Causes of atrial fibrillation. Atrial fibrillation. Types of atrial fibrillation

Atrial arrhythmia is the most common and dangerous type of heart rhythm disturbance. It is also called atrial fibrillation or atrial fibrillation. According to statistics, about 2% of people over 60 years of age experience such a violation. Pathology requires timely detection and adequate drug therapy, otherwise it can lead to severe complications, even death.

This pathology affects people of both sexes and different ages, however, the prevalence of the disease increases in accordance with age.

Atrial fibrillation is one of the most common atrial arrhythmias. This violation manifests itself as frequent, chaotic excitation and contraction of individual muscle fibers in the wall of the atria.

A characteristic feature of the pathology is a high heart rate (HR), which can reach 350-600 beats per minute. At the same time, the myocardium experiences an enormous load, which leads to its wear and tear and is potentially dangerous for the development of life-threatening complications.

There are three main forms of this violation:

paroxysmal;
persistent;
permanent (permanent) atrial arrhythmia.

The mildest form of arrhythmia is paroxysmal. It is characterized by a relatively short attack, which lasts no more than seven days. In practice, such attacks rarely last longer than two days. The main feature is that the attack begins spontaneously and also spontaneously passes, and the sinus rhythm is restored on its own, without specific treatment.

The persistent form is characterized by the duration of attacks over seven days. To stop the attack, you need to take special measures. If they are observed frequently, electrical impulses are used to restore the sinus rhythm of the heart.

Permanent, or constant, form of atrial fibrillation is a severe pathology that imposes serious restrictions on the patient's life. At the same time, attacks are frequent and prolonged, the heart rhythm does not recover on its own, special therapy is ineffective.

Important! Three forms of atrial fibrillation perfectly describe the progression of the pathology. The paroxysmal form is considered mild, but without proper treatment, over time, it turns into a persistent form of atrial fibrillation.

According to the severity of symptoms and restrictions in everyday life, 4 degrees of atrial arrhythmia are distinguished:

1 degree - symptoms are completely absent;
Grade 2 - there are mild symptoms that do not interfere with daily activities;
Grade 3 - symptoms are pronounced, normal activity is limited;
Grade 4 - very severe symptoms, disability due to complete limitation of normal activity.

As you can see, atrial fibrillation is very dangerous. It is necessary to treat the pathology immediately, after the first symptoms are detected.

Causes of the violation

Alcoholism can easily cause atrial fibrillation

Atrial arrhythmia can be caused by cardiac or non-cardiac pathologies. Cardiac causes of arrhythmia and atrial fibrillation include:

cardiac conduction disorders (AV blockade);
arterial hypertension;
chronic heart failure;
cardiosclerosis;
myocarditis;
sick sinus syndrome.

In these cases, atrial fibrillation acts as a secondary pathology or part of the symptom complex of the underlying disease.

Extracardiac causes of the development of pathology:

thyrotoxicosis;
severe intoxication of the body;
overdose of cardiac glycosides;
chronic alcoholism;
long-term therapy with thiazide diuretics;
psycho-emotional tension, stress and neurosis.

This type of arrhythmia very often develops against the background of long-term drug therapy. Taking thiazide diuretics can lead to loss of potassium. Hypokalemia, in turn, provokes a number of cardiac disorders, including arrhythmia.

Important! One of the main factors provoking the development of the disorder is the age of the patient. Arrhythmia occurs mainly in people over 60 years of age with concomitant cardiovascular pathologies.

Clinical picture and symptoms

Dizziness and general weakness are manifested in the second stage of atrial fibrillation

There are two types of atrial fibrillation: atrial fibrillation and atrial flutter. With atrial fibrillation, the electrical impulse from the sinus node propagates randomly, causing the atria to contract randomly, “flicker”. Atrial flutter is a disorder in which not every impulse enters the atria, as a result, they do not contract rhythmically, but randomly “tremble”.

Symptoms of atrial fibrillation and atrial flutter depend on the subspecies of the disorder and the severity.

Arrhythmia of the first degree is asymptomatic. A person does not notice changes in heart rate. The only thing that can disturb the patient is the sudden onset of shortness of breath during heavy physical exertion.

Starting from the second stage of the disease, patients notice the following symptoms:

clearly noticeable interruptions in the work of the heart;
chest pain;
feeling your own heartbeat;
a physically perceptible increase in heart rate;
darkening in the eyes, flies and spots before the eyes;
dizziness and general weakness;
shortness of breath, inability to take a deep breath;
pre-fainting state;
feelings of anxiety and panic;
fear for your life.

One of the specific signs of severe forms of arrhythmia are panic attacks. The feeling of all-consuming fear is accompanied by lack of air, hot flashes, pallor of the skin, sweating. During an attack, almost every patient manifests thanatophobia - the fear of death.

The severity of symptoms also depends on the duration of the attack and the change in heart rate at the time of the attack. As a rule, symptoms in short attacks are more pronounced than in long ones.

Complications

Atrial fibrillation is one of the most dangerous cardiac arrhythmias. This pathology requires timely diagnosis and adequate drug therapy. During an attack in the initial stages, sinus rhythm is restored on its own. This is encouraging for many patients, but does not indicate that the pathology can go away without treatment. In fact, self-restoration of sinus rhythm after a multi-day attack depletes the myocardium. The most common complication is heart failure.

During an attack, the heart rate can reach critical values, up to 600 beats per minute. This negatively affects hemodynamics. As a result, over time, there is a severe violation of the coronary and cerebral circulation. The consequences of such changes in the body:

cerebral hypoxia;
brain stroke;
thrombus formation;
myocardial infarction;
cor pulmonale;
sudden cardiac death.

One of the first complications that every person with this diagnosis faces is a gradual deterioration in exercise tolerance. Over time, this causes normal activities such as climbing stairs to cause arrhythmias, shortness of breath, and dizziness.

At the time of the attack, the pulse is uneven. Atrial fibrillation can manifest as both tachycardia and bradycardia. In the latter case, patients often experience fainting. If, after an attack, the heart rate drops rapidly below normal, there is a risk of developing hypoxia.

Diagnostics

Ultrasound of the heart is done to exclude other pathologies that can cause arrhythmia

Atrial fibrillation, or fibrillation, is a dangerous arrhythmia that can lead to disability and death. Pathology must be diagnosed in a timely manner. For this purpose, it is necessary to consult a doctor as soon as possible. List of required examinations:

physical examination;
24-hour Holter monitoring;
Echocardiography or ultrasound of the heart;
thyroid examination.

The physical examination is the initial examination to suggest a diagnosis. After listening to the heart, measuring the pulse and pressure, the doctor can draw preliminary conclusions about the state of the patient's cardiovascular system. An ECG is required to confirm the diagnosis. By the nature of the changes on the electrocardiogram, an accurate diagnosis is made.

An echocardiogram or ultrasound of the heart is done to exclude other pathologies, including myocarditis, which can cause an arrhythmia. Examination of the thyroid gland is necessary to exclude the pathologies of this organ.

Principles of treatment

The drug should be taken in the morning without chewing, regardless of the meal, with a small amount of liquid.

Treatment of arrhythmia is aimed at restoring sinus rhythm. This is achieved with the help of special medications. The choice of such drugs is very wide, but only a specialist should prescribe them.

Important! Drug treatment is most effective in the first week after the patient's first episode of arrhythmia.

With atrial fibrillation apply:

beta blockers;
class 1 antiarrhythmic drugs;
calcium antagonists.

The choice of drug depends on concomitant disorders. For example, if a patient has AV block, beta-blockers and calcium antagonists are not prescribed. In addition, some anti-arrhythmia medications can cause short-term abnormal heart rhythms and cause bradycardia, which is very dangerous after an atrial fibrillation attack.

It should also be noted that the listed drugs affect blood pressure. It can be dangerous for hypertensive patients and patients with low blood pressure to take such medications without a doctor's prescription.

Atrial fibrillation is somewhat stressful. During an attack, panic and anxiety are observed, for the removal of which sedative medication is required. If you do not get rid of the feeling of anxiety, the attack will continue for a long time. To normalize the psycho-emotional state, sedatives (Persen, Novo-passit, Sedistress) or tranquilizers (Gidazepam, Adaptol) are used. The latter should be prescribed only by a doctor.

In the treatment of arrhythmia, it is important to choose the optimal drug that will be well tolerated by the patient's body. To prevent extraordinary attacks, such drugs must be taken in a course.

Note! In severe attacks, the likelihood of normalization of sinus rhythm with the help of drugs is 60-80%.

There is only one way to quickly and effectively restore sinus rhythm - with the help of an electric current. This procedure is carried out only in a hospital setting. The patient is immersed in a medical sleep, and then they are given 1-2 discharges, which literally rebuild the heart to a normal rhythm. The efficiency of this method is over 90%.

The most severe in the treatment is a permanent, or constant, form of atrial fibrillation. Each attack in this case can end fatally, since it is impossible to restore sinus rhythm with drugs and electrical stimulation. In this case, the patient is selected complex drug therapy. Tablets must be taken constantly to prevent the development of an attack. The basis of therapy is cardioselective beta-blockers - Atenolol, Bisoprolol, Propranolol. Additionally, cardiac glycosides and potassium preparations can be used.

What to do during an attack?

In case of a heart attack, call an ambulance immediately

Atrial fibrillation is very dangerous, as it depletes the myocardium. In no case should an attack be tolerated, waiting for the rhythm to recover on its own. Here we are talking only about cases where there are pronounced symptoms of arrhythmia and the patient understands what is happening to his heart.

With arrhythmia, you must take the drug prescribed by the doctor. If after a few hours there is no improvement, you need to call an ambulance. First aid for such arrhythmias has the following goals:

restoration of sinus rhythm;
maintaining a normal rhythm;
preventing the development of blood clots;
normalization of blood pressure.

For this purpose, Novocainamide is administered intravenously. In case of intolerance to this drug, the patient may be shown taking Verapamil or Propranolol.

If the attack lasts more than two days, the symptoms are pronounced and there is a risk of life-threatening, the method of electrical stimulation of the myocardium is used.

Forecast

The prognosis depends on the type of arrhythmia and stage. With successful relief of an attack with pills, the prognosis is conditionally favorable. The patient needs to undergo regular examinations and take some drugs, but there is a high chance that a second attack will not happen.

In the case of severe symptoms and prolonged attacks (over 7 days), the patient should regularly visit a doctor. As a rule, the patient is prescribed long-term drug therapy, including the use of beta-blockers.

The most unfavorable prognosis is with constant arrhythmia. Due to the ineffectiveness of methods for stopping an attack, each new episode is potentially dangerous with sudden cardiac arrest. To prevent such a development of the disease, the patient is forced to take antiarrhythmic drugs for life and do an ECG every three months.

Our hearts are made to contract by electrical impulses. Usually the "generators" of these impulses work rhythmically. When impulses arrive irregularly, chaotically, then arrhythmia occurs. The most common type is atrial fibrillation.

What is atrial fibrillation of the heart? With this rhythm disturbance, atrial fibrillation (fibrillation) occurs, that is, uncoordinated twitching of the atrial muscle bundles, as a result of which it cannot fully contract.

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Consequences of atrial fibrillation

Atrial fibrillation causes the heart to fail to pump blood normally. That is, other organs receive less nutrition and oxygen, part of the blood may remain in the heart, and the risk of blood clots increases.

In 35% of cases, atrial fibrillation leads to a heart attack.

For these reasons, consequences such as ischemic stroke and myocardial infarction occur. Every sixth stroke develops in a patient with this diagnosis, and 35% of patients experience heart attacks throughout their lives.

Atrial fibrillation can transform into ventricular fibrillation, leading to heart failure and even sudden cardiac arrest and death.

Why is atrial fibrillation dangerous? Possible consequences:

Ischemic stroke,
myocardial infarction,
ventricular fibrillation,
Heart failure,
Arrhythmogenic shock (cardiac arrest).

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Reasons for the development of atrial fibrillation

Extracardiac causes (general causes)

thyroid disease,
nervous stress,
Intoxication with drugs, drugs, alcohol,
viral infections,
chronic obstructive pulmonary disease,
Electrolyte disorders, in particular a lack of potassium in the body.

Cardiac causes (cardiac)

High blood pressure
coronary artery disease,
Heart defects
cardiomyopathy,
Heart failure,
Pericarditis,
Disorders in the work of the sinus node,
Complications after heart surgery.

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Classification of atrial fibrillation

Depending on the clinical picture, paroxysmal and constant atrial fibrillation are distinguished.

Paroxysmal atrial fibrillation

The paroxysmal form of atrial fibrillation means its paroxysmal course.

An attack (paroxysm) of arrhythmia can last from one to several days. It consists in the failure of the rhythm of heart contractions. The heart works with increased load, so the attack is usually difficult to tolerate.

Diagnosis of paroxysmal atrial fibrillation is based on an electrocardiogram. On the ECG, signs of atrial fibrillation have their own characteristics.

Permanent form of atrial fibrillation

In chronic violation of the heart rhythm, long periods of its chaotic contraction, a constant atrial fibrillation is diagnosed.

In addition to an irregular heartbeat, weakness, trembling, sweating are noted, and a feeling of fear may occur. This form of arrhythmia is dangerous with the progression of heart failure and the formation of blood clots.

Most often, a permanent form of arrhythmia is observed in people over 60 years of age.

Depending on the heart rate, there are:

Normosystolic arrhythmia, at which the number of heart contractions remains normal (60-90 beats).
Tachysystolic arrhythmia when, in addition to a violation of the rhythm of heart contractions, their increase (over 90 beats per minute) is observed.
Bradisystolic arrhythmia, during an attack of which the heart contracts less frequently (less than 60 contractions).

Signs of atrial fibrillation

An attack (paroxysm) of atrial fibrillation is accompanied by heart pain, shortness of breath, muscle weakness, tremor.
Symptoms often include increased sweating and frequent urination.
Dizziness and even fainting may occur.
In addition, the patient feels a strong inexplicable fear.

The most pronounced signs are in the tachysystolic form of atrial fibrillation.

During normal heart function, P waves are present on the ECG (see Fig. "a"). With atrial fibrillation, P waves are absent, instead of them, f waves of different shapes and heights are recorded (see Fig. "b").
R-R intervals of different duration (see Fig. "b"), in contrast to the normal ECG, where the R-R intervals are the same (see Fig. "a").
The S-T segment and T wave may be slightly altered.

ECG during normal heart function (a) and ECG during atrial fibrillation (b).

Treatment of atrial fibrillation of the heart

Treatment is aimed at restoring the rhythm and normalizing the heart rate (with tachysystolic and bradysystolic forms of the disease). The cardiologist will draw up a diagram of how to treat atrial fibrillation of the heart, make the necessary appointments.

First aid for paroxysmal atrial fibrillation

How to remove an attack of atrial fibrillation? If, despite following the prescriptions, an attack has begun, you should immediately take the medicine for atrial fibrillation of the heart, prescribed by the doctor. This may be enough to stop the paroxysm.

An attack of atrial fibrillation must be stopped within 48 hours.

If the state of health has deteriorated sharply, there is pain behind the sternum, shortness of breath, you do not need to wait for the medicine to take effect - you need to urgently call an ambulance. While waiting for an ambulance, you should provide access to fresh air, with weakness and dizziness, you need to lie down.

One of the most formidable complications of atrial fibrillation is cardiac arrest. In this case, we are talking not so much about the removal of an attack, but about the treatment of paroxysmal atrial fibrillation to save the patient's life. You may have to do chest compressions and artificial respiration before the doctor arrives. It is important not to panic, because someone's life may depend on your actions.

In any case, the relief of an attack of atrial fibrillation must be done within 48 hours, otherwise blood clots form and the risk of complications such as heart attack and stroke increases significantly. The attack is usually stopped by the introduction of antiarrhythmic drugs, if the effect does not occur, electrical impulse therapy is performed.

Treatment of atrial fibrillation with folk remedies

In the early stages of the disease and with mild symptoms, as well as additional therapy, folk remedies can be used to treat.

Basically, alternative treatment is herbal medicine aimed at supporting and nourishing the heart. The most commonly used plants are:

hawthorn,
lemon,
celery,
adonis herb.

The action of plants is based on their high content of potassium, magnesium and other substances that have a beneficial effect on the heart muscle.

Hawthorn is used fresh, in the form of alcoholic tinctures and water decoctions.
Lemon and onion are most often used in pureed.
Celery can simply be eaten regularly.

Treatment methods prescribed by a cardiologist

medical therapy,
Surgical treatment: pacemaker implantation, catheter ablation.

Medical therapy

Drug treatment of a permanent form of atrial fibrillation involves the use of antiarrhythmic drugs, beta-blockers, anticoagulants and metabolic drugs. Each group of drugs has its own goals for influencing the body.

Drugs for the treatment of atrial fibrillation:

Antiarrhythmic drugs(Verapamil, Kordaron) - with their help, a normal heart rhythm is maintained. With intravenous administration, the action can begin within 10 minutes.
Beta blockers(Atenolol, Sotalol, Bisoprolol) is a large group of drugs used to regulate blood pressure and reduce heart rate. These drugs prevent the development of heart failure.
Anticoagulants- needed to thin the blood, respectively, to prevent the formation of blood clots.
Metabolic drugs- nourish and protect the heart muscle. These include ATP, potassium and magnesium preparations, Riboxin, Mexicor and others.

Surgical treatment of atrial fibrillation

Surgery involves the implantation of a pacemaker and catheter ablation, which can be performed using:

laser,
chemical substances,
cold
radiofrequency method.

Open heart surgery is almost a thing of the past.

Open heart surgery is almost a thing of the past. Today, surgical treatment of arrhythmia is a minimally invasive operation performed under local anesthesia, through small incisions and punctures in the clavicle or abdominal cavity, as well as by inserting a catheter through the femoral vein.

Implantation of a pacemaker in atrial fibrillation is a fairly effective treatment in the case when the patient has a bradysystolic form. The device gives the heart signals at the desired frequency, doing this only when the heart needs it.

Ablation is a kind of “cauterization” of that part of the heart that is responsible for supplying an electrical impulse. A micro scar is formed, due to which the affected area loses conductivity. Thus, it is possible to achieve the elimination of the cause of cardiac arrhythmias.

The most widely used radiofrequency ablation (RFA). Such an operation is performed quite quickly, has no age restrictions.

Immediately before the operation of radiofrequency ablation, a thorough examination is carried out, special preparation is performed: a drug is injected to prevent thrombosis.

The electrode with which the procedure is performed is brought to the heart through the femoral vein. The entire course of manipulations is controlled by visualization on the monitor. Due to this, the probability of erroneous actions of the surgeon is minimized.

The success of operations is about 85%. A significant part of patients today prefer to have such an operation instead of “sitting” on pills for many years.

Where to treat atrial fibrillation?

Extensive experience in performing operations for the treatment of atrial fibrillation has been accumulated in clinics in Germany and Israel. Many of them have the most modern equipment, which helps to perform diagnostics and treatment in the shortest possible time. As for pacemakers, Israeli clinics have been using them for the treatment of arrhythmias for more than 50 years.

How much should you expect to receive qualified assistance from foreign cardiologists? Diagnosis will cost about 2,000-3,000 US dollars, and treatment in Germany about 25,000 dollars. Israeli medicine is in many cases cheaper by 30-50 percent.

Treatment in an Israeli clinic

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Is it possible to prevent atrial fibrillation?

If there is no arrhythmia yet, then no special prevention other than a reasonable lifestyle is required.

Nervous tension must be able to relieve without harm to health.

How to live with atrial fibrillation? If there is already an arrhythmia, then to prevent its attacks it is necessary:

quit smoking,
improve weight control
learn to relieve nervous tension without harm to health.

Feasible physical activity with atrial fibrillation can be useful, but they should definitely be agreed with the doctor. Patients aged are hardly worth starting active physical training.

Nutrition for atrial fibrillation is an important factor in prevention

What should be the diet for atrial fibrillation?

Food should not be greasy
more herbal ingredients
for electrolyte balance, you need to regularly eat foods rich in potassium (honey, walnuts, dried apricots, pumpkins, zucchini).

Do not eat at night, it is better to take food in small portions.

The heart rhythm depends on impulses originating in the sinus node of the heart and transmitted to the bundle of muscles responsible for the normal mode of contractions of the ventricles. The rate of such rhythmic actions is from 60 to 90 beats per minute in a calm state. The atria serve as a reservoir for blood coming from the veins, and the ventricles pump it into the arteries. In a healthy body, heart contractions are carried out at regular intervals.

Atrial fibrillation is a serious condition that requires treatment.

Heart rhythm disturbances can manifest themselves in different ways:

more than 90 beats per minute (tachycardia that occurs as a pathology or as a temporary phenomenon resulting from feelings of fear, physical activity, etc.);
slow sinus rhythm (bradycardia);
appearance (extrasystole);
rapid chaotic contraction of the heart muscles (atrial fibrillation).

Interruptions in heart rate can be extremely dangerous and cause serious complications, so if abnormalities are found, it is important to contact a specialist in a timely manner.

What is atrial fibrillation

Atrial fibrillation, also called atrial fibrillation (fibrillation), is a serious rhythm disorder characterized by chaotic contraction of the atrial muscles at a frequency of 350 to 700 beats per minute. Pathology has been assigned a code in the International Classification of Diseases (ICD code 10 - 148), it occurs quite often and can be diagnosed at any age, but over the years the risk of its occurrence increases. If by the age of 50 atrial fibrillation is observed in 1% of the population, then after 60 there is an increase in the number of patients up to 10%. This is associated with the development of heart disease in old age.

Atrial contraction in the presence of pathology occurs in a frantic rhythm with great frequency, but is defective, because the walls twitch or “flicker”. This is provided by chaotic electrical waves, the appearance of which is due to pathological processes, they prevent the normal flow of impulses from the sinus node to the muscle of the organ. The atrioventricular node, which slows down the impulses, transmits them further along the conductive tissues, called the bundle of His, to the ventricles, causing them to contract. With violations of the conduction system, the ventricles contract irregularly, and each atrium is filled with blood unevenly.

Classification of pathology: ICD code 10 - 148

Atrial fibrillation can be:

paroxysmal (attack) - lasts no more than a week, passes on its own;
persistent (steady) - lasts more than 7 days and requires medical intervention;
long-term persistent, its duration can be more than a year;
permanent (permanent), not amenable to treatment.

Paroxysmal atrial fibrillation is short-lived and does not cause serious consequences, since a blood clot does not form in a short time. Rhythm is restored by itself. With a persistent form, there is a risk of blood clots, and the patient needs qualified medical care to normalize cardiac activity. Constant atrial fibrillation provokes serious deviations, medications in this case do not help the patient to eliminate the pathology.

According to the frequency of attacks, atrial fibrillation is divided into:

diagnosed for the first time;
with rare frequency;
systematic.

Manifestations of atrial fibrillation can be:

without symptoms;
with mild symptoms
with severe symptoms, in which the patient's activity is limited;
symptoms of the development of pathology leading to the patient's disability.

According to the frequency of contractions, there are:

bradysystolic form (less than 60 beats per minute);
normosystolic (60 - 90 beats per minute). This is the most favorable form, in which the frequency is normal for a healthy person;
tachysystolic (more than 90 beats per minute).

Atrial fibrillation may be characterized by atrial fibrillation (above 400 beats per minute and asynchronous ventricular contraction) or atrial flutter (less than 400 beats per minute, the rhythm may remain normal).

Atrial fibrillation provokes complications that can even lead to death. As the pathology progresses, the myocardium wears out, and the ventricles become unable to pump the required volume of blood, resulting in heart failure. In addition, the longer the arrhythmia proceeds, the greater the risk of blood clots, which can then come off and enter the organs, thereby providing an ischemic stroke or vascular thrombosis. The development of serious complications in the advanced age of the patient is especially likely.

Causes

The factors contributing to the course of atrial fibrillation include cardiac pathologies:

cardiosclerosis;
atherosclerosis of the coronary arteries;
heart failure (may be both a consequence and a source of arrhythmia);
congenital heart disease;
valvular defects;
damage to the sinus node;
myocarditis, pericarditis;
hypertension;
heart tumors;
transferred operations.

Non-cardiac reasons:

thyroid disease;
hormonal abnormalities;
diabetes;
obesity;
viral, infectious diseases;
respiratory diseases;
renal pathologies;
sleep apnea syndrome (stopping breathing during sleep, causing oxygen starvation);
deficiency of essential trace elements;
drug overdose;
alcohol, smoking, drugs;
electric shock;
exorbitant physical activity;
stresses, nervous shocks causing disorders of the central nervous system;
hereditary predisposition.

Symptoms

Sometimes the course of the pathology passes without symptoms, but the following symptoms are most often observed:

heaviness, pain in the chest;
uneven pulse;
coldness of the extremities;
violation of the frequency and depth of breathing, a feeling of lack of air;
dizziness, nausea, loss of consciousness;
excessive sweating;
increase in the volume of urine;
general weakness.

The severity of symptoms depends on the form of the pathology. If you find such signs, you should immediately contact your doctor for examination and diagnosis of the disease.

How to treat atrial fibrillation

Pathology is diagnosed (ICD-10 code - I48) by an electrocardiogram. The causes and evaluation of the clinical picture can be determined using the method of ultrasound of the heart with dopplerography, hormone studies, MRI, CT, chest x-ray. For the treatment of pathology, various methods are used to normalize the heart rhythm. The combination of methods allows you to stop the manifestations of pathology much faster. After taking measures to normalize heart contractions, the patient needs breathing exercises that improve heartbeat and impulse conduction.

Medical treatment

Therapy is carried out individually, taking into account all factors. In accordance with the severity of the pathology, the ongoing diseases, tablets and injections are prescribed that relieve symptoms, normalize the activity of the heart and prevent the formation of blood clots.

Tablets can be prescribed for emergency medical intervention or a long course. With a permanent form of pathology that cannot be treated, they are supportive agents.

Surgical treatment of atrial fibrillation

With the ineffectiveness of drug therapy, the following types of surgical interventions can be prescribed:

(RFA). The method involves cauterization of foci formed on the heart muscle and being the root cause of arrhythmia, with special catheters. Minimally invasive operation contributes to the normalization of the heart rhythm. During the procedure, holes are pierced to insert catheters, endocardial probes-electrodes, and an ablation electrode are installed. The operation is carried out under the control of electrophysiological equipment and X-ray television. The use of this type of surgical manipulation is considered the safest and most effective method of exposure.
Ablation with the introduction of a pacemaker is used for serious complications of the pathology. During surgery, the atrioventricular node is removed and an artificial rhythm stimulator is implanted.
Operation Labyrinth. It is carried out on an open heart by applying many notches resembling a labyrinth. Thus, unwanted impulses to the ventricles are not allowed.
Operation Corridor. During surgical manipulations, a kind of corridor is created to the ventricles, isolating the atria from the conduction system.

Treatment with folk remedies

After consultation with the attending physician, it is possible to use alternative medicine, which also successfully stops the development of the disease. At home, you can prepare decoctions and infusions that help eliminate arrhythmias,.

Hawthorn. Berries are used in many recipes to combat arrhythmias. The plant has a strengthening effect on the walls of blood vessels, reduces cardiac and nervous excitability, restores the balance of microelements responsible for the conduction of impulses. You can prepare a decoction only from hawthorn berries or add motherwort herbs, valerian, wild rose.
Honey is used as the basis of many traditional medicines. The medicinal mixture is prepared with the addition of lemon, various infusions and decoctions of wild rose, viburnum, calendula flowers, cranberries.
Herbs. You can use herbal infusions and decoctions of motherwort, adonis, calendula, mint, sweet clover, rose hips.

Nutrition for atrial fibrillation

When making a diagnosis of atrial fibrillation, it is necessary to reconsider not only the lifestyle, get rid of bad habits, but also change the daily diet. Eat foods that are rich in vitamins and minerals. A diet for atrial fibrillation should include citrus fruits, honey, nuts, onions, garlic, cranberries, dried fruit viburnum, sprouted wheat. The dietary diet excludes fatty foods, confectionery, coffee, chocolate, canned food, smoked meats. In addition, experts confirm the fact that atrial fibrillation and alcohol are incompatible. Drinking alcoholic beverages can trigger an attack. The pathology that appeared due to the large amount of alcohol drunk is designated by the medical term "holiday heart syndrome".

Atrial fibrillation: life prognosis

How long they live with atrial fibrillation is not easy to say, it all depends on the timely measures taken to eliminate the pathology, as well as its root cause. Modern medicine offers effective methods to get rid of the disease, so if the patient asked for help in time, serious consequences can be avoided. Even with a permanent form of pathology, proper treatment and a healthy lifestyle allow the patient to live for many years. The prognosis also depends on the nature of the underlying disease, against which the arrhythmia develops.

The human heart is able to generate and conduct electrical impulses, this ability is realized through the conduction system of the heart. In a normally functioning heart, impulses occur with the same frequency and frequency from 60 to 90 per minute, providing the correct rhythm of heart contractions. In the presence of certain heart diseases, rhythm and conduction disturbances occur, leading to non-synchronous contraction of the myocardium and causing discomfort. One such arrhythmia is atrial fibrillation.

Atrial fibrillation is a disease that occurs as a result of a chaotic contraction of individual muscle fibers of the atria, characterized by the occurrence of a correct (regular) or irregular rhythm and leading to myocardial wear with the development of heart failure. With the development of this type of rhythm disturbance, each fiber contracts separately, which prevents the full ejection of blood into the ventricles, and, accordingly, into the aorta and pulmonary arteries, followed by a violation of blood flow in other organs.

According to electrophysiological criteria, atrial fibrillation is divided into flicker (fibrillation) and atrial flutter. These two types differ in that during fibrillation, the atrial contraction rate exceeds 400 beats per minute (usually 600 - 800 per minute), while the rhythm is incorrect, that is, the ventricles contract at different intervals. With flutter, the atrial rate is less than 400 per minute (240 - 300), and the rhythm can remain correct, that is, the ventricles contract with the same frequency in response to every second, third, or fourth atrial contraction. With both types of atrial fibrillation, the frequency of ventricular contractions (respectively, heart rate) is less than the frequency of atrial contractions, since the atrioventricular node, due to physiological characteristics, can conduct impulses from the atria to the ventricles at a frequency of 200 - 220 per minute.

Often in the same patient, flickering and flutter occur sequentially, replacing each other, therefore, from the position of clinical terminology, the term atrial fibrillation is equated with the term atrial fibrillation, which is not entirely accurate.

There are paroxysmal (paroxysmal) and permanent forms of atrial fibrillation. Paroxysm is the occurrence and relief of an attack (independent or medication) during the first seven days, then, if the correct rhythm is not restored, atrial fibrillation is considered permanent. The difference between these forms lies in the tactics of managing patients - with a paroxysm of flickering or fluttering (for the first time or repeated), the rhythm should be restored, while with a permanent form, restoring the rhythm is fraught with the development of thromboembolic complications.

Depending on the heart rate, there are tachysitolic (heart rate more than 90 per minute), normosystolic (60 - 90 per minute) and bradysystolic (less than 60 per minute) types of atrial fibrillation.

Causes of atrial fibrillation

In the development of the disease, the main role is played by processes that cause the re-entry of electrical excitation to the same muscle fiber, which is manifested by the occurrence of fibrillation (literally, muscle twitching). Such repeated waves of circulation occur if the nearby fibers do not have the ability to conduct an impulse, which, as it were, returns back.

The most common cause of these processes in the myocardium are acquired heart defects, since overflowing with blood in the atria leads to stretching of their walls, an increase in intra-atrial pressure and malnutrition of muscle fibers, so they can no longer fully conduct impulses.

The presence of cardiosclerosis in a patient (replacement of the heart muscle with scar tissue) also provokes the above-described mechanism of improper impulse transmission, because the scar tissue is not able to conduct electrical signals. Diseases such as coronary heart disease, myocardial infarction, myocarditis (inflammatory diseases of the heart muscle - viral or rheumatic in nature) can lead to the formation of cardiosclerosis.

Endocrine diseases should be singled out as a separate item, due to the fact that some hormones have an effect on the heart muscle with an increase in rhythm, for example, thyroid and adrenal hormones (adrenaline, norepinephrine). With an excess of these hormones in the blood, constant stimulation of the heart muscle develops, which sooner or later will fail and lead to chaotic work of the atrial fibers. Such diseases include hyperthyroidism and pheochromocytoma.

In addition, disturbances in synchronous contraction can occur when the body is poisoned by toxic substances - alcohol, carbon monoxide, and other poisonous gases.

Symptoms of atrial fibrillation

Sometimes the disease is asymptomatic and is detected only during a routine examination. But in most cases, patients are concerned about the following complaints:

Feeling of rapid heartbeat, stopping and interruptions in the work of the heart;
- weakness, dizziness, sweating;
- pain in the region of the heart;
- shortness of breath, feeling of shortness of breath.

With a permanent form of atrial fibrillation, the clinical signs are more blurred, as patients adapt to the disease and get used to the subjective sensations of rhythm disturbance. With a long-term permanent form (for many years), the heart muscle gradually wears out, resulting in the formation of chronic heart failure. This pathology is characterized by stagnation of blood in the lungs, liver and other organs and is manifested by shortness of breath (when walking, climbing stairs, at rest), episodes of "cardiac" asthma or pulmonary edema (more often at night), swelling of the lower extremities, an increase in the abdomen and pain in the right hypochondrium (due to increased blood supply to the liver).

With the development of complications, the clinical picture is supplemented by characteristic symptoms - suffocation with bubbling breathing, loss of consciousness, paralysis of a part of the body, a sharp decrease in blood pressure, collapse, respiratory and cardiac arrest.

Diagnosis of atrial fibrillation

The diagnosis of atrial fibrillation may already be suspected on the basis of complaints. When examining the patient, an irregular, rapid pulse is felt, usually less often than the heart rate (pulse deficit occurs due to the fact that not every contraction of the ventricles can lead to a full cardiac output). When listening (auscultation) of the heart and lungs, non-rhythmic contractions of the heart are determined, with pulmonary edema there may be wet gurgling rales. Tonometry can show both elevated, normal or even reduced blood pressure.

The main diagnostic method is electrocardiogram. With atrial fibrillation, the ECG reveals the absence of a P wave (which means that the heart rate is set not from the sinus node, as normal, but from the muscle fibers themselves or the atrioventricular node) and a different distance between the ventricular complexes (irregular rhythm, with a heart rate that can reach 200-220 beats per minute, which is due to the "throughput" of the atrioventricular node). Instead of an isoline, small fibrillation waves (f) are noted. With atrial flutter, the absence of the P wave, large flutter waves (F) and the same frequency of ventricular contraction are also noted.

Signs of myocardial ischemia can be detected, since the heart muscle, which contracts at a fast pace, requires more oxygen, and the coronary vessels cannot cope with this.

This is what atrial fibrillation looks like on an ECG

24-hour Holter ECG monitoring reveals short runs of fibrillation or flutter that can pass on their own if rhythm disturbances were not recorded on a standard ECG, and the patient makes characteristic complaints. In addition, the relationship between rhythm disturbances and exercise is assessed, for which the patient must keep a diary during the day, in which he indicates in detail psycho-emotional and physical activity.

Transesophageal ECG can be shown when the standard electrocardiogram is uninformative.

When conducting echocardiography myocardial contractility, ejection fraction, stroke volume are determined. Thrombi in the cavity of the heart can also be detected (most often formed in the left atrial appendage).

X-ray of the chest organs is prescribed to detect congestive processes in the lung tissue, pulmonary edema, signs of pulmonary embolism, changes in the configuration of the heart due to the expansion of its departments.

In some cases, according to indications, MRI (magnetic resonance imaging) and MSCT (multispiral computed tomography) of the heart for better visualization.

Treatment of atrial fibrillation

Tactics of treatment of paroxysmal and permanent forms differ.

Aim of therapy paroxysmal form is the restoration of sinus rhythm. If more than two days have passed since the onset of paroxysm, then this issue is resolved strictly individually after three to four weeks of constant use of warfarin or its analogues (“thinning” blood drugs), since there is a high risk of developing thromboembolic complications. All therapeutic measures in this form require stationary observation. To restore the rhythm, the following methods are used:

Drug treatment - cordarone, novocainamide, strophanthin, corglicon, a polarizing mixture (potassium chloride, glucose and insulin, in diabetes mellitus - potassium chloride and saline) are prescribed intravenously. Cordarone is taken internally according to the scheme established by the doctor.
- in addition to drugs that restore the rhythm, drugs that slow down heart rate are prescribed for continuous use (beta-blockers - carvedilol, bisoprolol, nebilet, calcium channel antagonists - verapamil, diltiazem, etc.), antiarrhythmics (propanorm, allapinin), antiplatelet agents (drugs that prevent the formation blood clots in the vessels and heart - aspirin Cardio, cardiomagnyl, thromboAss, etc.).
- cardioversion is used when drug therapy is ineffective and is performed in the cardio intensive care unit with intravenous anesthesia. The essence of the method is to “restart” the heart with an electric discharge of a certain power and make it contract correctly.

For frequent seizures the issue is resolved either about translating the paroxysmal into a permanent form (that is, doctors do not restore the rhythm, but treat atrial fibrillation as a permanent one), or about conducting cardiac surgery.

With a permanent form, treatment aims to slow down the abnormal heart rhythm and maintain it at the most comfortable level for the patient. For this, digoxin, beta-blockers, antiplatelet agents and anticoagulants are constantly taken (warfarin under regular monitoring of blood coagulation indicators, in particular, INR)

Cardiac surgery for atrial fibrillation

This type of treatment is carried out with the ineffectiveness of drugs and cardioversion, as well as with severe clinical manifestations of the disease. There are two types of operations:

1) radiofrequency ablation of the pulmonary veins consists in passing a catheter through the peripheral artery to the left atrium and “cauterizing” the pathological foci of excitation, as a result of which the correct rhythm of heart contractions is established in the patient.

The figure shows RFA of the pulmonary veins

2) radiofrequency catheter ablation of the atrioventricular connection with the installation of a pacemaker consists in a complete rupture of the connection between the atria and ventricles, while the atria contract in their own rhythm, and the ventricle in the rhythm set by the stimulator.

Lifestyle with atrial fibrillation

Patients with atrial fibrillation should regularly take the drugs prescribed by the doctor, not only to improve the quality of life, but also to prevent complications. It is necessary to adjust the mode of work and rest, to observe the principles of healthy eating, to completely eliminate alcohol, since often this factor provokes “breaks” in the rhythm. You should also exclude significant physical exertion, and, if possible, limit the occurrence of stressful situations.

Pregnancy with atrial fibrillation is not contraindicated, but the possibility of bearing a child is determined by the underlying disease that led to the development of arrhythmia.

Complications of atrial fibrillation

The most common complications include thromboembolic - increased formation of blood clots in the heart and their movement with blood flow into the vessels of the brain with the development of ischemic stroke, into the vessels of the heart with the development of myocardial infarction, into the vessels of the liver, limbs, intestines. Increased thrombus formation is due to the fact that the blood in the “flickering” or “fluttering” atria is whipped, as in a mixer, as a result of which the injured blood cells adhere to each other, forming a blood clot. Prevention of complications is the constant use of antiplatelet agents and anticoagulants.

Other complications are acute heart failure, pulmonary edema, arrhythmogenic shock.

Disease prognosis

Subject to all the doctor's recommendations, the prognosis of uncomplicated atrial fibrillation is favorable. But it must be remembered that the prognosis will depend on the underlying disease that caused the atrial fibrillation, and with the development of stroke, heart failure and other complications, and on their severity as well.

Therapist Sazykina O.Yu.

Atrial fibrillation in medicine is not considered to be an independent disease, doctors define it as a pathological process, accompanied by a chaotic contraction of the muscle fibers of the heart, which leads to a violation of the heart rhythm. If this pathological process develops on its own without treatment, then this can provoke progressive heart failure, thromboembolism.

Why does a chaotic contraction of the heart muscles appear

The causes of the pathological process under consideration can be very diverse. For example, doctors often note a chaotic contraction of cardiac muscle fibers against the background of excessive physical exertion, a stressful situation, elevated body temperature, and the use of alcoholic beverages. In this case, we are talking about paroxysms (attacks) - the heart rate can reach 600 beats per minute, it happens several times a day.

Please note: if paroxysmal contractions of cardiac muscle fibers continue for 48 hours, and no medical assistance is provided, then this leads to the rapid development of coronary heart disease and the formation of complications.

Persistent flicker is provoked, as a rule, by serious heart diseases that occur in a chronic form:

cardiac ischemia;
myocardial infarction;
pathological processes in the membranes of the heart of infectious etiology (endocarditis);
heart defects;
pulmonary embolism;
cardiosclerosis;
sustained high blood pressure (hypertension).

The considered pathological condition is often diagnosed in people who are in the "risk group". These are those patients who have a history of diabetes mellitus, regular psycho-emotional disorders. Often, atrial fibrillation occurs after surgical interventions and against the background of forced long-term use of certain medications.

How does atrial fibrillation manifest itself?

Symptoms of atrial fibrillation are often non-specific. The patient may complain of trembling knees, increased sweating (especially often observed on the palms), fear similar to panic, general weakness. As a rule, these symptoms are characteristic of overly emotional people who overreact to any stress. As soon as the heart rhythm is restored and the paroxysm stops, the state of health is restored. It is extremely rare for patients with similar signs of atrial fibrillation to seek qualified medical help - they just need to calm down or take any sedative drug to improve their well-being.

Things are much worse with those who do not have the above symptoms, but there is shortness of breath, a feeling of acute lack of air, a feeling of chest compression - this is how persistent atrial fibrillation manifests itself. Such symptoms are a reason for immediate medical attention.

No doctor can make a diagnosis only on the basis of the patient's complaints; an examination and additional examination are necessary. With the above symptoms, an ECG, Holter monitoring, ultrasound examination of the heart, laboratory tests of blood tests are prescribed. The most informative examination is electrocardiogram, which allows you to identify a violation of the heart rhythm and all the changes associated with this pathological condition. Ultrasound of the heart is a necessary examination only because the specialist will be able to see the size of the heart chambers, assess the condition and operation of the valves. Daily monitoring makes it possible to assess the nature of paroxysms and determine their frequency.

Our doctors

Treatment of atrial fibrillation

There is no single algorithm for treating the pathological condition in question; therapy is selected on a strictly individual basis. Drug treatment has several goals - doctors must prevent the recurrence of paroxysms, control the heart rhythm. To do this, it is recommended to proceed as follows:

Quickly eliminate pain during a new attack. To do this, you can take oral antiarrhythmic drugs recommended by a cardiologist.
If the signs of the condition in question do not disappear within 48 hours, then antiplatelet and anticoagulant drugs are added to the treatment (also on the individual prescription of a doctor).
In the case of an acute form of atrial fibrillation, doctors resort to electrical cardioversion, when an electrical shock applied directly to the myocardium immediately restores the heart rhythm.
In the case of a chronic form of the pathological condition under consideration (most often it is atrial fibrillation that occurs), the patient will be prescribed specific medications that will have to be used all his life.

It will not be possible to finally get rid of the pathological condition in question and fully recover. But seeking qualified medical help will help maintain heart function at the proper level and lead a normal life without any special restrictions.

Prevention of atrial fibrillation

Atrial fibrillation is considered a chronic pathological process that develops against the background of heart disease, so it is impossible to somehow prevent its development. But preventive measures should include:

timely access to medical care;
compliance with all prescriptions and recommendations of the doctor;
treatment of the underlying disease, a complication of which was atrial fibrillation.

Prevention, carried out competently and in full, can enter the considered pathological condition into a stage of long-term remission, in which even cardiologists do not consider this condition to be life-threatening for the patient.

CELT offers people with signs of atrial fibrillation to be examined by experienced cardiologists who have at their disposal a complete diagnostic base. To identify the disease, conduct all the necessary additional examinations of the patient, prescribe treatment and introduce atrial fibrillation into a long-term remission - tasks that our specialists successfully perform. Patients are only required to do two things - seek help in time and comply with all the appointments / recommendations of cardiologists.