Atrial fibrillation (AF)- chaotic, irregular excitation of individual atrial muscle fibers or groups of fibers with loss of mechanical atrial systole and irregular, not always complete excitations and contractions of the ventricular myocardium. Clinical characteristic: atrial fibrillation.
Code according to the international classification of diseases ICD-10:
Causes
Etiology. Rheumatic heart defects. IHD. Thyrotoxic heart. Cardiomyopathies. Arterial hypertension. Myocardial dystrophy. COPD TELA. Condition after coronary artery bypass surgery. Vagotonia. Hypersympathicotonia. Hypokalemia. Idiopathic AF. Combinations of etiological factors.
Classification. Newly identified... Paroxysmal - lasting up to 7 days, self-limiting.. Persistent - usually lasting more than 7 days, not self-limiting.. Permanent form: cardioversion (CV) is ineffective or not indicated. According to the frequency of ventricular responses.. Tachysystolic form - AF with a ventricular activation frequency of more than 90 per minute.. Normosystolic form ¾ with a ventricular contraction frequency of 60-90 per minute.. Bradysystolic form - AF with a ventricular contraction frequency of less than 60 per minute. Special forms.. AF with Wolff-Parkinson-White syndrome.. AF with sick sinoatrial node syndrome (Brady-tachycardia syndrome).. AF with complete AV block (Frederick's syndrome). According to ECG parameters... Large-wave AF - amplitude of ff waves more than 0.5 mV, frequency 350-450 per minute. QRS complexes are not the same in shape.. Medium-wave AF - the amplitude of ff waves is less than 0.5 mV, frequency 500-700 per minute.. Small-wave - difficult to distinguish ff waves.
Symptoms (signs)
Clinical manifestations. They range from moderate weakness, palpitations, shortness of breath, dizziness and fatigue to severe heart failure, angina attacks, and fainting. The most pronounced subjective sensations are with diastolic myocardial dysfunction, as well as tachysystole or bradysystole.
Diagnostics
Differential diagnosis. Atrial flutter - lower frequency, contractions more regular. Atrial multifocal paroxysmal tachycardia is characterized by synchronous depolarization of the atria, but the pacemakers are two or more ectopic foci in the atria, alternately generating impulses. Atrial polytopic tachycardia is often observed in severe lung diseases, intoxication with cardiac glycosides, coronary heart disease and pulmonary embolism. Characterized by variability of the P wave and unequal R-R intervals.
Treatment
TREATMENT
Treatment tactics. Assessment of circulatory status. Conducting electropulse therapy (EPT) for emergency indications. Pharmacological CV - in the absence of urgent indications or necessary conditions for EIT. Pharmacological control of heart rate before CV and with permanent AF. If AF lasts for more than 2 days, indirect anticoagulants are prescribed for 3-4 weeks before and after CV (with the exception of patients with idiopathic AF under 60 years of age).. Prevention of relapses of AF.
Restoration of sinus rhythm— contraindications: . The duration of AF is more than 1 year - the unstable effect of CV does not justify the risk of its implementation. Atriomegaly and cardiomegaly (mitral valve disease, dilated cardiomyopathy, left ventricular aneurysm) - CV is performed only for urgent indications. Bradysystolic form of AF - after elimination of AF, sick sinoatrial node syndrome or AV block is often detected. Presence of blood clots in the atria. Uncorrected thyrotoxicosis.
Indications: AF with signs of increasing heart failure, a sharp drop in blood pressure, and pulmonary edema.
Method of implementation - see Electrical cardioversion.
The prognosis is elimination of AF in 95% of cases.
Complications of CV.. Thromboembolism during prolonged paroxysm of AF (for 2-3 days or more) due to the formation of intra-atrial thrombi (so-called normalization thromboembolism)... Before electrical CV (as well as before pharmacological) with a duration of AF more than 2 days, 3 are recommended -4 - a week course of therapy with indirect anticoagulants for the purpose of preventing thromboembolism... Transesophageal echocardiography, performed before EIT, makes it possible to exclude a thrombus located in the left atrial appendage (the most common localization of intraatrial thrombi) and conduct early CV against the background of heparin administration, followed by the administration of indirect anticoagulants for 3-4 weeks. Atrial asystole - see Atrial asystole.
Pharmacological CV most effective for early restoration of sinus rhythm (duration of AF 7 days or less). The administration of antiarrhythmic drugs should be carried out under constant ECG monitoring against the background of correction of hypokalemia and hypomagnesemia.
Procainamide 10-15 mg/kg IV, infusion at a rate of 30-50 mg/min, see Atrial flutter. In case of renal failure, the dose of the drug is reduced.
Propafenone 2 mg/kg IV over 5-10 minutes. Orally 450-600 mg at once or 150-300 mg 3 times a day for 1-2 weeks. Indicated in the absence or minimally expressed structural changes in the myocardium.
Amiodarone 5 mg/kg IV drip over 10-15 minutes (rate 15 mg/min) or 150 mg over 10 minutes, then either infusion of 1 mg/kg over 6 hours, or orally 30 mg/kg (10-12 tablets) once, or 600-800 mg per day for 1 week, then 400 mg per day for 2-3 weeks. Indicated for patients with reduced myocardial contractile function.
A combination of quinidine 200 mg orally 3-4 times a day with verapamil 40-80 mg orally 3-4 times a day is effective. Sinus rhythm is restored in 85% of patients on days 3-11.
Heart rate control with a permanent form of AF and before CV: the choice of drug is determined by the underlying pathology (thyrotoxicosis, myocarditis, MI, etc.), as well as the severity of heart failure.
Verapamil. It is especially indicated for concomitant COPD and peripheral arterial disease. Arterial hypotension may develop. Combination with IV b-blockers is contraindicated. Schemes: .. 5-10 mg IV over 2-3 minutes, if necessary, repeat after 30 minutes with another 5 mg IV, the initial effect can be maintained by infusing the drug at a constant rate of 0.005 mg/kg/min.. .orally 40-80-160 mg 3 times a day.
Diltiazem - 25 mg IV over 2-3 minutes or IV drip at a rate of 0.05-0.2 mg/min. Orally 120-360 mg per day.
B - Adrenergic blockers. Indicated for hypersympathicotonia, thyrotoxicosis. Arterial hypotension may develop. Drugs: propranolol IV slowly over 5-10 minutes 1-12 mg under blood pressure control or metoprolol 5-15 mg IV. Orally, 20-40-80 mg of propranolol 3-4 times a day.
Cardiac glycosides are indicated for persistent AF, especially for AF with reduced ventricular systolic function; contraindicated in the presence of Wolff-Parkinson-White syndrome.. Rapid rate of saturation... Digoxin 0.5 mg IV over 5 minutes, repeat the dose after 4 hours, then 0.25 mg twice with an interval of 4 hours (total 1 .5 mg per 12 hours) ... Digoxin 0.5 mg IV for 5 minutes, then 0.25 mg every 2 hours (4 times)... If intoxication with cardiac glycosides develops - solution of potassium chloride in /in drip, see Intoxication with cardiac glycosides.. Average rate of saturation... Intravenous infusion of 1 ml of 0.025% solution of digoxin (or 1 ml of 0.025% solution of strophanthin K) and 20 ml of 4% solution of potassium chloride in 150 ml of 5% glucose solution at a rate of 30 drops/min daily.... Digoxin first 0.75 mg orally, then 0.5 mg every 4-6 hours. The average dose for saturation is 2.5 mg.
If monotherapy with digoxin, beta-blockers and calcium channel blockers is ineffective, various combinations of them should be used. When verapamil is combined with digoxin, the level of the latter in the blood may increase significantly; the dose of digoxin should be reduced.
Treatment of AF due to Wolff-Parkinson-White syndrome- see Wolff-Parkinson-White syndrome.
Relapse Prevention
Selection of doses of antiarrhythmic drugs (amiodarone, quinidine, procainamide, etacizine, propafenone, etc.) with monitoring of hemodynamic parameters and ECG. Long-term use of antiarrhythmic drugs, especially subclass Ic, for the prevention of AF increases mortality in patients with post-infarction cardiosclerosis and impaired myocardial contractile function (see Cardiac Arrhythmias).
Treatment of the underlying disease.
Elimination of factors that provoke arrhythmia, such as psycho-emotional stress, fatigue, stress, drinking alcohol, coffee and strong tea, smoking, hypokalemia, viscero-cardiac reflexes in diseases of the abdominal organs, anemia, hypoxemia, etc.
Surgery used for severe clinical manifestations and ineffectiveness of drug therapy. An alternative method is radiofrequency catheter destruction of the atrioventricular node with implantation of a permanent pacemaker (if heart rate control with pharmacological drugs or severe adverse reactions is ineffective). Radiofrequency destruction of the mouths of the pulmonary veins in AF, caused by the presence of foci of automatism in this area. Implantation of atrial defibrillators that automatically detect and eliminate attacks of AF by generating an electrical impulse. Open “corridor” and “maze” operations, as well as isolation of the mouths of the pulmonary veins, are usually performed in combination with other open-heart interventions (valve replacement, etc.). In a small number of clinics, these same procedures are performed endovascularly.
Complications. Cardiogenic embolic stroke. Embolism of peripheral arteries. Bleeding during anticoagulant therapy.
Course and prognosis. The risk of stroke is small with long-term anticoagulant therapy. AF increases the risk of death from cardiovascular disease.
Synonym. Atrial fibrillation.
Abbreviations. AF - atrial fibrillation. EIT - electric pulse therapy. CV ¾ cardioversion.
ICD-10 . I48 Atrial fibrillation and flutter
Questions from users
How is Propanorm combined with β-blockers and calcium antagonists?
Propanorm goes well with beta blockers and calcium antagonists, especially in patients with coronary artery disease (without scar changes) and arterial hypertension, but we must not forget that Propanorm is also effective in patients with vagotonic rhythm disturbances (when atrial fibrillation occurs at night or early morning against the background of relative bradycardia) and in this case, drugs that can reduce heart rate (which include beta blockers and calcium antagonists) will reduce the antiarrhythmic effect of Propanorm, so in such patients it is better not to combine them.
If, when taking a loading dose of Propanorm, stopping AF paroxysm is ineffective, what are our further actions? Is it possible to administer other antiarrhythmics, etc. intravenously?
Zakharov Alexander Yurievich, Novorossiysk
If Propanorm does not stop the arrhythmia, you need to wait 7-8 hours (since the antiarrhythmic effect of the drug lasts up to 8 hours and the rhythm can be restored before this time), the patient can take a beta blocker to normalize the rhythm and reduce the symptoms of arrhythmia. After 8 hours, you can repeat the loading dose of Propanorm (450-600 mg at a time) or administer another antiarrhythmic drug.
Until this time, it is advisable not to use other antiarrhythmic drugs to exclude a proarrhythmic effect.
If hemodynamics are unstable, electrical cardioversion should be used and not wait 8 hours.
The patient takes Propanorm 450 mg/day for prophylactic purposes. At the same time, his rhythm still breaks down from time to time. Is it possible to stop a paroxysm of atrial fibrillation with the same Propanorm (“pill in your pocket”)? What dose of Propanorm should I use?
Emergency cardiologist from Ryazan
First of all, you need to assess the dynamics of the recurrence of paroxysms. If they have become more frequent only recently, look for the cause in the progression of the underlying disease (perhaps arterial hypertension has gotten out of control or CHF is progressing).
If there is no deterioration in the underlying disease, and the rhythm still breaks down after constantly taking a dose of 450 mg/day, most likely this amount of propafenone is not enough to maintain sinus rhythm. In this case, for complete prevention, the daily dose of the antiarrhythmic drug can be increased.
The resulting paroxysm can be stopped with the same Propanorm in a dose of 450 to 600 mg once, but it is necessary to take into account what dose of Propanorm the patient has already taken from the beginning of the day. The highest daily dose of propafenone is 900 mg.
Please clarify what is the tactics for using Propanorm for 1st-2nd degree AV block?
Anna Alekseevna from Sergiev Posad
Initial first-degree AV block is not a contraindication for the use of Propanorm (II-III degree AV block is a general contraindication for all antiarrhythmics). If the drug is prescribed to a patient with first-degree AV block, then after 3-5 days it is necessary to perform a HM ECG to exclude its progression to the second degree. If AV block of the first degree has progressed to the second degree, then using the HM ECG it is necessary to evaluate when it appears and what the pauses are:
- If the blockade appears only at night, then taking the drug can be continued, because the tendency to blockade may be explained by increased vagal influence on the sinus node and AV node at night.
- If the pause is more than 2500-3000 seconds, then it is better to stop the drug. In this case, the patient management tactics are as follows: if the drug effectively prevents episodes of AF, it is necessary to implant an pacemaker and continue treatment with Propanorm. You can also try to continue treatment with the drug, but move the evening dose to approximately early evening - 18 hours (not at night), and take 2 tablets directly at night. bellataminal or Zelenin drops, after which, against this background, be sure to perform a HM ECG again to monitor the effect.
- If, while AF is being relieved with Propanorm, a pause of 2500 or more occurs (1500 ms is not a big deal), then a TPES test must be performed to exclude SSSU.
If first degree AV block appeared during treatment with Propanorm, it should be regarded as a side effect of the drug. In this case, it is better to cancel Propanorm.
What is the effectiveness and safety of propafenone compared to sotalol?
In foreign (Reimold, 1993) and Russian (Almazov Research Institute of Cardiology, Tatarsky B.A.) comparative studies have proven that in terms of antiarrhythmic effectiveness, sotalol is somewhat inferior to propafenone, while side effects are recorded 3 times more often during its use (in including proarrhythmogenic effects - 1.5 times more often). It was also noted that due to side effects, sotalol 1.5 times more often has to be discontinued.
More significant regarding the dangers of sotalol use are reports of cardiac arrest and death in a number of comparative studies of sotalol with propafenone.
How does propafenone differ from other widely used class 1C drugs (etacizine, allapinin)?
O.E. Dudina from Moscow
The range of properties of propafenone is much wider than that of allapinine and etacizine, since it not only has class IC properties, but also has the characteristics of class II, III and IV antiarrhythmics. In addition to the main electrophysiological effect associated with the blockade of transmembrane sodium channels, propafenone is also characterized by β-blocking properties, explained by the structural similarity of the molecule to β-blockers. In addition, the main metabolites of propafenone (5-hydroxypropafenone and N-dipropylpropafenone) have a moderate calcium channel blocking effect. Thus, the antiarrhythmic effect of Propanorm is associated not only with the blockade of sodium channels, but also with the blockade of slow calcium channels and β-adrenergic blocking properties, which allows the drug to be widely used for the treatment of various heart rhythm disorders.
For the practicing physician, the most important factor remains that, unlike allapinin and etacizine, propafenone remains the only class 1C antiarrhythmic available in Russia, which for many years has been included in both international and Russian recommendations for the management of patients with arrhythmias. When prescribing allapinin and etacizin, the doctor acts on the basis of his own empirical experience and small local studies, which does not allow him to be protected by international experience and recommendations of professional associations, which is unsafe in such a complex field as arrhythmology.
In addition, the cost of therapy with allapinin and etacizin is higher than treatment with Propanorm.
I recently attended an improvement cycle with an emphasis on arrhythmology and learned about Propanorma. Until now, I have not prescribed “pure” antiarrhythmics - I was afraid of the proarrhythmogenic effect.
Ovchinnikova O.P. from Moscow
Unfortunately, when taking any antiarrhythmic drug, a proarrhythmic effect may occur. But when taking propafenone, this side effect develops less frequently. Due to the fact that the effectiveness and safety of propafenone has been proven in numerous studies, it is included as a priority drug in the official international and Russian recommendations for AF and PNT.
When prescribing Propanorm, you need to remember that it is not prescribed for myocardial infarction, unstable ischemic heart disease and severe CHF with reduced left ventricular EF (less than 50%).
Is there a proven method of transferring from Allapinin to Propanorm? What difficulties may arise in this case?
Terenina E.M. from Moscow
In the cardiological aspect, transferring a patient from Allapinin to Propanorm does not require special preparation: after Allapinin is discontinued, Propanorm is immediately prescribed.
If a patient has developed an alkaloid dependence while taking Allapinin, manifested by such vegetative symptoms as tachycardia, a feeling of lack of air, it will be useful to prescribe small doses of anaprilin (10-20 mg).
In cases of more serious addiction (dependence) of the patient on Allapinin, consultation with a psychiatrist is necessary.
Recently, quite a lot of patients have come to me who, while taking Amiodarone, have developed thyroid dysfunction in various manifestations (usually hypothyroidism). Is it possible to switch from Amiodarone to Propanorm? If this is possible, then how can this be done in practice?
Kuzmin M.S. from Moscow
- Indeed, taking amiodarone quite often causes extracardiac side effects. If you decide to transfer a patient from amiodarone to Propanorm, then this is possible.
- It must be remembered that an important condition for the prescription of Propanorm is the preservation of myocardial contractile function - EF > 40%.
- Most likely, rhythm disturbances (usually extrasystole or AF) are the result of diseases such as hypertension, coronary artery disease, CHF or cardiomyopathy. We know that for all of the above diseases complicated by arrhythmia, β-blockers are prescribed along with antiarrhythmics as the main drugs that reduce the risk of sudden death.
- When Amiodarone is discontinued, it is necessary to increase the dose of the blocker!
- Since amiodarone is eliminated from the body slowly (from 10 to 15 days), the moment at which Propanorm can be added to β-blockers is decided individually and depends on heart rate.
- If a patient, after stopping amiodarone, has a tendency to tachycardia (heart rate more than 75-80 beats/min), one can think that amiodarone has already been metabolized and “does not work.” This moment serves as a signal for the appointment of Propanorm.
- Ideally, of course, it is necessary to monitor the concentration of amiodarone in the blood and prescribe Propanorm at the moment when there is no longer any amiodarone left in the body, but, unfortunately, such research is practically not done in Russia.
Is it advisable to use Propafenone as a second-line drug after an unsuccessful attempt at drug cardioversion with Amiodarone? The rhythm disorder occurred more than 48 hours ago, but the patient has been under medical supervision all this time and receiving antiplatelet therapy. Is there a need for transesophageal echocardiography and subsequent 3-week preparation of the patient with indirect anticoagulants?
- If an attack of atrial fibrillation lasts more than 48 hours, it is necessary to prescribe Warfarin and perform an emergency echocardiography to ensure the absence of blood clots. If, for example, an emergency echocardiography was performed on the 4th day and it was confirmed that there were no blood clots, then electrical cardioversion (current) can be performed, but then continue taking warfarin for 3-4 weeks. If there are blood clots, then you need to continue Warfarin for 4 weeks, then repeat the emergency again
Echocardiography and decide on cardioversion.
How long can you take Propanorm for prophylactic purposes?
Low organotoxicity combined with high efficiency are undeniable arguments in favor of prescribing propafenone for the maximum required duration.
Paroxysm of atrial fibrillation ICD 10
Nosological form atrial fibrillation atrial fibrillation Diagnosis code according to ICD-10 I48 Primary diagnosis phase. Stage is all. In ICD-10, ARF and CRHD are classified as diseases of the circulatory system, class IX and. With paroxysms of atrial fibrillation, accompanied. However, in modern classifications of mental illnesses ICD-10. functional class; rare paroxysms of atrial fibrillation with.
At the moment of paroxysm, the state of health is relatively normal between attacks. Patients meeting criteria I48 according to ICD-10 were included. Gordeev S. A. New relationships in the pathogenesis of atrial fibrillation.
Wed, 10/31/2012 — - admin. Paroxysm of atrial fibrillation lasting less than a day, age up to 60 years, including individual ones. Paroxysms in atrial fibrillation and atrial flutter after restoration of sinus rhythm; If creatinine clearance is in the range of 10-30 ml/min, dose. Nosological classification of ICD-10. Vucheticha, 10-A. postoperative complications, such as hypertensive crisis, paroxysm of atrial fibrillation and pneumonia, as well as pulmonary embolism, etc. The international classification of sleep diseases lists about 80. Less frequent 10-60% nocturnal attacks of breathlessness, decreased libido and potency. and paroxysms of atrial fibrillation changed from regular to sporadic.
Atrial fibrillation emergency care in the dentist's chair
Bibliography: Golikov A.P. and Zakin A.M. Emergency therapy, p. 95, M. 1986; Mazur N.A. Fundamentals of clinical pharmacology and pharmacotherapy in cardiology, p. 238, M. 1988; Guide to Cardiology, edited by R.I. Chazova, t. 3, p. 587, M. 1982; Smetnev D.S. and Petrova L.I. Emergency conditions in the clinic of internal diseases, p. 72, M. 1977.
1. Small medical encyclopedia. - M. Medical Encyclopedia. 1991-96 2. First aid. - M. Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary of Medical Terms. - M. Soviet Encyclopedia. - 1982-1984
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The diagnosis of paroxysmal atrial fibrillation (PAF) is a type of arrhythmia, a disorder of atrial contraction. Another name for atrial fibrillation is atrial fibrillation. The paroxysmal form of the disease is characterized by the alternation of normal heart function with the occurrence of attacks (paroxysms) of tachycardia. During paroxysm, the atria contract irregularly and frequently (up to 120-240 beats per minute). This condition occurs suddenly and may end spontaneously. Such attacks require immediate contact with a specialist and treatment.
The paroxysmal form of atrial fibrillation is understood as a form of atrial fibrillation, in which an attack of pathological heart rhythm lasts no more than 7 days; with a longer duration of the attack, a permanent form of atrial fibrillation is diagnosed
Paroxysm in atrial fibrillation is one of the most common manifestations of disruption of the process of atrial contraction. This is a tachycardic attack, which is characterized by an abnormal heart rhythm and an increase in heart rate to 120-240 beats per minute.
The ICD 10 classification of diseases assigns paroxysmal atrial fibrillation the international code I48.
Attacks of this type of arrhythmia usually begin suddenly. After some time they stop in the same way. The duration of this condition on average takes from several minutes to two days.
Elderly people over 60 years of age are more susceptible to the disease. Only in 1% of cases does it occur in young people.
The paroxysmal form of the disease is difficult for humans to tolerate, since with atrial fibrillation the heart rate becomes high. During an attack, the heart works under increased load; it contracts frequently, but weakly. There is a high probability of blood clots forming in the atria due to blood stagnation. Thrombus embolism can lead to ischemic stroke.
A frequent complication of the pathology is the development of heart failure.
Clinical picture
Dizziness is one of the symptoms of paroxysmal atrial fibrillation
The paroxysm that occurs during atrial fibrillation manifests itself with certain clinical signs. Symptoms of the disease may differ in different cases. In some patients, during an attack, only pain is felt in the heart area. Others may complain of the following signs of illness:
- severe weakness throughout the body;
- feeling of lack of air;
- strong heartbeat;
- sweating;
- trembling in the body;
- feeling of coldness in the upper or lower extremities.
During an attack, some patients experience paleness of the skin and cyanosis, that is, blueness of the lips.
If the attack is severe, then the standard symptoms are supplemented by accompanying signs:
- dizziness;
- semi-fainting state;
- loss of consciousness;
- panic attacks.
The last symptom often manifests itself, since at the moment of a strong deterioration in health, a person begins to seriously worry about his own life.
Important! Symptoms characteristic of paroxysmal atrial fibrillation may also indicate other diseases. To accurately determine the cause of their appearance, it is necessary to undergo a set of diagnostic measures.
Upon completion of the attack of paroxysmal atrial fibrillation, the patient experiences a clear increase in intestinal motility. Also at this point there is profuse urination. If the patient's heart rate decreases excessively, the cerebral blood supply deteriorates. It is this change that explains the development of semi-fainting and fainting states. Respiratory arrest, requiring urgent resuscitation measures, cannot be ruled out.
Possible complications
The paroxysmal form of atrial fibrillation requires mandatory treatment. Otherwise, the disease will lead to serious complications. As a result of untreated pathology, patients develop heart failure and blood clots. These conditions lead to cardiac arrest and ischemic stroke. Possible development of Alzheimer's disease.
The most dangerous complication is death.
Diagnostics
The primary stage of diagnosing arrhythmia can be carried out by a therapist or cardiologist using an electrocardiogram
Atrial fibrillation is a sign of serious illness. If a person has atrial fibrillation, they may need emergency care. However, to carry out the necessary therapy, the correct diagnosis must be established.
The most important method for diagnosing paroxysmal atrial fibrillation is electrocardiography. The ECG shows the main signs indicating the disease.
Advice! It is necessary to trust the interpretation of the ECG result to a competent specialist. Self-assessment of the result may lead to an incorrect diagnosis.
Holter monitoring, exercise tests, listening to heart sounds with a phonendoscope, ultrasound and ECHO CG are used as auxiliary diagnostic methods.
Treatment
Only a competent specialist can prescribe the correct treatment. For paroxysmal atrial fibrillation, it may be necessary to use different techniques. They are selected individually for each patient.
The choice of treatment method directly depends on the duration of paroxysms and the frequency of their occurrence.
If atrial fibrillation bothers a person for no more than 2 days, then doctors take measures to restore sinus rhythm. At a later stage, treatment is required to help prevent the development of life-threatening complications.
In difficult situations, the patient is prescribed therapy, the main goal of which is to restore the correct rhythm of atrial contractions. Additionally, you need to take medications that can thin the blood.
Drug treatment
Class III antiarrhythmic drug, has antiarrhythmic and antianginal effects
Paroxysmal heart rhythm disturbances, which affect the entire cardiovascular system, can be combated using medications. To reduce heart rate and restore disturbed rhythm. the drug Cordarone is used. It has a minimal number of side effects, so it is suitable for treatment for most patients.
When diagnosed with atrial fibrillation, Novocainamide is often prescribed. The drug is slowly introduced into the human body. During the procedure, it is forbidden to rush, as the injection can sharply reduce blood pressure, thereby aggravating the situation. In some cases, Digoxin is prescribed, which is able to control ventricular contraction.
Note! The medications listed above are administered by injection. Therefore, patients should not use them themselves at home. Such drugs are administered to a person during an attack by emergency doctors or specialists who work in an inpatient department.
If the prescribed drug showed a good result for the first time, then when using it for a new attack you should not expect the same effect. Each time the effect of the medication will weaken.
Electropulse therapy
Electropulse therapy is used to treat atrial fibrillation, the procedure is carried out in the clinic in one day, the patient should not eat anything for 6 hours before the session.
To eliminate attacks of arrhythmia, a method of electrical pulse treatment was developed. It is prescribed if the medication course does not give the expected result. Electrical discharge is indicated for patients who have developed complications due to another paroxysm.
Electropulse treatment is performed according to the standard scheme:
- Initially, the patient is put into a state of medicated sleep and anesthesia (the procedure is characterized by high pain).
- 2 electrodes are installed on his chest area.
- Next, you need to set the required mode, which corresponds to the category of atrial contractions;
- All that remains is to set the current indicator and carry out the discharge.
After the discharge, the heart begins its work again. From now on, its functions are performed a little differently. The electric current “recharges” the conduction system, which is why it is forced to begin sending rhythmic impulses of excitation to the sinus node.
Practice shows that this treatment option in most cases guarantees a positive result.
Surgical intervention
If attacks of the disease occur too often, the patient will require surgical intervention. It is used to relieve symptoms of pathology and eliminate its cause. Thanks to this method, attacks of arrhythmia are stopped, since the surgeon destroys the source of pathological excitation in the heart.
Relieving paroxysm and preventing new attacks is the main goal of the operation.
Surgery (catheter ablation) is performed using a catheter that is inserted through an artery. If necessary, the operation is repeated after a certain period of time.
What to do during an attack?
The patient and his relatives should know what to do if a paroxysm occurs. The following procedures help to completely remove or reduce the intensity of the painful condition:
- abdominal compression;
- holding your breath;
- pressing on the eyeballs.
At the same time, it is necessary to call an ambulance. The doctor injects the patient intravenously with Korglikon, Strophanthin, and the drugs Ritmilen, Aymalin or Novocainamide. Sometimes an attack is relieved by intravenous administration of potassium chloride.
Forecast
In terms of prognosis, arrhythmias are extremely ambiguous; it is recommended to limit the intake of stimulants (caffeine), avoid smoking and alcohol, and independently select antiarrhythmic and other drugs
The prognosis for treatment of paroxysmal atrial fibrillation depends on the disease that caused the disturbance in the rhythm of atrial contraction.
With proper treatment, you can live another 10-20 years with this disease.
Lack of therapy and failure to provide timely assistance to a patient during an attack of paroxysmal atrial fibrillation can result in the development of dangerous conditions that lead to death.
In diagnoses you can often find a disease such as atrial fibrillation, which has a code according to the International Classification of Diseases (ICD-10) I48.
This indicates the beginning of a pathology that is dangerous in all respects. The disease is characterized by uncontrolled excitation of various muscle fibers localized in the atrium.
As clinical manifestations increase, the fibers lose mechanical strength. Against this background, pathological contraction of the ventricular myocardium often develops. In most cases, the patient is diagnosed with atrial fibrillation.
Physiological aspect of the disease
Regardless of the intensity of clinical manifestations, the international directory of diseases requires mandatory medical intervention. During the initial examination, the doctor conducts an oral interview and orders an examination. Its goal is to determine the causes of the disease. Cardiac pathology of this kind has the following prerequisites:
From the above list it is easy to understand that the disease develops against the background of chronic problems of the cardiovascular system. In this regard, doctors strongly recommend regular examinations for preventive purposes. The frequency of such a procedure depends on whether the person or his relatives have had a history of atrial fibrillation.
Cardiologists recommend not giving up the opportunity to learn something about your own body, even for those who have not previously complained of cardiac activity. A healthy person needs to visit a cardiologist at least once a year.
If the patient has hereditary preconditions or various diseases, then in this case the intensity of visits to the doctor should be increased - 2 times a year.
In addition, the heart can fail even a completely healthy person.
The presence of hereditary predispositions plays an important role.
Unfortunately, these latent factors are not always easy to detect.
That is why even a qualified doctor cannot always act proactively.
Types of pathological conditions
The generally accepted classification suggests that the disease manifests itself in several forms. The more accurately the doctor determines the true cause of the deterioration in health, the easier it is to prescribe an effective therapeutic course. It all starts with the form of the disease diagnosed for the first time, the duration of which does not exceed 8 days. In most cases, the disease is mild.
Despite this, a visit to the doctor is mandatory. Immediately after the tests and examination, an adequate therapeutic course is prescribed. It is carried out at home. The situation is more complicated when the patient has a paroxysmal form, the duration of which ranges from 7 to 21 days. The atrial valve cannot repair itself.
The patient is subject to mandatory hospitalization. For a certain time he is under the supervision of specialists. Their task is to determine the severity of the disease and predict its further development. As cardiac pathology develops, a citizen is diagnosed with a permanent form.
It takes several days to make a diagnosis and prescribe treatment. As a rule, the use of traditional means does not bring sufficient effect. In addition, there are several other forms of cardiac pathology:
- Normosystolic form - the number of ventricular contractions up to 85 per minute.
- Bradysystolic - ventricular flutter does not exceed 60 times within a minute.
- Tachysystolic - the maximum frequency of ventricular contractions exceeds 90 within one minute. This suggests that atrial fibrillation is of an unexpressed nature.
The forms listed above are described in the ICD, which facilitates the doctor’s work. Despite this, patients should not even try to make a diagnosis themselves.
This can only be done with the help of high-precision medical equipment. When using it, the cardiologist is able to determine the existing symptoms.
Clinical manifestations of the disease
In order to save the patient from atrial fibrillation, the doctor studies the clinical picture in detail. In some cases, consultation with a related specialist is required. This is done to comprehensively assess the patient’s health. Ischemic syndrome begins with general weakness, which is mistakenly explained by overwork.
As clinical manifestations increase, the patient develops shortness of breath and dizziness. Cardiologists urge people to remain prudent in such a situation. It’s one thing when a person’s heart rate increases after prolonged physical activity. The situation is completely different when the listed symptoms are frequent.
If the patient does not receive proper attention from doctors, the disease continues to progress. Over time, the patient becomes unable to perform even the simplest work. This is explained by the fact that with atrial fibrillation, the supply of oxygen and blood to the entire body deteriorates.
The modern scientific and technical level of medicine does not allow us to completely exclude the possibility of developing the disease. In this regard, the task of every person is to regularly undergo preventive examinations.
The persistent form of atrial fibrillation causes rapid heartbeat and leads to disruption of the circulatory system. From time to time shortness of breath and a feeling of weakness occur. The ICD-10 code is I48. Atrial fibrillation and flutter.
Quite often, the clinical picture of this disease is blurred, but in the end, most people still go to the doctor.
Causes
The persistent form of the disease is usually understood as a pathological condition in which heart attacks recur periodically. It can be present for up to 7 days, but with adequate therapy, the attack can be stopped almost immediately after its appearance - after 3-5 hours.
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Risk factors
The severity of the disease and prognosis are influenced by many factors.
The most common include the following:
- age;
- presence of problems in the functioning of the heart;
- chronic pathologies - this may be diabetes mellitus, thyroid disease, sleep apnea, metabolic syndrome;
- excessive alcohol consumption – this factor significantly increases the risk of cardiac arrest;
- obesity – being overweight significantly weakens the immune system and increases the tendency to develop cardiovascular diseases;
- hereditary predisposition.
Symptoms
To make an accurate diagnosis, you need to know what signs are characteristic of this disease:
- discomfort in the chest area and disturbances in the rhythm of the heartbeat - with this pathology it becomes more frequent;
- general weakness;
- dizziness;
- chronic fatigue.
If any of these manifestations occur, you should consult a specialist. The doctor will definitely prescribe an examination - this form of atrial fibrillation is visible on the ECG. In this case, the clinical picture during an attack and outside a paroxysm may differ.
Sometimes a persistent form of atrial fibrillation (tachysystolic variant) is observed. This disorder consists of an abnormal heart rhythm, which is observed at a fast pace - in this case, the number of heart beats per minute exceeds 90. It is worth noting that this form of the disease is the most difficult for patients to tolerate.
It is important to consider that chest pain in middle-aged and elderly people is a prerequisite for a heart attack. Therefore, the appearance of such sensations should definitely be a reason to consult a doctor.
Prevention
The human body has a high capacity for self-healing. That’s why it’s so important to eliminate bad habits, eat right, and lead an active lifestyle.
To start the regeneration processes, you should stop smoking and drinking alcoholic beverages. Regular visits to the doctor and strict implementation of all his recommendations are of no small importance.
Serious lifestyle correction helps restore the condition of all systems and organs. Thanks to this, the process of updating the immune system and restoring general condition is launched.
A persistent form of atrial fibrillation may be a prerequisite for the development of a heart attack. Therefore, people with this diagnosis definitely need to monitor their health.
The heart is a major organ and its condition directly depends on mental balance and physical health.
To cope with the persistent form of the pathology, Atorvastin is used in addition to traditional drugs for the treatment of arrhythmia - Bisoprolol and Amiodarone. This remedy must be taken every day, with a daily dosage of 10 mg.
Thanks to the combination of these drugs, it is possible to obtain stable remission and reduce side effects. This is due to the ability of Atorvastine to reduce the duration of the Q-T interval. In addition, this drug increases the inotropic function of the myocardium.
Currently, there are modern drug treatments for this disease, which include the use of antiarrhythmic drugs in combination with each other.
The combination of a beta blocker with Amiodarone is highly effective. In this case, Amiodarone is suitable for internal use in a volume of 200 mg. The product is used every 6-8 hours. As a result, the daily norm is 600-800 mg. However, this amount is prescribed only in the first two weeks.
After this, the dosage is gradually reduced - by 200 mg every 10 days. As a result, you need to come to a maintenance volume, which is 200 g per day. During the same period, a beta blocker is also prescribed. For a long course of therapy, the use of Amiodarone is indicated in accordance with a five-day regimen.
This method of therapy also has certain disadvantages. Thus, combination treatment leads to a negative inotropic effect. This is mainly due to the beta blocker. In addition, this feature is affected by prolongation of the QT interval due to the use of Amiodarone.
With prolonged therapy, there is a risk of developing the phenomenon of so-called arrhythmia escape. As a result, the drugs gradually lose their activity without changing the dosage.
Because of this, there is a need for constant monitoring of the state of the Q-T interval and inotropic function of the myocardium. This is quite difficult to implement from a practical point of view. The fact is that many antihistamines, foods and other factors lead to dispersion of the QT interval.
To minimize the likelihood of such problems, it is recommended to use an innovative treatment regimen. It lies in the fact that, in addition to the traditional use of drugs for arrhythmia, Atorvastatin is prescribed every day.
If any problems in the functioning of the heart occur, you must immediately contact a qualified doctor who will conduct all the necessary studies and select adequate therapy.
As a result, therapy involves the use of Amiodarone in a maintenance dosage of 200 mg per day in accordance with a five-day regimen and a beta blocker - Bisoprolol, which is used at 2.5 mg per day daily. In addition, Atorvastatin is used in a volume of 10 mg per day. This remedy is used constantly, regardless of the lipid spectrum of a person.
Thanks to the use of Atorvastatin as part of complex treatment, it is possible to increase the effectiveness and safety of therapy. Thanks to this, the duration of remission increases, because the drug has a cardioprotective effect.
In addition, as a result of its use, the duration of the QT interval is reduced by approximately 14.3%. Atorvastatin also increases the inotropic function of the myocardium. This result can be achieved due to sensitization of cardiomyocyte receptors to Ca2+.
The cardioprotective effect of Atorvastatin is due to the correction of Na+ ions. This process is also affected by lipid peroxidation. These results are noticeable several hours after using the product and are not due to its lipid-lowering effect.
To stop an attack of fibrillation, a person is indicated for intravenous administration of Amiodarone at a dosage of 300 mg. To do this, use 6 ml of the drug, which is mixed with 200 ml of 5% glucose solution.
Once the patient's condition has stabilized, amiodarone is prescribed on a loading schedule: 600 mg per day for the first week, then 400 mg per day for the next week, and 200 mg per day for the third week. After this, switch to 200 mg of Amiodarone per day in accordance with the five-day regimen.
At the same time, Bisoprolol is prescribed in a volume of 2.5 mg per day. As an adjunct to this therapy, Atorvastatin is prescribed in an amount of 10 mg per day. A repeat examination should be carried out 8 hours after starting to use the drug - long before the lipid-lowering effect occurs. At this time, the drug has pleiotropic properties, that is, not related to the reduction of cholesterol.
No complications or negative health consequences were identified during this type of complex therapy. In patients with this diagnosis, the phenomenon of so-called arrhythmia escape was not observed.
This means that complex therapy of patients with this form of atrial fibrillation based on the use of Amiodarone, Bisoprolol and Atorvastatin can achieve good results. This treatment is considered cost-effective and safe for people with this diagnosis.
It allows you to achieve stable remission, which subsequently does not require an increase in the dosage of antiarrhythmic drugs and constant monitoring. In addition, this type of complex therapy reduces the threat of sudden death, stops the development of heart failure and minimizes the risk of thromboembolic consequences.
Persistent atrial fibrillation is a fairly serious disease that can lead to a heart attack and even death. To prevent this from happening, it is very important to keep your health under control.
