What are the types of cardiac arrhythmia and the main method of its treatment. How not to guess with the diagnosis? We pass an ECG if sinus arrhythmia is suspected ECG arrhythmias examples

Arrhythmia looks like this on an ECG:
- the first is characterized by a slowdown in conduction, however, the complexes do not fall out and PQ > 0.2 sec remains;

conclusions

How not to guess with the diagnosis? We pass an ECG if sinus arrhythmia is suspected

This article describes what is the normal heart rhythm at different ages, what methods exist for detecting sinus arrhythmia, and how to read the cardiogram correctly.

Heart rhythm and its norm

The heart rate shows how often and at what intervals the heart muscle contracts. This characteristic is the main indicator by which the presence of pathologies can be determined.

Each cardiac cycle with the correct functioning of the heart is reduced at regular intervals. If the duration of the cycles is not the same, then this is already a violation of the rhythm.

The norm of heart contraction is considered to be from 60 to 90 beats per minute, but it all depends on external and internal factors that determine the state of a person. Excess by several indicators is not considered critical, but it is recommended to consult a doctor to determine the problem.

First of all, the heart rate depends on the age of the person. In children, the heart beats faster than in adults - the average is 120 beats per minute. This is considered completely normal, since the blood volume in babies is small, and the cells need oxygen.

Heart rate by year:

At the age of 20 to 30, men have 60-65, and women have 60-70 beats per minute;
At the age of 30 to 40, men have 65-70, and women have 70-75 beats per minute;
At the age of 40 to 50, men have 70-75, and women have 75-80 beats per minute;
At the age of 50 to 60, men have 75-78, and women have 80-83 beats per minute;
At the age of 60 to 70, men have 78-80, and women have 83-85 beats per minute;
At the age of 70 and older, men have 80, and women have 85 beats per minute.

Research methods and their description

Arrhythmia is considered a common disease among adolescents during puberty. The disease is determined by the following symptoms: chest pain, tachycardia, shortness of breath and others.

Sinus arrhythmia is an uneven distribution of the rhythm, in which it becomes more frequent or less frequent. Research is needed to determine the cause of the disease.

It happens that a situation arises when an in-depth study may be needed, a person may be prescribed invasive methods - that is, with penetration into the esophagus, blood vessels or the heart.

Tests with physical activity

In order to detect sinus arrhythmia during physical activity, most often used bicycle ergometry, treadmill test or tilt test.

Bicycle ergometry

As the name implies, the procedure is carried out using a design that resembles an exercise bike with an attached apparatus. First, the indicators are recorded before the procedure - they measure blood pressure, record ECG, heart rate. The patient begins to pedal at the speed and power that the doctor sets. Then the specialist increases the performance. During the entire procedure, ECG indicators are recorded, and blood pressure is measured every 2-3 minutes. The moment when the patient stops pedaling and rests is also fixed. It is important to understand how quickly the heart comes to a normal rhythm.

Treadmill test

This procedure is also associated with the simulator. The patient walks on the treadmill at different speeds. The intensity is controlled by changing the speed and incline.

Also, all indicators are recorded while driving. There are no significant differences from bicycle ergometry. But it is believed that the treadmill is more natural and familiar to the patient.

If any discomfort occurs, the patient can stop. The doctor also closely monitors the patient's condition.

Tilt test

To perform this procedure, the patient is placed on a special table, then he is fixed with straps and transferred to an upright position. During the change of positions, all ECG readings, as well as blood pressure, are recorded.

Event Monitoring

A special device is attached to the patient, but he turns it on only when he feels pain or any discomfort. The received records are broadcast to the doctor on the phone.

ECG is the most important research method, thanks to which violations can be detected. This can be determined by the following indicators:

what is the heart rate per minute - bracardia is less than 60, tachycardia is more than 90, and the norm is in the range from 60 to 90;
where is the source of the rhythm, if everything is normal, then it is located in the sinus node;
where the presence and place of extraordinary excitations of the myocardium - extrasyspol;
where the conduction from the sinus node is disturbed, inside the ventricles, or the problem lies in the atrium;
whether there is fibrillation and flutter in the ventricles or in the atrium.

During the procedure, the patient should undress to the waist, release his legs and lie down on the couch. The nurse then applies the agent to the abduction sites and attaches the electrodes. The wires go to the machine and take a cardiogram.

Get ahead of the presence of sinus arrhythmia on the cardiogram can be done as follows:

You can see the P wave in all leads, while it is always positive in II, and vice versa, it is negative in the aVR lead, while the electrical axis is within age limits.
Next, you should pay attention to changes in the R-R intervals. Usually, the intervals between the teeth shorten and lengthen smoothly, but if there is a place for sinus arrhythmia, then spasmodic changes are observed.
Again, if there is no difference in holding the breath in the R-R interval, then this indicates an arrhythmia. The exception is the elderly.

Holter ECG

A device is attached to the patient's body - halter, which records indicators for forty-eight hours. The person should keep a diary describing their daily activities and symptoms. After that, the doctor must analyze the obtained indicators.

This diagnosis allows you to accurately identify the presence of the disease, following the work of the heart in a certain period of time.

But it is worth taking into account the fact that the device may have some failures, so the indicators in some places may not be accurate or will have some deviations.

Electrophysiological study

This method is used if it was not possible to identify discomfort during the remaining studies. One of the electrodes is inserted through the nose into the food passage or a vein is catheterized into the heart cavity. After that, a small impulse is given, and the doctor monitors the change in rhythm.

Useful video

The following video tutorials will help you learn how to decipher the ECG results yourself:

Conclusion

Careful attention to the work of the heart can protect against more serious diseases. If shortness of breath occurs, or a rapid heartbeat, it is recommended to immediately consult a doctor. As described in the article, ECG is one of the most accurate ways to detect sinus arrhythmia, you can read the cardiogram yourself, but for an accurate diagnosis, it is recommended to contact specialists.

Sinus arrhythmia on the ECG: detailed decoding, all signs

The abnormal heart rhythm that characterizes sinus arrhythmia can be seen on an ECG. This condition is often diagnosed in healthy people. In this situation, it is considered as a variant of the norm that does not require medical intervention. In most cases, sinus arrhythmia is asymptomatic. Therefore, the only way to detect it is a planned electrocardiography.

What does sinus arrhythmia look like on an ECG?

The main method of diagnosing cardiovascular disease is electrocardiography.

The diagnosis of "sinus arrhythmia of the heart" means a condition in which the heart rate increases or decreases. The disorder is caused by uneven generation of impulses that occur in the sinus node.

The main method for diagnosing cardiovascular disease is electrocardiography. Based on the results of the diagnostics, a cardiologist can judge whether a person has disorders in the work of the heart. Pathology has a number of characteristic symptoms that allow you to accurately determine it in the process of deciphering the cardiogram.

First signs

Sinus arrhythmia, regardless of whether it is respiratory or not, on the ECG gives itself out as characteristic signs. It is through them that the cardiologist will be able to identify the presence of a violation in the patient, which has not previously manifested itself in any way.

The doctor will decipher the received cardiogram in accordance with the norms for taking readings after this type of diagnosis. He will do it in stages. Deciphering the cardiogram of a person who is sick with sinus arrhythmia involves the study of individual parts and leads. Their change should be characteristic directly for this pathological condition.

Sinus arrhythmia is given by the following signs that can be found on the cardiogram:

The presence of sinus rhythm. There will be a P wave in all leads. It is positive in lead II, and negative in aVR. The electrical axis can be found within the boundary, which corresponds to the variant of the age norm. In other leads, this tooth can have different values, both positive and negative. This indicator depends on the EOS.
Periodic change of R-R intervals. It can be as short as 0.1 seconds. As a rule, such changes are directly related to the phase of breathing. Occasionally, after the shortest interval, the longest interval is observed. The intervals that are present between the R waves can shorten or lengthen if the development of a physiological form of arrhythmia is observed. Organic disturbances lead to spasmodic failures on the part of the duration of the intervals. They can exceed normal values by 0.15 seconds.
No difference in the duration of the R-R intervals at the moment of holding the breath during inhalation. This symptom is usually observed in children and adolescents. For elderly patients, this symptom is not typical. In them, the violation persists even during manipulations with breathing (air retention in the lungs).

If the doctor knows these signs and can see them on the electrocardiogram, then it will not be difficult for him to make the correct diagnosis for the patient.

Symptoms as the disease progresses

The heart rate as sinus arrhythmia develops reaches 71-100 beats per minute

The results of scientific research have shown that the symptoms of the disease in its various manifestations become more pronounced on the ECG with the active development of the pathological process. Signs of sinus arrhythmia become noticeable to the patient himself, since a violation of the heart rhythm adversely affects his well-being.

Further development of arrhythmia leads to a greater change in the direction, shape and amplitude of the P-wave. These processes directly depend on the localization of the source of the rhythm and the speed of the flow of the excitation wave in the atria.

In patients with sinus arrhythmia, the heart rate gradually changes, which is also displayed on the cardiogram. As the disease progresses, it reaches 71-100 beats per minute. With a more rapid rhythm, the patient is diagnosed with sinus tachycardia.

It is better to entrust the doctor-specialist with the removal of the electrocardiogram and its interpretation.

People who are predisposed to developing cardiovascular disease should periodically do an ECG to monitor the functioning of the heart and the entire system. At least once every 3 months, they should visit a cardiologist and undergo all the necessary studies that will help identify even a slight violation of the heart rhythm.

An unscheduled visit to a cardiologist and an ECG will be required for a person who suddenly has symptoms of sinus arrhythmia. Timely access to a doctor will prevent the progression of the disease and the development of complications.

Repeated electrocardiography is required for a patient who periodically experiences jumps in blood pressure, fainting, shortness of breath and toxicosis. Frequent diagnostics by the ECG method does not cause any harm to human health, since the procedure is completely safe for his body.

The ECG does not always allow the cardiologist to obtain enough information in order to diagnose the patient and prescribe the appropriate treatment for him. In the event of controversial issues, he directs a person to undergo a number of additional studies, including:

Electrophysiological diagnostics.
orthostatic test.
Echocardiogram.
Holter monitoring.
Load test.

In addition to an electrocardiographic study, differential diagnosis is also required. With its help, the cardiologist can distinguish sinus arrhythmia from another pathological condition that has a similar clinical picture with it. Conducting only electrocardiography, a specialist cannot always obtain this information, even understanding what the ECG result means.

A differential method for diagnosing sinus arrhythmia is required in order to timely recognize an acute form of myocardial infarction in a patient. It can develop against the background of paroxysmal tachycardia. Therefore, an ECG is required to detect this violation.

The patient himself can decipher the ECG readings. To do this, you need to know which leads and intervals to pay attention to. Some patients try to conduct an ECG analysis on their own, as they want to save money on a specialist consultation, which is not always free. But you need to understand that a person who does not have experience in deciphering an ECG can make a serious mistake. As a result, an incorrect diagnosis will be made and an inappropriate treatment will be selected.

If the patient cares about his own health, then he must entrust a competent doctor with both the removal of the cardiogram and its decoding. This will prevent serious errors that may adversely affect the further behavior of the patient and provoke the active development of cardiovascular disease.

Signs of arrhythmia on the ECG: decoding the films

Arrhythmia is a condition in which the strength and frequency of heart contractions, their rhythm or sequence changes. Occurs as a result of disturbances in the cardiac conduction system, deterioration of excitability or automatism functions. It is not sinus rhythm. Some episodes proceed without symptoms, while others are manifested by a pronounced clinic and lead to dangerous consequences. In this regard, arrhythmia requires a different approach in the treatment of each specific case.

Signs of abnormal heart rhythm on the ECG

With arrhythmia, the rhythm and frequency of the heartbeat change, become more or less than normal. Irregular contractions and disturbances in the conduction of electrical impulses along the conduction system of the myocardium are recorded. A combination of more than two features is possible. The localization of the pacemaker may migrate, causing it to become non-sinus.

One of the criteria for arrhythmia is the frequency of contractions and its form, constant or paroxysmal. Also take into account the department in which the violation occurs. Pathological heart rhythm is divided into atrial and ventricular.

Sinus arrhythmia in violation of the intracardiac impulse in the focus of the sinus node is manifested by tachycardia or bradycardia:

For tachycardia, an increase in the frequency of contractions to 90-100 per minute is characteristic, while the rhythm remains correct. Occurs with increased automatism in the sinus node (SU), against the background of endocrine, cardiac and combined psychosomatic pathology. It is respiratory, disappearing on inspiration. Tachycardia on the cardiogram - P waves precede each ventricular complex, equal intervals R - R are maintained, the frequency of contractions increases from the number of the age norm of an adult or child (more than 80-100 per minute). Arrhythmia looks like this on an ECG:
Bradycardia is characterized by a decrease in the frequency of beats less than 60 per minute with the preservation of the rhythm. Occurs with a decrease in automatism in SU, provoking factors are neuroendocrine diseases, infectious agents:
- on the ECG, the rhythm is sinus with preserved P, equal intervals R - R, while the heart rate decreases to less than 60 beats per minute or from the number of age norms.
The sinus type of arrhythmia occurs when the transmission of impulses is disturbed, which is manifested by an irregular rhythm, more frequent or rare. It happens spontaneously in the form of a paroxysm. With weakening in the focus of the SU of the atria, a syndrome of weakness of the sinus node develops:
- Rhythm disturbance on the ECG manifests itself in the form of an irregular sinus rhythm with a difference between the R-R intervals of no more than 10-15%. Heart rate decreases or increases on the cardiogram.
Extrasystole speaks of additional foci of excitation, in which heart contractions are recorded out of turn. Depending on the location of the excitation, the atrial type of arrhythmic extrasystoles, atrioventricular or ventricular is distinguished. Each type of dysfunction - with characteristic features on the electrocardiogram.
Atrial supraventricular extrasystoles appear with deformed or negative P, with intact PQ, with a disturbed R-R interval and the clutch segment zone.
Antrioventricular extrasystoles on the ECG are detected as the absence of P waves due to their superposition on the ventricular QRS with each extraordinary contraction. The compensatory pause occurs as an interval between the R wave of the complex of the previous extrasystole and the subsequent R, which looks like on the ECG:
Ventricular are determined in the absence of P and the subsequent PQ interval, the presence of altered QRST complexes.
Blockades occur when slowing down the passage of impulses through the conducting cardiac system. AV blockade is registered when there is a failure at the level of the atrioventricular node or part of the trunk of the His launcher. Depending on the degree of conduction disturbance, four types of arrhythmia are distinguished:
- the first is characterized by a slowdown in conduction, however, the complexes do not fall out and PQ > 0.2 sec remains;
- the second - Mobitz 1 is manifested by delayed conduction with a gradual lengthening and shortening of the PQ interval, loss of 1-2 ventricular contractions;
- the second type of Mobitz 2 is characterized by impulse conduction and prolapse of every second or third ventricular QRS complex;
- the third - complete blockade - develops when impulses do not pass from the upper sections to the ventricles, which is manifested by sinus rhythm with a normal heart rate of 60-80 and a reduced number of atrial contractions of about 40 beats per minute. Individual P waves and the manifestation of dissociation of pacemakers are visible.
Arrhythmia looks like this on a cardiogram:
The most dangerous are mixed arrhythmias that occur with the activity of several pathological foci of excitation and the development of chaotic contractions, with the loss of the coordinated functioning of the upper and lower parts of the heart. The disorder requires urgent care. Allocate flutter, atrial fibrillation or ventricular fibrillation. ECG data for arrhythmias are presented in the photo with a transcript below:
Arrhythmia in the form of flutter appears as characteristic changes on the cardiogram:

conclusions

Heart rhythm disturbances differ depending on the cause of their occurrence, the type of cardiac pathology and clinical symptoms. To identify arrhythmia, an electrocardiogram is used, which is examined and deciphered to determine the type of violation and conclusion. After that, the doctor prescribes tests and a course of therapy to prevent complications and maintain quality of life.

The following sources of information were used to prepare the material.

Sinus arrhythmia of the heart

In modern society, it is no longer fashionable to smoke and drink alcohol, it is now fashionable to monitor your health and lead a healthy lifestyle. After all, the quality of life depends primarily on the well-being of a person.

It is for the purpose of early detection of diseases and their prevention in clinics that medical examinations are carried out annually, you can also take tests and make an electrocardiogram that reflects the work of the heart in private medical centers.

Opportunities for examination today are very wide, there would be a desire. But not always a person, after the examination, is clearly and intelligibly explained what this or that indicator in the analyzes means, or what the decoding of his cardiogram means. When reading the conclusion of the ECG “sinus arrhythmia”, the patient does not always understand what this wording means, what happens to the work of his heart, is sinus arrhythmia of the heart subject to treatment? Meanwhile, the primary right of the patient to know what is happening to his health.

1 What is sinus arrhythmia?

Moderate sinus arrhythmia

If you read “moderate sinus arrhythmia” or “sinus respiratory arrhythmia” in the transcript of your electrocardiogram, you should not immediately panic and attribute yourself to the category of cardiac patients, especially if you felt completely healthy before the ECG and had no problems with the heart. You should be aware that this definition does not always signal a disease, it can also be a physiological condition.

Sinus arrhythmia is an irregular heart rhythm, which is characterized by a periodic increase and decrease in electrical impulses in the sinus node with a changing frequency. The sinus node, which normally rhythmically generates impulses with a frequency of 60-90 beats per minute, under the influence of certain factors, ceases to maintain the correct rhythm and begins to "lazy" - to produce impulses of less than 60 beats per minute with the development of bradyarrhythmia, or "hurry up" - produce increased production of impulses of more than 90 beats per minute with the development of tachyarrhythmia.

2 Disease or physiology?

Sinus respiratory arrhythmia

There are two forms of sinus arrhythmia: respiratory (cyclic) and not associated with breathing (non-cyclic).

Respiratory arrhythmia is not a pathology, it does not require treatment, does not cause clinical symptoms. Doctors associate its occurrence with insufficient maturity and imbalance of the autonomic nervous system, which controls the heart. With this form, the predominance of the influence of n.vagi or the vagus nerve on cardiac activity is clearly visible.

Sinus respiratory arrhythmia is characterized by an increase in the heart rate during inhalation and a slowing of the heart rate during exhalation. It often occurs in children, young healthy people, in adolescents during puberty, in athletes, in patients with a tendency to neurosis, in patients with vegetative-vascular dystonia.

The non-cyclic form indicates the presence of a disease that is accompanied by a violation of the heart rhythm. This form is more serious in prognostic value, especially if it is a severe sinus arrhythmia.

3 Causes of the non-cyclic form

Rheumatic valve disease

Acyclic moderate or severe sinus arrhythmia can occur with the following conditions:

diseases of the heart and blood vessels (myocarditis, rheumatic valve disease, arterial hypertension, myocardial ischemia, congenital and acquired defects);
hormonal disorders (hyperfunction of the thyroid gland or insufficient production of thyroid hormones, diseases of the kidneys and adrenal glands, diabetes mellitus);
blood diseases (anemia of various origins);
lack of body weight, cachexia;
mental disorders (neurosis, depression, mania);
infectious diseases (rheumatism, tuberculosis, brucellosis);
intoxication with alcohol, nicotine;
electrolyte disorders (lack of potassium, calcium, magnesium in the blood);
overdose of antiarrhythmics, antidepressants, hormonal drugs.

Arrhythmia in the elderly when waking up from sleep or when falling asleep

All these diseases can cause disorders in the work of the sinus node and, as a result, arrhythmia. Also, the non-cyclic form is a frequent occurrence in older people, it occurs in them when waking up after sleep or when falling asleep. This is due, on the one hand, to age-related changes in the heart muscle, and, on the other hand, to a reduced controlling effect of the central nervous system during periods of transition from sleep to wakefulness and vice versa.

Knowing the cause of rhythm disturbances is very important for determining further treatment tactics.

4 Clinical symptoms

The respiratory form or moderately expressed non-cyclic arrhythmia may not manifest itself in any way, it can be detected only on the ECG. Severe sinus arrhythmia is characterized by symptoms such as palpitations, if there is a tachyarrhythmia, or interruptions in the work of the heart, sensations of heart failure, if bradyarrhythmia occurs. Often with bradyarrhythmias, dizziness, vestibular disorders, and fainting are observed. Symptoms such as weakness, shortness of breath, pain in the heart area may appear. Symptoms will be predominantly associated with the disease that caused the heart rhythm disorder.

5 How to determine sinus arrhythmia?

The doctor, after a thorough questioning, collecting complaints, will proceed to the examination. The pulse on the radial arteries will be irregular, when listening to heart tones, irregular contractions are also noted. With respiratory arrhythmia, a relationship with breathing will be heard: on inspiration, the heart rate will accelerate, on expiration it will slow down. With a non-cyclic form, such a connection will not be traced.

Assistants in the diagnosis - instrumental and laboratory methods of examination:

Holter ECG monitoring,
echocardiography
general clinical, biochemical analyzes,
Ultrasound of the thyroid gland, kidneys, adrenal glands,
Electrophysiological study of the heart.

6 How to distinguish respiratory arrhythmia from pathological?

There are medical methods and techniques that can easily distinguish between two forms of arrhythmia.

The respiratory form disappears on the ECG when holding the breath, the pathological form does not disappear after holding the breath;
Respiratory arrhythmia increases after taking b-blockers, and non-cyclic - does not change;
The non-respiratory form does not disappear under the influence of atropine, but the respiratory form disappears.

7 How to treat sinus arrhythmias

The respiratory form does not require treatment. Treatment of the non-cyclic form depends on the treatment of the disease that contributed to the occurrence of the rhythm disorder. Often, after adjusting the electrolyte balance of the blood, curing anemia, hormonal disorders, arrhythmia disappears and normal heart rhythm is restored.

In case of severe tachyarrhythmia, b-blockers, antiarrhythmics, antithrombotic drugs are used to slow down the heart rate; in case of severe bradyarrhythmia, drugs based on atropine, electrical impulse therapy can be used, or if medical treatment is ineffective, surgical: implantation of a pacemaker. Treatment of sinus arrhythmia is carried out in the presence of clinical symptoms and hemodynamic disorders.

Purpose of the lesson: To teach clinical and ECG diagnostics of the main types of cardiac arrhythmias.

Before the lesson, the student should know:

Classification of arrhythmias.

Arrhythmias associated with dysfunction of automatism.

Arrhythmias associated with dysfunction of excitability.

Arrhythmias associated with impaired conduction function.

Complex types of cardiac arrhythmias.

At the end of the course, the student should be able to:

Correctly recognize various types of arrhythmias by clinical signs.

Correctly recognize various types of arrhythmias by ECG.

Motivation. Arrhythmias are a common complication of heart disease. They aggravate the course of the disease. Therefore, timely accurate diagnosis of arrhythmias is important for the treatment of patients.

Initial data.

Educational elements.

Basic functions of the heart . The work of the heart is carried out thanks to 4 main functions: automatism, excitability, conductivity, contractility.

Classification of cardiac arrhythmias . Arrhythmias are divided into groups depending on the violation of a particular function of the heart: automatism, excitability, conduction and contractility.

Violations of the function of automatism. The most common are sinus tachycardia, sinus bradycardia, and sinus arrhythmia. On the ECG, a sign of sinus rhythm is the presence of a positive P wave in front of the QRS complex.

Sinus tachycardia . It is caused by increased activity of the sinus node as a result of physical or nervous stress, fever, when taking stimulants, thyrotoxicosis, heart failure. Patients complain of palpitations, the pulse is frequent and rhythmic. On the ECG, the RR and TP intervals are shortened.

Sinus bradycardia . It is due to the rare production of impulses from the sinus node. It is observed with hypothyroidism, the action of a number of medications, with an increase in the tone of the vagus nerve during sleep, in patients with diseases of the liver and gastrointestinal tract, and in athletes. The pulse is rhythmic and rare. On the ECG, the RR and TP intervals are lengthened.

sinus arrhythmia . It is caused by non-rhythmic generation of impulses from the sinus node. There are 2 forms: respiratory (youthful) and non-respiratory (with myocardial diseases). On the ECG - different duration of RR intervals in sinus rhythm.

Violation of the function of excitability. Manifested by extrasystole and paroxysmal tachycardia. It is caused by the appearance in some parts of the myocardium of ectopic foci of excitation, which can generate an impulse leading to an extraordinary contraction of the heart. Such heterotopic foci occur with myocardial diseases, with an overdose of a number of medications, with increased nervous excitability, etc.

Diagnostic signs of extrasystole :

extraordinary reduction;

complete or incomplete compensatory pause;

drawing of an extrasystolic complex on an ECG.

In addition to single ones, there are group extrasystoles, and sometimes there is a pattern of extrasystoles, which is called allorhythmia. The types of allorhythms are as follows:

bigeminia (extrasystoles are repeated after each normal sinus complex);

trigeminia (every two sinus complexes are followed by an extrasystole);

quadrigeminia (every three normal cycles are followed by an extrasystole).

Atrial extrasystole . The ectopic focus of excitation is located in the atrium. In this case, excitation spreads to the ventricles in the usual way, so the ventricular QRS-T complex will not be changed, some changes in the P wave may be observed. time interval.

Atrioventricular extrasystole . In this case, an extraordinary impulse leaves the atrioventricular node. Excitation covers the ventricles in the usual way, so the QRS complex is not changed. Excitation goes to the atria from the bottom up, one hundred leads to a negative P wave. Depending on the conditions of impulse conduction in the affected myocardium, excitation may reach the atria earlier and negative P will then be recorded before the normal QRS complex (“upper nodal” extrasystole). Or the excitation will reach the ventricles earlier, and the atria will be excited later, then the negative P will move after the QRS complex ("lower nodal" extrasystole). In cases of simultaneous excitation of the atria and ventricles, negative P is layered on the QRS, which deforms the ventricular complex (“mid-nodal” extrasystole).

Ventricular extrasystole due to the release of excitation from the ectopic focus in one of the ventricles. In this case, the ventricle in which the ectopic focus is located is first excited, the other excitation reaches later along the Purkinje fibers through the interventricular septum. The impulse does not reach the atria in the opposite direction, so the extrasystolic complex does not have a P wave, and the QRS complex is expanded and deformed.

Paroxysmal tachycardia. This is a long chain of extrasystoles, due to the high activity of the ectopic focus, which produces 160-220 or more impulses per 1 minute. The sinus node is suppressed and does not work. There is a supraventricular form of paroxysmal tachycardia (ectopic focus - in the atrium), when all complexes are of a normal type, since excitation to the ventricles goes in the usual way from top to bottom. There is a ventricular form of paroxysmal tachycardia (ectopic focus in one of the ventricles), when all the complexes are dilated and deformed due to the contraction of the ventricles at different times.

Conduction dysfunction- blockades. Blockade is a slowdown or a complete break in the conduction of an impulse, therefore, incomplete and complete blockades are distinguished. They are caused by a "lack of energy" for conducting an impulse in myocardial diseases, the presence of cicatricial, dystrophic, inflammatory changes in the heart muscle.

Sinoauricular blockade It is expressed in the fact that the entire cardiac cycle P-QRS-T falls out periodically, since “energy is quickly consumed” when conducting impulses from the sinus node to the atria.

Intra-atrial block noted with an increase in the size of the atria, it is right atrial (P-pulmonale) and left atrial (P-mitrale). Due to the fact that the P wave is caused by excitation first of the right and then the left atrium, with an enlarged right atrium, the P wave increases, becomes high and pointed. With an increase in the left atrium, the P wave is expanded, often two-humped.

Atrioventricular block subdivided into 3 levels.

1 degree manifested in the prolongation of the PQ interval for more than 0.20 s.

2 degree atrioventricular blockade is associated with an even greater slowdown in the conduction of the impulse from the atria to the ventricles due to a greater lack of energy. There are 2 types according to Mobitz. With atrioventricular blockade of the 2nd degree according to the 1st type of Mobitz, there is a gradual lengthening of the PQ interval with periodic prolapse of the ventricular complex - the Samoilov-Wenckebach periods.

At 3 degrees there is a complete break in the movement of the impulse from the atria to the ventricles. This is a complete transverse blockade. In this case, the atria work from the sinus node (pacemaker of the 1st order) and P waves will be rhythmically present on the ECG. The ventricles perceive impulses from the atrioventricular node (pacemaker of the 2nd order) or from the legs of the His bundle (pacemaker of the 3rd order), sometimes from the Purkinje fibers . Since the underlying pacemakers are less automatic, the ventricles contract less frequently than the atria, and QRS complexes will be recorded on the ECG less often than the P waves. With complete atrioventricular blockade, the pacemaker for the ventricles is periodically replaced, which leads to a short-term cardiac arrest. Clinically, this manifests itself Morgani-Edems-Stokes syndrome. There is a temporary cessation of cardiac activity, loss of consciousness, cyanosis and convulsive seizure. In the treatment of these patients, an artificial pacemaker.

Blockade of the legs of the bundle of His . With complete blockade of one of the legs of the bundle of His, the impulse from the atria passes to the unblocked leg, and to the other ventricle, the excitation goes along the Purkinje fibers through the interventricular septum. As a result, the ventricles contract alternately and after the P wave, a widened and deformed QRS will be recorded.

Complex rhythm disturbances - atrial fibrillation and atrial flutter. Most often observed in the triad of diseases: mitral stenosis, cardiosclerosis, thyrotoxicosis. In this case, all 4 functions of the heart are violated. Initially, the excitability function is disturbed, since due to pronounced dystrophic changes in the atria, many ectopic foci with high activity appear. In 1 minute, from 600 to 900 pulses are generated. The sinus node is suppressed and does not work. Due to the very large number of impulses, the atria do not contract, but fibrillar twitching of individual muscle fibers is observed (the atria "flicker"). The atrioventricular node non-rhythmically conducts only a part of the impulses, and blocks the majority. The ventricles work irregularly, therefore, with different blood supply and force of contraction. Clinical signs: the pulse is non-rhythmic and uneven, the work of the heart is non-rhythmic with different loudness of tones.

On the ECG atrial fibrillation manifested by 4 signs: different duration of the R-R interval, different height of the R wave in the same lead, absence of the P wave, the presence of a wavy isoelectric line, especially noticeable in 1-2 chest leads.

atrial flutter has the same mechanism, but fewer impulses are produced from ectopic foci in the atria (300-400 per 1 minute). Therefore, instead of a wavy isoline, step-like teeth are recorded on it, due to inferior weak contractions of the atria.

Test questions:

List the main functions of the heart.

Describe the classification of cardiac arrhythmias.

What are the signs of sinus rhythm on an ECG?

What are the clinical and ECG signs of sinus tachycardia?

What are the clinical and ECG signs of sinus bradycardia?

What are the clinical and ECG signs of sinus arrhythmia?

Define extrasystole.

The mechanism of development of extrasystole.

What are the clinical and ECG signs of different types of extrasystoles?

What is paroxysmal tachycardia?

What is the violation of the conduction function?

Describe sinoauricular blockade.

What is intra-atrial blockade?

What is atrioventricular block?

What degrees of atrioventricular blockade and their manifestations do you know?

What is the blockade of the bundle of His bundle?

What functions of the heart are impaired in atrial fibrillation?

What is the mechanism of atrial fibrillation?

What are the clinical and ECG signs of atrial fibrillation?

situational tasks.

Task 1. The patient complains of palpitations. There is a frequent and rhythmic pulse. On the ECG, the R-R and T-P intervals are shortened, a positive P wave precedes the QRS complex.

Purpose of the lesson: To teach clinical and ECG diagnostics of the main types of cardiac arrhythmias.

Before the lesson, the student should know:

Classification of arrhythmias.

Arrhythmias associated with dysfunction of automatism.

Arrhythmias associated with dysfunction of excitability.

Arrhythmias associated with impaired conduction function.

Complex types of cardiac arrhythmias.

At the end of the course, the student should be able to:

Correctly recognize various types of arrhythmias by clinical signs.

Correctly recognize various types of arrhythmias by ECG.

Initial data.

Educational elements.

Basic functions of the heart . The work of the heart is carried out thanks to 4 main functions: automatism, excitability, conductivity, contractility.

Diagnostic signs of extrasystole :

extraordinary reduction;

complete or incomplete compensatory pause;

drawing of an extrasystolic complex on an ECG.

In addition to single ones, there are group extrasystoles, and sometimes there is a pattern of extrasystoles, which is called allorhythmia. The types of allorhythms are as follows:

bigeminia (extrasystoles are repeated after each normal sinus complex);

trigeminia (every two sinus complexes are followed by an extrasystole);

quadrigeminia (every three normal cycles are followed by an extrasystole).

Atrioventricular block subdivided into 3 levels.

1 degree manifested in the prolongation of the PQ interval for more than 0.20 s.

Test questions:

List the main functions of the heart.

Describe the classification of cardiac arrhythmias.

What are the signs of sinus rhythm on an ECG?

What are the clinical and ECG signs of sinus tachycardia?

What are the clinical and ECG signs of sinus bradycardia?

What are the clinical and ECG signs of sinus arrhythmia?

Define extrasystole.

The mechanism of development of extrasystole.

What are the clinical and ECG signs of different types of extrasystoles?

What is paroxysmal tachycardia?

What is the violation of the conduction function?

Describe sinoauricular blockade.

What is intra-atrial blockade?

What is atrioventricular block?

What degrees of atrioventricular blockade and their manifestations do you know?

What is the blockade of the bundle of His bundle?

What functions of the heart are impaired in atrial fibrillation?

What is the mechanism of atrial fibrillation?

What are the clinical and ECG signs of atrial fibrillation?

situational tasks.

Task 1. The patient complains of palpitations. There is a frequent and rhythmic pulse. On the ECG, the R-R and T-P intervals are shortened, a positive P wave precedes the QRS complex.

Cardiac arrhythmias have recently become a fairly common pathology, and the quality of medical care depends on timely diagnosis. To identify this disease will help the idea of \u200b\u200bwhat atrial fibrillation looks like on an ECG.

📌 Read this article

The mechanism of occurrence of this disease

Failure of the contractile function of the heart muscle is usually caused by impaired excitability and conduction. In clinical practice, this includes atrial flutter and fibrillation, fibrillation or ventricular fibrillation. If a patient has chronic cardiac pathology, specialists are more likely to encounter atrial fibrillation.

It should be noted that atrial fibrillation is one of the most frequent and severe diseases of the cardiovascular system. This pathology was first diagnosed in the 19th century, but the disease received its modern name at the beginning of the 20th century in the works of domestic scientists.

The main component of the development of the disease is considered a violation of the conduction of electrical and nerve impulses in the fibers of the atria. In this case, the defeat of the ventricles of the heart is secondary.

The entire nervous system of the heart is autonomous and little dependent on the human central nervous system. The work of the heart muscle is regulated by several nodes. It is a malfunction and a weakening of the conduction function in the sinoatrial node that causes an increase in atrial excitability. The node indicated above ceases to fulfill its main role as a pacemaker, which can be perfectly confirmed by various ECG signs of atrial fibrillation.

A large number of ectopic foci occur in the atria, which leads to a failure in the rhythm of contractions in this part of the heart. Due to the fact that the myocardium is not able to respond to all incoming impulses, contractile movements occur in individual fibers of the atrial muscle, which resembles trembling or flickering.

Most often, such a pathology is observed only in the atria, only individual impulses can leak to the ventricles, which causes discord in the contractile work of the whole heart. However, most experts consider limiting the impact of unnecessary nerve stimuli on the walls of the ventricles as a kind of safeguard.

The atria are responsible for only 25% of all pumped blood, which allows the body with some difficulty to compensate for such a failure in hemodynamics. Ventricular fibrillation most often causes the death of the patient, since the symptoms of circulatory failure in this case will be landslide.

Classifications of atrial dysfunction

Modern clinical cardiology prefers to distinguish two main ones. ECG diagnosis of atrial fibrillation is based on the principles of this separation.

It is believed that the main course of cardiac arrhythmia in the atria is a permanent form of the disease, which occurs in more than 70% of patients and often occurs without severe symptoms. Constant atrial fibrillation is classified by the number of heartbeats and the interaction of atrial and ventricular work. There are three main types of the course of the disease:

Bradysystolic atrial fibrillation is characterized by a reduced number of heartbeats - less than 60 beats per 1 minute. Such a pathology most often develops in patients with chronic processes in the heart muscle or coronary vessels.
Normosystolic form of atrial fibrillation interesting in that since the number of heartbeats is close to normal and there is no discrepancy in the work of the atria and ventricles, the patient may not notice a failure in the activity of the heart for a long time. The body adapts to minimal hemodynamic disturbances and corrects it itself.
If the number of heartbeats exceeds 100 beats per minute, experts talk about the development of a tachysystolic form of the disease. Such symptoms are most often caused by various acute processes in the human body. Such a failure of the heart rhythm can occur even in a healthy person under the influence of acute poisoning, a large amount of alcohol, chronic lack of calcium in the blood.

In clinical practice, a picture is often observed when atrial dysfunction occurs without any apparent reason or under the influence of physical exertion. In this case, experts talk about the development of a paroxysmal form of atrial fibrillation.

In contrast to the constant change in heart rate, such attacks are short: they can last from a few seconds to 10 to 12 hours. In terms of symptoms, this disease is similar to the tachysystolic form of rhythm disruption, but there are certain differences.

If the patient has developed paroxysmal atrial fibrillation, the ECG can clearly diagnose the process. Cardiologists believe that the main sign of this pathology is the presence of specific F waves on the electrocardiogram, and an excessive frequency of ventricular complexes on the film is also possible.

Such subtleties of deciphering the electrocardiogram are most needed by emergency physicians and specialists in the intensive care unit. Ordinary users of medical sites should note for themselves the main features of what atrial fibrillation looks like on an ECG.

The main thing on the film is the pulse deficit, that is, the discrepancy between the contractions of the heart and the peristalsis of large vessels and the periphery. As mentioned above, under the influence of excess impulses, the rhythm breaks down, the frequency of contractions of the atria, and sometimes the ventricles, increases, and the pulse remains unchanged. This is due to the fact that the innervation of the activity of the heart and the rest of the body is produced from different sources.

Such an observation allows specialists to evaluate the work of the heart only by ECG, since the indicators of pulse contractions will be unreliable.

Atrial fibrillation is considered a fairly serious disease and should not be treated on its own. The ability to recognize an ECG pattern of atrial contractility is not a reason to refuse to consult a specialist. Only a doctor can determine the presence of pathology and prescribe the correct and timely treatment.

First signs

The electrocardiogram displays signs characteristic of the disease. Atrial fibrillation on the ECG will look like this:

There is no P wave on any electrocardiographic lead (this wave is a mandatory component of a normal ECG).
The presence of erratic f waves throughout the entire cardiac cycle. They differ from each other in amplitude and shape. In certain leads, these waves are best recorded. These include V1, V2, II, III. aVF. These waves result from atrial fibrillation.
Irregularity of ventricular R-R complexes (irregularity, different length of R-R intervals). It indicates an abnormal ventricular rhythm;
The QRS complexes are distinguished by their unchanged appearance and the absence of signs of deformity.

On the ECG, a small- or large-wave form of atrial fibrillation is distinguished (depending on the scale of the waves f).

Symptoms as the disease progresses

Chest pain is one of the possible symptoms of atrial fibrillation

The clinical symptoms of atrial fibrillation become more pronounced as the disease progresses. They can vary significantly from patient to patient.

Signs of atrial fibrillation, which appear on the electrocardiogram, are complemented by symptoms that are noticeable to the patient himself. We are talking about such painful conditions:

profuse sweating;
weakness;
cardiopalmus;
chest pain.

A patient with chronic atrial fibrillation may not even be aware of his illness if it is characterized by an asymptomatic course. In this case, only the result of an electrocardiographic study can determine the presence of pathology.

The types of electrocardiographic manifestations, that is, the symptoms that are visible on the ECG, correspond to the clinical signs of the disease in the patient. Thanks to this competent specialist, it is possible to accurately understand what exactly worries the patient and what kind of help he needs to be provided.

The procedure for taking an electrocardiogram is not difficult. It is only required to adhere to the phased implementation of the action plan, with which each specialist is familiar. He will explain in detail what the patient should do at the time of diagnosis. The total duration of the procedure does not exceed 10 minutes on average.

Electrodes are fixed on the patient's body, the position of which is changed by the doctor or laboratory assistant to obtain various ECG leads.

It is very important that the patient lies still and still during the ECG. In this case, an informative result can be guaranteed. Any movement, coughing, sneezing negatively affects the results of the electrocardiogram, and they can no longer be called reliable.

ECG interpretation

The arrhythmia of heart contractions can only be recognized by a competent specialist who describes the ECG with atrial fibrillation. The interpretation of the results obtained is available only to the doctor. If the case is an emergency, then the task can be entrusted to a paramedic who has repeatedly had to take and decipher the ECG.

The patient can also try to decipher his cardiogram. To do this, he needs to study the medical literature in order to assess the location and height of the teeth, the size of the intervals between them. Without basic knowledge of the ECG, a person risks making a serious mistake.

Patients who need to do an electrocardiogram are interested in the cost of this diagnostic. In Russian clinics, such a service costs from 650 to 2300 rubles. Additionally, payment for the interpretation of the obtained ECG results may be required.

Other diagnostic methods

In standard situations, a person is diagnosed with atrial fibrillation based on his complaints and the symptoms of the disease identified during the initial diagnosis. Questioning the patient and the result of electrocardiographic diagnosis is quite enough if there are no serious complications of the disease.

If the ECG does not provide sufficient information about the patient's condition, then the cardiologist sends him for additional studies:

Echocardioscopy.
Radiography.
Biochemical analyzes of blood and urine.
Transesophageal study of the conduction system of the heart.

An important stage in the study of a patient with atrial fibrillation is differential diagnosis: it is necessary to distinguish the disease from other pathological conditions that may have similar symptoms with it. Differential diagnosis is carried out with the following pathologies:

sinus tachycardia;
atrial flutter;
supraventricular paroxysmal tachycardia;
ventricular paroxysmal tachycardia.

ECG results allow the cardiologist to distinguish atrial fibrillation from the above heart conditions.

ECG frequency

Regular examination by a cardiologist will allow timely detection of the presence of disorders in the work of the heart

Patients may ask questions about the frequency of electrocardiography to check the state of the work of the cardiovascular system. This diagnostic option is absolutely safe for human health. During the procedure, indicators of the bioelectric activity of the heart are simply taken. There are no negative effects on the body.

The frequency of an ECG is dependent on several factors. Doctors recommend checking all people to prevent atrial fibrillation about 1 time per year. If a person's profession is associated with serious stress, then he should visit a cardiologist once every six months. The elderly should be checked every 3 months. They fall into a risk group, so regular checks of the cardiovascular system are mandatory for them.

A scheduled examination by a cardiologist and an ECG recording allows you to timely identify the presence of violations in the work of the heart in a person.

If the patient has atrial fibrillation, then he will have to repeat the ECG procedure at the frequency that will be indicated by the cardiologist.