Arrhythmia, what is it, causes, symptoms, diagnosis and treatment

Ectopic (heterotopic) rhythms,
due to the predominance of automatism
ectopic centers:

(substitute) slipping rhythms:
atrial, from AV connection,

ectopic rhythms (non-paroxysmal
tachycardia): atrial, from AV – connection,

supraventricular pacemaker.

Ectopic (heterotopic) rhythms,
mainly due to the mechanism
re-entry of the excitation wave:

(atrial, from AV connection,

tachycardia (atrial, from AV – connection,

(atrial fibrillation;

and ventricular fibrillation (fibrillation).

(interatrial) block;

blockade: I degree, II degree, III degree
(complete blockade);

blockades (blockade of the branches of the bundle of His):
one branch, two branches, three branches;

ventricular premature excitation
(DRV): Wolf – Parkinson – White Syndrome
(WPW), Shortened Interval Syndrome
P – Q (R) (CLC).

rhythms with an exit blockade;

the nature of the clinical course of the disorder
heart rate can be sharp and
chronic, transient and permanent.
To characterize the clinical course
tachyarrhythmias use such definitions,
as “paroxysmal”, “recurrent”,
“Continuously recurring”

classified into four large groups:

  • cardiac arrhythmias in violation of the function of automatism
  • cardiac arrhythmias with impaired excitability
  • cardiac arrhythmias with impaired conduction function
  • cardiac arrhythmias with impaired contractility

– violation of the formation of an electrical impulse necessary for contraction of the myocardium in the sinus node.

The main types of cardiac arrhythmias with a predominant violation of the function of automatism:

  • Sinus tachycardia
  • Sinus bradycardia
  • Sinus arrhythmia (non-respiratory and respiratory)
  • Nodal rhythm
  • Idioventricular rhythm

– increase the excitability of ectopic sections of the myocardium with a decrease in the excitability of the sinus node.

The main arrhythmias with a predominant violation of the excitability function:

  • Extrasystole (sinus, supraventricular, nodal, ventricular)
  • Passive slipping complexes (sinus, supraventricular, nodular, ventricular)
  • Paroxysmal tachycardia (sinus, supraventricular, nodular, ventricular)
  • Atrial fibrillation (tachysystolic, normosystolic and bradisystolic; large-wave and small-wave)
  • Interference dissociation

– violation of the electrical impulse from the source of the heart rhythm to the myocardium along the cardiac pathways.

The main arrhythmias with a predominant violation of the conduction function:

  • Sinoatrial block
  • Intraatrial
  • Atrioventricular block
  • Morgagni-Adams-Stokes Syndrome
  • Intraventricular block
  • Blockade of the legs of the bundle of His

– severe degenerative changes in the myocardium with cardiomyopathy, myocardial infarction, myocarditis, myocardiofibrosis. This group of cardiac arrhythmias is represented by an alternating pulse, which is characterized by the alternation of small and large pulse waves.

carried out depending on their type, cause and pathogenesis of the disease in which they occur. For the treatment of cardiac arrhythmias, various methods of therapy are used, both drug and non-drug. With cardiac arrhythmias, treatment is directed to the correction of the underlying disease. For correction

use various antiarrhythmic drugs.

There are several main classifications of arrhythmias. According to the rate of formation of an impulse, arrhythmias can be divided into tachyarrhythmias (increased heart rate) and bradyarrhythmia (decreased heart rate).

The following types of arrhythmias are distinguished at the place of formation: supraventricular (atrial), ventricular, and atrioventricular.

I. Violation of the rhythm.

  • Violation of the automatism of the pacemaker (sinus node):
  1. tachyarrhythmia;
  2. bradyarrhythmia;
  3. simple sinus arrhythmia;
  4. sinoatrial weakness syndrome.
  • Arrhythmias due to the occurrence of ectopic pacemakers (non-sinus node):
  1. slow atrial, ventricular, or atrioventricular replacement rhythms or complexes;
  2. accelerated atrial, ventricular, or atrioventricular replacement rhythms or complexes.
  • Arrhythmias arising from a re-emerging excitation wave in the pathways:
  1. extrasystoles (atrial, ventricular, atrioventricular);
  2. paroxysms of tachycardia (can occur in the atria, ventricles, atrioventricular node);
  3. ventricular/atrial flutter;
  4. ventricular/atrial fibrillation.

II. Impulse conduction disturbance.

  • blockade of the sinoatrial node;
  • blockade of the atrioventricular connection (three degrees);
  • intraventricular blockade of the bundle of His and its legs;
  • ventricular asystole;
  • syndrome of premature ventricular contraction.

III. Mixed violations.


High effectiveness of treatment for cardiac arrhythmias will be ensured if the patient appears for a consultation with a cardiologist when the first signs of a heartbeat occur. During the appointment, the doctor will not only be able to establish an accurate diagnosis, but will also inform the patient about the probable causes of arrhythmia. This is important, because if you ignore the root cause, it is impossible to ensure a high result of drug therapy.

Physicians distinguish, depending on their provoking causes, two main varieties of arrhythmia:

klassifikatsiya razlichnye metody lecheniya aritmii serdtsa - Arrhythmia, what is it, causes, symptoms, diagnosis and treatment

Organic heartbeat disorders occur against the background of existing and actively occurring cardiac pathologies in the body. Such problems have to be faced by patients who have previously been diagnosed with myocarditis, cardiomyopathies, congenital heart disease, or the patient has had chest injuries and heart surgery. Functional arrhythmias are also distinguished:

  • neurogenic (occur against the background of alcohol abuse, smoking, constant stay in a stressful situation, with excessive overwork);
  • with a failure of the parasympathetic nervous system (most often observed in patients who have previously identified problems with the functioning of the gall bladder, as well as the intestines);
  • dyselectrolyte (established in patients in whose body there is an imbalance of water and important trace elements, which include potassium, sodium, calcium, magnesium);
  • medical reasons (a malfunction can occur with the wrong prescription or use of certain medications, especially those characterized by a diuretic effect);
  • disturbance of the heartbeat may occur after an injury occurring in the chest area.

Along with this, despite the perfection of the diagnostic techniques used in determining pathologies, there are varieties of arrhythmia, the causes of which are impossible to establish. In such cases, they are called idiopathic. Also, many cardiologists are convinced that such a disease can be transmitted at the genetic level.

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Due to the fact that arrhythmia is accompanied by a malfunction of the heart rhythm, the main symptoms of such a pathology are manifested in the form of a rapid heartbeat, dizziness, headaches. Also, patients sometimes panic from the fact that they feel a sinking heart. With a rapidly developing disease, fainting conditions, severe weakness, and signs of suffocation can occur.

If sinus arrhythmia develops, patient complaints indicate a feeling of increased discomfort in the chest area. Symptoms of cardiac arrhythmias in women and men can provoke serious interruptions in the work of the body, accompanied by powerful tremors, which are immediately replaced by fading. If you do not take any action, the disease continues to actively develop and favor the emergence of additional serious problems. In this case, patients may encounter such symptoms:

  • severe shortness of breath even in the absence of intense physical activity;
  • feeling short of breath;
  • the occurrence of a shock condition.

It often happens that the arrhythmia of the heart has no symptoms, treatment in such cases, of course, is not carried out. The so-called “blind” arrhythmia to a greater extent is detected purely by accident during the diagnostic examination.

In medicine, there is a certain classification of arrhythmias, based on which doctors develop the optimal treatment regimen for patients. Having information on which type of such a disease is observed in the patient, it is much easier to figure out how to deal with arrhythmia, which medications for arrhythmia should be taken to provide effective first aid in case of attacks, and also completely get rid of the disease.

- Arrhythmia, what is it, causes, symptoms, diagnosis and treatment

According to the anatomical characteristic, pathology is classified into such varieties:

Also, arrhythmia is classified depending on the frequency and rhythm of heart contractions into such types:

  • tachycardia;
  • extrasystole;
  • bradycardia;
  • heart block.

According to the main mechanism for the development of arrhythmia, it can be divided into:

  • caused by organic heart damage (usually blockades)
  • caused by functional disorders of the heart (violation of the frequency of contractions, extrasystole).

Functional arrhythmias result from:

  • neurogenic influences, which include activation of the autonomic nervous system, the influence of stresses, emotions, mental or physical work, psychostimulants (nicotine, alcohol, coffee, tea), neurosis, nutrition components (spicy, salty, spicy).
  • metabolic disorders of electrolytes important for the heart (potassium, magnesium, sodium, calcium).
  • iatrogenic interventions (caused by treatment), which include diuretics, beta-blockers, cardiac glycosides, adrenomimetics.
  • hormonal influences, such as adrenaline and norepinephrine, an excess of thyroid hormones, ACTH (adrenocorticotropic hormone), cortisol.
  • painful conditions such as fever, intoxication, hypoxia, anemia.
  • idiopathic disorders (with an unknown cause).
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With organic arrhythmias, defects are formed in the heart muscle, because of which it can not normally conduct impulses along damaged nerve branches. If the pacemaker is affected – the sinus node, the pulses begin to be generated incorrectly.

With functional arrhythmias, impulses to the heart are disturbed due to external influences or the inability of the heart to process correctly all the signals arriving to it is formed.

Each type of arrhythmia has its own cause; for some types, the causes may be similar.

– drinking alcohol, smoking; – drinking energy and other caffeinated drinks; – taking certain medications; – stress; – excessive physical exertion, overstrain; – thyroid disease; – adrenal gland diseases; – diseases of the cardiovascular system (coronary heart disease, heart valve disease, heart failure, heart disease, myocarditis, etc.); – hypertension;

Now that it has become more or less clear with what arrhythmia is, one can go on to why they arise.

The causes of arrhythmias are divided into several main groups:

  • Extracardial causes (not related to heart damage):
  1. prolonged increase in body temperature over 38 degrees;
  2. changes in the thyroid gland – thyrotoxicosis (excessive increase in thyroid hormones in the blood), hypothyroidism (decrease in hormone production);
  3. acute vascular, respiratory, renal or liver failure;
  4. cardiopsychoneurosis ;
  5. poisoning with various substances;
  6. increased intracranial pressure;
  7. an overdose of drugs (cardiac glycosides, beta-adrenergic blockers);
  8. smoking (both active and passive), excessive use of alcohol, coffee;
  9. pathological reflexes that occur in the heart, but caused by diseases of other organs and systems.
  • Intracardial causes (directly “cardiology of arrhythmias” or heart damage):
  1. acute or chronic heart failure;
  2. acute myocardial infarction;
  3. severe leaking angina (acute attack);
  4. inflammatory diseases of the heart muscle – myocarditis;
  5. cardiosclerosis (resulting from atherosclerotic changes or after a heart attack);
  6. systemic diseases of the connective tissue;
  7. direct damage to the pathways during surgery;
  8. rheumatic diseases;
  9. hypoxic damage to the heart muscle;
  10. electrolytic imbalance.
  • Congenital pathology of the pathways, heart muscle, pacemaker.
  • Physiological reasons:
  1. physiological bradycardia in athletes;
  2. strong or prolonged physical activity;
  3. emotional overstrain.

In connection with these features, in men arrhythmias occur somewhat less frequently. Thus, in order to find out the causes of cardiac arrhythmias, a thorough examination of the patient is necessary.

Manifestations of arrhythmia

Symptoms of arrhythmias depend on the heart rate and their regularity. In this case, it is important whether arrhythmias affect the blood circulation of vital organs. There may be clinically not manifest arrhythmias that are detected only on the ECG.

  • interruptions in the work of the heart,
  • strong palpitations with attacks, with impaired well-being,
  • feeling of sinking heart
  • chest pains
  • dizziness
  • feeling of suffocation
  • fainting
  • weakness,
  • shock development.

Diagnosis and treatment

As soon as there are signs of heart rhythm disturbance, the patient should seek the help of a doctor in order to undergo a full diagnostic examination, during which it is possible to specify the disease and begin treatment. You can not take pills, referring to the recommendations of friends, to the information that was obtained by reading the literature. The medicine for cardiac arrhythmias should be prescribed only by a doctor.


It is not difficult to diagnose arrhythmia, since most clinics have equipment that allows the use of passive and active diagnostic techniques. In particular, passive techniques are:

  • electrocardiography;
  • echocardiography;
  • daily monitoring of ECG.

In most cases, the diagnosis of such a disease is carried out using such techniques. However, in a certain category of patients, cardiac arrhythmias occur against the background of increased physical activity. It is for this reason that the cardiologist can refer the patient to a diagnostic examination involving active techniques.

aritmiya eto 1 - Arrhythmia, what is it, causes, symptoms, diagnosis and treatment

In these cases, before the diagnosis, the patient is subjected to physical exertion, focusing on the implementation of exercises, offering a bicycle ergometry, involving riding on a special device that simulates a bicycle. Based on the results of the diagnostic examination, the doctor decides how the patients should be treated, which tablets are indicated for them to take. Also, the cardiologist draws attention to the danger of arrhythmia, so that the patient responsibly treats the prescribed treatment.

If the patient has been experiencing attacks of arrhythmia for several years, he already has sufficient information on what actions should be taken to prevent attacks, strengthen the heart. However, those patients who first experience symptoms of heart rhythm disturbance, and especially signs of atrial fibrillation, begin to panic, which further worsens their well-being.

Relatives and loved ones will be completely out of place to know how first aid is provided in case of arrhythmia attacks. This will help prevent the occurrence and intensification of a panic attack, as well as contribute to the rapid normalization of the general condition of the patient. Initially, the patient should be laid down or seated, but always so that the posture is comfortable.

Initially, they ask the patient about complaints and examine, listen to the heart and examine the pulse. The specialist must pay attention to what medications the patient is taking at the moment. To find out the cause of arrhythmia, it is first necessary to prescribe:

  • biochemical analysis of blood: potassium, glucose, thyroid hormones, etc. (both increased and decreased indicators are possible);
  • blood coagulation test, including INR – a mandatory study to select the correct dosage of drugs that prevent blood clotting.

But to clarify the type of arrhythmia and the severity of the lesion, it is necessary:

  • ECG in 12 leads and daily Holter monitoring of the ECG – to detect the fact of the arrhythmia itself,
  • Ultrasound of the heart (echocardiography) at rest and with a dosed physical and drug load (stress tests) – to assess structural changes in the heart, which can be the cause of conduction disturbances and the detection of functional disorders and organ work at rest and during exercise,
  • transesophageal echocardiography reveals in the heart those structures that are poorly visible when an ultrasound scan is performed through the chest wall, for example, blood clots (thrombi) in the left atrial ear, which most often cause the main complications of atrial fibrillation – ischemic strokes,
  • transesophageal electrostimulation of the heart is used to determine the nature and mechanisms of the formation of certain conduction disturbances.

Diagnosis of arrhythmia includes a comprehensive examination of the patient. One of the simplest and most reliable diagnostic methods is an electrocardiographic study.

Since arrhythmias can be transient, and during the day they can occur and disappear several times, Holter monitoring is necessary for the most accurate determination of arrhythmias. This is the same electrocardiographic study, only registration takes place during the day. In this case, the patient should note in a special notebook on the clock their actions (climbed the stairs, had a fight with a friend, etc.). Holter monitoring is the most accurate type of study.

When decoding an electrocardiogram, doctors can evaluate the heart rate (sinus, atrial, atrioventricular, ventricular), its regularity or irregularity. Then the conductivity is estimated. To do this, the duration of the teeth and the intervals is measured, with their expansion, delayed conductivity is noted.

For diagnosis, an echocardiographic study is also performed to identify structural changes in the heart. If the cause of arrhythmia is unknown, then conduct a comprehensive study of all organs and systems, based on complaints and anamnesis to exclude concomitant diseases.

– electrocardiography (ECG); – echocardiography; – daily or multi-day ECG monitoring; – ultrasound.

The most important method for diagnosing arrhythmia is, of course, an ECG. But she can not always show arrhythmia, since she shows a heart rhythm only for the period of time in which it is written, and arrhythmia attacks can occur suddenly and be short-lived.

Arrhythmias of the heart with a predominant violation of the function of contractility

Cardiologists are involved in the treatment of arrhythmias. Therapy of the underlying disease and the simultaneous correction of the heart rhythm are carried out.

Depending on the severity and neglect of the disease, different tactics are used: conservative (use of drugs) or surgical.

In the treatment of arrhythmias, the following drugs are used:

  • cell membrane stabilizers (procainamide, trimecaine, propafenone),
  • adrenergic blockers (atenolol, nadolol), but recently, drugs such as concor, egiloc, carvedilol, sotalol have been preferred;
  • potassium channel blockers (amiodarone),
  • calcium channel blockers (verapamil).
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But not only arrhythmias are dangerous, but their complications, such as thrombosis and thromboembolism. Therefore, drugs are added to therapy to prevent their occurrence:

  • antagonists of vitamin K (warfarin);
  • antiplatelet substances (acetylsalicylic acid);
  • new oral anticoagulants (xarelto, pradaxa) are today the most advanced, since they greatly simplify their use, since there is no need to monitor blood coagulation indicators every month.

It is very important to understand that when using traditional medicine, it is necessary to inform the attending physician about their use, since there is a high probability of an overdose of certain substances that can aggravate the situation.

Other methods include:

  • electric cardioversion (a way to restore heart rhythm using a special defibrillator mode);
  • transesophageal electrostimulation of the atria;
  • pacemaker implantation,
  • radiofrequency ablation (a method of suppressing pathological pulses).

The prognosis of arrhythmias depends on their type and severity of violations.

A major role is played by concomitant diseases. Thus, each person is individual and each needs his own approach and treatment, which should be determined by a cardiologist.

Important! For the effective treatment of arrhythmias, it is necessary to visit a doctor to find out whether arrhythmia is a concomitant disease of the underlying disease or independent. It is also necessary to determine the type of arrhythmia. After this, you need to follow the doctor’s prescriptions.

Arrhythmia can be either a separate disease or a symptom of a concomitant disease. If it is a separate disease, then treatment is carried out with the help of drugs that normalize the rhythm of the heart. If arrhythmia is a complication of a concomitant disease, which became the cause of its appearance, then after treatment of the underlying disease, arrhythmia can go away on its own, but, in most cases, arrhythmic drugs are still prescribed.

1. Sports activities. 2. Diet. 3. Vitamins and minerals. 4. Medicines. 5. Procedures.

Important! You can not prescribe treatment yourself. Before treatment, be sure to consult your doctor, as even folk remedies can harm the body.

diagnostika projavlenij aritmii - Arrhythmia, what is it, causes, symptoms, diagnosis and treatment

Infusion of Valerian. 1 tbsp. teaspoon of crushed valerian root pour 1 cup boiled water (room temperature). Insist in a sealed container for 8-12 hours, strain and take 1 tbsp. spoon 3-4 times a day.

A broth of valerian. 2 teaspoons pour 100 ml of water, boil for 15 minutes and take 1 tbsp. spoon 3-4 times a day before meals.

Infusion of calendula. 2 teaspoons of calendula inflorescences pour 2 cups of boiling water, let stand for 1 hour and strain. Drink 0,5 cups 4 times a day.

Infusion of lemon balm. 1 tbsp. pour 2,5 cups of boiling water in a spoon, let stand for a couple of hours (wrapping) and strain. Drink 0,5 cups 3-4 times a day. Take a weekly break once every 1 months.

Tincture of hawthorn. Pour 10 g of dry hawthorn fruit into 100 ml of vodka and let it brew for 10 days. Strain and take 10 drops with water 3 times a day before meals.

A decoction of hawthorn flowers. 5 g of flowers of hawthorn pour 1 cup boiling water, cover, heat in a water bath for 15 minutes, cool and strain. Drink 0,5 cups 2-3 times a day 30 minutes before meals.

Radish juice with honey. Mix in the ratio 1: 1 fresh juice of sowing black radish and honey. Take 1 tbsp. spoon 2-3 times a day.

Horsetail infusion. 1 tbsp. spoon dry chopped grass horsetail field pour 400 ml of boiling water, let it brew for 2 hours and strain. Take 1 tbsp. spoon 5-6 times a day.

Snack from arrhythmia. Grate celery, add parsley, dill, mayonnaise and a bit of salt. Eat the mixture once a day, before dinner. Such a tasty medicine can be eaten separately, or you can spread on bread.

Onion with an apple. Grind a small onion and 1 apple. Mix and take in between meals 2 times a day for 1 month.


Various types of arrhythmias are treated with various methods. Treatment plans are developed by a cardiologist; he also necessarily monitors the effectiveness of therapy using an ECG. Patients must be prescribed antiarrhythmic drugs. In order to strengthen the body, to allow it to successfully withstand any physical and nervous stress, doctors recommend that patients use vitamins for the heart with arrhythmias.

  • pacemaker;
  • implantation of a cardioverter defibrillator;
  • radiofrequency ablation;
  • open heart surgery.

Along with medical and surgical treatment, doctors recommend taking decoctions, infusions prepared on the basis of herbs, fruits. Alternative therapy, successfully combined with the main treatment, favors not only an improvement in overall well-being, but also the restoration of the normal functioning of the heart, normalization of the heartbeat.

Arrhythmia is a pathology that is dangerous if the patient does not seek help from a cardiologist. If the treatment process is led by an experienced doctor, the patient is responsible for fulfilling all appointments, strictly observes all recommendations, the heartbeat can completely normalize. In such cases, the patient manages to prevent dangerous consequences, followed by often incurable diseases.

For the treatment of cardiac arrhythmias, antiarrhythmic drugs are most often prescribed. They can reduce the automatism of the sinoatrial and atrioventricular nodes, shorten or speed up the heart rhythm (depending on the group of drugs) and worsen conduction in the atrioventricular node, which lengthens the period of excitability of the heart muscle.

Currently, doctors use the classification, which includes 5 main groups of antiarrhythmic drugs, to treat the symptoms of cardiac arrhythmias and the disease as a whole. The classification of drugs is based on what arrhythmias generally are, in accordance with this, the choice of drugs is carried out:

  • Sodium channel blockers: also contain three subgroups of the same means. The main effect of their action is to reduce automatism, slow conduction, lengthen repolarization, and increase the effective refractory period. A subgroup of lidocaine accelerates repolarization.
  • Beta-blockers – reduce automatism and slow down conduction.
  • Potassium channel blockers – from additional effects, they have the property of uniformly lengthening the repolarization and action potential.
  • L-type calcium channel blockers – significantly reduce conductivity in the atrioventricular junction, inhibit cell depolarization.
  • Cardiac glycosides – are rarely used to treat arrhythmias.

All drugs are available in tablet form for the most convenient use. For first aid, parenteral administration (intramuscular or intravenous) of these drugs is possible.

Non-drug therapies are also used to treat arrhythmias. These include:

  1. Electric cardioversion – restoration of a normal rhythm with fibrillation or trembling of the ventricles and atria. The procedure is very painful, so the patient is first sedated, anesthetized or given anesthesia. The patient is connected to an ECG monitor, electrodes are placed on the chest and a kit is prepared for resuscitation. The required charge is selected on the defibrillator, the patient’s skin is treated with an alcohol solution to reduce electrical effects and gauze wipes are applied. After the first discharge, in most cases, the rhythm returns to normal.
  2. Catheter ablation is a non-surgical method of treatment, with surgical functions, the purpose of which is the source of arrhythmia, which must be destroyed. It is used in the presence of tachycardia with high digital values ​​and in the presence of additional congenital pathways in the patient. During ablation, an electrode is passed to the heart to the patient, through which an RF pulse is emitted. It serves as a source of destruction of arrhythmic foci.
  3. Implantation of a cardioverter-defibrillator is the only way to prevent the patient from having life-threatening arrhythmias. A defibrillator is implanted in the heart, which is connected to the heart muscle using electrodes. The implantable device is a small box that records the heart rate 24 hours a day and restores it in the presence of irregularities. It is used mainly in patients with frequently occurring fibrillations. The device independently recharges the heart, and it continues to work in a normal rhythm.
  4. Electrical stimulator implantation is used in the treatment of heart block and severe bradycardia. The device consists of a unit that generates pulses and the electrode to which they are sent. An electrical stimulator is placed in the heart muscle under the endocardium. Depending on the degree of blockade, it is possible to conduct one or two electrodes, respectively, in one or two ventricles.

Remember that the state of your health is primarily up to you. With timely diagnosis and a healthy lifestyle, many diseases can be avoided.

Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.