Atrial fibrillation is an inconsistent myocardial excitation, when the frequency of contractions exceeds 300-500 beats per minute. However, the pulses are not strong enough to provide blood flow with oxygen. There are several classifications of pathology, but the following division of forms of arrhythmia is most common:
- Paroxysmal – an attack lasts less than a week, usually stops within two days, even without the use of therapeutic agents;
- Persistent form – on its own, rhythm disturbance does not pass within a week, the use of medications or other methods of treatment is required;
- Permanent form – characterized by the fact that the therapy was unsuccessful and a decision was made to maintain fibrillation. It requires regular monitoring by a specialist and the treatment of concomitant diseases.
The permanent form does not occur spontaneously, it is always preceded by a stage of seizures that may not be noticed by the patient.
The development of the disease continues for several years, the state of health and the characteristics of therapy affect the rate of change. At first, attacks are not often disturbed, over time, their duration and breaks increase, which leads to pathological disorders in the work of the atria. In the future, the appearance of constant fibrillation is possible.
Doctors have found that persistent atrial fibrillation is rare in healthy people. Pathology is manifested in patients who are already registered with a cardiologist, respectively, their heart is not working effectively, or violations are noted in the circulatory system.
What factors provoke the disease?
- Long-term use of drugs for arrhythmia – especially if the patient is self-medicating, is not observed by the doctor, or the specialist does not have sufficient qualifications;
- Asocial lifestyle – drinking alcohol and smoking throughout life lead to the fact that irreparable changes occur in the heart. Atrial fibrillation is only one of the possible pathologies;
- Heart surgery – with some surgical interventions there is a risk of side effects, rhythm disturbance is one of them;
- Intoxication of the body – we are talking about toxic substances, harmful products and microorganisms. If infection is not treated, changes in the functioning of the main muscle are likely;
- Increased physical activity – when a person is often overworked, does excessive and difficult work, has little rest, the heart wears out much faster;
- Vibration in the workplace – this factor is not common, although the disease can develop for this reason.
However, in most cases, constant atrial fibrillation occurs due to internal causes. These include heart disease, high blood pressure, pathologies of the kidneys and circulatory system, diabetes mellitus, pulmonary disorders, hyperthyroidism.
At risk are people suffering from enlargement of the left ventricle and its dysfunction. Most often, arrhythmia occurs in older people, so after 40 years the probability of deviations increases, and if alcohol is a frequent guest on the table, cardiac abnormalities will certainly be diagnosed.
About a third of patients do not notice attacks and heart rhythm disturbances. However, there are still symptoms, they are simply ignored by a person and attributed to age, fatigue, and a lack of vitamins.
The brightness of the symptoms depends on individual characteristics and the clinical picture, so atrial fibrillation, aggravated by heart failure or angina pectoris, will not go unnoticed.
What symptoms indicate violations and the need to visit a cardiologist?
- Sensation of weakness and rapid fatigue – a person has noticeable apathy, lethargy, even in the absence of exertion, fatigue is felt;
- Dizziness and fainting – occur for no reason, over time, their frequency may increase;
- Unpleasant sensations in the chest area – many feel a rapid heartbeat, as if the muscle is ready to jump out, interruptions are often noted – the heart does not work in one rhythm;
- The appearance of shortness of breath – since the necessary amount of oxygen does not enter the lungs, a person cannot “breathe”, because of this, depression is felt;
- Chest pain is the most dangerous symptom, which is strictly forbidden to ignore. At the first attack you need to visit a doctor, otherwise the consequences will not be the most pleasant;
- Cough – also caused by a lack of oxygen, usually it intensifies in a horizontal position;
- Panic attacks – at the time of the attack, the pressure in a patient, even with hypertension, can drop significantly, which leads to autonomic disorders.
Violations are aggravated even with minimal physical exertion, so it becomes difficult for people to play sports, and even completely dangerous. The disease manifests itself and an irregular pulse, its deficiency is observed.
At home, you can conduct elementary measurements: count the heart rate and pulse, if the readings of the latter are less than the heart rate, then there are violations.
But to determine what kind of atrial fibrillation (permanent form or paroxysmal) you have should be a specialist.
Atrial fibrillation is an easily diagnosed disease. It is enough to contact a cardiologist and make the necessary tests to make an accurate diagnosis. There are several accurate and effective methods for examining a patient:
- Visual examination – the doctor listens to the pulse and heartbeat, notes their irregularity, interruptions in the work of the heart, listens to the person’s complaints;
- An ECG is the easiest and most effective way. On the cardiogram, the constant form is manifested by an irregular heart rate interval, an irregular rhythm, P-waves are absent, and the frequency of chaotic waves exceeds 200 units. Changes in ventricular rhythm may also be noted;
- Monitoring using a cardioregistrator – a person carries equipment for a day or more. At the same time, the device works on the basis of an ECG, only continuously. So it is possible to identify more accurate data, but a daily examination will cost several thousand rubles.
Diagnosis using a registrar (holter) is carried out in the usual conditions, that is, the patient does not need to go to hospital. At the appointed time, he simply comes to the cardiologist.
The indicated methods are enough to make an accurate diagnosis and prescribe treatment. If a person has comorbidities, or the attack has been going on for a long time, other methods can be used to create a more complete clinical picture.
Treatment of a constant form of atrial fibrillation is reduced to restoring the correct sinus rhythm. This can be done with medication or a cardioverter; in addition, you need to control the formation of blood clots, which entail the closure of blood vessels and death.
As practice shows, the effectiveness of drugs for arrhythmia for this form does not exceed 50%, and cardioversion – about 90% with timely medical attention.
The specialist is faced with the task of restoring or not restoring the rhythm, since taking pills can lead to aggravation of the pathology, provoke even greater deviations and lead to death.
The patient gets used to the constant form, but if jumps in the heart rate are observed in the body, the condition will significantly worsen.
If the cardiologist doubts that the results of the action of the drugs can be saved, the decision is made that restoring the rhythm is impractical.
Drug therapy includes the following drugs:
- Medications for rhythm retention – Digoxin, Diltiazem or analogues of 120-400 mg per day, beta-blockers are additionally used;
- Drugs that prevent the appearance of blood clots. Usually, 300 mg acetylsalicylic acid is used, or warfarin if there is a risk of complications.
With an increased tendency to bleeding, taking blood thinners is strictly prohibited.
Another method of treatment is the use of a pacemaker – an apparatus that acts on the ventricles by electrical impulses. The effectiveness of therapy increases if atrial fibrillation is observed up to 2 years, otherwise the chances of recovery are not more than 50%.
A pacemaker helps to eliminate the symptoms of the disease, it acts even in a situation where drug treatment has failed. However, the installation of the device is associated with surgical intervention, and in the future, constant monitoring by a cardiologist is still necessary.
With the constant form of fibrillation, it is necessary not only to take pills, but also to significantly change your life. Only with an integrated approach will you be able to feel comfortable and eliminate the occurrence of complications. What measures should be taken?
- Revise your diet, refuse harmful and fatty foods. The daily menu should include cereals, fruits, vegetables, as well as foods high in potassium and magnesium;
- You can not give up physical exertion, however, sports are carried out in a gentle mode – just walk and morning exercises. But the exhausting workouts will have to be completely forgotten;
- Be attentive to your health – if dangerous symptoms appear, you should immediately visit a doctor. Heart rate is constantly monitored, it is advisable to keep track of their performance.
Without a doubt, you will need to abandon bad habits – alcohol and cigarettes are banned, abuse will lead to side effects that threaten life.
With a constant form of the disease, you will have to become a frequent visitor to a cardiologist, do an ECG and take various tests.
If surgery is planned (for example, tooth extraction with anesthesia), you must definitely warn the doctor about the presence of pathology and tell the names of the drugs you are taking.
Atrial fibrillation in constant form is a dangerous and difficult to treat pathology. Symptoms may not be noticeable, because violations develop over time, misleading patients. However, one can live with such a disease, and in high quality, the main thing is to follow all doctor’s prescriptions, give up bad habits, and lead a healthy lifestyle.
- Prevalence in society
- Characteristic features of persistent atrial fibrillation
- What’s this
- Symptoms and signs
- Tactics of therapy
- Paroxysmal atrial fibrillation: causes, symptoms and treatment
- Folk methods
- Who is at risk
- Diagnosis of persistent atrial fibrillation
- Signs on an ECG
- Relevance of the problem
- Classification of Atrial Fibrillation
- Paroxysmal atrial fibrillation: causes, symptoms and treatment
- Clinical effects of AF
Prevalence in society
The tachysystolic form of atrial fibrillation, which is the most common, occurs in 3% of adults aged 20 years and older. Moreover, older people suffer from the disease to a greater extent. This trend is due to several factors:
- increase in life expectancy;
- early diagnosis of asymptomatic forms of pathology;
- the development of concomitant diseases that contribute to the appearance of atrial fibrillation.
It was revealed that the risk of getting sick in women is slightly lower than in men. But at the same time, the former are more often susceptible to strokes, have a greater number of concomitant diseases and a pronounced clinic of fibrillation.
Characteristic features of persistent atrial fibrillation
- Atrial fibrillation, in particular atrial fibrillation (AF), is one of the most common rhythm disturbances.
- Despite the fact that many patients live with this condition for many years and do not experience any subjective sensations, it can provoke serious complications such as fibrillation tachyform and thromboembolic syndrome.
- The disease is treatable, several classes of antiarrhythmic drugs have been developed that are suitable for continuous administration and rapid relief of a sudden attack.
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Atrial fibrillation refers to inconsistent excitations of atrial myocardial fibers with a frequency of 350 to 600 per minute. In this case, a full atrial contraction does not occur.
The atrioventricular connection normally blocks excessive atrial activity and passes the normal number of impulses to the ventricles. However, sometimes there is rapid ventricular contraction, perceived as tachycardia.
In the pathogenesis of AF, the main role is given to the micro-re-entry mechanism. The tachyform of the disease significantly reduces cardiac output, causing circulatory failure in a small and large circle.
Why is atrial fibrillation dangerous? The unevenness of the atrial contractions is dangerous by the formation of blood clots, especially in the ears of the atria, and their separation.
The prevalence of atrial fibrillation is 0,4%. Among the group younger than 40 years, this figure is 0,1%, older than 60 years – up to 4%.
It is known that in patients over the age of 75 years, the probability of detecting AF is up to 9%. According to statistics, in men, the disease occurs one and a half times more often than in women.
The pathological substrate cannot normally conduct an impulse, causing an uneven contraction of the myocardium. Arrhythmia provokes the expansion of the chambers of the heart and lack of function.
According to the clinical course, five types of atrial fibrillation are distinguished. They are distinguished by the features of the appearance, clinical course, compliance with therapeutic effects.
The first >
Three forms of atrial fibrillation are distinguished by the frequency of ventricular contractions:
- bradysystolic, in which the heart rate is less than 60 per minute;
- with normosystolic number of contractions within normal limits;
- tachysystolic is characterized by a frequency of 80 per minute.
Various causes can contribute to the occurrence of rhythm disturbances, including extracardiac diseases, inflammation of the layers of the heart, and congenital pathological syndromes. In addition, functional mechanisms and a hereditary predisposition are possible.
Reasons are divided into the following groups:
- inconsistent causes: low potassium in the blood, low hemoglobin in the red blood cell, open heart surgery;
- long-acting: hypertension, coronary heart disease, heart and valve defects, cardiomyopathy, amyloidosis and hemochromatosis of the heart, inflammatory diseases of the muscle membrane and pericardium, valve structures, myxoma, Wolff-Parkinson-White syndrome;
- catecholamine-dependent fibrillation: provoke emotional overload, taking strong coffee and alcohol;
- vagus-induced: occurs against a background of reduced heart rate, often at night;
- genetic forms.
Risk factors in young people are addiction to bad habits, excessive use of caffeinated drinks and alcohol, drugs, in older patients – myocardial infarction, prolonged history of hypertension, congenital heart disease.
Symptoms and signs
Clinic of the disease is observed in 70% of cases. It is caused by a lack of blood supply, which accompanies dizziness, general weakness.
The tachyform of atrial fibrillation is characterized by a rapid heartbeat and pulse, a sensation of interruptions in the work of the heart, and fear. When thrombotic masses occur in the atria, thromboembolic cider occurs.
A thrombus from the right atrium enters the right ventricle and pulmonary trunk, respectively, enters the vessels that feed the lungs. When a large vessel is blocked, shortness of breath and shortness of breath occur.
From the left atrium, a blood clot in a large circle of blood circulation can enter any organ, including the brain (in this case there will be a stroke clinic), lower extremities (intermittent claudication and acute thrombosis).
The paroxysmal form is characterized by the suddenness of the onset, shortness of breath appears, rapid heartbeat with interruptions, irregular heartbeat, chest pain. Patients complain of acute shortage of air.
Often there is dizziness, a feeling of weakness. Fainting sometimes occurs.
With a constant or persistent form, symptoms (a feeling of an irregular heartbeat) occurs or is aggravated by the performance of any physical activity. The clinical picture is accompanied by severe shortness of breath.
On examination and auscultation, an irregular heartbeat and heart rate are found. The difference between heart rate and pulse is determined. Laboratory tests are necessary to establish the etiology of the disease.
The diagnosis is confirmed by electrocardiography.
ECG signs of atrial fibrillation: instead of the P waves, f waves are recorded with a frequency of 350-600 per minute, which are especially clearly visible in the II lead and the first two chest. With tachyform, along with the waves, the distance between QRS complexes will be reduced.
With an inconsistent form, daily monitoring is indicated, which will reveal attacks of atrial fibrillation.
Transesophageal stimulation, intracardiac EFI, is used to stimulate possible myocardial activity. All patients need echocardiography to establish the hypertrophic processes of the heart chambers, to identify the ejection fraction.
AF from the sinus rhythm, in addition to the atrial waves, is distinguished by different distances between the ventricular complexes, the absence of the R wave.
If insertion complexes occur, diagnosis with ventricular extrasystoles is required. With ventricular extrasystole, the intervals of adhesion are equal to each other, there is an incomplete compensatory pause, in the background – a normal sinus rhythm with R waves.
Emergency care for paroxysm of atrial fibrillation consists in cessation of action and treatment of the cause of the disease, and hospitalization in a cardiology hospital; the tactics of drug recovery of rhythm – 300 mg of cordarone intravenously – are used to stop the attack.
Tactics of therapy
How to treat atrial fibrillation? Indications for hospitalization are:
- first-time, paroxysmal form less than 48 hours;
- tachycardia more than 150 beats per minute, lowering blood pressure;
- left ventricular or coronary insufficiency;
- the presence of complications of thromboembolic syndrome.
Tactics of treatment of various forms of atrial fibrillation – paroxysmal, persistent and constant (permanent):
Paroxysmal form of atrial fibrillation and first occurring.
An attempt is made to restore rhythm. Medical cardioversion is performed with amiodarone 300 mg or propafenone. Compulsory ECG monitoring. As antiarrhythmics, procainamide is used intravenously jet 1 g in 10 minutes.
With a disease duration of less than 48 hours, it is advisable to administer 4000-5000 units of sodium heparin to prevent thrombosis. If AF occurred more than 48 hours ago, warfarin is used before restoring the rhythm.
With severe symptoms, a significant decrease in pressure, symptoms of pulmonary edema, electro-pulse therapy is used.
For prophylactic antiarrhythmic treatment use:
- propafenone 0,15 g 3 times a day;
- ethacisin 0,05 g 3 times a day;
- allapinin in the same dosage;
- amiodarone 0,2 g per day.
In bradycardia, allapinin will be the drug of choice for atrial fibrillation. Monitoring the effectiveness of treatment is carried out using daily monitoring, repeated transesophageal stimulation. If it is impossible to restore the sinus rhythm, it is enough to reduce the frequency of paroxysms and improve the patient’s condition.
Persistent forms of atrial fibrillation.
Patients of young and middle age, as well as in a subjective state, it is necessary to try medication or electric pulse cardioversion.
Before restoring the rhythm, it is necessary to check the INR level (the target value is 2-3 for three weeks).
Electrical cardioversion is carried out in the intensive care unit, before the intervention, 1 ml of 0,1% atropine is premedicated. For medicinal cardioversion, 15 mg of nibentan or 450 mg of propafenone are used.
Permanent form of atrial fibrillation
To reduce the rhythm, digoxin is used, diltiazem 120-480 mg per day. It is possible to combine with betablokatorov.
For the prevention of thromboembolism, acetylsalicylic acid is prescribed in a dosage of up to 300 mg, with a risk factor for stroke – warfarin (with INR control), with numerous risk factors for atrial fibrillation (advanced age, hypertension, diabetes mellitus) – indirect anticoagulant therapy.
A heart rate of 70 times per minute is taken as the norm, due to the continuous connection of the organ with the sinus node. During atrial fibrillation, other atrial cells take responsibility for contraction.
Paroxysmal atrial fibrillation: causes, symptoms and treatment
I want to note that it is very important to distinguish the true cause of atrial fibrillation from factors that only contribute to the manifestation of the disease.
At the moment, about 14 variants of changes in the genotype are known, leading to rhythm disturbance. It is believed that the most frequent and significant mutation is located on chromosome 4q25.
In this situation, a complex violation of the structures and functions of the myocardium of the atria occurs – it is remodeled.
In the future, it is supposed to resort to the help of genomic analysis, which will improve the prognosis of the disease and reduce disability due to early diagnosis of the pathology and timely treatment.
A permanent form of atrial fibrillation is cardiological pathology, a form of atrial fibrillation. Such a violation is characterized by a chaotic contraction of the muscle fibers of the atria. Most often, pathology develops after the age of 40, but may occur earlier.
A persistent form of atrial fibrillation develops under the influence of cardiological diseases. This is the most stable form of arrhythmia. In the event of its appearance, it is impossible to normalize the sinus rhythm for a long time. The risk of developing such a pathology increases with age.
Atrial fibrillation (another name – atrial fibrillation) is a violation of the rhythm of heart contractions, which occur randomly. As a result of an inconsistent contraction of muscle fibers, the pump function of the atria, and then the ventricles and the whole heart as a whole, is disturbed.
Under normal conditions, the sinus node determines the frequency of contractions of the heart muscle. This figure is approximately 60-80 reductions per minute. If, for some reason, the sinus node does not function fully, then the atria generate impulses with a frequency of up to 300 times or more. But under such conditions, not all impulses enter the ventricles.
As an independent phenomenon, the constant form of atrial fibrillation does not pose a danger to the patient’s life, but can cause negative consequences in the form of blood clots in the vessels of the brain. Such complications threaten human health and life.
In most cases, fibrillation occurs against a background of various cardiovascular diseases, but other causes may also be its cause. The violation develops as a result of factors such as:
- arrhythmias of one nature or another;
- inflammatory processes in the heart muscle (pericarditis, myocarditis);
- arterial hypertension;
- myocardial infarction;
- violation of valve structures of the heart muscle;
- cardiac ischemia;
- type diabetes mellitus, especially against the background of obesity;
- various cardiomyopathies;
- acquired and some congenital heart defects;
- tumors of the heart muscle;
- endocrine pathologies (in particular – thyrotoxicosis);
- diseases of the central nervous system;
- prolonged stay in rooms with high air temperature;
- conducting surgical interventions in the heart;
- diseases of the gastrointestinal tract (calculous cholecystitis);
- alcohol abuse, nicotine, smoking;
- prolonged exposure to vibrations on the body;
- regular stress;
- intense exercise;
- kidney disease.
As for the age factor, the likelihood of progression of the pathology increases if a person turns 55 years old. The risk increases as the body ages.
At risk are also people who have come under the influence of an electric current discharge.
A persistent form of atrial fibrillation occurs in approximately 75% of cases. An asymptomatic course of such a disorder is observed in 25 out of 100 patients.
The main symptoms of heart rhythm disturbance are:
- pain in the chest;
- bouts of fear or panic;
- a feeling of interruption in the work of the heart, which manifests itself in the fact that the heart first freezes for a short while, and then starts functioning again;
- fainting conditions, fainting;
- darkening of the eyes;
- irregular pulse of different filling;
- In some cases, the pathology can manifest itself in rapid urination.
- Typically, symptoms indicating fibrillation appear after exercise, even if it is mild.
- The clinical picture of the deviation is exacerbated in the presence of coronary heart disease, hypertension, valve defects.
- Symptoms with this form of pathology can increase over several years.
- The constant form of atrial fibrillation is determined using such methods:
- visual inspection;
- analysis of hormones produced by the thyroid gland;
- Holter monitoring, monitoring the rhythm during the day.
When making a diagnosis, clinical manifestations such as:
- irregularity or pulse deficiency in the patient;
- different sonority of heart sounds;
- the presence of specific changes in the cardiogram;
- the presence of signs of the underlying disease (pathology of the cardiovascular or endocrine system);
- profuse urination after attacks indicating a constant form of atrial fibrillation;
- the presence of signs of heart failure (wheezing in the lungs, enlarged liver, shortness of breath);
- arrhythmic activity of the heart.
The criteria for a permanent form of atrial fibrillation are:
- shortness of breath, coughing and fatigue after physical exertion;
- dull pain in the heart;
- interruptions in the work of the heart.
Therapy of the disease requires the regular use of specific drugs that control the heart rate, as well as means to prevent stroke. They should be taken for life.
The treatment is carried out by a cardiologist.
The chronic form of pathology cannot be corrected, therefore therapeutic measures are aimed at preventing complications that may be caused by a violation.
Patients are prescribed the following groups of drugs:
- antiarrhythmic (Flecainide, Amiodarone, Anaprilin, Propafenone);
- calcium antagonists (Diltiazem, Verapamil);
- adrenergic blockers (Concor, Atenolol);
- drugs that slow down the heart rate: they are prescribed if other drugs have not helped restore the heart rate (Digoxin, Propranolol);
- diuretics, vitamin complexes can also be used to eliminate arrhythmias;
- to prevent the likelihood of blood clots inside the blood vessels of the heart, prescribe the use of anticoagulants (Warfarin, Cardiomagnyl), during the course of the therapy, indicators of the blood coagulation system must be monitored;
- To improve blood flow in the heart muscle, complexes with potassium and magnesium are indicated.
Restoring the heart rhythm in the presence of certain health indicators cannot be carried out. These contraindications include the following:
- an increase in the size of the left atrium (more than 6 cm);
- the presence of a blood clot in the cavity of the heart muscle;
- untreated thyrotoxicosis;
- age over 65 years;
- the presence of concomitant arrhythmias;
- side effects from taking antiarrhythmic drugs.
Also, drugs to restore heart rhythm are not prescribed if patients have anomalies of the heart muscle of an innate nature. In this case, the course of treatment is determined individually.
Surgical treatment with a constant form of atrial fibrillation is indicated if antiarrhythmic drugs do not give effect or the patient is intolerant of such drugs, as well as in the case of rapid progression of heart failure. In these cases, cauterization, or ablation.
In the course of radiofrequency ablation, portions of the atria in which pathological pulsations are observed are affected by an electrode at the end of which there is a radio sensor. It is injected through the femoral vein. Intervention is carried out under general anesthesia.
If the main cause of the pathology is heart disease, then the surgical intervention will allow you to get rid of the main risk factor and prevent recurrence of atrial fibrillation.
Important in the process of adjusting the patient’s condition is the diet. This is due to the need to control weight, the excess of which creates an additional load on the heart muscle, as well as the exclusion from the diet of foods and drinks that can adversely affect the work of the body.
Patients should observe the following principles of nutrition:
- dishes should be warm, both cold and hot foods should be discarded;
- the last meal should be carried out no later than 2-3 hours before bedtime;
- eat food only when a feeling of hunger appears;
- any kind of food should be chewed carefully.
From the patient’s diet, it is necessary to exclude:
The listed products increase the risk of the formation of cholesterol plaques in the vessels, which hamper the blood flow and further aggravate the situation of the patient.
- different types of cereals;
- fresh fruits;
- protein-rich foods;
- lean meats – chicken, turkey, lean pork;
- dairy products;
- dried fruits.
With atrial fibrillation of a constant form, coffee and tea are contraindicated. The drinking regimen must be observed when drinking up to 2,5 liters of water per day (this indicator does not include the volumes of meat or vegetable broth consumed). If there are severe problems with the cardiovascular system or kidneys, you should drink less fluids in order to avoid swelling and not exert additional load.
Read more about the diet for atrial fibrillation – read here.
Alternative methods of treatment can complement a comprehensive course of treatment. You can use them only on the recommendation of a doctor.
Such recipes are known for correcting the constant form of atrial fibrillation:
- Infusion of calendula. To prepare, pour a tablespoon of the flowers of the plant, pour 300 ml of hot water. Place the container with the composition in a warm place for an hour. Strain, take half a glass before meals, three times a day.
- Infusion on calendula and mint. You need to take 4 calendula flowers, a teaspoon of freshly chopped mint. The resulting mass is brewed with 200 ml of boiling water. Leave the liquid under the lid for half an hour, then strain. Take 200 ml of the finished drink 3-4 times a day.
- A decoction based on rose hips. You need to take a tablespoon of fruit, having previously removed the seeds from them, pour them with two glasses of boiling water, boil for 10 minutes, then strain. Take the broth chilled, in half a glass 30 minutes before meals, 4 times a day. Natural honey can be added to the drink to taste.
- Infusion on motherwort and fruits of hawthorn. It is necessary to take in equal parts dry grass and dry fruits. Take a tablespoon of the resulting plant mixture, pour it with 300 ml of boiling water, wait 2 hours, then strain. Ready broth to take 3 times a day, 100 ml each time.
- Infusion of viburnum. To cook it, you need to grind 3 cups of berries and pour the resulting mass with two liters of hot water. Insist the container with the composition, wrapping it, for 6 hours. After this, the tincture should be filtered, add 200 g of natural honey to it. It is recommended to take one glass of such a product a day before meals. The daily amount should be divided into three doses.
- Juice from grapes and turnips. Finely chop fresh medium-sized white turnips, squeeze the juice with gauze or a juicer. Grapes of red or dark varieties (one large brush is enough) to squeeze to obtain juice. For each dose, mix 150 ml of the obtained juices. Take twice a day.
- Herbal medicine. It is necessary to take in equal parts vegetable raw materials: rosemary, peppermint, valerian root, St. John’s wort. Take a tablespoon of the mixture and pour a glass of boiling water. Put in a water bath, hold for 15-20 minutes. Do not bring liquid to a boil. After 2 hours, strain the broth. Drink 4 times a day, 5 ml, regardless of meals.
Who is at risk
Diagnosis of persistent atrial fibrillation
The most informative method for diagnosing atrial fibrillation is an ECG.
But before that, the doctor will collect an anamnesis. Important information will be information about:
- similar rhythm disturbances in the next of kin;
- concomitant diseases, for example, pathology of the lungs, thyroid gland, gastrointestinal tract;
- the initial manifestations of menopause in women.
If the patient independently noticed an irregular pulse, then the doctor will ask: how long have these changes been observed, and whether attempts were made to eliminate them. This is followed by a physical examination, which will immediately allow for differential diagnosis with flutter. Indeed, with atrial fibrillation, heartbeats occur at different intervals.
When listening, the inefficiency of the abbreviations of our “engine” is revealed. This means that the heart rate determined in this case will differ from the pulse rate palpable on the wrist. The “floating” volume of the first tone will also attract attention. No matter how informative the physical examination is, nevertheless, in a number of cases with severe tachycardia, the doctor cannot figure out the cause of the disease and give an opinion on the irregular rhythm. Then a cardiogram comes to the rescue.
Signs on an ECG
Examination of the patient, especially in old age, with the help of an ECG should be carried out during each visit to the doctor. This can significantly reduce the number of consequences of atrial fibrillation (ischemic stroke, acute heart failure) and improve the diagnosis of latent (asymptomatic) and its paroxysmal forms.
But all of them are still inferior in terms of informativeness to the traditional cardiogram, on which the following changes are detected during atrial fibrillation:
- there is no P wave;
- RR intervals, responsible for the rhythm of the ventricles, have different lengths;
- there are ff waves, considered the main sign of the disease.
I draw your attention to the fact that in order to diagnose a paroxysmal form of pathology, one should resort to either a daily short-term recording of an ECG or round-the-clock Holter monitoring.
The photo below shows examples of films of people with atrial fibrillation.
- Studying a medical history, patient complaints. Specific symptoms of arrhythmia, its form, frequency and duration of attacks, provoking factors and the presence of chronic diseases are detected.
- ECG, echocardiography. The type of arrhythmia is determined, the state of the heart valves is assessed.
- Blood test. Thyroid disorders, signs of other cardiopathologies, and a lack of potassium are determined.
If necessary, a number of additional studies help diagnose the disease.
- Daily Holter ECG monitoring. Registration of indications during the day allows you to determine the frequency of heart contractions and record attacks of atrial fibrillation.
- Transesophageal echocardiography. It makes it possible to determine the presence of a thrombus in the left atrium.
- Exercise tests, including bicycle ergometry and treadmill. They are prescribed for the purpose of provoking arrhythmias to determine the frequency of ventricular contractions. They eliminate ischemia in case of the need for drug therapy.
- Electrophysiological study. It is carried out to determine the mechanism of development of atrial fibrillation before performing radiofrequency ablation or implantation of a pacemaker.
For the initial diagnosis of an acute attack, it is sufficient to have patient complaints, anamnesis and ECG.
Relevance of the problem
Atrial fibrillation (AF) is the most common heart rhythm disorder characterized by uncoordinated electrical activity of the atria, followed by a deterioration in their contractile function. Manifestations of AF on an electrocardiogram (ECG) – absence of P wave; the presence of waves f, which vary in amplitude, frequency and shape;
The prevalence of AF in the general population is 1–2%; this figure is likely to rise in the next 50 years. Systematic ECG monitoring reveals AF in every 20 patients with acute stroke, that is, significantly more often than with a standard ECG in 12 leads. AF can remain undiagnosed for a long time (asymptomatic AF), and many patients with AF are never hospitalized. Accordingly, the true prevalence of AF most likely approaches 2% in the general population.
In a population study conducted at the National Science Center (NSC) “Institute of Cardiology named after Academician ND Strazhesko ”, it was found that, according to the ECG recorded during the epidemiological survey, the prevalence of AF/atrial flutter (AT) among the urban population is 1,2%.
The standardized indicator (SP) of the prevalence of AF/TP in the urban population of Ukraine is 0,9% for men and 1,0% for women. Based on the questionnaire data and analysis of medical documentation, in particular ECG, provided by patients, the prevalence of AF/TP prevalence is 2,7% in men and 2,4% in women.
AF is associated with various cardiovascular conditions that contribute to arrhythmia. Diseases associated with AF are more likely markers of overall cardiovascular risk and/or heart damage, and not just etiological factors. These include heart failure (HF), age, valvular pathology, arterial hypertension (AH), diabetes mellitus (DM), myocardial ischemia, etc.
Thus, a steady increase in the prevalence of AF in the population has led to the fact that it has become the most frequent prolonged symptomatic tachyarrhythmia that a physician encounters in clinical practice.
The relevance of the problem of AF study is primarily due to the fact that the presence of this heart rhythm disturbance significantly increases the relative risk of general and cardiovascular mortality. At present, AF is considered as potentially lethal arrhythmia, given the wide range of its negative consequences associated not only with a significant deterioration in the quality of life, but also with a significant increase in the frequency of serious complications and death.
Classification of Atrial Fibrillation
Currently, there are three classifications of atrial fibrillation used by practicing cardiologists. Pathology is divided by:
- form (the duration of arrhythmia is implied, that is, paroxysmal, constant, persistent);
- the cause of the occurrence, or rather, the factor contributing to its development;
- severity, taking into account the severity of the symptoms that accompany heart rhythm disturbance.
Such a distribution is extremely important, as it allows the doctor to further determine the most effective way to treat the disease and prevent its secondary complications.
The national cardiology guidelines provide 5 forms of atrial fibrillation:
- first identified;
In some patients, the disease has a progressive character, that is, rare short-term attacks of arrhythmia gradually become more frequent and become longer. As clinical experience shows, this situation ends in the development of permanent cardiac arrhythmias. Only 2-3% of patients can “boast” of periodic flickering for 10-20 years.
In the same section, I would like to mention the atypical form of pathology that entered Frederick’s syndrome. The described disease belongs to the category of tachyarrhythmias, which are manifested by an increase in heart rate and different intervals between strokes. But this extremely rare type of pathology, which occurs in 0,6-1,5% of patients, is considered normosystolic, and sometimes bradysystolic. That is, heart rate will be either within the normal range – 60-80 beats/min, or less than 60 beats/min, respectively.
A similar development is possible if the patient has severe organic heart pathologies, for example, ischemic heart disease, heart attack, myocarditis, cardiomyopathy.
1. First identified AF. Each patient with a first observed AF is considered a patient with a newly diagnosed AF, regardless of the duration of the arrhythmia, the nature of its course and the severity of symptoms. First detected AF may be paroxysmal, persistent, or constant.
2. Paroxysmal AF is characterized by the ability to independently restore the sinus rhythm (usually within 24–48 hours, less often up to 7 days). The period up to 48 hours is clinically significant, since at the end of it the likelihood of spontaneous cardioversion decreases, which dictates the need to consider the appointment of anticoagulant therapy.
5. Constant AF – when both the patient and the doctor recognize the constant presence of arrhythmia; due to its refractoriness to cardioversion, the latter, as a rule, is not performed.
It should be remembered that AF is a chronic progressive disease in which there is a gradual evolution from paroxysmal to persistent and subsequently to a constant form of AF. If the first detected paroxysmal AF is often stopped spontaneously, then later it can recur (in about 50% of patients within 1 month), and the frequency and duration of paroxysms increase with time.
After 4 years, AF transforms into a persistent form in 20% of patients, and after 14 years in 77%. The incidence of persistent AF is 5–10% per year, and the presence of concomitant cardiac pathology contributes to its increase. At the same time, restoration of sinus rhythm is an increasingly difficult task, due to the fact that treatment is becoming less effective.
Depending on the severity of the disabling symptoms associated with AF, patients are classified according to the scale proposed by the European Heart Rhythm Association (EHRA):
- EHRA I – absence of symptoms;
- EHRA II – mild symptoms that do not interfere with daily activity;
- EHRA III – severe symptoms that interfere with daily activity;
- EHRA IV – Disabling symptoms that preclude daily activity.
Note that this scale takes into account only those symptoms that are related to AF and disappear or their severity decreases after restoration of sinus rhythm or against the background of effective control of heart rate (HR).
Paroxysmal atrial fibrillation: causes, symptoms and treatment
Although paroxysmal atrial fibrillation in itself is not life threatening, it can have serious consequences. Therefore, early diagnosis and treatment of this disorder is very important.
- – Cardiac pathology
- – Acute myocardial infarction (impaired myocardial conduction and excitability).
- – Arterial hypertension (overload of drugs and LV).
- – Chronic heart failure (impaired myocardial structure, contractile function and conduction).
- – Cardiosclerosis (replacement of myocardial cells with connective tissue).
- – Myocarditis (structural disorder with myocardial inflammation).
- – Rheumatic defects with valve damage.
- – Dysfunction of the sinus node.
- – Extracardiac pathology
- – Diseases of the thyroid gland with manifestations of thyrotoxicosis.
- – Narcotic or other intoxication.
- – Overdose of digitalis preparations (cardiac glycosides) in the treatment of heart failure.
- – Acute alcohol intoxication or chronic alcoholism.
- – Uncontrolled treatment with diuretics.
- – Overdose of sympathomimetics.
- – Hypokalemia of any origin.
- – Stress and psycho-emotional overstrain.
– Age-related organic changes. With age, the structure of the atrial myocardium undergoes changes. The development of small focal atrial cardiosclerosis can cause fibrillation in old age.
- Such symptoms include:
- – Dizziness;
- – weakness;
- – acceleration of the heartbeat;
- – chest pain.
Sometimes there are no symptoms. However, the doctor will be able to diagnose this disorder using a physical examination or an ECG.
Paroxysmal AF can cause complications. Stroke and embolism are the most serious of them. Blood inside the heart can clot and form blood clots.
These clots can float through the bloodstream, and once in the brain cause a stroke.
Blood clots can also enter the lungs, intestines, and other sensitive organs, blocking the flow of blood and causing thromboembolism, which leads to the death of tissues, which is extremely dangerous for life.
If AF persists for a long period of time without treatment, the heart can no longer effectively pump blood and oxygen throughout the body. This can potentially lead to heart failure.
AF therapy is aimed at normalizing heart rate and preventing blood clots. With paroxysmal atrial fibrillation, the heart rate can independently normalize. However, if the symptoms bother you often enough, doctors may try to normalize your heart rate with medication or cardioversion (electric shock).
Your doctor may suggest antiarrhythmic drugs like Amiodarone or Propafenone even when your heart rate has returned to normal. He may also prescribe beta blockers to control blood pressure.
If episodes of atrial fibrillation occur repeatedly, your doctor may prescribe blood thinning medications, such as warfarin, to prevent blood clots.
A healthy lifestyle, regular physical activity and an appropriate diet is the key to a full life in AF. Quitting smoking and excessive drinking will help limit the likelihood of developing paroxysmal AF.
You should follow a healthy and balanced diet and try to lose weight if you are overweight or obese. Although long workouts can provoke the development of paroxysmal AF, moderate exercise is beneficial.
This violation is not a contraindication to driving, but if you begin to experience symptoms of AF, you should slow down and stop in a safe place on the side of the road.
Avoid stimulants such as caffeine and nicotine and excessive alcohol consumption – this will help you prevent additional symptoms of paroxysmal atrial fibrillation.
For the occurrence of AF, a trigger mechanism (trigger) is required, and for its conservation, a vulnerable atrial substrate. The most frequent source of the focus of automatism is the pulmonary veins, but it can also be localized in other parts of the atria: the Marshall ligament, the posterior wall of the atrium, crista terminalis, coronary sinus, superior vena cava.
At the same time, several foci of ectopic activity can occur, generating flicker waves in the atria. However, rapid pulsation is not transmitted to the atria in an organized manner – the heterogeneity of electrical conduction around the pulmonary veins due to a fixed or functional blockade in the atrial myocardium contributes to the emergence of a re-entry mechanism (re-entry of excitation).
Thus, the focus of automatism in the pulmonary veins is the trigger mechanism, and the heterogeneity of the conduction contributes to the maintenance of AF. In such patients, a paroxysmal AF is more likely than a persistent one. Ablation of the focus of ectopic activity may be more effective than drug treatment of AF.
The development of AF is preceded by the development of diffuse fibrosis in the atria, which contributes to the inhomogeneity of the propagation of the excitation wave due to the dispersion of refractory periods. An increase in the mass of the atria, shortening of the refractory period of the atria and a slowdown in the atrial conduction increases the number of “daughter” waves, which contributes to the occurrence of AF by the re-entry mechanism – chaotic re-excitation and multiple propagation of excitation waves. Thus, AF can cause any atrial extrasystole.
The occurrence of AF leads to a progressive electrophysiological, contractile, structural remodeling of the atria, which contributes to the preservation of AF and its progression into a constant form (the phenomenon of “AF gives rise to AF”).
Electrophysiological remodeling is characterized by changes in atrial refractoriness and atrial conduction. The high frequency of their contractions (350–900/min) in AF leads to overload of the myocardium with calcium, which poses a threat to cell viability and is prevented by both fast and long compensatory mechanisms that reduce calcium entry into the cell (inactivation of L-type calcium channels) .
As a result of this, the duration of the action potential and the effective atrial refractory period are shortened, which helps preserve AF. Electrophysiological atrial remodeling occurs quickly (usually within a few days) and increases AF stability, but quickly reversible (completely disappears when sinus rhythm is restored within 1 hour – 3-4 days).
Contractile atrial remodeling occurs at the same time frames as electrophysiological remodeling. A decrease in the concentration of intracellular calcium at a high frequency of atrial contractions leads to a decrease in their contractility and subsequent dilatation, which contributes to the preservation of AF.
Clinical effects of AF
Patient A., 25 years old, was complained to the admission department with complaints of lack of air, inability to breathe fully, palpitations, dizziness, sharp general weakness. The patient was engaged in semi-professional powerlifting, and with the next approach he lost consciousness. In the family, grandmother and mother were diagnosed with atrial fibrillation. Objectively:
To confirm the diagnosis used: clinical blood and urine tests, determination of the level of TSH, ECG, Echo-KG. The patient underwent pharmacological cardioversion “Dofetilide”, after which the sinus rhythm with heart rate was restored within 60-64 beats/min. During the hospital stay, -hour ECG monitoring was performed, and paroxysms of fibrillation were not observed. The patient was recommended to limit physical activity.
The clinical consequences of AF are associated with hemodynamic and thrombogenic complications of the arrhythmia itself, the patient’s age, the presence and severity of the associated pathology, and the quality of its treatment. The danger of AF is associated primarily with the possibility of developing thromboembolic complications and tachycardiomyopathy, in which, against a background of high heart rate, dilatation of the heart chambers and myocardial dysfunction occur, which leads to the formation or progression of heart failure.
In the vast majority of patients, AF causes symptoms, which significantly violates all aspects of the quality of life: physical and mental health, social functioning. Moreover, the severity of these disorders may exceed the violation of the quality of life of people who have suffered myocardial infarction (MI). The degree of violation of the quality of life in AF depends on the severity of symptoms, the presence of complications, the presence and severity of concomitant pathology, side effects of drug treatment.
According to the REACH (REduction of Atherothrombosis for Continued Health) register, which included over 63 thousand patients with AF, cardiovascular death, MI, stroke, the need for hospitalization due to the progression of symptoms of heart failure was recorded more often than in patients without AF.
The most serious complication of AF is ischemic stroke (blood stasis in the non-contracting ear of the left atrium contributes to thrombosis and subsequent embolization of the cerebral arteries).
It was found that approximately ⅓ of all strokes are due to AF. The frequency of stroke in patients with non-valvular AF who do not take anticoagulants is on average 5% per year, which is 2-7 times more often than in individuals without AF. Cerebrovascular complications of AF are especially common in older patients. According to the Framingham study (5070 patients over 34 years), the risk of stroke at the age of 50–59 years increases by 4 times, 60–69 years – by 2,6 times, 70–79 years – by 3,3 times, 80 –89 years – 4,5 times.
A significant risk factor for stroke is the presence of mitral heart disease, primarily mitral stenosis. In AF of non-valve genesis, stroke is promoted by factors such as previous embolism or strokes, hypertension, age gt; 65 years old, myocardial infarction, diabetes, severe systolic dysfunction of the left ventricle (LV) and/or congestive heart failure, increased size of the left atrium (gt; 50 mm), the presence of a thrombus in the left atrium.
Cognitive dysfunction, including problems with attention, memory and speech, occurs 2 times more often in individuals with AF than without AF, regardless of the presence of a stroke. The incidence of dementia is 10,5% in the first 5 years after the diagnosis of AF. Independent predictors of dementia are age and diabetes. Possible causes of its development are cerebral microembolization due to the lack of mechanical activity of the left atrium, as well as the variability of brain perfusion due to variability of the heart rhythm with the development of asymptomatic cerebral infarction. According to Doppler ultrasound, cerebral microembolism is detected in 30% of patients with AF.
AF is a factor both primarily provoking and exacerbating the course of heart failure. The presence of AF increases the risk of developing heart failure 3-4 times. High heart rate in AF leads to hemodynamic disturbances due to decreased filling of the ventricles, decreased coronary blood flow, decreased contractility and dilated ventricles. In addition, the preservation of heart rate gt; 130 bpm
/ min for 10-15% of the duration of the day can lead to the development of tachycardic cardiomyopathy with severe congestive heart failure. However, even with normal heart rate, loss of atrial contribution to cardiac output and irregular rhythm significantly impair hemodynamics. In this case, the stroke volume of the heart decreases on average by 20%, cardiac output – by 0,8–1,0 l/min, and the jamming pressure in the pulmonary artery increases by 3-4 mm RT. Art.
Concomitant cardiovascular diseases have a significant effect on prognosis in patients with AF. In patients with hypertension in the presence of AF, the risk of complications over 5 years is 2 times higher, the development of left ventricular failure is 5 times more likely, stroke is 3 times higher, and mortality is 3 times higher. With MI, mortality increases by 2 times, mortality – by 1,8 times.
According to various studies, the presence of AF in patients with heart failure increases mortality from 2,7 to 3,4 times, while the risk of stroke and thromboembolic complications doubles. Ischemic stroke, which occurred on the background of AF, is characterized by a more severe clinical course than strokes of another etiology. Mortality in the first 3 months is 1,7 times, the frequency of disability is 2,2 times higher than in people with stroke without AF.
AF leads among hospitalization causes for cardiac arrhythmias (up to 40%). Repeated hospitalization occurs mainly in the first 6 months (65,8% of patients with constant and 67,2% with newly diagnosed AF). 22,7% of the newly diagnosed AF return to the hospital in the first month after discharge.
Based on the foregoing, it can be said that it is important for a practitioner to have a clear idea of the management tactics of patients with AF and HF and the methods of prevention of serious complications in them. Consider these issues in light of the new recommendations of the European Society of Cardiology (ESC) (2010) for managing patients with AF.