart muscle. It mainly affects children under 15 years of age. The main cause of inflammation is an attack of the body by streptococcal infection, which provokes diseases such as tonsillitis, tonsillitis, pharyngitis, etc. Rheumatism occurs as a complication, leading to impaired contractility of the heart, increased temperature, joint and heart pain and the development of other symptoms in the patient.

Heart defects

Heart defects are congenital or acquired. The concept of “defect” implies a deviation in the structure or structure of an organ, as a result of which electrical conductivity or blood flow in it is disrupted. In addition to the congenital or acquired type, doctors classify the disease into combined or isolated, as well as the presence of a symptom such as cyanosis (bluish tint of the skin) or its absence.

Sick sinus syndrome

A dangerous condition that carries the risk of sudden cardiac arrest. The causes of this disorder are congenital or acquired. These include coronary heart disease, cardiomyopathies, injuries of the heart muscle, oncological formations in this area, defects, toxic lesions organ and much more.

A person suffers from arrhythmia, decreased heart rate, weakness, headaches, paresis, decreased vision, hearing, and memory. Without the necessary treatment, the pathology is often accompanied by death.

Cardiac ischemia

IHD is a very common disease, which is accompanied by many disturbances in the functioning of a vital organ. Pathology is provoked by many factors, the most common of which are smoking, anatomical aging of the body, genetic predisposition, diabetes, hypertension and so on. The atrial rhythm is shown on the cardiogram of many people with this deviation. In addition, signs such as shortness of breath, headache, chest discomfort, chronic fatigue.

Vegetovascular dystonia

VSD is a set of disorders of a functional nature, which is caused by a violation of the regulation of vascular tone by the autonomic nervous system. In this case, an ectopic rhythm is formed, the patient experiences periodic or constant disturbances in heart rate, excessive sweating, frequent headaches, coldness in the extremities, fainting states or fainting.

Important! Vegetative-vascular dystonia often provokes a persistent increase in blood pressure and nervousness, significantly reduces the patient’s quality of life.

Other reasons

In addition to various diseases that lead to the development of ectopic heart rhythm, other causes can be identified. These include:

• persistent increase in blood pressure;
• smoking and drinking alcoholic beverages;
• intoxication carbon monoxide;
• taking certain medications;
• frequent stress;
• hormonal disorders;
• regular physical activity;
• professional sports.

Arrhythmia often occurs during severe physical activity

These and other changes in the body can lead to intra-atrial conduction, which causes the development of many unpleasant symptoms.

Features of the patient's symptoms

Often, cardiac conduction disturbance occurs without visible symptoms, but more often the following clinical picture is observed:

• attacks of heartbeat sensations. The patient seems to feel tremors in the chest;
• the average number of heartbeats increases;
• depending on the pathology that provoked the extracardiac rhythm, a slowdown in organ contractions may be diagnosed;
• sometimes the heart freezes for a few seconds. In this case, the patient may feel panic, fear, and a feeling of excitement;
• sweat production often increases;
• headaches and dizziness occur;
• due to shortness of breath, breathing is impaired;
• discomfort and pain, burning or tingling sensation are observed in the chest area;
• the skin of the face acquires a bluish tint, cyanosis may spread to the fingertips.

In addition, patients complain of the appearance of a veil before the eyes, difficulty breathing, and bouts of fever. In severe situations, nausea occurs, often accompanied by vomiting and abdominal pain. There is a malfunction digestive system, which entails belching, heartburn, hiccups, flatulence, and bowel dysfunction. A common sign of the disease is pre-syncope or fainting.

Tachycardia – common symptom atrial rhythm

People with this pathology are characterized by an increase in heart rate. Signs of atrial tachycardia include strong heartbeat, shortness of breath, panic, increased sweating, redness of the face. Attacks occur mainly at night. Their duration is usually short, lasting from several minutes to several hours. At the same time, the patient experiences panic and fear for his life.

Atrial rhythm in children

The regulation of the autonomic nervous system and the cardiac conduction system in newborns differs from that in adults. They do not function fully due to insufficient formation. This provokes the development of atrial rhythm in infants and preschool children. Normally, such a rhythm is independently transformed into a sinus rhythm; the condition does not require additional methods treatment.

Cardiac conduction disorders in children often develop with minor abnormalities of the organ. For example, with mitral valve prolapse or accessory chord. But this does not mean that you should not pay attention to this symptom, because often a deviation can indicate serious heart defects, infectious myocardial lesions, hypoxia, intoxication and other conditions.

The risk group includes children who have suffered an intrauterine infection or prolonged intoxication with alcohol or nicotine, as well as during severe pregnancy and childbirth. Such patients should undergo a thorough examination after birth to ensure timely detection of various diseases and prevent the development of severe complications.

Types of ectopic disorders

Ectopic arrhythmias include various disorders that develop in the area of ​​the ventricles and atria. According to research, it turned out that often the right atrial rhythm, which does not manifest itself on the electrocardiogram, does not come from the sinus node. That is, an electrical impulse is provoked in neighboring areas of the organ.

The most dangerous type of disorder is considered to be atrial fibrillation.

Types of atrial rhythm:

• extrasystole - occurs quite often (about 60% of people), this condition consists of untimely contraction of the heart muscle or its individual parts;
• paroxysmal tachycardia – separate species atrial rhythm, accompanied by periodic attacks of rapid heartbeat. In this case, the number of strokes can reach 220 per minute. Paroxysms replace the normal heart rhythm and have a sudden onset and end. Electrical impulses are generated in the atria, atrioventricular node or ventricles. The duration of the attack varies;
• ectopic accelerated rhythms - attacks of accelerated heartbeat, in which the heart rate increases to 130 beats. In this case, electrical impulses are generated in the atria, ventricles or atrioventricular junction. In ECG time a non-sinus pacemaker is recorded in the P–QRS–T complex;
• atrial fibrillation or atrial fibrillation - frequent excitation of the atria or individual muscle fibers of a chaotic nature. In some cases, heart rate reaches 600 beats per minute. The prolonged course of such an attack significantly increases the risk of blood clots and the development of ischemic stroke. If left untreated, acute heart failure occurs.

Important! Therapy for any type of ectopic rhythm should be carried out immediately, regardless of the severity and symptoms of the patient.

Treatment methods

The atrial rhythm may be hidden and not manifest itself in any way. If the patient does not feel any unpleasant symptoms and abnormal pacemakers were identified by chance, most often special treatment not required. It is enough for such people to undergo a thorough medical examination to exclude serious anomalies in the structure of the heart and other organs. If no deviations are detected, the ectopic rhythm is considered safe for health.

Treatment methods are determined depending on the diagnosis and symptoms of the patient

When a patient has complaints from the cardiovascular system and any pathologies are detected, drug therapy is carried out. The group of drugs includes the following:

• beta blockers and other drugs intended to lower blood pressure (Nadolol, Metoprolol, Carvedilol);
• medications that accelerate the rhythm during bradycardia. These include Atropine, Isoprenaline, Eufillin. Plant-based extracts are often recommended - ginseng, eleutherococcus;
• sedatives are prescribed to patients who develop vegetative-vascular dystonia. Popular remedies include tincture of motherwort, valerian, as well as Novopassit, Fitosed, Dormiplant;
• Preventive medications are used to prevent strokes, heart attacks and other dangerous complications. For this, Panangin and Cardiomagnyl are prescribed.

Treatment tactics always depend on the disease that acts as a factor provoking arrhythmia. Based on the data received during instrumental diagnostics and based on the patient’s medical history, the doctor selects the necessary medications.

In particularly difficult situations, when conservative therapy turned out to be useless, the patient is given an artificial pacemaker (cardioversion). Often this method is effective for atrial fibrillation and other dangerous conditions.

Folk recipes

Healthy lifestyle and proper nutrition help patients prevent many dangerous complications. They are especially indicated for patients with developed atrial rhythm. Giving up bad habits and saturating your diet with plenty of vitamins and minerals is an important step towards health. Some folk recipes have proven themselves well in the fight against heart disorders. Here are some of them:

• mix 200 ml grapefruit juice with three teaspoons olive oil. Take half a glass of the drink in the morning and evening for one month;
• combine chopped figs and walnuts, season the resulting mass with honey and refrigerate for a day. Take a teaspoon of the mixture twice a day. The course of treatment is at least 60 days;
• To restore rhythm, a decoction of calendula flowers is often used. To do this, brew a spoonful of herbs with a glass of boiling water and let the medicine brew for at least 2 hours. Take a quarter glass twice a day for a month;
• A decoction of hawthorn and lemon balm has a beneficial effect on heart health. To prepare it, combine a tablespoon of raw material, pour a liter of boiling water over the mixture, and simmer over low heat for 10 minutes. After this, the medicine should infuse for 40 minutes. Take the drink instead of tea several times a day.

Folk recipes – great way maintaining the heart

Important! Any folk remedies should only be used after consultation with a specialist. Self-treatment can be extremely hazardous to health.

Prognosis for the patient

The patient's atrial rhythm should not be ignored, as it often indicates various diseases. People with this pathology need constant medical monitoring and appropriate treatment. If the deviation is not accompanied by severe anomalies in the structure of the heart, it proceeds without acute symptoms, the prognosis for a person is often favorable. Severe forms of ectopia and lack of treatment are often accompanied by death.

Proper work healthy heart normally affected sinus rhythm. Its source is the main point of the conduction system - the sinoatrial node. But this doesn't always happen. If the center of automatism of the first level for some reason cannot fully perform its function, or it completely falls out of the general scheme of pathways, another source of generation of contractile signals appears - ectopic. What is ectopic atrial rhythm? This is a situation in which electrical impulses begin to be produced by atypical cardiomyocytes. Specified muscle cells also have the ability to generate a wave of excitement. They are grouped into special foci called ectopic zones. If such areas are localized in the atria, then the sinus rhythm is replaced by the atrial rhythm.

Atrial rhythm is a type of ectopic contraction. Ectopia is an abnormal arrangement of something. That is, the source of excitation of the heart muscle does not appear where it is supposed to be. Such foci can form in any part of the myocardium, causing a disruption in the normal sequence and frequency of contractions of the organ. The ectopic rhythm of the heart is otherwise called a replacement rhythm, since it takes on the function of the main automatic center.

There are two possible atrial rhythm options: slow (it causes a decrease contractility myocardium) and accelerated (heart rate increases).

The first occurs when sinus node blockade causes weak impulse generation. The second is the result of increased pathological excitability of the ectopic centers; it overlaps the main rhythm of the heart.

Abnormal contractions are rare, then they are combined with sinus rhythm. Or the pre-sulfur rhythm becomes the leading one, and the participation of the first-order automatic driver is completely canceled. Such violations can be typical for different time periods: from a day to a month or more. Sometimes the heart works constantly under the start of ectopic foci.

What is inferior atrial rhythm? Active atypical connections of myocardial cells can be located both in the left and right atrium, and in the lower parts of these chambers. Accordingly, lower right atrial and left atrial rhythms are distinguished. But when making a diagnosis, there is no particular need to distinguish between these two types; it is only important to establish that the excitatory signals come from the atria.

The source of impulse generation can change its location within the myocardium. This phenomenon is called rhythm migration.

Causes of the disease

Inferior atrial ectopic rhythm occurs under the influence of various external and internal conditions. A similar conclusion can be given to patients of all age categories. Such a malfunction in the functioning of the heart muscle is not always considered a deviation. Physiological arrhythmia, as a variant of the norm, does not require treatment and goes away on its own.

Types of disorders caused by lower atrial rhythm:

• tachycardia of paroxysmal and chronic nature;
• extrasystoles;
• flutters and fibrillation.

Sometimes the right atrial rhythm is no different from the sinus rhythm and adequately organizes the work of the myocardium. Such a failure can be detected completely by accident using an ECG during the next routine medical examination. At the same time, the person is completely unaware of the existing pathology.

The main reasons for the development of ectopic inferior atrial rhythm:

• myocarditis;
• weakness of the sinus node;
• high blood pressure;

• myocardial ischemia;
• sclerotic processes in muscle tissue;
• cardiomyopathy;
• rheumatism;
• heart defect;
• exposure to nicotine and ethanol;
• carbon monoxide poisoning;
• side effects of medications;
• congenital feature;
• vegetative-vascular dystonia;
• diabetes.

Inferior atrial rhythm in children can be either congenital or acquired. In the first case, the child is already born with the presence of ectopic foci. This is the result oxygen starvation during childbirth or as a consequence of abnormalities intrauterine development. Functional immaturity of the cardiovascular system, especially in premature infants, is also the cause of the formation of ectopic rhythm. Such disorders can normalize on their own with age. However, such babies need medical supervision.

Another situation is adolescence. During this period, boys and girls experience serious changes in their bodies,
hormonal levels are disrupted, and the sinus heart rhythm may be temporarily replaced by the atrial rhythm. With the end of puberty, all health problems usually end. In adults, hormonal problems may be associated with aging (for example, menopause in women), which also affects the appearance of ectopic heart rhythms.

Professional sports can also be considered as a cause of the development of atrial rhythm. This symptom is a consequence of degenerative processes in the myocardium that occur under the influence of excessive stress in athletes.

Symptoms

Inferior atrial abnormal rhythm may develop asymptomatically. If signs of cardiac dysfunction are present, they will reflect the disease that caused this condition.

• A person begins to feel contractions of the myocardium and “hear” its tremors.
• The number of minute beats of the organ is growing.
• The heart seems to “freeze” for a while.
• There is increased sweat production.
• A dark, continuous veil appears before your eyes.
• My head suddenly began to spin.
• The skin became pale, a blue tint appeared on the lips and fingertips.
• It became difficult to breathe.
• Pain appeared in the chest area.

• Frequent urination bothers me.
• The person experiences great fear for his life.
• Nausea or vomiting may occur.
• Disorders of the gastrointestinal tract.
• Fainting develops.

Short attacks take the patient by surprise, but end as quickly as they begin. Often such rhythm disturbances occur at night during sleep. A person wakes up in panic, feeling tachycardia, chest pain or heat in the head.

Diagnostics

The presence of atrial rhythm can be detected based on data obtained during an ultrasound of the heart or an electrocardiogram.

Since the pathology can manifest itself from time to time, and often this happens at night, Holter ECG monitoring is used to obtain a more complete clinical picture. Special sensors are attached to the patient’s body and record changes occurring in the heart chambers around the clock. Based on the results of such a study, the doctor draws up a protocol for monitoring the state of the myocardium, which makes it possible to detect both daytime and nighttime paroxysms of rhythm disturbances.

Transesophageal electrophysiological examination, coronary angiography, and ECG recording under stress are also used. A standard analysis is required biological fluids body: general and biochemical examination of blood and urine.

Signs on the electrocardiogram

An ECG is an accessible, simple and fairly informative way to obtain data on various heart rhythm disorders. What does the doctor evaluate on the cardiogram?

1. The state of the P wave, reflecting the process of depolarization (appearance of an electrical impulse) in the atria.
2. The P-Q region demonstrates the features of the excitation wave traveling from the atria to the ventricles.
3. The Q wave marks initial stage ventricular excitation.
4. The R element displays the maximum level of ventricular depolarization.
5. The S tooth indicates the final stage of propagation of the electrical signal.
6. The QRS complex is called the ventricular complex; it shows all stages of the development of excitation in these sections.
7. The T element registers the phase of decline in electrical activity (repolarization).

Using the available information, the specialist determines the characteristics of the heart rhythm (frequency and periodicity of contractions), the source of impulse generation, and the location of the electrical axis of the heart (EOS).

The presence of atrial rhythm is indicated by the following signs on the ECG:

• negative P wave with unchanged ventricular complexes;
• the right atrial rhythm is reflected by the deformation of the P wave and its amplitude in additional leads V1-V4, the left atrial rhythm - in leads V5-V6;
• teeth and intervals have increased duration.

EOS displays electrical parameters of cardiac activity. The position of the heart as an organ with a three-dimensional volumetric structure can be represented in a virtual coordinate system. To do this, the data obtained by the electrodes during the ECG is projected onto a coordinate grid to calculate the direction and angle of the electrical axis. These parameters correspond to the localization of the excitation source.

Normally, it has a vertical (from +70 to +90 degrees), horizontal (from 0 to +30 degrees), intermediate (from +30 to + 70 degrees) position. A deviation of the EOS to the right (over +90 degrees) indicates the development of an ectopic abnormal right atrial rhythm; a deviation to the left (up to -30 degrees and further) are indicators of a left atrial rhythm.

Treatment

Treatment measures will not be required if the adult or child does not experience any discomfort when an anomaly has developed, and they have not been diagnosed with heart or other diseases. The occurrence of atrial rhythm in this situation is not dangerous to health.

Otherwise, the therapeutic effect is carried out in the following directions:

1. Accelerated pathological atrial rhythm is treated with beta blockers (Propranalol, Anaprilin) ​​and other drugs that reduce heart rate.
2. For bradycardia, medications are prescribed that can accelerate the slow rhythm: drugs based on atropine, sodium caffeine benzoate, and plant extracts (Eleutherococcus, ginseng).
3. Vegetative-vascular disorders that cause ectopic rhythm require treatment sedatives“Novopassit”, “Valocordin”, motherwort tinctures, valerian.
4. To prevent heart attack, it is proposed to use Panangin.
5. In addition to antiarrhythmic drugs (Novocainamide, Verapamil), for irregular rhythms it is prescribed specific treatment upon establishment specific reason developed disorders.
6. In severe cases that are not amenable to standard drug treatment, cardioversion is applied, installation artificial driver rhythm.

Traditional methods

Atrial rhythm, as one of the types of cardiac disorders, requires constant monitoring by a doctor. Even the absence of alarming symptoms is not a reason to be negligent about such a condition. If the development of ectopic contractions is caused by diseases, it is imperative to find out the cause of the pathology and treat it with all seriousness. Launched severe forms atrial arrhythmias can threaten human life.

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Causes of sinus bradyarrhythmia, treatment methods

Higher education:

Kuban State medical University(KubSMU, KubSMA, KubGMI)

Level of education - Specialist

Additional education:

“Cardiology”, “Course on magnetic resonance imaging of the cardiovascular system”

Research Institute of Cardiology named after. A.L. Myasnikova

"Course on functional diagnostics"

NTsSSKh them. A. N. Bakuleva

"Course in Clinical Pharmacology"

Russian Medical Academy of Postgraduate Education

"Emergency Cardiology"

Cantonal Hospital of Geneva, Geneva (Switzerland)

"Therapy course"

Russian State Medical Institute of Roszdrav

The heart, being one of the main muscles in the human body, has a number of special properties. It can contract regardless of nerve impulses coming from the brain and taking part in the control of the neurohumoral system. The correct route for transmitting information in the heart muscle begins in the area of ​​the right atrium (sinus node), continues in the area of ​​the atrioventricular node and then spreads across the entire area of ​​the septum. All other contractions that do not follow this route are considered an ectopic rhythm.

How do atrial rhythms appear?

An ectopic impulse, appearing outside the sinus node, is formed and excites the heart muscle before the signal is transmitted from the main pacemaker. Such situations allow us to say that an accelerated atrial rhythm appears due to the “advanced” of the main rhythm by a secondary contraction of the ectopic type.

The theoretical basis for the ectopic rhythm is the re-entry theory, according to which a certain area of ​​the atrium is not excited in parallel with others due to the fact that there is a local blocking of the propagation of the nerve impulse. At the time of its activation, this area experiences an additional contraction - thus, it goes out of turn and thereby disrupts the overall rhythm of the heart.

Some theories suggest the autonomic and endocrine nature of the occurrence of atrial rhythms. As a rule, such phenomena occur in children during puberty or in adults with certain hormonal changes (age-related or resulting from pathologies).

There is also a version of the following type: hypoxic and inflammatory processes in the myocardium during cardiopathy and inflammatory diseases can cause atrial rhythms. Thus, in children who suffer from a sore throat or flu, there is a risk of myocarditis with a subsequent change in atrial rhythm.

The heart, being one of the main muscles in the human body, is endowed with special properties. It can contract regardless of the nerve impulses coming from the brain that control neurohumoral system. The correct route for receiving information in the heart muscle begins in the area of ​​the right atrium (sinus node), passes in the area of ​​the atrioventricular node and then spreads along the septum. All other beats that do not follow this route are called ectopic rhythm.

Etiology of atrial rhythm

As noted above, the reasons for changes in atrial rhythm are changes that take place in the sinus node. All changes are divided into ischemic, inflammatory and sclerotic. Non-sinus rhythms that appear as a result of such changes appear in the following forms:

1. Supraventricular ectopic rhythm;

Accelerated atrial rhythm occurs, as a rule, in people who suffer from rheumatic diseases, various diseases heart disease, dystonia, diabetes, coronary disease or hypertension. In some cases, atrial rhythm can appear even in healthy adults and children, and can also be congenital in nature.

Impulses can come from different departments heart, since the source of emerging impulses moves through the atrium. IN medical practice This phenomenon is called migrating rhythm. When measuring such an atrial rhythm, the amplitude on the ECG changes according to the source of the location of the impulses.

Clinical picture

Atrial rhythm has a direct relationship with the specific disease that caused it. This means that there are no specific symptoms. Clinical picture directly caused by the pathological picture in the patient’s body. This rule applies only to short-term attacks of rhythm disturbance. With prolonged attacks, the following symptoms are possible:

• Initially there is a feeling of anxiety and fear. A person tries to take the most comfortable position that would stop further development attack.
• The next stage is accompanied by severe tremor (shaking) in the limbs, and in some cases, dizziness.
• The next step is the appearance of pronounced symptoms - increased sweating, dyspeptic disorders manifested in the form of bloating and nausea, and frequent urge to urinate.

Short attacks may be accompanied by an increase in heart rate and shortness of breath, after which the heart stops for a moment and a noticeable jolt is felt. A similar impulse in the heart indicates that sinus rhythm has been restored - this can also be confirmed by minor painful sensations in the chest and heart area.

The change in atrial rhythm resembles paroxysmal tachycardia. Patients themselves can determine that they have an abnormal heart rhythm. If the heart rate is high, these changes will not be noticeable. An ECG examination helps to accurately determine this condition. In the case of atrial fibrillation, patients may complain of chest pain characteristic of angina pectoris.

Prolonged attacks of atrial rhythm disturbance pose a danger to humans - at this moment blood clots can form in the heart muscle, which, if they enter the blood vessels can cause a heart attack or stroke. The danger also lies in the fact that when the disease is latent, patients may ignore the above symptoms, and therefore are not able to determine its further development.

Diagnosis of atrial rhythm

The main method for studying atrial rhythm is ECG. A cardiogram allows you to accurately determine where the rhythm disturbance occurs, as well as accurately determine the nature of such a rhythm. An ECG allows you to determine the following types of atrial escape rhythm:

• Left atrial rhythm: aVL is negative, aVF, PII, III are positive, PI, in some cases, smoothed. PV1/PV2 are positive, and PV5-6 are negative. According to Mirovski et al., the P wave in left atrial rhythm consists of two parts: the first has a low-voltage and dome-shaped rise (affected by depolarization of the left atrium), the second part is characterized by a narrow and high peak (the right atrium is depolarized).
• Right atrial rhythm: characterized by a negative P wave in the area of ​​the third standard branch, in the first and second - positive. This phenomenon is characteristic of a mid-lateral right atrial rhythm. The lower rhythm of this form is characterized by the indication of the P wave, negative in the second and third branches, as well as aVF, smoothed in the 5-6 thoracic.

• The lower atrial rhythm is characterized by a shortening of the PQ interval, in which its value is less than 0.12 seconds, and the P wave is negative in branches II, III and aVF.

The following conclusion can be drawn: based on electrocardiogram data, the doctor can determine a change in atrial rhythm based on changes in the P wave, which has a different physiological norm amplitude and polarity.

Note that to determine the right atrial rhythm, the specialist must have impressive work experience, since ECG data with such a rhythm, they are blurred and difficult to differentiate. In view of this, Holter monitoring can be used to form the most complete and accurate picture of cardiac activity.

Treatment of pathology

Since the change in rhythm is directly determined by the presence of pathologies in the human body (in particular, circulatory system and heart), treatment is aimed at identifying and eliminating the underlying causes. Thus, in case of vegetative-vascular disorders, sedatives can be prescribed; in case of increased vagus, drugs based on atropine or belladonna are prescribed. If there is a predisposition to tachycardia, beta-blockers are used - the most popular are isoptin and cordarone. In case of polytopic extrasystoles and ventricular fibrillation, potassium preparations, panangin, and lidocaine are used.

In situations where the above methods do not allow you to get rid of diseases that cause changes in heart rhythm, the doctor may prescribe the use of special therapy - preventive procedures aimed at promoting health, as well as the use of electropulse therapy.