The norm of the heart rhythm in men and women, the causes of heart rhythm disturbances by gender. Heart rhythm disorders: types, causes, signs, treatment

Heart rhythm disorders: types, causes, signs, treatment

The human heart under normal conditions beats evenly and regularly. The heart rate per minute in this case is from 60 to 80 contractions. This rhythm is set by the sinus node, which is also called the pacemaker. It contains pacemaker cells, from which excitation is transmitted further to other parts of the heart, namely to the atrioventricular node, and to the His bundle directly into the ventricular tissue.

This anatomical and functional division is important from the standpoint of the type of a particular disorder, because a block for impulse conduction or an acceleration of impulse conduction can occur in any of these areas.

Cardiac arrhythmias and its are called and are conditions when the heart rate becomes less than normal (less than 60 per minute) or more than normal (more than 80 per minute). Also, arrhythmia is a condition when the rhythm is irregular (irregular, or non-sinus), that is, it comes from any part of the conduction system, but not from the sinus node.

Different types of rhythm disturbances occur in different percentages:

• So, according to statistics, the lion's share among rhythm disturbances with the presence of underlying cardiac pathology are atrial and ventricular, which occur in 85% of cases in patients with coronary artery disease.
• In second place in frequency is the paroxysmal and constant form of atrial fibrillation, which occurs in 5% of cases in people over 60 years of age and in 10% of cases in people over 80 years of age.

Nonetheless, even more common are violations of the sinus node, in particular, and that have arisen without heart pathology. Probably every inhabitant of the planet experienced, caused by stress or emotions. Therefore, these types of physiological abnormalities have no statistical significance.

Classification

All rhythm and conduction disorders are classified as follows:

1. Heart rhythm disorders.
2. Conduction disorders in the heart.

In the first case, as a rule, there is an acceleration of the heart rate and / or irregular contraction of the heart muscle. In the second, the presence of blockades of varying degrees with or without a slowing of the rhythm is noted.
Generally the first group includes a violation of the formation and conduction of impulses:

The second group of conduction disorders includes blocks () on the path of impulses, manifested by intra-atrial blockade, 1, 2 and 3 degrees and blockade of the legs of the bundle of His.

Causes of heart rhythm disorders

Rhythm disturbances can be caused not only by a serious pathology of the heart, but also by the physiological characteristics of the body. So, for example, sinus tachycardia can develop when walking or running fast, as well as after playing sports or after strong emotions. Respiratory bradyarrhythmia is a variant of the norm and consists in an increase in contractions during inhalation and a decrease in heart rate during exhalation.

However, such rhythm disturbances, which are accompanied by atrial fibrillation (atrial fibrillation and flutter), extrasystole and paroxysmal types of tachycardia, in the vast majority of cases develop against the background of diseases of the heart or other organs.

Diseases that cause rhythm disturbances

Pathology of the cardiovascular system, occurring against the background of:

• , including acute and transferred ,
• , especially with frequent crises and long-term,
• (structural changes in the normal anatomy of the myocardium) due to the above diseases.

Extracardiac diseases:

• Stomach and intestines, for example, gastric ulcer, chronic cholecystitis, etc.,
• acute poisoning,
• Active pathology of the thyroid gland, in particular hyperthyroidism (increased secretion of thyroid hormones into the blood),
• Dehydration and electrolyte disturbances in the blood,
• Fever, severe hypothermia,
• alcohol poisoning,
• Pheochromocytoma is a tumor of the adrenal glands.

In addition, there are risk factors that contribute to the appearance of rhythm disturbances:

1. Obesity,
2. Bad habits,
3. Age over 45 years old
4. Concomitant endocrine pathology.

Are heart rhythm disturbances the same?

All rhythm and conduction disturbances clinically manifest themselves differently in different patients. Some patients do not feel any symptoms and learn about the pathology only after a planned ECG. This proportion of patients is insignificant, since in most cases patients report obvious symptoms.

So, for rhythm disturbances accompanied by a rapid heartbeat (from 100 to 200 per minute), especially for paroxysmal forms, a sharp sudden onset and interruptions in the heart, lack of air, and pain in the sternum are characteristic.

Some conduction disorders, such as beam blockade, do not manifest themselves in any way and are recognized only on the ECG. Sinoatrial and atrioventricular blockades of the first degree proceed with a slight decrease in the pulse (50-55 per minute), which is why clinically they can manifest only slight weakness and increased fatigue.

Blockades of 2 and 3 degrees are manifested by severe bradycardia (less than 30-40 per minute) and are characterized by short-term attacks of loss of consciousness, called MES attacks.

In addition, any of the listed conditions may be accompanied by a general severe condition with cold sweat, intense pain in the left side of the chest, low blood pressure, general weakness and loss of consciousness. These symptoms are caused by a violation of cardiac hemodynamics and require close attention from an emergency doctor or clinic.

How to diagnose pathology?

Establishing a diagnosis of rhythm disturbance is not difficult if the patient presents with typical complaints. Before the initial examination by a doctor, the patient can independently calculate his pulse and evaluate certain symptoms.

However directly the type of rhythm disturbances is established only by the doctor after, since each species has its own signs on the electrocardiogram.
For example, extrasystoles are manifested by altered ventricular complexes, tachycardia paroxysm - by short intervals between complexes, atrial fibrillation - by irregular rhythm and a heart rate of more than 100 beats per minute, sinoatrial blockade - by lengthening of the P wave, which reflects the conduction of an impulse through the atria, atrioventricular blockade - by lengthening of the interval between atrial and ventricular complexes, etc.

In any case, only a cardiologist or therapist can correctly interpret the changes on the ECG.. Therefore, when the first symptoms of rhythm disturbance appear, the patient should seek medical help as soon as possible.

In addition to the ECG, which can be performed already upon the arrival of the ambulance team at the patient's home, additional examination methods may be needed. They are prescribed in the clinic if the patient was not hospitalized, or in the cardiological (arrhythmological) department of the hospital, if the patient had indications for hospitalization. In most cases, patients are hospitalized because even a mild arrhythmia can be a harbinger of a more serious, life-threatening arrhythmia. The exception is sinus tachycardia, since it is often stopped with the help of tablet preparations even at the prehospital stage, and generally does not pose a threat to life.

Of the additional diagnostic methods, the following are usually shown:

1. during the day (according to Holter),
2. Tests with physical activity (walking up the stairs, walking on a treadmill - treadmill test, cycling -),
3. Transesophageal ECG to clarify the localization of rhythm disturbance,
4. in the case when a rhythm disturbance cannot be registered using a standard cardiogram, and it is necessary to stimulate heart contractions and provoke a rhythm disturbance in order to find out its exact type.

Cardiac MRI may be required in some cases, for example, if a patient has a suspected cardiac tumor, myocarditis, or a scar after a myocardial infarction that is not reflected on the cardiogram. A method such as is a mandatory research standard for patients with rhythm disturbance of any origin.

Treatment of rhythm disorders

Therapy for rhythm and conduction disorders varies depending on the type and the cause that caused it.

So, for example, in the case of coronary heart disease, the patient receives nitroglycerin (thromboAss, aspirin cardio) and drugs to normalize elevated blood cholesterol levels (atorvastatin, rosuvastatin). With hypertension, the appointment of antihypertensive drugs (enalapril, losartan, etc.) is justified. In the presence of chronic heart failure, diuretics (lasix, diacarb, diuver, veroshpiron) and cardiac glycosides (digoxin) are prescribed. If the patient has a heart defect, he may be shown surgical correction of the defect.

Regardless of the cause, emergency care in the presence of rhythm disturbances in the form of atrial fibrillation or paroxysmal tachycardia consists in administering rhythm-restoring (antiarrhythmics) and rhythm-reducing drugs to the patient. The first group includes drugs such as panangin, asparkam, novocainamide, cordarone, strophanthin for intravenous administration.

In case of ventricular tachycardia, lidocaine is administered intravenously, and in case of extrasystole, betaloc in the form of a solution.

Sinus tachycardia can be stopped by taking anaprilin under the tongue or egilok (Concor, Coronal, etc.) orally in tablet form.

Bradycardia and blockade require a completely different treatment. In particular, prednisolone, aminophylline, atropine are administered intravenously to the patient, and at a low level of blood pressure, mezaton and dopamine, along with adrenaline. These drugs speed up the heart rate and cause the heart to beat faster and harder.

Are complications of cardiac arrhythmias possible?

Heart rhythm disturbances are dangerous not only because the blood circulation throughout the body is disturbed due to improper functioning of the heart and a decrease in cardiac output, but also the development of sometimes formidable complications.

Most often, in patients against the background of a particular rhythm disturbance, they develop:

• Collapse. It is manifested by a sharp drop in blood pressure (below 100 mm Hg), general severe weakness and pallor, pre-syncope or fainting. It can develop both as a direct result of rhythm disturbance (for example, during an attack of MES), and as a result of the administration of antiarrhythmic drugs, for example, procainamide during atrial fibrillation. In the latter case, this condition is treated as drug-induced hypotension.
• Arrhythmogenic shock- occurs as a result of a sharp decrease in blood flow in the internal organs, in the brain and in the arterioles of the skin. It is characterized by a general grave condition of the patient, lack of consciousness, pallor or cyanosis of the skin, pressure below 60 mm Hg, and a rare heartbeat. Without timely assistance, the patient may die.
• occurs due to increased thrombus formation in the cavity of the heart, since with paroxysmal tachycardia, the blood in the heart is “whipped”, as in a mixer. The resulting blood clots can settle on the inner surface of the heart (parietal thrombi) or spread through the blood vessels to the brain, blocking their lumen and leading to severe ischemia of the brain substance. It is manifested by abrupt speech disorders, unsteady gait, complete or partial paralysis of the limbs.
• occurs for the same reason as a stroke, only as a result of clogging of the pulmonary artery by blood clots. It is clinically manifested by severe shortness of breath and suffocation, as well as blue discoloration of the skin of the face, neck and skin of the chest above the level of the nipples. With complete obstruction of the pulmonary vessel, the patient experiences sudden death.
• Acute myocardial infarction due to the fact that during an attack of tachyarrhythmia, the heart beats with a very high frequency, and the coronary arteries are simply not able to provide the necessary blood flow to the heart muscle itself. Oxygen deficiency occurs in the heart tissues, and a site of necrosis, or death of myocardial cells, is formed. It is manifested by sharp pains behind the sternum or in the chest on the left.
• Ventricular fibrillation, and clinical death. More often they develop with a paroxysm of ventricular tachycardia, which turns into ventricular fibrillation. In this case, the contractility of the myocardium is completely lost, and an adequate amount of blood does not enter the vessels. A few minutes after fibrillation, the heart stops, and clinical death develops, which, without timely help, flows into biological death.

In a small number of cases, the patient immediately develops rhythm disturbance, any of the complications and death. This condition is included in the concept of sudden cardiac death.

Forecast

The prognosis of rhythm disturbances in the absence of complications and in the absence of organic pathology of the heart is favorable. Otherwise, the prognosis is determined by the degree and severity of the underlying pathology and the type of complications.

Failure of the heart rhythm has the corresponding name in medicine - arrhythmia. Pathology is a failure in the frequency, regularity of the body, a violation of electrical conductivity. Sometimes the disease occurs against the background of fainting, dizziness caused by air deficiency and pain in the region of the heart. Diagnosis can be made with the help of instrumental and physical examination. In the process of therapy, cardiosurgical techniques and drugs are involved.

Many are concerned about the question of what to do if the heart rhythm fails? A brief overview of this heart disease will help to understand. Arrhythmia, or failure of the heart rhythm, is a general term indicating a disorder in the generation and transport of an electrical impulse. Pathology is very dangerous, has negative consequences.

Rhythm disturbance is manifested against the background of a failure in the conduction of the cardiovascular system, which regenerates regular and coordinated contractions. Functional, organic factors should be considered as the cause of heart rhythm failure. Arrhythmia can provoke dangerous changes. Not even a heart attack is ruled out. The characteristic of the disease indicates the appearance of a strong pulse, the fading of the organ and an interruption in its work. Sometimes there are fainting, pain in the chest, difficulty breathing, weakness and dizziness.

If you do not make a timely diagnosis and do not start timely, competent treatment, then symptoms of angina pectoris may appear. With this disease, there is a risk of cardiac arrest or swelling of the lungs.

Impaired cardiac conduction and rhythm cause death in both a child and an adult in 15% of all cases. The causes of the pathology are determined by the cardiologist.

Forms of arrhythmia:

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

The specific rhythm, frequency, sequence of contractions are controlled by the conduction system. In case of its defeat, signs of arrhythmia develop. If the bundles of His are hit, then a blockade appears, namely, a failure in conduction. The consequence of this is incorrect coordination of the functioning of the ventricles, atria.

Reasons for development

Before you learn how to treat a pathology, you should consider its description and origin. The causes of heart rhythm failure may lie in other diseases. Their attending physician determines, for which a detailed diagnosis is carried out.

In accordance with the etiological factors and the mechanism of development of the disease, two forms of arrhythmia are distinguished - functional and organic. As for the latter, it is a frequent companion of myocarditis, coronary artery disease, injuries, defects, insufficiency, VSD, complications after surgery.

If there is a failure of the heart rhythm, the reasons for this may be as follows:

In order to provide first aid for arrhythmias in time, it is advisable to know what the symptoms of a heart rhythm failure look like. Interestingly, a change in the electrolyte balance in this organ provokes the development of arrhythmias. The process significantly complicates the contractile capabilities of the muscle.

Clinical picture

During an attack, emergency medical attention may be needed. That is why it is important to know about the symptoms of heart rhythm failures and dangerous indicators.

Signs of arrhythmia:

• dizziness;
• severe weakness, chills;
• palpitations, the presence of fading and interruptions;
• angina;
• suffocation;
• cardiogenic shock;
• fainting state;
• nausea.

During an attack, everything possible should be done to alleviate the patient's condition. You need to know what kind of medicine or folk remedy will help to cope with an exacerbated disease.

Arrhythmias can be fatal. From the very first seconds, weakness, dizziness, convulsions appear. It is impossible to determine the pulse and pressure, breathing worsens. Pupil dilation is observed, clinical death may occur. If the patient has asystole, there is a risk of developing syncope. With a ciliated type of disease, a thromboembolic complication ends with a stroke.

Diagnostic and therapy methods

The initial stage of diagnosis is carried out by a therapist, a cardiologist. After that, instrumental studies are used.

Diagnosis of cardiac arrhythmia:

• Ultrasound of the heart;
• medical examination;
• measurement of pulse rate, blood pressure;
• ECG monitoring, blood pressure;
• OAM, KLA, electrolytes.

Most often, the cause of the pathology is the chronic form of coronary artery disease, hypertension, heart failure. In this case, drugs and tablets are prescribed that show high efficiency in therapy.

The main medications for arrhythmia:

• statins;
• blockers for beta-adrenergic receptors;
• diuretics;
• angiotensin-preventing inhibitors;
• cardiovascular drugs.

A good effect is observed with their stable use. Drugs can be prescribed only by the attending physician. Antiarrhythmic drugs help well: Sotaleks, Propanorm, Kordaron. They help to relax the heart muscle. Of great importance is prevention, which implies a healthy lifestyle, moderate physical activity, taking certain drugs.

Alternative methods of treating arrhythmia:

1. You can make an infusion of horsetail, you need dried leaves. Preparation: 2 tsp. brew raw materials in a glass of boiling water. Strain after twenty minutes. Take every 2 hours for a tablespoon.
2. Peppermint. In 200 ml of boiling water, brew a teaspoon of herbs. Infuse for half an hour, drink once a day for a year.
3. Fight against tachycardia: cut asparagus shoots - 1 tbsp. spoon, pour 250 ml of boiling water, wrap. Infuse for an hour, drink daily for 2 tbsp. l. about a month.
4. Mix equal amounts of black radish juice with liquid honey. Take 3 tsp. after meal.
5. Calendula. For 0.5 liters of hot water 1 tbsp. l. plant flowers. Cool down. Take 100 ml 4-5 times a day.

The course of treatment should be agreed with the doctor in order to avoid side effects and complications.

Most cases do not threaten health and life. The ciliated form of the pathology, which contributes to the development of stroke, heart failure, deserves special attention. A particular threat and negative consequences are observed with fibrillation, ventricular flutter.

Thus, failure of the heart rhythm is a dangerous disease, which is fraught with the development of many complications, as well as negative consequences. If you have any suspicious symptoms, you need to consult a doctor, undergo a preventive examination. It is strictly forbidden to self-medicate.

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Atrial rhythm: why it occurs and what to do?

Cardiac arrhythmia: what is it and how is it treated?

Heart rhythm disturbances (arrhythmias) are conditions in which the frequency, rhythm and sequence of contractions of the heart muscle change.

Normally, these processes are regulated by the conduction system of the heart. An electrical impulse is born in the sinus node, which is located in the right atrium. From there, the impulses go to the next node, located between the atrium and the ventricle, and then along the bundle of His and its legs to the right and left ventricles. The result is heart contraction.

Violation of the heart rhythm may be due to changes that have arisen in any part of the conduction system. Accordingly, atrial, atrioventricular and ventricular arrhythmias are distinguished.
Most often, rhythm disturbances occur with various functional and organic diseases of the cardiovascular system, endocrine disorders (and primarily with thyroid diseases), vegetative disorders, and intoxications.

Symptoms of a heart rhythm disorder

• Feeling a heartbeat (a person feels their heart beat loudly in their chest)
• Heart rate faster than 90 beats per minute (tachycardia) or slower than 60 beats per minute (bradycardia)
• Feeling of periodic "fading" of the heart, interruptions in its work - with extrasystole
• Sudden disruption of the heart rhythm (the heart "pounds furiously in the chest") - an attack of paroxysmal tachycardia
• The appearance of dizziness, general weakness, fainting in violation of the heart rhythm
• Arrhythmia may be accompanied by pain in the heart, shortness of breath
• Often, concomitant neurotic disorders develop: anxiety, a feeling of fear of death, panic appear.

The main types of arrhythmia

• Tachycardia is an increase in the resting heart rate above 90 beats per minute. This condition often occurs normally in a healthy person during physical and psycho-emotional stress and quickly passes after a short rest and relaxation. Persistent tachycardia appears in the acute period of infectious diseases (including influenza and acute respiratory infections), with heart diseases (myocarditis, heart failure), intoxication, anemia
• Paroxysmal tachycardia is a sudden attack of palpitations with a frequency of 140-240 beats per minute (“rhythm breakdown”) that occurs with severe stress and heart disease. An attack of cardiac arrhythmias may spontaneously end in a few seconds or minutes, or it may last for hours, worsening general well-being, accompanied by weakness, fainting, and without timely assistance, death may occur.
• Bradycardia is a decrease in heart rate to 60 beats per minute or less. In healthy people, bradycardia can occur during rest, during sleep, and also on an ongoing basis in well-trained people involved in sports (especially runners, rowers, swimmers, skiers). A heart rate of 40-60 beats per minute may be a sign of vegetative dystonia, organic heart disease (myocarditis, cardiosclerosis, myocardial infarction), hypothyroidism, some viral diseases, intoxications. With heart block, the heart rate can often be below 40 beats per minute. This condition poses a real threat to life, and without the timely installation of a pacemaker, it ends sadly.
• Atrial fibrillation is an abnormal heart rhythm caused by atrial fibrillation. At the same time, the pulse differs in filling and frequency and varies from 100 to 150 beats per minute. The cause of atrial fibrillation is mitral heart disease, angina pectoris, thyrotoxicosis, alcoholic cardiomyopathy. Without treatment, atrial fibrillation often leads to the formation of blood clots and the development of pulmonary embolism, coronary and cerebral circulation disorders.
• Extrasystoles - periodic extraordinary contractions of the heart. These heart rhythm disturbances are most often found, both in healthy people and in intoxications, neurotic disorders. Extrasystoles can be atrial, atrioventricular, ventricular. With rare functional extrasystoles, any treatment, as a rule, is not required. Frequent (more than 5 extrasystoles per minute), polymorphic, early and other potentially dangerous extrasystoles require emergency care.

Diagnosis of cardiac arrhythmias

• The study of anamnesis, complaints, an objective medical examination with a study of the pulse (its frequency, rhythm, filling) on ​​the radial and carotid arteries, its comparison with heart contractions during auscultation
• Electrocardiographic study (ECG), including under load (veloergometry, treadmill test)
• Long-term ECG recording (Holter monitoring)
• Electrophysiological examination of the heart (intracardiac or transesophageal ECG)
• Laboratory studies (study of electrolyte metabolism, hormonal status, etc.)

Your attending physician will tell you in detail about the need for treatment of arrhythmia, recommended medicines, and the possibility of using surgical intervention. Along with the recommendations of the cardiologist, it is possible, with his consent, to use medicinal herbs, acupressure, exercises of physiotherapy exercises for violations of the heart rhythm. These methods are discussed in the following articles.

The heart beats out of rhythm for a variety of reasons. The causes of disruption of the rhythmic work of the heart may be physiological in nature and not pose a danger.

Organic rhythm disturbances are characterized by deviations occurring in the structure of the heart. They require special attention, such pathological conditions need to be treated.

Characteristics of cardiac failures

H Arrhythmia is characterized by a deviation from the rhythmic work of the heart. For normal cardiac function, it is necessary that the phases periodically replace each other. There are two such phases:

• the phase of systole, in which the stimulation of blood flow occurs;
• the diastole phase is the period of relaxation and rest of the heart muscle.

A healthy heart rhythm involves a uniform change of phases. In case of violation of the periodicity, failures in the regulation of the endocrine system occur. With a shortened diastolic phase, the heart gets tired without having time to rest.

Disorders in the work of the heart muscle can be divided into two groups. One of them will include a slow work of the heart, the other is characterized by a rapid rhythm.

In the first case, the patient may experience a violation of blood circulation, and in the second case, interruptions in cardiac activity are noted.
Violations of the sequence, as well as the strength and frequency of the heart rhythm, are called arrhythmias.

Types of heart rhythm disorders

FROM The heart of a healthy person can contract at different speeds, it is impossible to derive a single indicator that would be considered the norm for absolutely everyone. For some, a rapid rhythm is characteristic, for others it may be somewhat slow. And yet there are averages.

The pulse of a healthy person is on average 60 to 90 beats per minute. At the same time, women have a higher heart rate than men. This is due to the fact that the heart in women is smaller in size.
The heart rhythm can go astray for a variety of reasons that are considered normal.

But in some cases, the failure of heart contractions has a pathological basis and poses a danger not only to health, but also to human life.

Heart failure can be represented by different types:

1. Violations associated with the formation of an impulse. With the formation of an impulse in the sinus node, sinus tachycardia or sinus bradycardia may develop. The first case is characterized by an increase in the number of heartbeats over 90 beats. The second case is characterized by a slowing of the heart pulsation below 60 beats. Impulses can occur in the atria and ventricles, then atrial or ventricular palpitations are diagnosed. This category includes such pathologies as: extrasystole, paroxysmal tachycardia, atrial fibrillation or ventricular fibrillation.
2. Cardiac conduction disorders. This type of failure includes impulse conduction blocks that can form in any part of the conductive system. In this case, the following types of blockade are diagnosed: sinoatrial, intraatrial, atrioventricular.
3. mixed species. This group includes conditions when an additional rhythm is formed in the heart, due to uneven work of the atria and ventricles.

Causes of heart failure

The rhythm of the heart is lost for several reasons. These reasons can be quite harmless, and the violation of the rhythm itself does not pose any danger. But there are also serious violations in the work of the heart, caused by heart disease or ailments of a different kind.

Increased heart rate is characteristic of sinus tachycardia. This condition can occur after physical exertion. In addition to increased heart rate, other symptoms appear: shortness of breath, weakness, pain in the chest.

If the increase in rhythm appears for no apparent reason, then this fact may indicate the presence of diseases. A short list of diseases that cause sinus tachycardia:

• thyroid disease;
• intoxication of the heart;
• heart failure;
• myocardial infarction;
• heart disease.

Sinus tachycardia usually affects young people. It can develop due to increased nervousness, affective psychosis. An increase in heart rate can accompany such ailments as tonsillitis, tuberculosis, pneumonia.

A rare pulse, a pulse with a slowing of the rhythm to 60 beats per minute, is called sinus bradycardia. Such a heart rhythm disorder rarely occurs in healthy people. The exception is athletes in whom this condition develops against the background of regular physical exertion and is not a pathology, due to the training of the heart muscles.

Sinus bradycardia is felt as a sinking heart, dizziness and even fainting can complicate the patient's condition. Bradycardia may be accompanied by heart block. Frequent bouts of bradycardia pose a serious danger to human life.

Premature contraction of the heart is called extrasystole. When it occurs, a strong cardiac impulse occurs, after which a temporary pause occurs. Additional symptoms are expressed in anxiety, discomfort, lack of air.

Extrasystole can be temporary and occur after taking strong drinks: coffee, tea, alcohol. The disease can develop on a nervous basis and be the result of stressful situations. There are more serious causes, which include heart disease.

Chaotic contraction of the muscles of the heart atria is diagnosed as flicker. Flutter is characterized by contraction of the atria or part of them in a rhythm reaching up to 300 beats per minute.

The contraction of the ventricles at the same time occurs in a more moderate rhythm. Both of these forms can replace one another.

But it is worth noting that flutter happens much more often than flicker. The disease is usually caused by heart disease.

A sharp increase in heart rate occurs with paroxysmal tachycardia. A person can be in this state for several seconds, but it also happens that the attack persists for several days. The cause of seizures is most often oxygen starvation or metabolic disorders.

Such disruptions in the rhythm of the heart are accompanied by the following symptoms: weakness, shortness of breath, tinnitus, a feeling of chest constriction.

In addition to the causes individual for each type of tachycardia, there are common causes that contribute to the development of the disease. The characteristic of common causes is as follows:

• osteochondrosis;
• insufficient function of the thyroid gland;
• poisoning and subsequent intoxication of the body;
• unbalanced diet;
• dysfunction of the kidneys and liver.

To about To determine the presence and nature of a heart rhythm failure, it is often enough to make an electrocardiogram.

This type of diagnosis will accurately determine the type of arrhythmia.

But it is not always possible, as they say, to catch the rhythmic fight and fix it.

How to restore heart rate

To avoid repeated attacks of arrhythmia, you need to monitor your health. First of all, excessive physical and emotional stress should be avoided. It is very important to watch your diet. In order for the heart to function normally, fatty and spicy foods will have to be removed from the menu.

To bring the heart rate back to normal, you need to take a deep breath and, holding your mouth and nose, try to exhale with an effort. This exercise should be done several times.

You should not prescribe treatment yourself, all problems must be solved together with the attending physician.

Normal work of the heart is characterized by alternate uniform contraction of the atria and ventricles. A measured rhythm is characteristic of a healthy heart.

Any deviation from the norm can signal the presence of heart disease. Therefore, if heart failures occur regularly, for no apparent reason, this is a reason to seek advice from a cardiologist.

A timely visit to a doctor helps to determine the causes of a heart disorder, make a diagnosis and take the necessary measures to eliminate the disease.

For citation: Chudnovskaya E.A. Cardiac arrhythmias: etiology, pathogenesis, clinic, diagnosis, treatment // BC. 2003. No. 19. S. 1064

H Heart rhythm disturbances are one of the most common types of disorders, their frequency cannot be accurately estimated. Transient rhythm disturbances occur in most healthy people. When diseases of the internal organs occur, conditions are created for the development of cardiac arrhythmias, which sometimes become the main manifestation in the clinical picture of the disease, such as, for example, in thyrotoxicosis, coronary artery disease. Arrhythmias complicate the course of many cardiovascular diseases.

The term "cardiac arrhythmias" refers to arrhythmias and heart blocks. Arrhythmias are a violation of the frequency, regularity and sequence of heartbeats. Violations of the conduction of excitation cause the development of heart blocks.

All arrhythmias are the result of changes in the basic functions of the heart: automatism, excitability and conduction. They develop when the formation of the action potential of the cell is disturbed and the speed of its conduction changes as a result of changes in potassium, sodium and calcium channels. Violation of the activity of potassium, sodium and calcium channels depends on sympathetic activity, the level of acetylcholine, muscarinic M 2 receptors, ATP.

Mechanisms of cardiac arrhythmias:

1. Disturbances in the formation of an impulse: - violations of the automatism of the sinus node (SU); - abnormal automatism and trigger activity (early and late depolarization).

2. Circulation of the excitation wave ( re-entry).

3. Violations of impulse conduction.

4. Combinations of these changes.

Impulse formation disorders . Ectopic foci of automatic activity (abnormal automatism) can be located in the atria, coronary sinus, along the perimeter of the atrioventricular valves, in the AV node, in the system of the His bundle and Purkinje fibers. The occurrence of ectopic activity is facilitated by a decrease in the automatism of SU (bradycardia, dysfunction, sick sinus syndrome (SSS)).

Violation of impulse conduction . Violations of impulse conduction can occur in any part of the conduction system of the heart. Blockade in the path of the impulse is manifested by asystole, bradycardia, sinoatrial, AV and intraventricular blockade. This creates conditions for a circular motion re-entry.

Circular motion . For the formation re-entry it is necessary to have a closed conduction loop, a unidirectional blockade in one of the sections of the loop and a slow spread of excitation in another section of the loop. The impulse slowly spreads along the knee of the circuit with preserved conduction, makes a turn and enters the knee where there was a blockade of conduction. If the conductivity is restored, then the impulse, moving in a vicious circle, returns to the place of its origin and repeats its movement again. Waves re-entry can occur in the sinus and AV nodes, atria and ventricles, in the presence of additional pathways, and in any part of the conduction system of the heart where dissociation of excitation conduction may occur. This mechanism plays an important role in the development of paroxysmal tachycardia, flutter and atrial fibrillation.

trigger activity . With trigger activity, the development of trace depolarization occurs at the end of repolarization or the beginning of the resting phase. This is due to the disruption of transmembrane ion channels.

In the development of arrhythmias that occur in various diseases and conditions, an important role is played by exogenous and endogenous factors, such as psychosocial stress preceding life-threatening arrhythmias in 20-30% of cases, neurovegetative imbalance, with a predominance of the activity of the sympathetic or parasympathetic divisions of the autonomic nervous system, toxic effects (alcohol, nicotine, drugs, drugs, industrial poisons, etc.), diseases of internal organs.

Etiology of cardiac arrhythmias:

• Myocardial damage of any etiology: atherosclerosis of the coronary arteries, myocarditis, dilated and hypertrophic cardiomyopathy, heart defects, diabetes mellitus, thyroid disease, menopause, amyloidosis, sarcoidosis, hemochromatosis, myocardial hypertrophy in arterial hypertension and chronic pulmonary heart, intoxication (alcohol, nicotine, medicines, industrial substances (mercury, arsenic, cobalt, organochlorine and phosphorus compounds), closed heart injuries, involutive processes during aging.
• Damage to the SU and the conduction system of the heart of congenital and acquired genesis, for example, SSS, sclerosis and calcification of the fibrous skeleton of the heart and primary sclerodegenerative damage to the conduction system of the heart with the development of AV and intraventricular blockades, additional pathways (for example, WPW, CLC syndromes).
• Prolapse of the heart valves.
• Tumors of the heart (myxomas, etc.).
• Diseases of the pericardium: pericarditis, pleuropericardial adhesions, pericardial metastases, etc.
• Electrolyte disorders (disturbances in the balance of potassium, calcium, sodium, magnesium).
• Mechanical stimulation of the heart (catheterization, angiography, heart surgery).
• Reflex influences from the internal organs when swallowing, straining, changing body position, etc.
• Violations of the nervous regulation of the heart (vegetative dystonia syndrome, organic lesions of the central nervous system).
• Under stress (with the development of hyperadrenalemia, hypokalemia, stress ischemia).
• Idiopathic cardiac arrhythmias.

Examination of a patient with cardiac arrhythmias includes questioning the patient, clinical and instrumental research methods. It is aimed at identifying the causes of the development of arrhythmias, those adverse factors that may contribute to their progression in the future, accurately determining the types of arrhythmias, diagnosing the state of the heart (valvular apparatus, heart chamber size, wall thickness, contractility).

When questioning the patient, pay attention to the anamnestic data: the first appearance of unpleasant sensations in the region of the heart and their accompanying phenomena; diagnosing (if it was carried out) objective disorders of the cardiovascular system and other organs and systems that could lead to the development of cardiac arrhythmias; previous treatment and its effectiveness; the dynamics of the development of symptoms up to the moment the patient goes to the doctor. It is very important to find out if the patient had bad habits, occupational hazards, what diseases he had, and also know the family history. Identification of the patient's complaints is of great importance, since cardiac arrhythmias are often accompanied by the appearance of unpleasant sensations. They are determined by the type of rhythm disturbance, the degree of hemodynamic disorders, the nature of the underlying disease. The most frequent complaints of patients with arrhythmias are unpleasant sensations in the region of the heart: palpitations (feelings of rhythmic or non-rhythmic heartbeats), interruptions, sensations of fading and “stopping” of the heart, pain of a different nature or a feeling of compression, a feeling of heaviness in the chest, etc. Sensations may have a different duration and frequency, develop suddenly or gradually, periodically or without a definite pattern. In addition, there may be a sharp weakness, headache, dizziness, nausea, syncope, which is an indicator of the development of hemodynamic disorders. With a decrease in the contractility of the left heart, shortness of breath, cough, and suffocation are noted. The appearance or progression of heart failure in arrhythmias is prognostically unfavorable.

Heart rhythm disturbances in many cases are accompanied by a feeling of fear and anxiety. In some patients, arrhythmias are asymptomatic.

Clinical studies reveal: the patient's condition may be different (from satisfactory to severe) depending on the type of disorder and the patient's initial condition. Possible lethargy, loss of consciousness (fainting), manifestations of hypoxic encephalopathy up to coma. Autonomic nervous system disorders manifest as restlessness, anxious behavior, skin discoloration, sweating, polyuria, defecation, etc. The color of the skin can be both pale and hyperemic, especially in the presence of arterial hypertension, cyanotic in heart failure. With left ventricular heart failure, changes are detected during a physical examination of the respiratory system - weakening of vesicular breathing or hard breathing, wet unvoiced rales, sometimes in combination with dry rales. In this case, the accent of the II tone on the pulmonary artery can be determined. A study of the cardiovascular system often reveals changes in heart rate (HR) and pulse rate - an increase or decrease, a violation of the rhythm of heart sounds and pulse waves. The volume of tones changes, for example, different loudness of the I tone with atrial fibrillation (MA), amplification of the I tone with ventricular extrasystole, weakening it with paroxysmal supraventricular tachycardia (PNT). A decrease in the filling of the pulse is determined with vascular insufficiency, with MA, a pulse deficit often occurs. Changes in blood pressure are often observed - hypo- or hypertension. With right ventricular heart failure - an increase in the liver and its soreness. With a decrease in renal blood flow - oliguria. Thromboembolic syndrome may also develop.

Instrumental research methods . Electrocardiography remains the leading method in the recognition of cardiac arrhythmias. It is used as a one-time study, as well as a longer one: for 3 minutes, 1 and 24 hours. For example, in patients with IHD, ventricular extrasystoles on a conventional ECG are detected in 5% of cases, with a 3-minute registration - in 14%, with a 1-hour registration - in 38% of patients, within 24 hours - in 85% of patients. 24-hour Holter ECG monitoring provides research under various conditions (during exercise, sleep, eating, etc.), which makes it possible to identify provoking factors in the development of arrhythmias. Holter monitoring allows you to give a qualitative and quantitative assessment of cardiac arrhythmias. Samples with dosed physical activity are used to clarify the diagnosis of coronary artery disease, identify the relationship of rhythm disturbances with angina pectoris and physical activity, assess the effectiveness of therapy, as well as the arrhythmogenic effect of drugs. If the ECG study is not effective enough to diagnose the syndrome of premature ventricular excitation, transesophageal ECG is used to diagnose and treat transient or permanent SSS. It is not always possible to obtain the necessary information using this method, so the most reliable method is an intracardiac electrophysiological study, which includes endocardial ECG recording and programmed pacing (ECS).

Classification of rhythm disturbances . Arrhythmias are divided into supraventricular and ventricular. There are a large number of classifications of cardiac arrhythmias, of which the classification proposed by M.S. Kushakovsky, N.B. Zhuravleva modified by A.V. Strutynsky et al. :

I. Violation of the formation of an impulse.

A. Violation of automatism of the SA node (nomotopic arrhythmias): sinus tachycardia, sinus bradycardia, sinus arrhythmia, SSS.

B. Ectopic (heterotopic) rhythms due to the predominance of automatism of ectopic centers: 1) Slow (replacement) escape rhythms: atrial, from the AV connection, ventricular. 2) Accelerated ectopic rhythms (non-paroxysmal tachycardia): atrial, from the AV connection, ventricular. 3) Migration of the supraventricular pacemaker.

C. Ectopic (heterotopic) rhythms, mainly due to the mechanism of re-entry of the excitation wave: 1) Extrasystole (atrial, from the AV connection, ventricular. 2) Paroxysmal tachycardia (atrial, from the AV connection, ventricular). 3) Atrial flutter. 4) Atrial fibrillation (fibrillation). 5) Flutter and flicker (fibrillation) of the ventricles.

II. Conduction disorders: 1) Sinoatrial blockade. 2) Intra-atrial (inter-atrial) blockade. 3) Atrioventricular blockade: I degree, II degree, III degree (complete blockade). 4) Intraventricular blockade (blockade of the branches of the His bundle): one branch, two branches, three branches. 5) Asystole of the ventricles. 6) Ventricular Preexcitation Syndrome (PVZh): Wolff-Parkinson-White Syndrome (WPW), Short P-Q (R) Interval Syndrome (CLC).

III. Combined arrhythmias: 1) Parasystole. 2) Ectopic rhythms with exit block. 3) Atrioventricular dissociations.

Principles of antiarrhythmic therapy . Treatment tactics depend on the severity of the course of the disease, the prognostic value of cardiac arrhythmias, and the presence of aggravated heredity. The patient does not need antiarrhythmic therapy with asymptomatic rhythm disturbances, with normal heart size and contractility, high exercise tolerance. These are, for example, such disorders as sinus bradycardia (in the absence of heart disease and normal hemodynamic parameters), pacemaker migration, sinus arrhythmia, slow ectopic rhythms. In this case, dispensary observation, preventive measures, and the exclusion of bad habits are necessary. Etiotropic treatment of arrhythmias (treatment of the underlying disease that causes the development of rhythm disturbance) in some cases is effective in eliminating them. "Basic" therapy is aimed at creating a favorable electrolyte background for exposure to antiarrhythmic drugs (AAT). In the treatment of paroxysmal supraventricular tachyarrhythmias, the use of reflex stimulation of the vagus - "vagal tests" is effective. In severe arrhythmias, accompanied by a progressive deterioration of hemodynamic parameters (heart failure, vascular insufficiency), there is a real threat of death of the patient, electrical impulse therapy (EIT) and pacemaker are used. There are methods of surgical treatment of some types of arrhythmias (ventricular tachyarrhythmias resistant to antiarrhythmic drugs, MA, PVH syndrome with treatment-resistant attacks of supraventricular and ventricular tachycardia, a combination of PVH and SSS syndromes) and radiofrequency catheter ablation.

Pharmacotherapy of cardiac arrhythmias is widespread and is used in 85-90% of patients suffering from arrhythmias. A wide range of drugs with different mechanisms of action allows you to choose the most effective for the treatment of specific types of arrhythmias. The mechanism of action of AARP is the blockade of sodium, calcium, potassium ion channels, which leads to a change in the electrophysiological properties of the myocardium. Many AARP act simultaneously on different types of transmembrane ion channels. Currently, it is considered a generally accepted classification, which includes 4 classes of AARP (Table 1). If any antiarrhythmic drug is ineffective, the next drug is selected from another group. When prescribing AARP, the indications for prescribing a particular drug should be clearly defined. It is necessary to take into account the possibility of an arrhythmogenic effect of AARP.

Against the background of many synthetic drugs, a special place is occupied by a preparation of plant origin. Allapinin (A), which is the hydrobromide of the alkaloid lappaconitine, obtained from aconite (wrestler) of the white-mouthed buttercup family. According to the mechanism of action, A is an inhibitor of fast sodium current and belongs to the IC class of AARP. It slows down the conduction of the impulse through the atria and the His-Purkinje system, unlike most class I AARP, it does not inhibit the automatism of the sinus node. A causes blockade of abnormal conduction pathways, in some cases reaching their “complete chemical destruction”, which makes it especially effective in the treatment of patients with WPW syndrome, including those refractory to other AAPs. Efficiency A in this violation reaches 80%. It does not have negative inotropic and hypotensive effects. The listed features of the electrophysiological action of A significantly distinguish it from the currently used AAs. The activity of the drug is manifested in relation to atrial and ventricular arrhythmias. The greatest effectiveness of Allapinin is observed in the prevention of paroxysms of supraventricular tachyarrhythmias (MA, TP and PNT). Its effectiveness in these cases reaches 77.8%. In the treatment of ventricular extrasystoles, the effect is 71.4%. A has been shown to be used in the treatment of arrhythmias in myocardial infarction. The advantage of the drug is low arrhythmogenic activity. Tolerability of the drug is good. It is prescribed orally in tablets for a long course. There is also a solution for parenteral use.

Brief description of some types of cardiac arrhythmias

Flickering (atrial fibrillation). The frequency of MA is about 80% of all supraventricular arrhythmias. According to the Framingham Study, MA occurs in 0.3-0.4% of the adult population, and its frequency increases with age. It is customary to distinguish two main forms of MA: chronic and paroxysmal. Approximately 90% of patients with chronic AF are caused by organic heart disease, among them the most common are organic heart defects (30%) and coronary artery disease (20%). In the paroxysmal form, up to 60% of patients are individuals with idiopathic MA. Among diseases that do not cause gross morphological changes in the atrial myocardium and lead to the development of MA, thyrotoxicosis and dysfunction of the autonomic nervous system, in particular, vagotonia, play an important role. The mechanism for the development of MA is the re-entry of the excitation wave, with several loops functioning re-entry. ECG signs of atrial fibrillation are characterized by the absence of a P wave in all leads, the presence of random f waves of various shapes and amplitudes with a frequency of 350-700 per minute, an irregular rhythm of QRS complexes, which, as a rule, have an unchanged appearance (Fig. 1a). The frequency of ventricular contractions in most cases is 100-160 per minute, but there are also normosystolic and bradysystolic forms. According to modern ideas about the mechanisms of MA, AAs that block potassium and sodium channels (class I and III drugs) are used to treat it.

Rice. 1. ECG for some types of cardiac arrhythmias (according to the book: A.V. Strutynsky "Electrocardiography: analysis and interpretation", 1999)

Paroxysmal supraventricular tachycardia . The electrophysiological mechanism of PNT is the re-entry of the excitation wave, in some cases, the increased automatism of ectopic foci. ECG signs: suddenly starting and just as suddenly ending attack of tachycardia with a heart rate of 140-250 per minute while maintaining the correct rhythm, changes in the shape, size, polarity and localization of the P wave (with PNT from the AV connection, P is located behind the ventricular complex), unchanged ventricular QRS complexes, except for cases with aberration of ventricular conduction (Fig. 1c, d). Sometimes there is a deterioration in AV conduction with the development of AV block I or II degree. The type of PNT depends on various electrophysiological mechanisms, which determines the choice of AAP in each specific case. All four classes of drugs are used.