Heart rhythm disturbances: types, causes, signs and identification, treatment. Why is atrial rhythm dangerous? There are heart rhythm disturbances

Normal heart rhythm

The human heart is relatively small in size compared to the work it does. It pumps an average of 4.7 liters of blood every minute, or 282 liters every hour, through the vessels, supplying organs and tissues with oxygen. Disturbances in the frequency, rhythm and sequence of excitation and contraction of the heart are called cardiac arrhythmia.

The heart has two upper chambers - the atria, and two lower chambers - the ventricles. The atrium pumps blood to the ventricles, then the right ventricle pumps blood to the lungs, while the left ventricle supplies blood to all organs of the body. Rhythmic contractions of the heart occur due to electrical impulses coming from the “natural stimulator” - the sinoatrial node. Each impulse passes through the atria into the atrioventricular (atrioventricular) node, and then into the ventricles. After the contraction, there is a pause until the next impulse, during which the heart “rests.” The normal heart rate is 60 - 80 beats per minute in a calm state; with increased activity, the heart rate increases.

Cardiac arrhythmia and its signs

Cardiac arrhythmia (Greek: arrhythmia, absence of rhythm, irregularity)

If your heart is beating too fast

For certain diseases (coronary heart disease, heart attack, cardiomyopathy, congenital diseases heart) normal heart function may be disrupted. Cardiac arrhythmia occurs. Excessively fast heartbeats are called tachyarrhythmia. One of the types of tachyarrhythmia is ventricular tachycardia, in which electrical impulses arise in the ventricles of the heart.

Ventricular tachycardia is a life-threatening rhythm disorder. With excessively frequent contractions, the ventricles of the heart do not have time to fill with enough blood. As a result, insufficient blood flows to organs, including the brain. In addition to palpitations, you may feel weak, dizzy, and possibly lose consciousness.

Chaotic unstable contractions of muscle fibers are called fibrillation, which, in turn, leads to cardiac arrest. This is the most dangerous complication of ventricular tachycardia and requires immediate resuscitation. Cardiac arrest usually occurs suddenly. To restore normal heart rhythm, immediate defibrillation is necessary - an electrical impulse that restores normal heart rhythm.

Unfortunately, this procedure is not always possible in the first minutes of cardiac arrest. Therefore, an implantable ICD has a built-in defibrillator and pacemaker. A defibrillator uses stimulation or electrical impulses to bring the heart out of ventricular tachycardia or fibrillation.

If the heart beats too slow

In some diseases, the heart beats too slowly. Such heart rhythm disturbances are called bradycardia. With bradycardia, the volume of blood flowing to the organs is insufficient. Dizziness, weakness, feeling of lack of air, fainting occur.

Bradycardia can occur when the sinus node is malfunctioning or during heart block, when the conduction of impulses from the sinus node to the ventricles is impaired. In case of bradycardia, the implantable ICD restores the normal heart rate. The volume of blood flowing to the organs is normalized, and the symptoms of bradycardia are eliminated.

Analysis of heart rate variability is a complex indicator that allows you to assess the functional relationship between the cardiovascular and neurohumoral systems. First of all, the technique is used to assess the functional capabilities of healthy people.

The study of HRV is widely used to examine athletes and astronauts. However, this method has worked well in early diagnosis functional disorders of the cardiovascular system. Another advantage of this tool is its simplicity (unlike Holter ECG) and low cost.

Why does rhythm variability appear and what manifestations does it have?

In simple words, heart rate variability is changes in the intervals between systoles that appear due to the influence of external and internal factors.

This indicator is measured by studying the duration of periods of heart contractions over a certain period of time. Typically, electrocardiography data is used for this, namely the distances between the R waves (i.e., the highest peaks on the ECG).

Beyond measurement R-R intervals, also applies N-N study- intervals between normal contractions.

This is especially important if the patient has an arrhythmia.

It is known that man is open system. Those. any changes in the external or internal environment affect the functioning of organs and cells.

Characteristics of rhythmic heart beats

This is the basis of variability - variability of vital signs under the influence of certain factors.

The heart is a very sensitive organ in this regard.

Its work very much depends on the general condition of the person, especially on the influences of the nervous and endocrine systems.

Sensing changes in the functioning of the body, the nervous system regulates the activity of the heart accordingly.

The sympathetic department increases the heart rate and increases the force of myocardial contractions. In turn, the vagus nerve acts in the opposite way - it reduces the mentioned indicators.

The respiratory system also has a certain influence.

Thus, during inhalation, parasympathetic activity is inhibited and tachycardia occurs. On the contrary, when you exhale, the tone of the sympathetic part of the central nervous system decreases.

This phenomenon is the basis of respiratory arrhythmia.

Thus, HRV analysis allows us to identify changes in cardiac activity, and, consequently, disruptions in the functioning of regulatory systems.

Diagnostic methods

Despite the simplicity of the technique, it is usually used in a hospital setting.

This is due to the fact that strict control over the load on the body is needed. Only in this case can accurate conclusions be drawn about the state of the heart and its reaction to various stimuli.

There are several ways to diagnose variability.

Depending on the duration of registration:

• short-term - up to 5 minutes (used for mass or outpatient examinations);
• average duration - up to 2 hours (for functional tests);
• multi-hour and daily recordings (used during operations and in intensive care units).

Five-minute recordings are most often used.

Depending on the goals, there are:

• parallel studies (as a means of medical control, for example, during surgery);
• specialized (used to examine the whole organism - in functional diagnostics).

  As for the actual methods of analysis, there is also a considerable arsenal. Statistical methods - take direct measurements of the R-R and N-N gaps, and then determine values ​​such as standard deviation intervals or coefficient of variation.

Geometric methods (variation pulsometry) consist in calculating the probabilistic characteristics of the obtained data and constructing graphic histograms.

Correlation rhythmography consists of graphically displaying a sequence of cardiointervals.

In this case, prolapses or, conversely, additional contractions of the heart become clearly visible.

Spectral methods make it possible to determine different frequency indicators of heart rate. This makes it possible to study the impact of regulatory authorities. However, it should be remembered that the presence of arrhythmias can significantly distort the results of this analysis.

Analysis of variability and further tactics of action

It is important to remember that heart rate variability values ​​depend not only on health status, but also on many personal and external factors:

• gender (usually higher in women);
• age (in older people, some parameters of the cardiac conduction system are reduced);
• weight (obesity contributes to decreased variability);
• playing sports (a trained person has large reserves of variability);
• emotional state (worsens performance).

Also, HRV is negatively affected by sleep disturbances, nutrition, taking certain medications and a polluted environment.

In general, everything that generally disrupts the functioning of the body and, especially, its regulatory systems.

Rate variability is sharply reduced in some acute pathologies:

The rate decreases to a lesser extent in chronic diseases:

• overtraining syndrome;
• chronic heart failure in the initial stage;
• multiple sclerosis;
• orthostatic hypertension;
• metabolic cardiomyopathies (diabetes mellitus, infectious and autoimmune diseases);
• adaptation disorders.

The use of this technique in fetuses and newborns to assess the risk of sudden death syndrome may be promising.

What to do if you have a decrease in HRV?

Such a conclusion from a diagnostician is far from a death sentence.

First of all, you need to find out the reason for the decline.

Perhaps this is the result of the constant stress in which he lives modern man. In this case, proper rest or psychotherapy would be a very good remedy.

Excess weight indicates the need to adjust your diet and regular physical activity.

Basically, maintaining healthy image life can significantly improve the condition of the body in this regard.

conclusions

Studying heart rate variability is a simple and reliable way to study the state of the most important organ systems.

The low cost of the technique allows it to be used for mass screening examinations in order to identify hidden pathologies in the early stages.

Widespread use in sports and astronautics emphasizes the preventive nature of this product, which corresponds to modern trends in medicine.

If you are found to have a violation of this indicator, this does not mean the need for treatment. Try these simple remedies corrections as sports and recreation. However, heart rate variability can be sharply reduced in some acute pathologies, such as myocardial infarction or stroke.

Indicators of cardiac activity.

Stroke, or systolic, volume of the heart- the amount of blood ejected by the ventricle of the heart into the corresponding vessels with each contraction. In an adult healthy person at relative rest, the systolic volume of each ventricle is approximately 70-80 ml .

Thus, when the ventricles contract in arterial system 140-160 ml of blood arrives.

Minute volume- the amount of blood ejected by the ventricle of the heart in 1 minute.

3. Heart rhythm. Indicators of cardiac activity.

The minute volume of the heart is the product of the stroke volume and the heart rate per minute. On average, minute volume is 3-5l/min . Cardiac output can increase due to an increase in stroke volume and heart rate.

Laws of cardiac activity.

Starling's Law– the law of the heart fiber.

Formulated like this: The more a muscle fiber is stretched, the more it contracts. Consequently, the force of heart contraction depends on the initial length of the muscle fibers before the start of their contractions.

Bainbridge reflex(law of heart rate).

This is the viscero-visceral reflex: an increase in the frequency and strength of heart contractions with increased pressure at the mouths of the vena cava. The manifestation of this reflex is associated with the excitation of mechanoreceptors located in the right atrium in the area of ​​​​the confluence of the vena cava. Mechanoreceptors, represented by the sensitive nerve endings of the vagus nerves, respond to an increase in blood pressure returning to the heart, for example, during muscle work.

Impulses from the mechanoreceptors along the vagus nerves go to the medulla oblongata to the center of the vagus nerves, as a result of which the activity of the center of the vagus nerves decreases and the influence of the sympathetic nerves on the activity of the heart increases, which causes an increase in heart rate.

Lecture No. 2 Regulation of heart activity.

The heart has automaticity, that is, it contracts under the influence of impulses arising in its special tissue.

However, in the whole organism of animals and humans, the work of the heart is regulated due to neurohumoral influences that change the intensity of heart contractions and adapt its activity to the needs of the body and living conditions.

Nervous regulation.

A heart like everyone else internal organs, innervated by the autonomic nervous system.

Parasympathetic nerves are fibers vagus nerve, which innervate the formations of the conduction system, as well as the myocardium of the atria and ventricles.

The central neurons of the sympathetic nerves lie in the lateral horns spinal cord at the level of the I-IV thoracic vertebrae, the processes of these neurons are sent to the heart, where they innervate the myocardium of the ventricles and atria, forming the conduction system.

The centers of the nerves innervating the heart are always in a state of moderate excitement.

Due to this, nerve impulses constantly flow to the heart. The tone of neurons is maintained by impulses coming from the central nervous system from receptors located in the vascular system. These receptors are located in the form of a cluster of cells and are called the reflexogenic zone of the cardiovascular system.

The most important reflexogenic zones are located in the area of ​​the carotid sinus, in the area of ​​the aortic arch.

The vagus and sympathetic nerves have opposite effects on the activity of the heart in 5 directions:

1. chronotropic (changes heart rate);

2. inotropic (changes the strength of heart contractions);

3. bathmotropic (influences excitability);

4. dromotropic (changes the ability to conduct);

tonotropic (regulates the tone and intensity of metabolic processes).

The parasympathetic nervous system has a negative effect in all five directions, and the sympathetic nervous system has a positive effect.

Thus, with stimulation of the vagus nerves there is a decrease in the frequency and strength of heart contractions, a decrease in the excitability and conductivity of the myocardium, and a decrease in the intensity of metabolic processes in the heart muscle.

When the sympathetic nerves are stimulated there is an increase in the frequency and strength of heart contractions, an increase in the excitability and conductivity of the myocardium, and stimulation of metabolic processes.

Correct heart rhythm

How does heart rate occur?

Heartbeat depends on the impulses that arise in the sinus node or drivers of the heart. This group of cells is located at the junction of the superior vena cava with the right atrium and is capable of creating rhythmic impulses that spread under other cells.

Usually sinus node creates impulses with a frequency of 60-100 per minute, while suppressing the abilities of other pacemakers. Normal frequency own heart rhythm is calculated: 118.1 - (0.57*age). It is very important that the heart contracts at regular intervals.

Violation of the interval leads either to a reduction in the systole period ( heart contractions), and then it does not supply the organs with blood and oxygen, or it leads to a reduction in the diastole period ( relaxation of the heart), and then the organ does not rest and works poorly.

The heart rhythm is regulated by hormones entering the blood, that is, by work endocrine system and autonomic nervous system.

The difference in the concentration of electrolytes inside and outside the cells, as well as their movement, creates the electrical impulse of the heart.

Heart rhythm disturbance goes in the form:

• acceleration (tachycardia);
• slowing down (bradycardia);
• the appearance of extra beats (extrasystole);
• complete rhythm disturbance (atrial fibrillation).

Why is the heart rhythm disrupted?

Causes of rhythm disturbances there may be any heart disease that eventually leads to sick sinus syndrome– a set of symptoms that can disappear, appear, or even relate to another disease.

These include:

• dizziness,
• fatigue,
• fainting,
• disturbances of consciousness,
• heart failure.

The heart rhythm is affected by the following: factors:

1. lack of oxygen (hypoxia);
2. high blood pressure;
3. myocardial infarction;
4. inflammatory diseases (rheumatism) and heart defects;
5. congenital anomalies of the sinus node;
6. use of stimulant drugs;
7. endocrine diseases;
8. use of certain medications;
9. overeating, alcohol abuse, smoking;
10. stress and strong emotions;
11. anemia;
12. heart failure;
13. cardiac ischemia;
14. physical exercise.

Sinus tachycardia- acceleration of the generation of impulses in the sinus node.

Any nervous and physical stress naturally causes increased activity of the heart, since the body reflexively prepares to protect itself from stress and danger, for which it intensively supplies the musculoskeletal system with blood (due to increased heart function). However, such a reaction to “danger” may be pathological, and then excessive tachycardia occurs with every mental irritation, that is, increased release of adrenaline, other pituitary hormones and thyroid gland.

Tachycardia may occur with an increase in body temperature, a drop in blood pressure, certain infectious diseases (typhoid fever, tuberculosis, subacute tonsillitis), shock, and blood loss.

Sinus tachycardia unlike tachycardias that occur in other parts of the heart, very often it does not lead to excessive stress on the body and does not occur in the form of an attack.

Sinus bradycardia– slowing down the production of impulses – is very often a congenital condition, and is also observed in athletes or people doing heavy physical work.

Along with a slowing of the rhythm (up to 60 beats per minute), they noticed low blood pressure and a lengthening of the interval between the beginning of atrial systole and the beginning of ventricular systole ( distance Р-R- electrocardiograms).

Heart rhythm and arrhythmia

However, bradycardia can be pathological - as a result of irritation of the vagus nerve, exhaustion of the nervous system. This deviation occurs with brain tumors, meningitis, tumors hearts, compensatory in case of increased pressure, with vomiting, with middle ear disease, with attacks cholelithiasis, decreased thyroid function, depression, the postpartum period, atherosclerosis.

Sinus arrhythmia is often determined by an increase in heart rate during inhalation and a slower rate during exhalation.

This is a complete disturbance of the rhythm of the sinus node, determined by simply palpating the pulse. For example, with complete relaxation, the pulse slows down and respiratory arrhythmia occurs - which is typical for childhood and adolescence. There is also respiratory arrhythmia during the period of recovery after infectious diseases.

How to cope with rhythm disturbances?

When found heart rate(usually it beats unnoticed by us), especially if the disorder affects the general condition, you need to consult a doctor:

• if there are obvious interruptions in the functioning of the heart, unnecessary shocks, increased heart rate for no reason;
• if the heart rate drops to 50 beats per minute, and then sharply rises to 100 or higher;
• if, without any physical or nervous stress, the heartbeat accelerates above 100 beats per minute.

Unpleasant symptoms, Related arrhythmias, can be reduced if you treat heart rhythm disturbances more calmly:

1. If you notice an increase in your heart rate, there is no need to worry.

   It’s better to talk about abstract topics with the person who is nearby, read a book, and switch your attention.

2. Avoid coffee, tea and other drinks that stimulate the heart.
3. Eat more vegetables and fruits, which contain potassium - a heart electrolyte.
4. Eat more nuts, beans, bran and beans - they contain magnesium, which helps with tachycardia.
5. It is necessary to normalize sleep with the help of medicinal herbs (infusion of trefoil, peppermint and valerian - 30 g each in a collection, a spoonful of the mixture per glass of boiling water), which should be taken 30 minutes before bedtime.

Heart rate is normal in adults

Systolic or stroke volume (SV, SV) is the volume of blood that the heart ejects into the aorta during systole; at rest, about 70 ml of blood.

Minute volume of blood circulation (MCV) is the amount of blood ejected by a ventricle of the heart per minute.

The IOC of the left and right ventricles is the same. IOC (l/min) = CO (l) x HR (bpm). On average 4.5-5 liters.

Heart rate (HR). Resting heart rate is about 70 beats/min (in adults).

Regulation of heart function.

Intracardiac (intracardiac) regulatory mechanisms

Heterometric self-regulation is an increase in contraction force in response to an increase in the diastolic length of muscle fibers.

Frank-Starling law: the force of myocardial contraction in systole is directly proportional to its filling in diastole.

2. Homeometric self-regulation - an increase in contractility parameters without changing the initial length of the muscle fiber.

a) Anrep effect (force-velocity relationship).

As pressure in the aorta or pulmonary artery increases, the force of myocardial contraction increases.

The rate of shortening of myocardial fibers is inversely proportional to the force of contraction.

b) Bowditch ladder (chronoinotropic dependence).

Increased force of contraction of the heart muscle with increased heart rate

Extracardiac (extracardiac) mechanisms regulating cardiac activity

Nervous mechanisms

A. Influence of the autonomic nervous system

The sympathetic nervous system has effects: positive chronotropic ( increase in heart rate ), inotropic(increased strength of heart contractions), dromotropic(increased conductivity) and positive bathmotropic(increased excitability) effects.

The mediator is norepinephrine. Adrenergic receptors α and b-types.

The parasympathetic nervous system has effects: negative chronotropic, inotropic, dromotropic, bathmotropic. Mediator – acetylcholine, M-cholinergic receptors.

B. Reflex effects on the heart.

1. Baroreceptor reflex: when the pressure in the aorta and carotid sinus decreases, the heart rate increases.

Chemoreceptor reflexes. When there is a lack of oxygen, the heart rate increases.

3. Goltz reflex. When the mechanoreceptors of the peritoneum or abdominal organs are irritated, bradycardia is observed.

4. Danini-Aschner reflex. When pressing on the eyeballs, bradycardia is observed.

Humoral regulation of heart function.

Adrenal medulla hormones (adrenaline, norepinephrine) - the effect on the myocardium is similar to sympathetic stimulation.

Adrenal cortex hormones (corticosteroids) have a positive inotropic effect.

Hormones of the thyroid gland cortex (thyroid hormones) are positive chronotropic.

Ions: calcium increases the excitability of myocardial cells, potassium increases myocardial excitability and conductivity.

A decrease in pH leads to depression of cardiac activity.

Functional groups of blood vessels:

1. Shock-absorbing (elastic) vessels(aorta with its sections, pulmonary artery) transform the rhythmic release of blood into them from the heart into uniform blood flow.

They have a well-defined layer of elastic fibers.

2. Resistive vessels(resistance vessels) (small arteries and arterioles, precapillary sphincter vessels) create resistance to blood flow, regulate the volume of blood flow in various parts systems. The walls of these vessels contain a thick layer of smooth muscle fibers.

Precapillary sphincter vessels - regulate blood flow exchange in the capillary bed.

Contraction of smooth muscle cells of the sphincters can lead to blockage of the lumen of small vessels.

3.Exchange vessels(capillaries) in which exchange takes place between blood and tissues.

4. Shunt vessels(arteriovenous anastomoses), regulate organ blood flow.

5. Capacitive vessels(veins), have high extensibility, deposit blood: veins of the liver, spleen, skin.

Return vessels(medium and large veins).

Heart rhythm disturbances are a very complex branch of cardiology. People who have no idea about the structure of the heart and its conduction system will find it difficult to understand the mechanisms of arrhythmia. No need! For this purpose, there is a whole section of cardiology that deals only with heart rhythm disturbances (arrhythmology), and the doctor who treats them is an arrhythmologist. Everyone must do their job.

Arrhythmias are very common in our lives, and every person should know what arrhythmia is, how and under what circumstances it occurs, how it manifests itself and why it is dangerous.

As simply as possible, without delving into the physiological mechanisms of arrhythmias, we will consider their most common types. What is arrhythmia

There is a special node in the heart - the sinus node. It sets the rhythm for the whole heart. The correct (normal) heart rhythm is called - sinus rhythm. The heart rate in normal (sinus) rhythm is 60-90 beats per minute. All rhythm disturbances (arrhythmias) are irregular (non-sinus) rhythms, with an increased (more than 90 beats per minute) or decreased (less than 60 beats per minute) heart rate. In other words, this is any deviation from the norm.

If the heart beats faster than 100 beats per minute, this is a disorder called tachycardia (increased heart rate). If the heart beats less frequently, for example, 55 beats per minute, this is bradycardia (rare heartbeats).

In young children, the heart rate is not 60-90 beats per minute, as in adults, but 140 or more, so for children 140 beats per minute is the norm.

Classification of arrhythmias. What are the types of arrhythmias?

1. Sinus tachycardia - increased heart rate to 120-200 beats per minute while maintaining normal rhythm(the heart beats faster, but the rhythm is correct).

Sinus tachycardia is a normal response of the heart to physical activity, stress, and drinking coffee. It is temporary and is not accompanied by unpleasant sensations. The restoration of normal heart rate occurs immediately after the cessation of the factors that caused it.

Doctors are only concerned about tachycardia that persists at rest, accompanied by a feeling of lack of air, shortness of breath, and a feeling of palpitations. The causes of such tachycardia may be diseases that manifest themselves in heart rhythm disturbances or are accompanied by them: hyperthyroidism (thyroid disease), fever (increased body temperature), acute vascular insufficiency, anemia (anemia), some forms of vegetative-vascular dystonia, the use of medications (caffeine, aminophylline).

Tachycardia reflects the functioning of the cardiovascular system in response to a decrease in the contractility of the heart, which is caused by heart diseases such as chronic heart failure, myocardial infarction (death of a section of the heart muscle), a severe attack of angina in patients with coronary heart disease, acute myocarditis (inflammation of the heart). muscles), cardiomyopathy (changes in the shape and size of the heart).

2. Sinus bradycardia - slowing the heart rate to less than 60 beats per minute.

In healthy people, it indicates good fitness of the cardiovascular system and is often found in athletes (in response to stress, the heart does not start beating strongly because it is accustomed to the stress).

Causes of bradycardia not related to heart disease: hypothyroidism, increased intracranial pressure, overdose of cardiac glycosides (drugs for the treatment of heart failure), infectious diseases(flu, viral hepatitis, sepsis, etc.), hypothermia (lower body temperature); hypercalcemia (increased calcium in the blood), hyperkalemia (increased potassium in the blood).

The causes of bradycardia associated with heart disease: myocardial infarction, atherosclerosis (deposition of atherosclerotic plaques on the vessel wall, which, when growing, narrow the lumen of the vessel and lead to circulatory disorders), post-infarction cardiosclerosis (a scar on the heart that interferes with its full functioning).

3. Paroxysmal ventricular tachycardia - a sudden onset and suddenly ending attack of increased heart rate from 150 to 180 beats per minute.

This type of arrhythmia occurs in people with the following heart diseases: myocardial infarction, post-infarction aneurysm (formation of a vascular “bag” of blood at the site of a heart attack after scarring), cardiomyopathies, heart defects (changes in the structure of the heart that interfere with its normal functioning).

Paroxysmal ventricular tachycardia occurs 2 times more often in women than in men and often causes a decrease in blood pressure and loss of consciousness.

4. Extrasystole - extraordinary contractions of the heart. It may be asymptomatic, but more often patients feel a jolt or a sinking heart.

Causes of extrasystole not related to heart disease: stress and, as a consequence, vascular reaction; emotional stress, overwork; abuse of coffee, smoking, alcohol, often during alcohol withdrawal due to chronic alcoholism (withdrawal syndrome); drug use.

Causes of extrasystole associated with heart disease: coronary heart disease, acute myocardial infarction; mitral stenosis (narrowing of the mitral valve of the heart), rheumatic carditis (heart disease due to rheumatism), thyrotoxicosis (thyroid disease), intoxication with cardiac glycosides.

5. Ventricular fibrillation is a serious condition in which the heart contracts chaotically, incoherently, and has no rhythm. As a rule, ventricular fibrillation of the heart, a complication after extensive myocardial infarction, is the cause of death

Causes of rhythm disturbances (arrhythmias)

1. Cardiovascular diseases:

• coronary heart disease (myocardial infarction, angina pectoris, post-infarction cardiosclerosis) - ventricular arrhythmias and sudden cardiac arrest occur more often due to damage to the heart muscle and a decrease in the ability of the heart to contract:
• heart failure - there is an increase in the parts of the heart, loss of elasticity of the heart muscle, it ceases to contract adequately, blood stagnates inside the heart, or a turbulence in its flow occurs, resulting in arrhythmia;
• cardiomyopathy - when the walls of the heart are stretched, thinned or thickened, the contractile function of the heart decreases (it cannot cope with its work), which leads to the development of arrhythmia;
• acquired heart defects - disorders of the structure and structure of the heart (usually after rheumatism), which affect its functioning and contribute to the development of arrhythmia;
• congenital heart defects - congenital disorders of the structure and structure of the heart that affect its functioning and contribute to the development of arrhythmia;
• myocarditis is an inflammatory disease of the heart muscle, which sharply reduces the function of the heart (prevents it from contracting) and can cause various arrhythmias; mitral valve prolapse - an obstruction in the mitral valve that prevents blood from flowing from the left atrium to the left ventricle (normally), blood from the ventricle is thrown back into the atrium (where it came from, but this should not happen), all these disorders can trigger the occurrence of arrhythmia .

2. Medicines. An overdose of cardiac glycosides, antiarrhythmic drugs, diuretics, beta blockers (drugs for regulating blood pressure and heart rate) leads to heart rhythm disturbances (arrhythmias).

3. Electrolyte disturbances(violation of water-salt balance in the body): hypokalemia, hyperkalemia, hypomagnesemia (decreased magnesium in the blood), hypercalcemia (increased calcium in the blood).

4. Toxic effects on the heart: smoking, alcohol, bioactive supplements, herbal treatment, working with toxic substances (poisons).

Clinical manifestations (symptoms and signs) of arrhythmia

Arrhythmias may for a long time not manifest itself in any way, and the patient may not suspect that he has an arrhythmia until the doctor identifies the disease during normal medical examination or taking an electrocardiogram.

But often arrhythmias are not so “quiet” and make themselves known, significantly preventing a person from living his usual life. They can manifest themselves in the form of “turning over”, “transfusion” and “freezing” of the heart, but more often it is a feeling of interruptions in the heart, increased heartbeat, “fluttering” of the heart, extremely fast or, conversely, slow heartbeat, dizziness, shortness of breath, chest pain a cell of a pressing nature, a feeling of “failure” of the ground under your feet, nausea and (or) vomiting (especially when the normal rhythm changes to arrhythmia, and vice versa, when it is restored from arrhythmia to a normal heart rhythm), loss of consciousness.

Such diverse manifestations of arrhythmia do not always indicate the complexity of the rhythm disorder. People with minor rhythm disturbances may lose consciousness, but patients who have truly life-threatening rhythm disturbances do not show any complaints. Everything is very individual.

Risk factors for arrhythmia development

Age - with age, the heart muscle, our pump, weakens and can fail at any moment, and the diseases that we have “accumulated” over our lives will aggravate the situation.

Genetics - in people with congenital anomalies (malformations) of the development of the heart and its conduction system, arrhythmias are much more common.

Heart diseases - myocardial infarction and the scar on the heart that forms after it, coronary heart disease with vascular damage and rheumatism with damage to the heart valves are fertile ground for the development of arrhythmia.

Arterial hypertension (systematic increase in blood pressure) - increases the risk of developing coronary heart disease and contributes to the development of left ventricular hypertrophy (increase in size), which also increases the risk of developing arrhythmia.

Obesity is a direct risk factor for the development of coronary heart disease with all the ensuing consequences.

Diabetes mellitus - an uncontrolled increase in blood glucose can easily trigger the development of arrhythmia; coronary heart disease and arterial hypertension, which contribute to the development of arrhythmia, are faithful companions of diabetes mellitus.

Taking medications - uncontrolled use of diuretics and laxatives leads to disruption of the water-salt balance in the body and can cause arrhythmia.

Electrolyte disturbances - potassium, magnesium and sodium form the basis of the contractile mechanism of the heart, therefore, an imbalance in them (imbalance) can lead to arrhythmia.

Coffee, smoking and drugs are the cause of the development of extrasystole; amphetamine and cocaine provoke ventricular fibrillation and sudden cardiac arrest.

Alcohol abuse - risk of developing ventricular fibrillation; Chronic alcoholism leads to the development of cardiomyopathy (enlargement of the heart), followed by a decrease in the contractile function of the heart and the addition of arrhythmia. Complications of arrhythmia

A person with arrhythmia automatically falls into the risk group for the development of myocardial infarction and stroke, since the heart contracts incorrectly, the blood stagnates, blood clots (clots) form, which are carried throughout the body with the blood flow, and in the vessel where the blood clot gets stuck, it happens catastrophe. If a blood clot gets into the coronary (heart) vessels, there will be a heart attack, if it gets into the vessels of the brain, there will be a stroke. In third place, after the vessels of the heart and brain, are the vessels of the lower extremities.

Arrhythmia can cause the development of diseases such as myocardial infarction, cerebral stroke, pulmonary embolism, intestinal vascular thrombosis, vascular thrombosis of the extremities with subsequent amputation, and also lead to sudden cardiac arrest. Diagnosis of arrhythmia ECG (electrocardiogram) - records the electrical activity of the heart, evaluates the rhythm, heart rate and condition of the heart parts.

Ultrasound or echocardiography (echocardiography) - obtains an image of the heart. This method allows you to see all sizes, shapes and abnormalities of the heart; determine how the valves and parts of the heart work; recognize scars after myocardial infarction; assess the contractile function of the heart.

Daily Holter monitoring is the recording of an ECG during the day, which is possible thanks to a sensor attached to the patient. He wears it 24 hours, and an ECG is recorded during daily activities and during night sleep. After 24 hours, the rhythm, episodes of arrhythmia, at what time they occurred and what they are associated with are assessed.

EPI and mapping (electrophysiological study) is the most accurate and informative method for determining arrhythmia. Its essence is that the thinnest catheters are inserted into the cavity of the heart, recognizing the area of ​​the heart from which incorrect impulses emanate. In this case, thermal radiofrequency exposure is used, which allows not only to identify, but also to eliminate the source of arrhythmia.

Treatment of heart rhythm disturbances (arrhythmias)

Under no circumstances should you treat arrhythmia yourself! The recommendations that can be found on the Internet regarding self-medication of arrhythmia are illiteracy, obvious negligence and disregard for the patient and his life. Arrhythmia is a disruption of the heart, the most important motor in the human body, and its inept treatment, namely self-medication, can lead to death.

Arrhythmia should be treated by a doctor after conducting a special examination and determining the type of arrhythmia: from which part of the heart and under the influence of what causes this condition arose.

The goal of treating arrhythmia is to restore the correct (sinus) rhythm of the heart, reduce the manifestations of arrhythmia, eliminate its consequences and prevent complications.

There are two types of treatment for arrhythmia: medication and surgery.

Drug treatment of arrhythmia

Provides for the prescription and use of antiarrhythmic drugs. Their range is quite large. In cardiological practice, there are four classes of antiarrhythmic drugs.

1. Antiarrhythmic drugs: verapamil, adenosine, digoxin - used to eliminate atrial arrhythmias; lidocaine, disopyramide, mixletine - for ventricular arrhythmias; amiodarone, propafenone, flecainide - for both atrial and ventricular arrhythmias.

Amiodarone (cordarone) is the most commonly used and well-proven drug for the treatment of almost all types of arrhythmias. It is prescribed for arrhythmias in patients with myocardial infarction and heart failure. When administered intravenously, antiarrhythmic activity occurs within the first 10 minutes after administration. Usually, for the first two weeks after the onset of arrhythmia, cordarone is used orally to saturate the heart, and then the dose is reduced to a maintenance dose and continued thereafter. Contraindications for use: bradycardia (slow pulse, 50 beats per minute or less), bronchial asthma, heart block (atrioventricular), thyroid disease and pregnancy.

2. Beta-blockers are a group of drugs that have an antiarrhythmic and pronounced hypotensive (lowering blood pressure) effect. Beta blockers reduce heart rate and prevent the development of heart failure. Contraindications to the use of beta blockers are chronic respiratory diseases and bronchial asthma, since their use can cause an attack of suffocation.

3. Cardiac glycosides - increase myocardial contractility, improve blood circulation and reduce the load on the heart (digoxin, digitoxin, strophanthin, korglykon).

4. Metabolic drugs - help improve metabolism, nourish the heart muscle and protect the myocardium from ischemic effects.

Surgical treatment of arrhythmia Radiofrequency ablation is a procedure that allows, using small punctures, to completely cure arrhythmia. A special catheter in the heart is used to cauterize the area (source) of arrhythmia and restore correct rhythm hearts.

Installation of an electrical pacemaker (ECS), a device that eliminates cardiac arrhythmia. Main function ECS is the imposition of a certain (desired) heart rate on the patient’s heart to maintain the correct heart rhythm. For example, if a patient has bradycardia (slow pulse) with a heart rate of 40 beats per minute, then when setting the pacemaker, the correct rhythm is set with a frequency of 80 beats per minute.

ditch per minute. There are one-, two- and three-chamber pacemakers. Single-chamber pacemakers are activated on demand. When bradycardia appears against the background of normal rhythm and heart rate (heart rate is 40-50 beats per minute), the pacemaker is turned on with the desired heart rate. Dual-chamber pacemakers automatically control heart rate. Three-chamber pacemakers are used to treat arrhythmias, life-threatening patient (ventricular arrhythmias), and are reliable prevention of sudden death.

There is a so-called cardioverter - defibrillator. It instantly turns on and stimulates the heart, in other words, it resuscitates the heart when life-threatening arrhythmias develop.

Atrial fibrillation or atrial fibrillation

Atrial fibrillation (AF) is a heart rhythm disorder accompanied by an increase in heart rate to 350-700 beats per minute. At the same time, the heart rhythm is absolutely erratic and there is no way to accurately calculate the pulse. AF most often develops after 60 years and accounts for 40% of all hospitalizations for arrhythmias.

Causes of MA: heart disease (myocardial infarction, arterial hypertension, heart failure, cardiosclerosis, myocarditis, rheumatic heart disease); diseases of other organs (thyrotoxicosis; intoxication with narcotic substances; overdose of cardiac glycosides; acute alcohol poisoning and chronic alcoholism; uncontrolled use of diuretics; hypokalemia - decrease in potassium content in the blood; complication of severe poisoning and overdose of diuretics; stress and neuropsychic stress) .

MA forms by nature clinical course: paroxysmal - a first-time attack that lasts up to five days, usually less than a day; persistent - a condition when attacks are periodically repeated, the attack lasts more than seven days, but with effective treatment it is relieved immediately after the occurrence, after 3-5 hours; chronic (permanent) - erratic contractions of the heart over a long period of time.

• Based on the speed of heart contractions, the following variants of MA are distinguished: normosystolic - abnormal heart rhythm at a normal pace (60-90 beats per minute);
• tachysystolic - abnormal heart rhythm at a fast pace (90 or more beats per minute), patients tolerate this form of arrhythmia the worst;
• Bradysystolic - abnormal heart rhythm at a slow pace (60 or less beats per minute).

1. Fibrillation (atrial fibrillation). Normally, impulses from the atria enter the ventricles of the heart, and they contract, during which blood is pushed out of the heart. Fibrillation (atrial fibrillation) is a contraction not of the entire atrium, but only of its sections, and the remaining impulses do not reach the ventricles, but only jerk them and force them to contract in wrong mode. As a result, there is no complete transmission of the impulse from the atrium to the ventricles and proper contraction of the heart is impossible.

2. Atrial flutter - rapid contractions of the atria in the correct rhythm, but very fast (200-400 beats per minute). In this case, contraction of both the atria and ventricles suffers. The atria do not have time to relax because they work at a very fast pace. They become overfilled with blood and do not have time to give it to the ventricles. Because of this “greedy” relationship of the atria to the blood, the ventricles of the heart suffer, which cannot receive enough blood to push it out of the heart and give it to all the organs and tissues of the body.

Symptoms and complaints of patients with atrial fibrillation

Some patients may not feel the arrhythmia and still feel fine. Others feel a rapid heartbeat, “interruptions” in the heart, shortness of breath, which worsens with minimal physical activity. Chest pain may not always be present. Some patients feel pulsation in the neck veins. All this is accompanied by weakness, sweating, a feeling of fear and frequent urination. With a very high heart rate (200-300 or more beats per minute), dizziness and fainting are observed. All these symptoms disappear almost immediately after normal rhythm is restored. When the rhythm changes (from the correct rhythm to an arrhythmia and from an arrhythmia to the correct rhythm), nausea and vomiting may occur. Patients suffering from a permanent (chronic) form of MA stop noticing it. Complaints appear only with increased blood pressure, stress and physical activity, because the heart rate changes and arrhythmia reminds itself.

Complications of atrial fibrillation

Thromboembolism and stroke. In the presence of intracardiac thrombi, LA acts as a powerful provocateur of the development of thromboembolism in various organs. In AF, blood clots travel from the heart into the blood vessels of the brain and cause a stroke. Every seventh stroke develops in patients with MA.

Heart failure. MA in people suffering from mitral stenosis (narrowing of the mitral valve of the heart) and hypertrophic cardiomyopathy (thickening of the walls of the heart), against the background of heart failure, can lead to the development of cardiac asthma (an attack of suffocation) and pulmonary edema.

Dilated cardiomyopathy. MA against the background of heart failure provokes it and quickly leads to the development of dilated cardiomyopathy (enlargement of the cavities of the heart).

Arrhythmogenic shock. MA in the setting of heart failure can cause the development of arrhythmogenic shock (a sharp decrease in blood pressure, loss of consciousness and cardiac arrest).

Heart failure. AF (atrial fibrillation) can progress to ventricular fibrillation and cause cardiac arrest.

Diagnosis of atrial fibrillation is similar to that described above (ECG, echocardiography or ultrasound of the heart, Holter daily monitoring, EPI and mapping, and also includes a conversation with the patient (they find out the probable causes of the arrhythmia, how long the person has been suffering from atrial fibrillation, how often and under what conditions the arrhythmia manifests itself), his examination (listen to erratic heartbeats and determine the pulse rate) and transesophageal electrophysiological study is a method of studying the heart, which makes it possible to determine the source and mechanism of development of AF).

Treatment of atrial fibrillation

Only a doctor should prescribe medicine, select doses and restore rhythm!

The goals of drug treatment for AF are: restoration of the correct (sinus) rhythm of the heart, prevention of relapses (repeats) of an attack of AF, control of the heart rate and maintenance of the correct heart rhythm, prevention of thromboembolism. In case of AF, it is first necessary to treat the diseases that led to the development of arrhythmia.

Drug treatment of AF (atrial fibrillation) is similar to that described above and includes: antiarrhythmic drugs, beta blockers, anticoagulant therapy, metabolic drugs,

Surgical treatment of AF (atrial fibrillation):

• Radiofrequency ablation. In case of frequently recurring attacks or a chronic form of MA, they “cauterize” (using a special electrode) the area of ​​the heart responsible for conducting the impulse, thereby causing a complete blockade in the heart. After this, a pacemaker is installed, which sets the heart to the correct rhythm.
• Radiofrequency isolation of pulmonary veins. This is a method of radical elimination of MA (effectiveness is about 60%). The focus of “incorrect” excitation, located at the mouth of the pulmonary veins, is isolated from the atria.

Every year, new methods of surgical treatment of arrhythmias are developed, antiarrhythmic drugs are improved, and the number of side effects is reduced; Research continues to develop a universal antiarrhythmic drug. But all this does not give us the right not to be treated on time and correctly.

The longer an arrhythmia lasts, the more likely it is that it will remain for life. Do you need such travel companions? Get rid of them before it's too late...

Attention! All information in the article is provided for informational purposes only and cannot be taken as a guide to self-medication.

Treatment of diseases of the cardiovascular system requires consultation with a cardiologist, a thorough examination, prescription of appropriate treatment and subsequent monitoring of the therapy.

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Causes of the disease

The causes of arrhythmia can be very different. They are caused by various diseases or special conditions of the body.

The main causes of the disease include the following factors:

• cardiac ischemia;
• heart injuries;
• myocarditis;
• heart failure;
• heart defects;
• strong feelings;
• overwork;
• anemia.

Irregular heart rhythm always symbolizes any diseases or health-related problems, therefore, you should not neglect them. The presence of arrhythmia is a reason to consult a doctor for examination.

Types of arrhythmia

The form of arrhythmia is influenced by the heart rate. In this regard, the following types of arrhythmia are noted:

• tachycardia;
• bradycardia;
• extrasystole;
• atrial fibrillation;
• heart block.

Tachycardia

Tachycardia is the most common type of heart rhythm disorder. It manifests itself by rapid heartbeat. Heart rate exceeds 90 beats per minute.

In some cases Aach tachycardia can also appear in healthy people. It occurs:

• under stress;
• after physical activity;
• after taking certain medications;
• when drinking strong tea, coffee, alcohol.

Tachycardia is often diagnosed in children preschool age. This does not apply to pathological phenomena. It proceeds favorably and belongs to the physiological norm.

Pathological tachycardia carries many dangers. An increase in heart rate affects a decrease in the volume of blood ejected, resulting in a decrease in blood pressure and the blood supply to all vital organs deteriorates.

Tachycardia, in turn, is divided into two more subtypes:

1. Ectopic tachycardia.

Sinus tachycardia most often occurs in people with healthy heart, but suffering from vegetative-vascular dystonia. Sometimes it indicates the presence of heart failure.

The cause of the ectopic form of tachycardia is severe heart disease, such as myocardial infarction and myocarditis.

If with tachycardia the heart rate increases, then with bradycardia, on the contrary, the heart begins to beat more slowly. The person becomes weak and dizzy, and there is a risk of loss of consciousness.

Loss of consciousness in this case lasts no more than 2 minutes, after which the person comes to his senses. Blood pressure is unstable.

Some diseases can cause the development of bradycardia:

• increased intracranial pressure;
• swelling or swelling of the brain;
• stomach ulcer;
• stroke;
• myocardial infarction;
• cardiosclerosis.

In addition, bradycardia can occur when the dose of medications is exceeded or poisoning with toxic substances.

Bradycardia can be age-related and occur in people over 60 years of age.

L The mild form of bradycardia is practically not felt, but the pathological form has certain symptoms. These include:

• pain in the heart of the chest;
• dyspnea;
• swelling of the legs;
• noise in ears;
• pallor.

In severe forms of bradycardia, the doctor prescribes drug therapy to stabilize the heart rhythm. In rare cases, it is necessary to resort to surgery and the introduction of a pacemaker.

Ek Strasystole is manifested by an extraordinary cardiac contraction, which is felt as a sudden cardiac impulse. You may feel your heart sinking and a rush of blood to your head. The following symptoms are also characteristic:

• hot flash;
• weakness;
• discomfort;
• anxious feeling;
• lack of air;
• dizziness;
• fainting.

Episodic extrasystoles occur from time to time in relatively healthy people. For example, in women, during menstruation, or after drinking strong coffee. Stress and neuroses can cause extrasystolic attacks. This pathology often accompanies serious heart disease.

Single attacks do not require treatment. But if such conditions occur regularly, drug treatment and additional diagnostics to determine the concomitant disease will be required.

Flicker This arrhythmia is special condition, which is characterized by chaotic heartbeat. Namely, alternating correct and incorrect rhythm. The heart rate can reach up to 600 beats per minute. Atrial fibrillation is expressed in two forms:

1. Atrial fibrillation (irregular activity of the atria).
2. Atrial flutter (regular rhythm arrhythmia).

These two types of atrial fibrillation are closely related and can replace each other, but atrial flutter is much less common.

When an attack of atrial fibrillation occurs, the patient experiences the following sensations:

• heaviness in the heart area;
• chaotic heart twitching;
• weakness;
• cold extremities;
• panic state;
• pulse disturbance;
• nausea;
• labored breathing.

Mer causative arrhythmia has quite serious consequences. It can promote the formation of blood clots in the heart. Atrial fibrillation requires urgent diagnosis of the whole body and a course of treatment. The basis of therapy is drug treatment.

IN special cases required surgery, during which a pacemaker is installed.

The causes of the disease are in most cases heart disease. Elderly people are also at risk.

Heart block is a serious pathology that can lead to fatal outcome. Blockades are divided into two types:

1. Atrial block.
2. Ventricular block.

Ventricular bl Okadas can be a complete blockade, in which cardiac activity stops completely. Complete blockade requires immediate hospitalization and immediate treatment.

The disease is caused by diseases of the heart and circulatory system. Symptoms of heart block include bluish lips, weakness, shortness of breath, wheezing in the lungs, and the patient may lose consciousness.

The occurrence of arrhythmia attacks indicates that something is going wrong in the human body.

Before starting treatment, it is necessary to find out what forms of arrhythmia there are. This will require a consultation with a cardiologist.

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Arrhythmias caused by impaired automaticity

There is an abnormal change in heart rate or sequence. The classification of arrhythmias involves the identification of two forms of disorders depending on the pathological mechanism: nomotopic and heterotopic.

Nomotopic form

This type of arrhythmia is characterized by changes in the parameters of pulse movement. However, the sinus node retains its function as the main pacemaker. It generates impulses leading to myocardial contraction.

The pathology is characterized by a significant increase in the number of contractions of the heart muscle while maintaining normal rhythm. There is an increase in the rate of impulse generation by the sinus node, so the heart rate can reach 180 beats per minute.

Cardiologists distinguish the following forms of sinus tachycardia:

• Physiological. Occurs in an absolutely healthy person during physical activity, a stressful situation, or anxiety;
• Pathological. Develops with ischemic heart damage.

With this form of arrhythmia, patients report the following symptoms:

• Heartbeat. The heart seems to “flutter” in the chest;
• Shortness of breath with slight exertion;
• Weakness;
• Decreased performance;
• Chest pain, dizziness, and loss of consciousness are also possible.

Special treatment for the physiological form of tachycardia is not required; it is enough to exclude provoking factors. Pathological arrhythmia requires accurate diagnosis and treatment of the underlying disease.

Sinus bradycardia

This form of arrhythmia is characterized by a decrease in the heart rate of the heart muscle to less than 60 beats in 60 seconds. This condition is caused by reduced automaticity of the sinus node when exposed to the parasympathetic nerve.

The main forms of sinus bradycardia:

• Extracardiac. Associated with a toxic effect on the sinus node, activation of the parasympathetic nerve, which leads to disruption of the vagal component. The main causes: hypothyroidism, jaundice, alkalosis, drug overdose, infectious diseases.
• Intracardiac. Develops due to damage to the sinus node. The causes are the following diseases: heart defects, heart attack, ischemia, cardiosclerosis.

At an early stage, severe symptoms do not occur, only with the development of pathology does dizziness, pain in the heart area, and weak pulse occur. Treatment involves eliminating the causes of arrhythmia; Belloid, Eufillin, Alupent, and Atropine are often used.

Sinus arrhythmia

The condition is characterized by an uneven and inconsistent distribution of impulses in the node. Both increased and decreased heart rate is possible. The cause of the condition is instability of the vagus nerve or uneven filling of the myocardium with blood during the act of breathing. The condition often develops at a young age after severe infectious diseases.

Patients feel a change in heart rate during physical activity, weakness occurs, and fainting is possible.

Heterotopic arrhythmias

This pathology occurs when the excitability of the sinus node is suppressed, so the ventricular component becomes the new pacemaker.

Atrioventricular rhythm

Some factors (heart attack, infections, rheumatism, quinidine, digitalis) lead to the appearance of a new pacemaker in the atrioventricular node. This results in a reduction in the time it takes for an impulse to reach the atrium or ventricles.

A sign of pathology is an increase in the pulsation of the veins in the neck. Heart rate is in the range of 40-80 beats.

Sick sinus syndrome

Pathology occurs due to disturbances in the automatism of the sinus node. The causes of the pathology are ischemic lesions, cardiosclerosis, myocarditis or organic defects. As a result, migration of the pacemaker is noted with the involvement of the atrioventricular node. There are 3 types of syndrome: transient, latent and permanent.

Arrhythmias caused by impaired excitability

The following forms of pathology are distinguished: extrasystole and paroxysmal tachycardia.

With this disorder, the appearance of one or more contractions of the heart muscle, which are extraordinary, is noted. It develops as a result of the appearance of impulses not only from the sinus node, which is the main pacemaker, but also from secondary elements that should only normally conduct the main impulses.

Of particular danger is arrhythmia, which people do not feel. In such cases, immediate treatment is required. With the development of extrasystole, patients note the following symptoms:

• Strong tremors;
• Sweating and hot flashes;
• "Somersault of the Heart";
• Sense of anxiety;
• Lack of air;
• Fading of the heart muscle;
• Possible: headache, shortness of breath, fainting, urination problems, angina attack.

Measuring the pulse is often not indicative, because only normal pulse beats reach the extremities.

Paroxysmal tachycardia

The pathology is a heart rhythm disorder, which is characterized by a sharp increase in heart rate up to 240 beats. Additional signals from secondary pacemakers may appear. Treatment of this form involves stopping acute condition with the help of Verapamil, Novacainamide, and with ventricular type– Lidocaine, Ethacizin, Etomosin.

Mixed arrhythmia

This is the most dangerous pathology, the development of which is caused by a violation of several myocardial functions: excitability and conductivity.

This pathological condition is characterized by a change in rhythm, which is associated with the occurrence of chaotic impulses in the myocardium, fibrillation of individual muscle fibers. Heart rate can reach 500-600 beats. Atrial fibrillation is characterized by the occurrence of a pulse deficit: the number of minute contractions is greater than the pulse waves. With long-term pathology, the risk of stroke and blood clots is significantly increased. This is the most common type of arrhythmia, which occurs mainly in elderly patients.

There are the following types of pathology:

• Constant. Electrical cardioversion is noted to be ineffective. The duration of the attack is more than a week;
• Persistent. May be recurrent;
• Transient. The attack can last up to 7 days, usually up to 24 hours.

Patients note the following symptoms of arrhythmia:

• Chaotic heartbeat;
• Sweating;
• Trembling and fear;
• Weakness;
• Polyuria;
• Possible: fainting, dizziness.

Restoring normal sinus rhythm allows symptoms to be completely eliminated.

Atrial flutter

This form of mixed arrhythmia is supraventricular tachycardia. Characterized by uncoordinated electrical activation of the atria up to 700 beats. How the result decreases contractility myocardium, loss of the ventricular filling phase.

The following options are available:

• Typical. Circulation of the excitation wave is noted in the right atrium in a normal circle. Heart rate is 250-350 beats;
• Atypical. The excitation wave circulates in both atria in an abnormal circle. Heart rate can reach 700 beats.

Symptoms of the pathology: palpitations, shortness of breath, reduced physical endurance, discomfort in the heart, an attack of angina, pulsation of the veins in the neck, dizziness, decreased blood pressure. The frequency of arrhythmia attacks can vary from 1 in 12 months to several paroxysms per day.

Treatment of the pathology is aimed at stopping the attack, restoring normal sinus rhythm, and preventing the development of episodes in the future. For this purpose, beta blockers, cardiac glycosides, calcium channel blockers, and antiarrhythmic drugs are widely used.

Arrhythmias caused by conduction disturbances

Pathology is associated with the occurrence of obstacles to the propagation of impulses. As a result, they may not penetrate into the underlying sections or may be delayed. This condition is called blockade. It can be congenital or acquired, and can be localized in various parts of the heart muscle. There are these types of arrhythmia:

• Atrial blocks are characterized by slow conduction of impulses. The pathological condition is sometimes confused with the development of bradycardia. There are left and right blockades, depending on the type of atrium. This rhythm disturbance sometimes occurs in healthy people;
• Atrioventricular blocks (atrioventricular) occur when there are obstacles to impulses on the way from the atrium to the ventricle;
• Ventricular blockades. The pathology is characterized by conduction disturbances in the His bundle. The cause of the pathology can be ischemic lesions, cardiomyopathy, endocarditis, and heart attacks. Hospitalization and emergency treatment are required for blockade of both branches of the His bundle.

Treatment of this type of arrhythmia is based on the use of Isoprenarine hydrochloride, Orciprenaline sulfate, Atropine. In severe conditions, electrical stimulation is prescribed. Pacemaker implantation is indicated for patients over 60 years of age.

Arrhythmia can lead to the development of serious pathologies. Therefore, this condition requires careful and accurate diagnosis, effective therapy. At the first signs of pathology, you should contact a cardiologist.

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Types of arrhythmia

• Flickering.
• Ventricular tachycardia.
• Heart rate disturbances.

The most common is extrasystole, when an extraordinary contraction of the heart occurs with sensations of an additional cardiac impulse or its fading. When this happens, the heart rhythm is disrupted, and the person himself does not notice it.

Extrasystole is a disease characteristic of older people, which is also called atrial fibrillation. There is a violation of cardiac contraction due to atherosclerotic damage to the blood vessels of the heart muscles, which forms cardio-sclerotic areas, leading to chaotic and irregular contraction.

When starting recovery, it is necessary to consider the duration of the changes, exclude the presence of blood clots and, depending on the person’s condition, make the right decision.

Sometimes extrasystole is referred to as permanent form arrhythmias. But in this case, it is still necessary to undergo a course of treatment to bring the extrasystole to normosystole. That is, ensure that the heart rate does not exceed 90 beats per minute.

Ciliated

This type of deviation is more often called “atrial flutter”, which is often not noticed due to its regular nature. Most often, atrial fibrillation occurs due to diseases associated with lung diseases.

Ventricular tachycardia

More dangerous look deviations from the norm - supraventricular and ventricular tachycardia, which occur in both adults and children, both men and women. The disease is especially dangerous during pregnancy. Here you cannot do without urgent qualified help.

Ventricular - when the heart contracts from the sinus node. If variability occurs elsewhere, arrhythmia appears, even if the heart rate is normal, and the number of beats per minute is far beyond acceptable limits.

Ventricular and supraventricular arrhythmias can be caused by many diseases and may not necessarily be associated with heart disease.

Rate abnormalities in adults can occur as a result of tachyarrhythmias and bradyarrhythmias, abnormalities that are associated with congenital heart defects and in rheumatism and myocarditis.

Treatment

For extrasystoles, treatment is prescribed only when an adult or child is bothered by an extraordinary contraction, and is carried out only with medications, the prescription of which depends on the presence of a certain number of extrasystoles and the causes of the disease.

After a course of drug treatment, the patient stops complaining of extraordinary contractions, that is, the heart rhythm normalizes.

Rhythm failure with atrial fibrillation, as well as with extrasystole, is treated with medication. Only in this case, before prescribing drugs, the doctor determines the likelihood of blood clots using ultrasound examination heart and its vessels. To maintain the normal rate of strokes, the doctor prescribes a special course of drug treatment.

Ventricular and supraventricular arrhythmias are more difficult to treat. Here, in addition to medicines, in in case of emergency Electrical discharges are used, which must be carried out as quickly as possible, since the patient may lose consciousness at any moment, which will worsen the condition, which can cause death.

But there are cases when it is possible to normalize the functioning of a person’s heart only after cardiac surgery.

Treatment of arrhythmia in adults and children is carried out only in a hospital after a preliminary complete examination.

The cause of heart rhythm disturbances can be diseases of the endocrine system, most often thyrotoxicosis, when the heart rate increases. Here it is necessary to treat the underlying disease, aimed at reducing hormones in the blood, then heart rate variability (HRV) will return to normal.

Abnormal heart rhythm in adults, when the heart rate is above 91 beats, can be caused by anemia - oxygen deficiency is compensated.

If the beats per minute is below 59, this is a clear sign of sinus bradycardia, weakening of the sinus node occurs, which occurs more often in older people than in young people. Their sinus bradycardia is of a slightly different nature and manifests itself as a result of a decrease in the level of thyroid hormones.

Irregular heart rhythm – blockade – is a disease that can only be cured with cardiac surgery. It all depends on the degree of the disease.

Arrhythmia during pregnancy

Pregnancy is a change in the body of women, which is accompanied by disturbances in heart rhythm. It’s rare that a woman does not notice a rapid heartbeat, especially at the end of her pregnancy. Arrhythmia develops during pregnancy in 58% of women. Moreover, 44% of pregnant women have clear signs of functional arrhythmia. And even if the expectant mother has never suffered from heart disease before, while pregnant, she may experience an increase in heart rate. In this regard, it is urgent to normalize the patient’s heart rate. After all, pregnancy is already a kind of complication that occurs with a change in heart rhythm.

Features of arrhythmia in women and men

The symptoms of the disease are similar. There are some differences though. For example:

• In women, heart rhythm is disrupted after the age of 50.
• Men experience their first attacks of arrhythmia by the age of 45.

With arrhythmia, weakness, interruptions in heart function, anxiety, pain in the chest, and shortness of breath are felt.

The main causes of arrhythmia in women:

• Excessive emotionality.
• Stress.
• Excess weight.
• Physical overexertion.

The main causes of arrhythmia in men:

• Unhealthy lifestyle, that is, unhealthy diet, alcohol abuse.
• Incorrect transition to physical activity during sports training.
• Passive lifestyle.

Recently, smoking has been the cause of arrhythmia in both.

Failures in the normal rhythm of the heart do not always require treatment, although there are cases when the failure is difficult to bear, then the help of a specialist will not hurt. The main thing is to consult a doctor in a timely manner to prevent the development of stroke, heart attack, and so on.

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Single supraventricular extrasystole - what is it? Arrhythmia tablets
Sinus arrhythmia in children

Cardiac activity disorder

are represented mainly by disturbances in the tempo, rhythm or strength of heart contractions. In some cases, they do not affect well-being and ability to work (they are detected by chance), in others they are accompanied by various painful sensations, for example: dizziness, palpitations, pain in the heart area, shortness of breath. Happy Birthday. do not always indicate heart disease. Often they are caused by imperfections or disturbances in the nervous regulation of cardiac activity in diseases of various organs and endocrine glands. Some abnormalities in the activity of the heart can sometimes be observed in practically healthy people.

The heart rhythm is normally formed by electrical impulses, which with a frequency of 60-80 per 1 min originate in the so-called sinus node, located in the wall of the right atrium. The rhythm of heart contractions subordinated to these impulses is called sinus. Each of the sinus nodes spreads along the conduction paths, first to both atria, causing them (at the same time being pumped into the ventricles of the heart), then to the ventricles, with the contraction of which blood is pumped into vascular system. This appropriate sequence of contraction of the heart chambers is ensured precisely by sinus rhythm. If the source of the rhythm becomes not the sinus, but another part of the heart (it is called the ectopic source of rhythm, and the rhythm itself is ectopic), then this sequence of contraction of the chambers of the heart is disrupted the more, the further away from the sinus node the ectopic source of rhythm is located (when it is in the ventricles of the heart , they contract earlier than the atria). Ectopic impulses occur with pathological activity of their source and in cases where the sinus node is depressed or its impulses do not excite the ventricles of the heart due to a violation of their conduction (blockade) in the conduction pathways. All these disorders are well recognized using electrocardiography, and many of them can be determined in oneself and in other people by palpating the pulse on the radial artery (in the area of ​​the wrist joint) or on the carotid arteries (on the anterolateral surfaces of the neck to the right and left of the epiglottis). In healthy people at rest, it is defined as moderately strong arterial filling impulses occurring at approximately equal intervals (regular rhythm) with a frequency of 60-80 beats per 1 min.

The main deviations in the pace and rhythm of the heart include a very slow pace (), an excessively fast pace () and irregularity (arrhythmia) of heart contractions, which can be combined with a slow pace (bradyarrhythmia) or tachycardia (tachyarrhythmia). All these deviations can relate to sinus rhythm (sinus bradycardia and tachycardia, sinus arrhythmia) or be generated by ectopic impulses. Of ectopic origin are, for example, such forms of cardiac arrhythmia as premature (extraordinary) contractions of the heart - including group, forming paroxysmal ectopic tachycardia (), as well as complete irregularity of heart contractions in the so-called atrial fibrillation.

Rare cuts hearts. Bradycardia includes a heart rate less than 60 beats per 1 min. This border is conditional. You should not be alarmed if the pulse rate, upon random examination, is within 45-60 per 1 min. This rate of heart contractions often occurs in completely healthy people, especially often in people engaged in physical labor and athletes, sometimes combined with a decrease in blood pressure. In these cases, bradycardia is caused by the slowing effect of the nervous system on the impulses of the sinus node due to the reconfiguration of the heart to a more economical mode of metabolism and energy in the body. Sinus bradycardia has a similar origin in injuries and diseases of the brain, decreased function of the thyroid gland and adrenal glands. This form of cardiac dysfunction does not require special treatment and disappears during the process of recovery from the disease that caused it.

A different attitude should be taken to a pronounced decrease in pulse detected during an attack of chest pain, fainting, or in connection with the patient’s complaints of sudden lightheadedness, severe general weakness, in the form of rare strong heartbeats. In such cases, bradycardia is often ectopic and is most often associated with a blockade of the conduction of excitation impulses from the atria to the ventricles of the heart. The complaints described above (except for the complaint about the chest, which is closer to the cause than to the consequence of bradycardia) usually appear at a heart rate of 40 per 1 min or with significant bradyarrhythmia (with separate pauses between contractions of more than 2 With), and if it is less than 30 in 1 min, then deep and prolonged fainting is possible, sometimes with the appearance of convulsive seizures. In such cases, bradycardia requires emergency treatment, and those around them must organize assistance for the patient with a series of actions, the sequence of which is determined by the severity of the condition and the nature of the patient’s complaints.

First of all, the patient should be placed in a horizontal position on his back with his legs raised, placing 2 pillows under his feet, and only a roll of a towel or a small pillow under his head (if he has lost it, then it is better to lay him on a hard surface, for example, covered with a blanket). If a patient complains of chest pain, it is necessary to give him 1 tablet or 2 1% solution (on a piece or on a bottle stopper) of nitroglycerin as quickly as possible. After this, waiting for the action of nitroglycerin (2-4 min) or immediately (if there is someone to do this) you need to call an ambulance and determine the actions that are possible before its arrival. If the patient has already had similar conditions, then the recommendations received in this case from the doctor earlier are followed. Most often they involve the use of isadrin, 1 tablet of which (0.005 G) should be placed under the patient’s tongue until completely absorbed. At the same time, the pulse quickens, and the patient’s condition improves somewhat after 5-10 min. If an attack of bradycardia occurs for the first time and isadrin was not purchased in advance, the patient should be given orally belladonna extract, crushed into 2 tablets of 0.015 each. G. If the effect is positive, the pulse will begin to increase after 30-40 min. If among your neighbors or those around you there is a person suffering from bronchial asthma, it is advisable to borrow from him a dosed aerosol of isadrin (euspiran) or alupent (asthmopent, ipradol) and irrigate with three doses (i.e., using three finger presses on the head of the inhaler at intervals of 5- 7 With) any of these remedies under the patient's tongue, expecting action after 3-6 min.

Most often, ectopic bradycardia occurs in a patient with chronic heart disease. His first aid kit may contain medications that should absolutely not be given in case of bradycardia; if the patient took them, then from the moment bradycardia occurs they should be immediately discontinued. These medications include (digoxin, celanide, isolanide, lantoside, digitoxin, acedoxin, cordigitate, digitalis leaf powder, lily of the valley), the so-called anaprilin (obzidan, inderal), trazicor (oxprenolol), visken (pindolol), cordanum (talinolol) ), Korgard (nadolol) and many, including amiodarone (cordarone), verapamil (isoptin, finoptin), novocainamide, ethmosin, etatsizin, disopyramide (rhythmylen, rhythmodan), quinidine.

Frequent contractions hearts. Athletes who control their heart rate know well that with significant physical activity, its frequency can increase to 140-150 per 1 min. This normal phenomenon, indicating that the sinus rhythm regulation system brings it into line with the metabolic rate in the body. Sinus tachycardia during fever has the same nature (for every 1° increase in body temperature, the rate of heart contraction increases by 6-8 beats per 1 min), emotional excitement, after drinking alcohol, with increased thyroid function. With heart defects and cardiac weakness, sinus tachycardia is often compensatory (adaptive). As a sign of imperfect regulation of cardiac activity, sinus tachycardia is possible with physical inactivity, neurocirculatory dystonia, neuroses, and various diseases accompanied by autonomic dysfunction. The reason for contacting a doctor, including urgently, is usually not tachycardia, but other signs of diseases in which it is observed. At the same time, you should consult a doctor (as planned) regardless of the severity of other manifestations of the disease in all cases when, on different days under conditions of complete rest, the pulse rate is above 80 per 1 min. Unlike ectopic tachycardia, which occurs in the form of an attack (see below), the rate of heart contractions during sinus tachycardia depends on the level of physical activity, and it changes gradually (smoothly) and does not, as a rule, exceed 140 per 1 min.

Attack of tachycardia, or paroxysmal tachycardia, refers to conditions requiring emergency care, because. the efficiency of the heart decreases with it, especially if the ectopic rhythm comes not from the atria (supraventricular tachycardia), but from the ventricle of the heart (ventricular tachycardia). The attack begins suddenly. Initially, the patient feels a sharply rapid heartbeat, dizziness, and weakness. Sometimes an attack is accompanied by other autonomic disorders: sweating, frequent and profuse urination, increased blood pressure, rumbling in the stomach, etc. The more pronounced these vegetative disorders, which usually frighten the patient, the more favorable the attack, because these disorders occur only with supraventricular tachycardia, most often associated with a disorder of the functions of the nervous system, and not with heart disease. With a prolonged attack, pain often appears, worsening in a lying position (the patient is forced to sit).

The attack often goes away on its own (without treatment), and it ends as suddenly as it begins. In case of repeated attacks, medications recommended by the doctor are used to relieve them. If the attack occurs for the first time, you should call an ambulance. Before the doctor arrives, you must, first of all, calm the patient, relieve the seizure that often occurs at the beginning of the attack, and also try to interrupt the attack with some simple techniques. There should be no fuss, much less panic in the behavior of those around the patient; the patient is created with rest conditions in a position that is comfortable for him (lying or half-sitting), and is offered to take what is available at home - valocordin (40-50 drops), preparations of valerian, motherwort, etc., which in itself can stop the attack. Techniques that can help stop an attack include a quick change of body position from vertical to horizontal, straining for 30-50 With, inducing a gag reflex by finger irritation of the pharynx. There are other techniques, but only . He also uses special medications to relieve an attack and recommends medications that the patient should have with him and use independently in case of a recurrence of the attack.

Irrhythmic heart contractions. Inequality of intervals between heartbeats and, accordingly, irregular pulse are sometimes observed in practically healthy people. For example, in healthy children and adolescents, often (less often in adults) the intervals between heartbeats differ significantly during inhalation and exhalation, i.e., respiratory sinus arrhythmia is observed. It is not felt in any way, does not interfere with the functioning of the heart, and in all cases is assessed as a variant of the norm. To irregular heartbeats that require special attention, and sometimes special treatment, include extrasystole and.

Extrasystole is a contraction of the heart that is extraordinary in relation to the main rhythm. Depending on the location of the ectopic focus of excitation, supraventricular and ventricular extrasystoles are distinguished. Previously, it was believed that extrasystoles were always caused by some disease. IN last years When recording an electrocardiogram around the clock, it was found that rare supraventricular extrasystoles also occur in healthy people, but more often they are associated with a violation of the nervous regulation of cardiac activity. Ventricular extrasystoles, as a rule, indicate existing or past heart disease. These two types of extrasystole can be reliably distinguished using electrocardiography, but often a doctor can do this based on the characteristics of the manifestations of extrasystole.

The patient can detect an extrasystole when examining the pulse as a premature appearance of a pulse beat, as well as in cases where there are interruptions in the work of the heart (premature contraction followed by an extended pause), “tumbling” of the heart, “bird fluttering” in the chest, etc. The more distinct such sensations are and the more pronounced the sometimes accompanying feelings of fear, anxiety, “fading” of the heart and other unpleasant sensations of a general nature, the more reason to assume supraventricular extrasystole. Ventricular extrasystoles are rarely felt by the patient, and their presence and quantity are discussed more characteristic changes pulse rhythm.

If you suspect that you have supraventricular extrasystole, especially if it occurs rarely (several extrasystoles per day), you should consult a doctor as planned. If the extrasystoles are frequent (one or more per minute) or paired or group (three or more in a row) and appear for the first time, you should immediately consult a doctor, and if they are combined with chest pain or sudden shortness of breath, you should call an ambulance help. For chest pain, before the doctor arrives, the patient should be put to bed and given one nitroglycerin tablet under the tongue. If extrasystole does not occur for the first time, then during periods of its increase, follow the doctor’s recommendations received from him earlier. It should be borne in mind that even frequent extrasystoles do not always require treatment with special antiarrhythmic drugs. With supraventricular extrasystole, the use of sedatives (valocordin, valerian, motherwort, tazepam) is often more effective. program proper treatment Only a doctor can determine.

Atrial fibrillation is a complete irregularity of heart contractions due to the chaotic occurrence of excitation impulses in different parts of the atria. These impulses vary in strength, some of them do not reach the ventricles of the heart at all, others come to them after such a short pause that the ventricles contract before they have time to fill with blood. As a result, the pulse beats not only occur at different intervals, but also have different sizes. Atrial fibrillation can be permanent (with some heart defects, after myocarditis or myocardial infarction) with a normal heart rate or in the form of bradyarrhythmia or tachyarrhythmia. In the latter case, the doctor recommends a treatment aimed at slowing down heart contractions. Persistent arrhythmia is often preceded by paroxysms that last from several minutes to several hours or days. They usually occur in the form of tachyarrhythmia. In this case, the patient suddenly feels an erratic heartbeat, often dizziness, sudden general weakness, shortness of breath, and in some cases these sensations are preceded by chest pain. First aid tactics are almost the same as for paroxysmal tachycardia (see above). The patient should avoid drinking coffee, tea, or smoking. If the patient took before the attack medications, then, except for the treatment of angina pectoris (nitroglycerin, nitrong, nitrosorbide, etc.), all medications are immediately discontinued. It is especially unacceptable to take medications such as caffeine, aminophylline, ephedrine, and heart medications before the doctor arrives.

1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. encyclopedic Dictionary medical terms. - M.: Soviet Encyclopedia. - 1982-1984.

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