Myocardial fibrillation, atrial flutter have similar mechanisms of appearance, but also a number of differences. The first term refers to the supraventricular type of tachyarrhythmias. At this point, heartbeats become chaotic, and the frequency when counting reaches 350-750 beats per minute. The presented feature excludes the possibility of rhythmic atrial work with atrial fibrillation.
Depending on the classification, fibrillation is divided into several forms. Development mechanisms may have some differences from each other. These include the following:
- provoked by a specific disease;
- atrial fibrillation at rest, permanent form;
- potassium deficiency;
A constant form of atrial fibrillation (or paroxysmal) becomes a manifestation of a number of diseases. In many patients, mitral stenosis, thyrotoxicosis, or atherosclerosis are most often found. The circle of patients with arrhythmia with a dystrophic process in the alcoholic myocardium, diabetes mellitus and hormonal imbalance is expanding.
Paroxysmal arrhythmia occurs in patients in a horizontal position. During sleep, they often awaken from unpleasant symptoms. It can appear with a sharp turn of the body when a person is lying. The mechanism of occurrence of such disorders is associated with pronounced reflex effects on the vagus nerve myocardium.
Under their influence, the conduction of nerve impulses in the atria slows down. For this reason, fibrillation begins with them. The described form of cardiac arrhythmias is able to normalize itself. This is due to a decrease over time of exposure from the nerve to the muscle.
Hyperadrenergic paroxysms are more common than those described above. They appear in the morning and during physical and emotional stress. The last, chronic variant of arrhythmia is called hemodynamic.
It is attributed to stagnant forms of pathology, which is associated with the presence of an obstacle to the normal contraction of the myocardium. Gradually, the atria begin to expand. The leading place among the reasons is occupied by the following:
- weakness of the wall of the left ventricle;
- narrowing of the lumen of the holes between the cavities in the heart;
- insufficiency of the valve apparatus function;
- reverse blood flow (regurgitation) in the atrium;
- tumor-like formations in the cavities;
- chest trauma.
In many cases, fibrillation becomes a manifestation of the disease. For this reason, before starting treatment, you need to establish its origin.
Flutter is characterized by heartbeats up to 350 per minute. This form is called supraventricular or atrial myocardial flutter. Tachyarrhythmia differs from that described above by the presence of the correct rhythm in most patients.
There are people with features of such a disease. Their normal sinus contractions alternate with episodes of flutter. The rhythm is called permanent. This variant of the pathology of the heart has the following etiology (causes):
- CHD (coronary heart disease);
- malformations of rheumatic origin;
- arterial hypertension;
- after surgery for defects or shunting;
Tachysystolic rhythm occurs in patients with diabetes mellitus, insufficient potassium levels in the blood, with intoxication with drugs and alcohol. The basis of pathogenesis (development mechanism) is repeated repeated excitation in the myocardium. Paroxysm is explained by the circulation of such impulses a large number of times.
The provoking factors include episodes of flickering and ectrasystole. The frequency of contractions in the atria increases to 350 beats per minute.
Unlike them, the ventricles cannot. This is due to the lack of opportunity for the pacemaker to high bandwidth. For this reason, they are reduced by no more than 150 per minute. The permanent form of atrial fibrillation is characterized by blocks, which explains such differences between the cardiac cavities.
- Causes of atrial fibrillation
- Clinical manifestations of atrial fibrillation
- First aid
- Operative therapy
- Diagnosis of atrial fibrillation
- Paroxysmal form of atrial fibrillation. Tachysystolic variant
- Principles for the treatment of atrial fibrillation
- Classification of Atrial Fibrillation
- Electrocardioversion. Catheter radiofrequency ablation
- Treatment and prevention of atrial fibrillation
- Contraindications for the relief of attacks of atrial fibrillation
- Paroxysmal atrial fibrillation: symptoms, treatment, complications
- Who is at risk
- Causes of
- Filling out medical documents for patients receiving treatment in a hospital
- How to deal with the problem of atrial fibrillation? Cardiologist Tips
Causes of atrial fibrillation
There are cardiological and other factors that caused atrial fibrillation. The first include:
- neoplasms in the heart;
- myocardial infarction;
- heart defects;
- heart ischemia;
- heart failure;
- consequences of heart surgery. Arrhythmia is formed due to a violation in the muscle tissues of the organ of the balance of trace elements (magnesium, calcium, sodium and potassium), as well as the occurrence of an inflammatory process in the area of sutures. It completely disappears after a course of treatment.
The presence of several pathologies in an individual, for example, hypertension and angina pectoris, increases the risk of rhythm disturbances. In individuals of mature and old age, the cause of the tachysystolic form of atrial fibrillation is IHD in combination with or without hypertension.
- gene mutations;
- kidney disease;
- chronic obstructive pulmonary pathology;
- vascular dystonia;
- poisoning with alcohol-containing drinks;
- tobacco smoking;
- electrical injury;
- side effects of certain medications.
Extracardiac factors provoke atrial fibrillation at a young age, and heart disease in older people.
Atrial fibrillation occurs in medical practice for unknown reasons – ideopathic rhythm disturbance.
Atrial fibrillation can occur for a variety of reasons. Among them, cardiac pathologies and extracardiac factors are distinguished.
- heart valve defects (congenital or acquired type);
- heart ischemia;
- hypertonic disease;
- consequences of heart surgery;
- heart failure;
- heart tumors;
- myocardial infarction;
Most often, atrial fibrillation provokes a postoperative condition. Why? The balance of electrolytes (potassium, calcium, sodium, magnesium) in the muscle tissues of the heart is disturbed, the inflammatory process develops in the suture area, hemodynamics are rebuilt inside the chambers (due to elimination of valve imperfections). Arrhythmia caused by such reasons, after undergoing a rehabilitation course of treatment should be completely canceled.
Valve defects are in second place in the frequency of distribution among cardiac factors for the development of atrial fibrillation. Usually this is the pathology of the mitral valve (it blocks the cavity of the left atrium from the left ventricular chamber). Cases of simultaneous damage to two or three valves at once (aortic, tricuspid, mitral) are not uncommon.
The patient may combine different cardiac pathologies, which increases the risk of developing atrial fibrillation. For example, cardiac ischemia and coronary disorders, angina pectoris and arterial hypertension.
Non-heart disease factors:
- side effects of adrenergic agonists, cardiac glycosides;
- alcohol poisoning;
- tobacco abuse;
- disorders of the nervous system (often associated with vegetovascular dystonia);
- kidney disease;
- the presence of chronic obstructive processes in the lungs;
- hereditary factor;
- gene mutations;
- electric shock;
Regular consumption of alcoholic drinks in a daily dose of more than 35-40 g increases the risk of atrial fibrillation by almost 35%.
Vegetovascular dystonia is one of the most common prerequisites for the appearance of paroxysms of atrial rhythm.
Causes of extracardiac origin usually (isolated fibrillation) in most cases contribute to the development of pathology at a young age. Heart disease provokes atrial fibrillation in older people.
At times, atrial fibrillation is recorded for unknown reasons. We are talking about ideopathic rhythm disturbances.
One of the most common types of supraventricular tachyarrhythmias is atrial fibrillation (AF). Atrial fibrillation is called rapid irregular atrial contraction, with a frequency of contractions of more than 350 per minute. The appearance of AF is characterized by irregular contraction of the ventricles.
AF accounts for more than 80% of all paroxysmal supraventricular tachyarrhythmias. Atrial fibrillation is possible in patients of all age categories, however, in elderly patients, the prevalence of the syndrome increases, which is associated with an increase in organic heart pathology.
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.
Clinical manifestations of atrial fibrillation
Symptoms with a tachysystolic form of AF may be absent, and pathology can be diagnosed only by ultrasound of the heart or ECG. However, the development of acute signs is also possible, in such cases, the unstable psycho-emotional state of the individual acts as a provocateur. Basically, the first manifestation of rhythm disturbance is in the form of an unexpected attack (paroxysm).
- fear of death;
- feeling short of breath;
- chest pains;
- tremor of limbs and body;
- the pulse is unstable, its speed changes;
- cold sweat is released;
- pressure drops;
- pallor of the skin;
- disruption of the digestive tract.
Possible manifestation of neurological signs:
Such a clinical picture is present if rhythm disturbance provokes thrombosis.
In humans, edema appears at the end of the day with a constant form of arrhythmia.
Atrial flutter and atrial fibrillation does not always occur under the influence of the same factors. Stress is able to worsen stress, physical activity, a sharp change in weather. Symptoms are characteristic of the following:
- pain in the heart or discomfort in this area;
- weakness that does not disappear after rest;
- feeling of heartbeat;
- low blood pressure;
- sensation of interruptions in the region of the heart.
Transient disorders can occur several times a year or more often when the normosystolic rhythm is replaced by a flutter. At a young age, they appear under the influence of provoking factors. In older people, the signs of arrhythmia are disturbing even at rest.
An asymptomatic course is considered the most dangerous. The patient is not worried about anything, which increases the risk of complications – stroke, myocardial infarction, thrombosis and heart failure.
Of great difficulty is the treatment of atrial fibrillation in the elderly and especially the chronic form. Atrial flutter is almost always corrected with the help of medications. After the diagnosis, drug therapy is started.
Treatment begins with an integrated approach, for this they include more than one remedy. Conservative therapy includes the following groups of drugs:
- cardiac glycosides;
- calcium ion blockers – Verapamil;
- potassium preparations;
- anticoagulants – “Heparin”, “Warfarin”;
- antiarrhythmic drugs – “Ibutilide”, “Amiodarone”.
Together with antiarrhythmic drugs, beta-blockers, calcium channel blockers and glycosides are included in the scheme. This is done to prevent tachycardia in the ventricles. It can be triggered by an improvement in the conductivity of nerve impulses in a pacemaker.
In the presence of congenital anomalies, the listed funds are not used in people of young and older age. Normally, it is required to prescribe anticoaculants and drugs to eliminate arrhythmias. If there are no contraindications to alternative methods of treatment, then you can take herbal remedies. Before this, the patient must obtain consent to their appointment with his doctor.
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With a sharp appearance of signs of flutter or fibrillation in combination with hypotension, cerebral ischemia, cardioversion is indicated. It is carried out by an electric current of insignificant voltage. Antiarrhythmic drugs are injected into a vein at the same time. They increase the effectiveness of therapy.
If there is a risk of complications, then Amiodarone is required as a solution. In the absence of dynamics, cardiac glycosides are needed. When the sinus rhythm is not restored, following all the stages of the patient management scheme, electrical stimulation is indicated.
Separate tactics of managing patients with seizures, the duration of which takes 2 days, are distinguished. As he continues to persist, Amiodarone, Cordaron, Verapamil, and Disopyramides are indicated. To return the sinus rhythm, transesophageal stimulation of the myocardium is prescribed. When arrhythmia lasts more than 2 days, anticoagulants are administered before cardioversion.
In the absence of effectiveness, ablation is prescribed for drug therapy. Other indications are frequent relapses and a persistent variant of arrhythmia. The prognosis after treatment is favorable for the patient’s life.
A special approach is needed in identifying Frederick’s syndrome. In history, it was first described in 1904. The disease is rare, but represents a great danger. It includes clinical and electrocardiographic changes of complete blockade together with cardiac fibrillation (or atrial flutter).
Pathology has a difference not only in manifestations. Drug treatment does not give a positive answer. The only way out is to establish an artificial pacemaker. It will generate, if necessary, an impulse of electricity.
When signs of arrhythmia appear, timely diagnosis is important. In patients, it is possible to normalize the work of the heart with medications. The advanced stage and the chronic course of the pathology is considered an indication for surgery.
Severe symptoms in a pathology such as atrial fibrillation may be completely absent. Then it can be detected only when conducting an ECG or ultrasound of the heart. In other cases, acute symptoms develop, the distinguishing features of which depend on the cause of arrhythmia, its variety, functional abilities of the valve structure, and the state of the muscle layer of the heart. A significant role is played by the psychoemotional background of the patient.
Most often, the first manifestation of atrial fibrillation occurs in the form of a sudden paroxysm. In the future, seizures can become more frequent and lead to persistent or constant fibrillation. Sometimes people encounter only rare short paroxysms throughout life, which do not turn into a chronic form.
The onset of an attack is described by many patients as a sensation of a sharp push in the chest from the inside, as if the heart had stopped or rolled over. The following is a series of characteristic features:
- lack of air;
- trembling of the body and limbs;
- sweat is released;
- a person can shiver;
- a decrease in blood pressure is possible (sometimes the case ends in arrhythmogenic shock and loss of consciousness);
- the skin turns pale, acquires a bluish tint or redden;
- randomness of the pulse, a change in its speed;
- weakness and dizziness;
- fear of death;
- frequent urge to urinate;
- violation of the gastrointestinal tract;
- chest pains.
In some cases, signs of a neuralgic nature are observed: paresis, paralysis, loss of sensation, coma. This occurs when atrial fibrillation provokes blood clots. Blood clots clog large arteries that carry food and oxygen to the brain, which causes the development of cardioembolic stroke.
Diagnosis of atrial fibrillation
Treatment of a permanent form of atrial fibrillation is carried out on the basis of data obtained after a comprehensive diagnosis. The exact cause is established using clinical, laboratory and instrumental studies. The main symptom that helps to suspect the disease is considered to be frequent and rhythmic pulsation in the veins of the neck.
It corresponds to atrial contractions of the myocardium, but exceeds the frequency in the peripheral arteries. There is a noticeable difference between the data obtained during the inspection. Additional methods include the following:
- blood test for biochemistry;
- INR level (international normalized ratio);
- ECG (electrocardiography);
- daily monitoring of ECG;
- ultrasound examination of the heart (ultrasound);
- transesophageal echocardiography.
To establish a diagnosis, unlike other pathologies, several diagnostic methods from the list indicated are enough. In complex cases, a more detailed examination may be required.
The main indicator, which is determined with a paroxysmal rhythm, is the level of lipids in the blood plasma. It belongs to one of the predisposing factors of atherosclerosis. The following data is important:
- liver enzymes – ALT, AST, LDH, CPK;
- plasma electrolytes – magnesium, sodium and potassium.
They must be taken into account before prescribing treatment to the patient. If necessary, the study is repeated.
For diagnosis, this indicator is very important. It reflects the state of the blood coagulation system. If there is a need for the appointment of “Warfarin” – it must be carried out. During the treatment of atrial fibrillation or flutter, the INR level should be monitored regularly.
With atrial fibrillation or flutter, even in the absence of a disease clinic, changes are detected on the electrocardiogram film. Instead of the P waves, pyloric teeth appear in leads I, III and avf. The frequency of the waves reaches 300 per minute. There are patients who have a permanent form of atrial fibrillation of an atypical nature. In this situation, such teeth will be positive on the film.
The study reveals an irregular rhythm, which is associated with impaired conduction of impulses through the atrioventricular node. There is also the opposite situation when normoform is observed. The pulse of such people is constantly within acceptable values.
In some cases, atriventricular blockade is found on the film of the electrocardiogram. There are several variations:
- 1 degree;
- 2 degree (includes 2 more types);
- 3 degree.
When slowing down the conduction of nerve impulses through the pacemaker, the PR interval lengthens. Such changes are characteristic of blockade of the 1st degree. It appears in patients with constant treatment with certain drugs, damage to the myocardial conductive system or an increase in parasympathetic tone.
Divide the 2nd degree of violations into 2 types. The first is the Mobitz type, characterized by an elongated PR interval. In some cases, an impulse to the ventricles does not occur. When examining an electrocardiogram film, a QRS complex is detected.
Often there is type 2 with a sudden absence of a QRS complex. No extension of the PR interval is detected. With blockade of grade 3, there are no signs of nerve impulses on the ventricles. The rhythm slows down to 50 beats per minute.
This method for fibrillation or atrial flutter is considered one of the main instrumental. With its help, you can trace what changes occur during the work of the myocardium in various situations. During the day, tachysystole, blockade and other disorders are found.
The study is based on the registration of electrical activity in the process of the heart. All data is transferred to a portable device, which processes them into information in the form of a graphical curve. The electrocardiogram is stored on the device media.
For some patients, a cuff is additionally applied to the shoulder area when flickering. This allows you to control the dynamics of the level of blood pressure electronically.
A physical exercise test (treadmill test) or bicycle ergometry is indicated to the patient to determine cardiovascular system disorders. The duration of the study may vary. When unpleasant symptoms appear, it is stopped and the data obtained is evaluated.
Signs of pathological changes in the heart are detected using ultrasound. The state of blood flow, pressure, valve apparatus, and the presence of blood clots are evaluated.
A special sensor for receiving data is inserted into the esophagus. When the patient has a constant form of fibrillation, atrial flutter, treatment should take about 2 days. For this reason, the main recommendation is to undergo therapy until normal rhythm is restored. The purpose of the instrumental study is to detect blood clots and assess the condition of the left atrium.
Upon examination, the patient reveals:
- cyanosis near the nasolabial fold;
- pale skin;
An ECG for this ailment was first recorded in 1906, and described in detail in 1930. On the ECG, atrial fibrillation of the tachysystolic form is as follows:
- P wave is missing – this means that there is no sinus rhythm;
- there are waves f of different heights and shapes;
- RP intervals are different in duration;
- ST segment and T wave are subject to change.
Additional diagnostic methods are:
- biochemical and general blood analysis;
- transesophageal examination;
In practice, the diagnosis of atrial fibrillation, tachysystolic form is made on the basis of patient complaints, his questioning, external examination and ECG.
Paroxysmal form of atrial fibrillation. Tachysystolic variant
One of the most commonly diagnosed heart ailments is considered a paroxysmal form of atrial fibrillation. In normal condition, the heart contracts about seventy times per minute. Violation of its contractile activity leads to a change in the frequency of contractions, which can reach 800. Paroxysmal arrhythmia is accompanied by circulatory failure.
Its danger lies in the fact that myocytes contract chaotically, the sinus node does not function, only two ventricles work. Paroxysm refers to frequently recurring seizures or seizures. A characteristic symptom of paroxysmal atrial fibrillation is an increased heart rate and sudden tachycardia with the correct heart rhythm.
If in 60 seconds the frequency of contractions exceeds 90, then this is a tachysystolic variant of the paroxysmal form of atrial fibrillation. Less than 60 is bradisystolic, and the intermediate option is normosystolic. The attack lasts from several minutes to seven days, it occurs suddenly and also stops. The following types of abbreviations are distinguished:
- flickering – the number of heart contractions per minute is more than 300;
- flutter – a maximum of 200.
This form of fibrillation can be recognized by the following symptoms:
- the appearance of trembling;
- heart palpitations;
- increased sweating;
- limbs get colder;
- panic attacks;
- fainting condition.
However, some individuals do not notice an attack, and a brady-systolic or tachysystolic form of paroxysmal atrial fibrillation is detected during the examination, that is, at the doctor’s appointment in a medical institution. When the sinus rhythm returns to normal, all signs of arrhythmia disappear. After an attack, a person develops polyuria and increased intestinal motility.
It is necessary to stop the disease as soon as possible, and preferably within two days after the onset of the attack. With constant fibrillations, drug therapy is recommended, which will help prevent a violation of cerebral circulation. Due to the irregular contraction of the atrial walls, the blood moves at high speed.
Violation of the rhythm, accompanied by frequent and chaotic work of the heart chambers, is called tachysystolic atrial fibrillation. The source of such excitation is myofibrils located in the atria (ectopic foci of electrical impulses), which make up to 700 contractions per minute. Moreover, the ventricles during the same period make more than 90 shocks. Symptoms are similar to the typical pattern of atrial fibrillation:
- heavy sweating;
- discomfort in the chest area;
- panic attacks;
- throbbing veins on the neck.
A hallmark of the tachysystolic form of atrial fibrillation is considered to be heart failure with accelerated heartbeat, which leads to:
- flicker, if this cause caused such a heartbeat, then the number of contractions is 350-700;
- atrial flutter. Reductions occur 200-400 per minute. In this case, the correct atrial rhythm is preserved and transmitted to the ventricles.
Atrial tachysystolic atrial fibrillation is more dangerous compared to others and is more difficult to tolerate, since in this case a huge load is on the heart. A rather frequent complication is acute heart failure due to circulatory failure in peripheral vessels as a result of a decrease in minute and systolic blood volume.
The tachysystolic variant of atrial fibrillation in constant form is a rather dangerous ailment that is difficult to treat. Nevertheless, it is possible to live with quality life. The main thing is to carry out all the appointments of a doctor. The provocateur of atrial fibrillation in adulthood and old age is coronary heart disease, accompanied by hypertension or without it. In young individuals, the provocative factors are:
Conditions in which atrial fibrillation of the tachysystolic form may occur:
- acute pulmonary heart;
- myocardial infarction and some other pathologies.
With the normo-and bradysystolic form of heart rhythm disturbances, subjective sensations may be absent or frequent heartbeat is noted. An arrhythmic pulse with its deficiency is objectively determined. With a tachysystolic form, symptoms of heart failure and swelling occur.
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.
Due to its duration, fibrillation takes the following forms:
- the paroxysmal form of AF is characterized by the appearance of unforeseen arrhythmias. In this case, the attack can last from a couple of minutes to a whole week. How soon the seizure stops depends on the quality and accuracy of first aid. Practice shows that the normalization of the rhythm of the heartbeat occurs during the day. But there are cases when the rhythm returns to normal on its own, without outside help.
- the persistent form of AF is characterized by a longer duration of the attack, which ranges from a week to six months. Treatment of the disease with medication or appropriate therapy. When an attack lasts more than six months, surgical intervention is recommended.
- a constant form of AF is the alternation of the normal rhythm of the heartbeat and arrhythmia. Moreover, the latter may last about a year. In this case, you should not turn to surgical intervention: the desired effect will not work, since this form is chronic. It is possible to maintain a normal state with the help of drugs and constant examination by a specialist.
With age, the tendency to paroxysmal AF is higher.
Some healthcare providers have atrial fibrillation and flutter. Whereas the combination of these concepts is called atrial fibrillation.
Fibrillation takes two forms:
- Flicker. A heart rate of more than 300 beats per minute, but not all myocardial fibers are reduced.
- Flutter. Heart rate does not exceed 300 beats in 60 seconds, the sinus node completely “rests”.
There is recurrent paroxysm. Its characteristic symptom is periodic occurrence. Features of pathology:
- rare, short-term ailments that do not provoke discomfort;
- frequent attacks causing oxygen starvation in the ventricles.
Another classification of fibrillation is based on the ventricular contraction factor. Allocate:
- Tachysystolic. The ventricles contract to 100 times a minute. The patient lacks air, shortness of breath, pain in the sternum.
- Normosystolic. The number of cuts varies between 60-100.
- Bradisystolic. The ventricles contract no more than 60 times.
Violation of the heart rhythm with paroxysmal atrial fibrillation is accompanied by physiological abnormalities in the patient’s body, which serve as the cause of the disease in the future:
- functional disorders that formed after the inflammation;
- heart ischemia;
- pathological abnormalities, including defects that arose in the process of life and caused an increase in the chambers of the heart;
- hypertension in a chronic form, which leads to an increase in myocardial mass;
- hereditary cardiomeopathy.
There are a number of causes of paroxysmal atrial flutter, provoked by non-cardiac factors:
- alcohol abuse;
- lack of potassium and magnesium in the body;
- changes in the muscles of the heart that are formed as a result of lung disease;
- serious infectious diseases;
- excessive use of adrenergic agonists and cardiac glycosides, including their regular use;
- problems with the nervous system, overstrain, stress, emotional exhaustion;
- hormonal failures;
- health difficulties after surgery.
Important! Sometimes circumstances so develop that it is unrealistic to identify AF paroxysm, or rather, the main cause of the disease. This applies to young people and adolescents.
Signs of cardiac arrhythmias may vary from patient to patient. Some have pain in the heart. While most patients have arrhythmic scintillation with the following symptoms:
- sudden single attack of a strong heartbeat;
- a sharp deterioration in well-being and weakness;
- lack of fresh air;
Symptoms of paroxysmal AF
- feeling of cold in the arms and legs;
- extreme sweating;
- trembling over the body and more.
In some cases, pale areas of the skin and blueness of the lips are observed.
With severe pathology, the symptoms are aggravated. The following symptoms are observed:
- dizziness up to loss of consciousness;
- panic attacks caused by a sharp deterioration in overall health and its normalization. As a result, the patient does not understand what is happening to him, and worries about his own life.
Important! Whatever happens, first of all – do not panic and consult a specialist. Only after examination (ECG) can you find out the cause of symptoms and health problems.
As soon as the paroxysmal rhythm disturbances, or rather seizures, are over, the patient has increased intestinal motility. The latter causes profuse urination.
When there is a significant decrease in the number of heart contractions, the patient has a decrease in blood flow to the brain. Therefore, there is a loss of consciousness, respiratory arrest and the pulse is not felt.
In this case, the patient needs urgent resuscitation.
Paroxysmal atrial fibrillation is an irregular contraction of the muscles of the atria. The frequency is quite high, reaching up to 360 per minute. Fibrillation manifests itself in the contraction of the ventricles. This is the most common heart disease (ischemia).
The treatment of heart disease is not an easy task of cardiology. With a change in heart rhythm and proarrhythmogenic action, the doctor diagnoses a violation of cardiac activity.
Paroxysmal atrial fibrillation is found in almost every patient with heart surgery. The disease manifests itself in different ways, and the course of treatment is selected according to the patient’s condition.
Principles for the treatment of atrial fibrillation
The main goals of therapeutic measures: to remove unpleasant symptoms and prevent the development of negative consequences. Therefore, the entire treatment process is conducted in two directions:
- The return of rhythm to normal (with the supply of pulses from the sinus node).
- Maintaining the optimal frequency of myocardial contractions while maintaining established chronic arrhythmias.
The effectiveness of work in these areas is achieved using the following treatment methods:
- the use of drugs that prevent blood coagulation (anticoagulants);
- exposure to electric shock (electrocardioversion);
- antiarrhythmic therapy;
- the use of drugs to reduce the rhythm.
Additional emergency measures to help the patient are catheter radiofrequency ablation, the introduction of a pacemaker.
Therapy of this kind is carried out in order to prevent thromboembolism, the result of which often becomes an embolic stroke. To do this, use the following tools:
- Anticoagulants (Warfarin, Pradaxa).
Medications can be used for a long period. In this case, it is necessary to monitor the therapy process with the help of a coagulogram. Warfarin is suitable for the treatment of older patients. After 60 – with a diagnosis of diabetes mellitus, cardiac ischemia, 75 years old and older – with thyrotoxicosis, congestive heart failure, hypertension.
- Heparin low molecular weight drugs.
They are prescribed in especially severe cases requiring emergency measures before performing a cardioversion.
- Antiplatelet agents (acetylsalicylic acid, Aspirin, Dipyridamole).
Used for the treatment of patients of different age categories. Moreover, it is considered appropriate to use Aspirin in patients who are not subject to the influence of risk factors.
Anticoagulant therapy can contribute to the development of bleeding, especially with prolonged use. Therefore, it must be prescribed with caution in relation to patients whose blood coagulation is reduced.
This term refers to the process of stabilizing the rhythm of contractions with the help of electric current discharges. This is a powerful treatment method, it is often used as an emergency measure in a life-threatening situation.
The procedure is carried out under anesthesia, and is accompanied by the removal of ECG readings. A special device (cardioverter-defibrillator) delivers an electrical signal to the heart simultaneously with the appearance of R-teeth, so as not to provoke ventricular fibrillation. The planned cardioversion is indicated for patients with long-term arrhythmia, but without severe circulatory disorders. Before such manipulation, the patient should undergo a course of treatment with Warfarin for 3 weeks, and continue it for about a month after the procedure.
If the arrhythmia attack is short-term, but it is accompanied by significant problems with blood circulation, urgent cardioversion is necessary. In this case, heparin or other low molecular weight substances are introduced.
Electropulse therapy is used when treatment with tablets does not bring the desired effect. It is possible to act on the heart both outside the chest and by bringing the electrode directly to the organ through a catheter.
It involves the appointment of drugs to restore sinus rhythm.
The medicine is inexpensive, but has many negative side effects (lowering pressure, vertigo, headaches, can cause hallucinations). Used for injection into a vein.
It is administered intravenously, gives a strong effect. However, it can seriously affect the rhythm of contractions of the ventricles. Therefore, the patient is under constant outpatient monitoring after using such a drug for a whole day.
Means for injection. It is proposed in the treatment of patients who are diagnosed with organic myocardial disorders (scar formation after a heart attack).
It happens in the form of tablets or ampoules for intravenous administration. The drug is not used for serious pathological processes in the lungs, ischemic disease, poor contractility of the left ventricle. Weakly helps when a persistent form of atrial fibrillation is detected.
The medicinal type of cardioversion is used in situations of primary fibrillation, as well as in the paroxysmal form of arrhythmia. At the same time, the patient has pronounced pathological manifestations, increased heart rate, and blood flow disorders. If treatment is started in the first hours of an attack, then the effect will be positive.
Most often used “Amiodarone”. It more effectively stops attacks of atrial fibrillation and causes fewer adverse reactions. Heart failure with regular use of the drug does not progress, the risk of death from sudden cardiac arrest is reduced by more than 50%.
In general, antiarrhythmics can be prescribed for a long course of treatment in order to prevent recurrence of rhythm failure.
When a decision has been made to preserve arrhythmia that has arisen, such drugs are used to normalize the frequency of contractions:
- calcium channel inhibitors – Verapamil, Diltiazem;
- beta-adrenoreceptor blockers – Metoprolol, Carvedilol;
- if the effect of taking previous funds is not enough, “Amiodarone” is used.
These groups of medicines are used in order to achieve optimal heart rate values (80-110 beats per minute). Such therapy helps to significantly alleviate the patient’s well-being, eliminate unpleasant symptoms as much as possible, and prevent the development of life-threatening conditions. However, the chosen strategy cannot stop the further progression of heart rhythm disturbances.
It is used as the most extreme option when proper results from other treatment methods are absent. RFA is an operation with minimal surgical intervention. A minimally invasive endovascular procedure involves the insertion of a catheter through a vein, which delivers an electrode into the heart tissue. This miniature device destroys by means of electric discharges the aberrant section of pulse generation.
Such an operation requires simultaneous implantation of a pacemaker into the chest. This is necessary because when some electrically active sites (atrioventricular node, His bundle) are eliminated, contractile signals do not reach the ventricles.
If a person has rare, but severely occurring attacks of atrial fibrillation, cardioverter defibrillators are implanted in the atrial cavity. These devices cannot stop the development of paroxysm, but they help to quickly eliminate its symptoms if necessary.
Atrial fibrillation is a dangerous condition with progressive deterioration in well-being. This type of rhythm disturbance can lead to sudden cardiac death. A particular threat is the tachysystolic form of atrial fibrillation. Therefore, it is important to take the proposed range of wellness measures seriously, to comply with all the doctor’s recommendations.
Preventive measures include taking prescribed medications. The treatment regimen for each patient is selected individually. Medicines and other methods of therapy are necessary to prevent new attacks and slow down the formation of a chronic form of pathology that increases the risk of serious consequences.
Classification of Atrial Fibrillation
Atrial fibrillation is systematized:
- by the frequency of ventricular contractions;
- duration of chaotic rhythm;
- waves on the cardiogram.
The duration of fibrillation is distinguished:
- Primary – a single rhythm disturbance was recorded for the first time. It can be different in clinical manifestations, in duration and complications.
- Persistent – lasts more than seven days. It does not stop without medical intervention and can last up to a year.
- A constant one, like the previous one, lasts a long period of time, but restoring the normal rhythm of the sinus node is inappropriate. The main goal of therapy is to maintain the existing rhythm and control the frequency of contractions.
- Paroxysmal – atrial fibrillation unexpectedly begins and also ends. Up to seven days, an attack of atrial fibrillation continues, which stops on its own.
- large – 300-500 cuts per minute. On the ECG, large and rare teeth;
- small – up to 800 contractions (small and frequent teeth).
Depending on the damage to the heart valves, fibrillation can be:
- Non-valve – with prosthetic valves.
- Valvular – with heart defects (congenital or acquired). The second can form against the background of infectious endocarditis, rheumatism. With this type of atrial fibrillation, therapy begins with the elimination of the provocateur.
According to the frequency sign, different forms of fibrillation are distinguished:
- Tachysystolic. The ventricles per minute contract more than 90 times, and there may be no pulse for a while. The reason for this phenomenon lies in the fact that the heart works with incomplete force. Insufficient contractions do not produce a pulse wave, cardiac output is irregular, and the ventricles are poorly supplied with blood.
- Normosystolic. Ventricular contractions are in the acceptable range from 60 to 90.
- Bradisystolic – reduction of about 60 times, ventricular function is inhibited. However, the pulse wave passes normally.
The second and third forms are most favorable.
Treatment of a tachysystolic form of atrial fibrillation is to relieve unpleasant symptoms and prevent the occurrence of negative consequences. All therapeutic actions are directed:
- to maintain a certain frequency of contractions;
- return to the rhythm rate.
To achieve these goals apply:
- drug therapy with anticoagulants, antiarrhythmic drugs, calcium channel blockers and beta-adrenergic receptors;
- electrocardioversion, i.e., exposure to electric shock;
- installation of a pacemaker;
- catheter radiofrequency ablation.
The use of anticoagulant agents helps prevent thromboembolism. Medicines in this group can be used for a long time. Patients of the older age category with concomitant pathologies (coronary heart disease, diabetes mellitus, thyrotoxicosis, hypertension, congestive heart failure, rheumatic heart disease) recommend “Warfarin”.
In order to normalize heart rate in the treatment of a tachysystolic form of atrial fibrillation, Amiodarone, Diltiazem, Metoprolol, Verapamil, Carvedilol are recommended. The use of these funds can alleviate the condition and remove unpleasant symptoms, and in addition, prevent the development of conditions that provoke a threat to the existence of the individual. Unfortunately, such therapy is not able to stop the progression of rhythm disturbances.
Electrocardioversion. Catheter radiofrequency ablation
With a persistent tachysystolic form of atrial fibrillation, it is possible to achieve stabilization of the heart rhythm by discharges of electric current. It is mainly used in life-threatening situations. Manipulation is carried out under the supervision of an ECG and under general anesthesia. A device called a cardioverter-defibrillator delivers simultaneously an electrical signal to the heart without causing ventricular fibrillation.
In cases of problems with blood circulation with a short-term attack of arrhythmia, urgent cardioversion is indicated. At the same time, heparin preparations are administered. Effects on the heart can be carried out both externally and internally. In the first case, through the chest, and in the second, the electrode is inserted through the catheter to the organ.
With the medical form of cardioversion, they use means to restore sinus rhythm, which are administered intravenously:
- Nibentan has a strong effect. Due to possible side effects, including those that affect the rhythm of contractions of the ventricles, the patient should be monitored for a day.
- Amiodarone relieves seizures well. It is indicated for people with identified organic myocardial disorders. Its constant intake reduces the risk of sudden cardiac arrest by 50 percent.
- “Procainamide” has a membrane stabilizing effect. Often provokes undesirable reactions in the form of a headache, hallucinations, pressure reduction.
This type of cardioversion is usually used with a paroxysmal form of arrhythmia and primary fibrillation. Therapy carried out in the first hours of the attack gives a positive result.
Catheter radiofrequency ablation is a surgical procedure that is used when other methods do not give the desired effect. A catheter inserted into a vein delivers an electrode into the heart tissue. It destroys the anomalous region generating the pulses by electric discharges. At the same time, a pacemaker is implanted.
Treatment and prevention of atrial fibrillation
In the absence of contraindications in a hospital, antiarrhythmic drugs are used:
If the rhythm has not recovered when using the above funds, then they switch to other drugs:
With a constant form of atrial fibrillation, medications are recommended for the prevention of thromboembolism:
In the absence of the effect of drugs, try electrocardioversion. After the restoration of the rhythm, it is required to maintain it. In practice, it has been proven that the effectiveness of taking medications with a constant form of arrhythmia is about 50 percent, and of cardioversion – 90, provided that you consult a doctor in a timely manner.
A large number of patients already have relapses during the first year. Provocative factors are:
- physical exercise;
- the use of alcohol-containing drinks;
- taking diuretics;
- physiotherapeutic procedures.
If seizures are less than once a month, then continuous therapy with antiarrhythmic drugs is not needed. With frequent attacks, the dosage regimen and dose of medication are selected for each patient. Treatment monitoring is carried out using:
In the presence of a constant form of atrial fibrillation (tachysystolic form or another), it is inappropriate to restore the sinus rhythm. The goal of treatment is to prevent thromboembolism and reduce the frequency of contractions. In addition, the constant intake of medications is indicated:
- calcium antagonists;
- cardiac glycosides;
For the prevention of thromboembolism, aspirin or indirect anticoagulants are recommended.
Contraindications for the relief of attacks of atrial fibrillation
In the following conditions, stopping attacks is not recommended:
- Tachy-bradisystolic syndrome.
- Frequent bouts of atrial fibrillation, in which electrocardioversion or the introduction of antiarrhythmic drugs into a vein is indicated. Due to the fact that in such patients it is impossible to maintain a sinus rhythm for a long period, it is not advisable to stop an arrhythmia attack.
- Severe chronic heart failure and an observed enlargement of the left ventricle.
- An absolute contraindication is a history of thromboembolism and the presence of a thrombus in the atria.
Paroxysmal atrial fibrillation: symptoms, treatment, complications
Who is at risk
Atrial fibrillation is more common in older people, and the older you are, the more likely it is that you will experience this condition.
Among all forms of atrial fibrillation, paroxysmal atrial fibrillation occurs more often in young people.
People with heart disease, thyroid disease, high blood pressure (hypertension), or sleep apnea are at greater risk for AF.
Some people may experience a single episode of AF. However, people with irreversible heart damage experience persistent or chronic atrial fibrillation.
- Paroxysmal atrial fibrillation is a condition in which the heart can only fibrillate from time to time, after which the symptoms disappear by themselves. Episodes can last from a few minutes to several days, and then the heart returns to its normal sinus rhythm.
- Persistent atrial fibrillation does not go away without treatment, but you can restore normal rhythm with medication or electroshock therapy.
- Chronic or persistent atrial fibrillation occurs continuously. Often this type of AF cannot be treated even with medication or electroshock therapy.
In addition to heart damage caused by diseases of the cardiovascular system or high blood pressure, drugs and other risk factors can lead to the development of paroxysmal atrial fibrillation. These factors include:
- stimulant drugs and drugs, e.g. methylphenidate, pseudoephedrine, cocaine
- low potassium (electrolyte imbalance)
- stress (especially due to illness or surgery)
- viral infections
- heart defects or heart valves
Symptoms of paroxysmal atrial fibrillation include:
- chest pain
This form of AF can cause complications. Stroke and embolism are the most serious of them. Blood inside the heart can clot and form blood clots.
Paroxysmal atrial fibrillation can lead to complications such as pulmonary embolism
Atrial fibrillation 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 such as Amiodarone (Cordarone) or Propafenone (Rhythmol) even when your heart rate has returned to normal. He may also prescribe beta blockers to control blood pressure.
If episodes of AF occur repeatedly, the doctor may prescribe a blood-thinning medication, such as Warfarin (Coumadin), to prevent blood clots.
After the first episode of atrial fibrillation, a person may experience another episode.
A study published in QJM: An International Journal of Medicine shows that in 70% of patients who once experienced symptoms of paroxysmal atrial fibrillation, a repeated episode occurs within one year. In addition, 90% of patients experience another episode within four years.
According to the American Heart Association (AHA), if episodes of paroxysmal atrial fibrillation last longer than two days, a person is more likely to develop chronic AF.
A prolonged course of atrial fibrillation provokes the consequences:
- Severe cardiomyopathy with symptoms of heart failure, developing against the background of a chronic form of atrial fibrillation.
- Thromboembolism, the cause of which lies in ineffective atrial contractions. Blood clots can be in the kidneys, lungs, spleen, brain vessels, peripheral vessels of the limbs.
- Violation of hemodynamics, as a result of which heart failure is formed or progresses, the quality of life and the working capacity of the individual are reduced.
A rather high mortality rate among individuals with atrial fibrillation due to ventricular fibrillation. Of particular danger is the tachysystolic form of atrial flutter, therefore it is advisable to follow the advice of specialists on taking medications and other preventive measures.
Filling out medical documents for patients receiving treatment in a hospital
For a patient being treated in a hospital, medical documents are filled in, which contains all the information about his state of health, for example, a medical history. “Atrial fibrillation, tachysystolic form” is the main diagnosis, the concomitant and complications are indicated below. In addition, the following data is entered into the medical history:
- FULL NAME.;
- place of work;
- date of admission to a healthcare institution;
- medical history;
- anamnesis of life;
- patient’s condition (described by organs);
- research results;
- differential and clinical diagnosis;
- etiology and pathogenesis of the underlying disease;
This is how the medical history looks like a schematic.
How to deal with the problem of atrial fibrillation? Cardiologist Tips
Regardless of the causes and clinical picture of atrial fibrillation, it is necessary:
- prevent relapse;
- maintain normal sinus rhythm;
- control the frequency of contractions;
- prevent the development of complications.
For this, the constant intake of medications under the supervision of the attending doctor is indicated. Secondary prevention involves a complete rejection of alcohol, smoking, overstrain – both mental and physical. The prognosis of the disease depends on the cause of the tachysystolic form of atrial fibrillation, and its consequences.
Improving the quality of life requires the timely help of an experienced professional. With constant fibrillation, it is recommended not only to take the necessary medicines, but also to change the usual activity. Only an integrated approach will improve the quality of life and delay or eliminate complications. To do this, you must:
- Refuse fatty foods. Include potassium, magnesium rich foods in your daily diet. More vegetables, cereals, fruits.
- Exercise should be gentle.
- Regularly monitor your heart rate. At the first unpleasant or dangerous symptoms, consult a doctor.
- Stop alcohol and cigarettes completely.
In addition, the constant form of atrial fibrillation (tachysystolic form) involves frequent visits to the cardiologist and regular instrumental examinations. Patients need to know that with atrial fibrillation, both minute and systolic blood volumes decrease, which subsequently leads to a failure of peripheral circulation.
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