Atrial fibrillation - a form of disruption of the contractile activity of the heart, caused by disruption of the electrical activity of the atria.If atrial fibrillation has been a sharp increase in heart rate up to 600 beats per minute, as well as reductions in the number of mismatch the atria and ventricles.
Among all the possible types of arrhythmias at a fraction of atrial fibrillation accounts for 30%.The main risk group is men over 60 years old, suffering from organic disorders of the cardiovascular system.For the development of atrial fibrillation is also important sex - men 1.7 times more likely to suffer than women.
Permanent atrial fibrillation without an adequate antiarrhythmic therapy provokes serious violations of the cardiovascular system and is fraught with the development of stroke and thromboembolic complications.
Atrial fibrillation heart
The normal activity of the heart lies in its ability to continuous and regular reduction.Contractile ability o
If you have the paroxysm of atrial fibrillation occurs ineffective contraction of the atria and the ventricles pumping the blood is carried out passively, and insufficient.Thus, there is no regular ejection of blood into the aorta.
When atrial flutter in the ventricles and the insufficient amount of blood, but there is it for another reason.When atrial flutter are constantly in a state of systolic, that is virtually absent diastolic phase.Since the atria are in a compressed state, the blood enters therein to a limited extent.
Thus, when any form of atrial fibrillation, the conditions for the development of ischemic events in all the organs and systems that clinically brain stroke, coronary heart disease and acute coronary syndrome.An extreme manifestation of cardiac ejection is arrhythmogenic shock.
Atrial fibrillation causes
most common etiological factors of atrial fibrillation are diseases of the cardiovascular system: hypertension, chronic ischemic heart disease, heart defects, resulting from the transferred rheumatic disease, cardiomyopathy.
during cardiac surgery and / or in the early postoperative period, quite often there are attacks of paroxysmal atrial fibrillation, and in most cases, it goes without medical intervention.
Frequent consumption of caffeine-containing beverages, and medicines can lead to atrial fibrillation, because coffee has a potentiating effect on the contractility of the heart muscle.
a negative effect on the heart rate provides a systematic use of alcohol as it causes cardiomyopathy and alcoholic intoxication.
In people suffering from thyroid disorders with associated symptoms of hyperthyroidism, the incidence of atrial fibrillation is about 25%.This high figure is due to potentiate the action of catecholamines on the excitability of atrial myocardium.
When receiving certain groups of drugs (diuretics, atropine and adrenaline) increases the risk of arrhythmias, since these drugs have an effect on the heart and disrupt the balance of trace elements involved in the generation of electrical impulses.
At a young age the most common cause of atrial fibrillation is a congenital mitral valve prolapse.
Diseases accompanied by a rise in temperature, provoking malfunction of the autonomic nervous system and accelerate the heart rate, which can lead to malfunction of the sinus node.
acute shortage of electrolytes in the body leads to violations of automatism and conduction system of the myocardium.
great influence on the occurrence of atrial fibrillation has a nervous system.When activity of certain parts of the nervous system are formed by different types of arrhythmias.There vagal and hyperadrenergic version of atrial fibrillation.The first type is more common among the male half of the population and the provocative attack is a horizontal position during sleep, overeating and wearing tight clothing.The second type most often affects women, and there is a clear relationship between the occurrence of attacks and emotional stress.
There is also a variant of idiopathic atrial fibrillation, in which to reliably determine the cause of the attack is not possible.The share of this form of arrhythmia accounting for 30% of cases.
Atrial fibrillation symptoms
degree of clinical manifestations of any form of atrial fibrillation depends on heart rate and the degree of ventricular dysfunction.There are cases where a person does not feel an attack of atrial fibrillation, but in most situations developing detailed clinical symptoms.The most seriously ill patients are transferred tahisistolicheskoy atrial fibrillation.
transferred patients with severe paroxysmal type of atrial fibrillation, and in its subsequent transformation into a permanent atrial fibrillation, many patients no longer pay attention to the symptoms of heart rhythm disorders.
most common complaints of patients in the event of an attack of atrial fibrillation is the feeling heart palpitations, a feeling of shortness of breath, dizziness, discomfort in the heart, sweating and trembling inside.There is a clear correlation between the appearance of these symptoms and the provoking factors, which acts in the role of excessive physical activity, psycho-emotional arousal, smoking and alcohol abuse.
An objective study of the patient's attention is drawn to the sharp increased heart rate and increased blood pressure, combined with the weakness of the filling rate.Auscultation changes are manifested in unequal sonority I tint.
attack flutter manifests itself in the feeling heart palpitations, shortness of breath sharply until suffocation, pulsation of the superficial veins in the neck and chest discomfort.
If you have atrial fibrillation in a patient with heart disease available to the fore the clinical symptoms of heart failure.
Normally, the correct diagnosis is sufficient to conduct an objective examination of the patient with a mandatory palpation and auscultation of the heart pulse, but in order to reliably determine the atrial fibrillation is necessary to perform a Holter ECG monitoring, in which it is possible around the clock to monitor changes in the activity of the heart.Additional methods of research of the patient with atrial fibrillation are: cardiac ultrasound (evaluation of the size and condition of the heart valve), blood tests for electrolytes, and thyroid hormones.
Atrial fibrillation form
Nosological form of "atrial fibrillation" is a comprehensive concept that includes two basic mechanisms of cardiac activity - flutter and atrial fibrillation.Both concepts are combined, since they have a similar nature aetiological, clinical manifestations and is often seen simultaneously in the same patient.
fundamental difference of these options arrhythmia is atrial fibrillation that is characteristic not coordinated contraction of the atria, resulting in an abnormal rhythm of ventricular and atrial flutter is observed only when a significant acceleration of the contractility of atrial and ventricular non-infringement.
depending on heart rate, atrial fibrillation is divided into options: normosistolichesky (heart rate of 60-90 beats per minute, but irregular heart rhythm), tahisistolicheskoy (palpitations combination of more than 90 beats per minute with the wrong heart rate) and bradisistolichesky(abnormal heart rhythm and slow - less than 60 beats per minute).
In turn, atrial flutter may be regular, when every second or third atrial contraction is accompanied by ventricular contraction and irregular, in which there is no coordinated chaotic atria and ventricles.
The first episode of atrial fibrillation occurs first revealed atrial fibrillation, if the episodes are repeated, then this state is regarded as a relapsing form.
There are common variants of atrial fibrillation: paroxysmal (duration of clinical manifestations does not exceed 48 days, and the attack comes to an end on their own), persistent (duration of the attack, more than 7 days and in need of relieving using drugs and cardioversion) and permanent (restoration of normal sinusrate possible).
Paroxysmal atrial fibrillation
first signs of atrial fibrillation in a patient is most often paroxysmal atrial fibrillation, which can later move into permanent form.Time of transition from paroxysmal to permanent depends on the individual and the state of the heart muscle.
Paroxysm of atrial fibrillation is a sudden attack caused palpitations accompanied by weakness, shortness of breath, pale skin, feeling of inner trembling and excessive sweating.When tahisistolicheskoy form often occurs in patients with transient loss of consciousness as a result of cerebrovascular accident.The above symptoms occur after exposure to the organism provoking factors (excessive physical activity, smoking, stress) or on the background of well-being.The first episodes of paroxysmal arrhythmias are short-lived and do not require medical correction.
Recurrent bouts of worsening the quality of life of patients and thrombolytic complications require antiarrhythmic treatment, which is not only in mild asthma, but also systematically taking anti-arrhythmic drugs and medications to correct heart rate.
paroxysmal atrial fibrillation is dangerous for its complications, among which the most common are: cardiogenic shock with a sharp drop in blood pressure, congestive heart failure and pulmonary edema, disturbance of coronary and cerebral circulation, asystole, and thromboembolism, which develops within two days after the onset of an attackfibrillation.
cupping of paroxysmal atrial fibrillation is carried out by intravenous procainamide (15 mg / kg), verapamil (0.15 mg / kg) or digoxin (0.25 mg), and in the absence of the effect of drug therapy method is used transesophageal atrial electrical stimulation.
Atrial fibrillation treatment
All medical assistance activities in patients with atrial fibrillation attacks directed at relief of clinical manifestations, as well as prevention of possible complications, thereby reducing the risk of death.
indications for immediate hospitalization in a hospital are newly diagnosed episode of atrial fibrillation, not cropped paroxysmal atrial fibrillation, the occurrence of complications and adverse reactions as a result of the use of drugs, the combination of a permanent form of atrial fibrillation with heart failure and high tachycardia.
in the treatment of atrial fibrillation episodes follow two main methods: the restoration of the right sinus heart rhythm or regaining control of heart rate during atrial fibrillation saved.Each of these methods has both advantages and disadvantages.The disadvantage of the first option is a manifestation of the patient's adverse reactions to the drug administration, as well as the risk of thromboembolism.When the heart rate control with preservation of atrial fibrillation patients require long-term anticoagulation.
In situations where the attack of atrial fibrillation is not accompanied by clinical signs and is a random finding during a routine examination of the patient, it is necessary to adhere to watchful waiting for 72 hours, with constant need to monitor hemodynamic parameters.In most cases, such attacks of atrial fibrillation are alone.This waiting period is sufficient to appoint a patient a soothing therapy.
Restoring sinus rhythm is carried out by the use of antiarrhythmic drugs and groups of electrical cardioversion.Note that the recovery rate in the unregulated performance heart rate is inappropriate.
to reduce the heart rate are different groups of drugs for atrial fibrillation: B-blockers (Propranalol intravenously at a dose of 0.15 mg / kg, atenolol 50 mg per os), calcium antagonists (verapamil intravenously 0.15 mg / kg, amiodaronedaily dose of 800 mg in a tablet form), cardiac glycosides (digoxin 0.25 mg intravenously).
Amid ongoing antiarrhythmic therapy necessarily carried out monitoring of blood clotting and, if necessary, apply anticoagulants (acetylsalicylic acid 365 mg per day)
to restore normal sinus rhythm is preferable to the use of propafenone and quinidine (loading dose of 300-600 mg), but it should beconsider that they can trigger an increase in heart rate as a result of the transition to the atrial fibrillation.Procainamide is widely used in a dose of 5-15 mg / kg intravenously to restore the rhythm.
second most effective relief of an attack of paroxysmal atrial fibrillation after Quinidine is Ritmilen.It is necessary to observe a system of load application of the anti-arrhythmic agents: the initial dose is 0.2 g, one hour electrocardiographic monitoring is carried out in the absence of positive results, give the patient every hour to 0.1 g, thus bringing a dose of 1 g Absolute contraindicationsfor use Ritmilena are: glaucoma, prostate adenoma.
When an episode of atrial fibrillation in a patient suffering from congestive heart failure, the drug of choice is amiodarone (loading dose of 800-2000 mg per day).A significant advantage of this drug is its ability to control the rhythm of ventricular contraction, which is very important in this form of atrial fibrillation, as atrial fibrillation.
indications for electrical cardioversion is a number of factors:
- a combination of paroxysmal atrial fibrillation, acute coronary syndrome;
- the occurrence of an attack of atrial fibrillation on a background of severe hypotension and progressive symptoms of heart failure;
- the absence of a positive effect from the use of medicines;
- idiosyncrasy of anti-arrhythmic drugs or the presence of contraindications to their use;
- with positive results from the use of cardioversion in history.