home Consultations Atrial fibrillation of the heart - causes, symptoms and treatment, drugs. Atrial fibrillation symptoms and treatment Atrial arrhythmia

Atrial fibrillation of the heart - causes, symptoms and treatment, drugs. Atrial fibrillation symptoms and treatment Atrial arrhythmia

Atrial fibrillation is one of the forms, due to the occurrence pathological focus of impulse circulation in the sinus node or in the atrial tissue, characterized by the occurrence of non-rhythmic, rapid and chaotic contraction of the atrial myocardium, and manifested by a feeling of frequent and irregular heartbeat.

Forms of atrial fibrillation; paroxysmal, persistent

In the general concept of atrial fibrillation, there are fibrillation (flickering) And atrial flutter. In the first type, atrial contractions are “small-wave”, with a pulse of about 500 per minute, providing a rapid contraction of the ventricles. In the second type, atrial contractions are about 300-400 per minute, "large-wave", but also causing the ventricles to contract more often. Both in the first and in the second type, ventricular contractions can reach more than 200 per minute, but with atrial flutter, the rhythm can be regular - this is the so-called rhythmic, or regular form of atrial flutter.

In patients with heart defects, atrial fibrillation occurs in more than 60% of all cases, and in patients with coronary heart disease - in almost 10% of cases.

What happens with atrial fibrillation?

normal heartbeats

Pathogenetic changes in this rhythm disturbance are due to the following processes. In normal myocardial tissue, the electrical impulse moves in the same direction.- from the sinus node towards the atrioventricular junction. If there are any blocks in the path of the impulse (inflammation, necrosis, etc.), the impulse cannot bypass this obstacle and is forced to move in the opposite direction, again causing excitation of the myocardial regions that have just contracted. Thus, a pathological focus of constant circulation of impulses is created.

heart contraction in atrial fibrillation

Constant stimulation of certain areas of atrial tissue leads to the fact that these areas spread excitation to the remaining atrial myocardium, and it fibers contract singly, chaotically and irregularly, but often.

In the future, the impulses are conducted through the atrioventricular connection, but due to its relatively small “throughput” capacity, only a part of the impulses reaches the ventricles, which begin to contract at different frequencies and also irregularly.

Video: atrial fibrillation - medical animation

What causes atrial fibrillation?

In the vast majority of cases, atrial fibrillation occurs as a result of organic damage to the myocardium. Diseases of this type include primarily heart defects. As a result of stenosis or insufficiency of valves over time, the patient develops a change in the structure and morphology of the myocardium. Cardiomyopathy causes part of the normal muscle fibers in the heart to be replaced by hypertrophied (thickened) fibers that lose their ability to conduct impulses normally. Areas of hypertrophied tissue are pathological foci of impulses in the atria when it comes to stenosis and / or insufficiency of the mitral and tricuspid valves.

organic heart disease - the main cause of atrial fibrillation

The next disease, which occupies the second place in the frequency of development of atrial fibrillation, is, including acute and transferred. The path of development of arrhythmia is similar to defects, only areas of normal muscle tissue are replaced by necrotic rather than hypertrophied fibers.

Also a significant cause of arrhythmia is the proliferation of connective (scar) tissue instead of ordinary muscle cells. Cardiosclerosis can form within a few months or years after heart attacks or (inflammatory changes in the heart tissue of a viral or bacterial nature). Often, atrial fibrillation occurs in the acute period of myocardial infarction or in acute myocarditis.

In some patients, atrial fibrillation occurs in the absence of organic heart damage due to diseases of the endocrine system. The most common cause in this case is thyroid disease, accompanied by an increased release of its hormones into the blood. This condition is called hyperthyroidism, occurring with nodular or autoimmune goiter. In addition, the constant stimulating effect of thyroid hormones on the heart leads to the formation of dyshormonal cardiomyopathy, which in itself can lead to impaired conduction through the atria.

In addition to the main reasons, one can distinguish risk factors, increasing the likelihood of developing atrial fibrillation in a particular patient. These include age over 50, female gender, obesity, endocrine pathology, including a history of heart disease.

Factors provoking the occurrence of atrial fibrillation paroxysm in individuals with a history of arrhythmia already present include conditions that cause changes autonomic regulation cardiac activity.

For example, with the predominant influence of the vagus nerve (vagal, parasympathetic influences), an arrhythmia attack can begin after a heavy meal, when turning the body, at night or during daytime rest, etc. With the influence of sympathetic nerves on the heart, the onset or worsening of the course of arrhythmia occurs as a result of stress, fear, strong emotions or physical exertion - that is, all those conditions that are accompanied by increased secretion of adrenaline and norepinephrine into the blood.

Symptoms of atrial fibrillation

Symptoms of atrial fibrillation may vary in individual patients. Moreover, the clinical manifestations are largely determined by the form and variant of atrial fibrillation.

So, for example, the clinic of paroxysmal atrial fibrillation is bright and characteristic.. The patient, against the background of complete health or minor precursors (shortness of breath when walking, pain in the region of the heart), experiences sudden unpleasant symptoms - a sharp feeling of rapid heartbeat, a feeling of lack of air, an asthma attack, a sensation of a lump in the chest and throat, inability to inhale or exhale. At the same time, according to the description of the patients themselves, the heart flutters like a “hare’s tail”, is ready to jump out of the chest, etc. or blanching of the skin of the face, nausea, feeling light-headed. This symptom complex in simple language is called “breakdown” of the rhythm.
But the formidable signs that should alert relatives and the doctor examining the patient are a sharp jump in blood pressure upwards (more than 150 mm Hg) or, conversely, a significant decrease in pressure (less than 90 mm Hg), since against the background of high pressure there is a high risk stroke, and low blood pressure is a sign of acute heart failure or arrhythmogenic shock.

Clinical manifestations are brighter, the greater the heart rate. Although there are exceptions when the patient tolerates a frequency of 120-150 per minute more than satisfactorily, and, conversely, a patient with a bradysystolic variant experiences interruptions in the heart and dizziness more pronounced than with normo- and tachysystole.

With an uncompensated constant form of atrial fibrillation or flutter, the heart rate is usually 80-120 per minute. Patients get used to such a rhythm, and practically do not feel interruptions in the work of the heart, only during physical exertion. But here, due to development, complaints of shortness of breath during physical exertion, and often with minimal household activity and at rest, come to the fore.

Diagnostics

The algorithm for diagnosing atrial fibrillation consists of the following points:

Examination and questioning of the patient. So, even in the process of collecting complaints and anamnesis, it is possible to establish that the patient has some kind of rhythm disturbance. Counting the pulse per minute and determining its irregularity may prompt the doctor to think about atrial fibrillation.
-diagnostics is a simple, affordable and informative method for confirming atrial fibrillation. The cardiogram is already performed when an ambulance is called or when the patient first contacts the clinic with interruptions.

The criteria for atrial fibrillation are:

The presence of a non-sinus rhythm (appears not in the cells of the sinus node), which is manifested by the absence of P waves in front of each ventricular complex,
The presence of an irregular rhythm, which is manifested by different R-R intervals - a different interval between complexes, reflecting ventricular contractions,

Heart rate can be a different value - from 40-50 to 120-150 per minute or more,

QRS complexes (ventricular complexes) are not changed,

Flicker waves f or flutter waves F are visible on the isoline.

After the ECG, indications for hospitalization are determined(see below). In case of hospitalization, further examination is carried out in the department of cardiology, therapy or arrhythmology, in case of refusal of hospitalization, the patient is sent for additional examination to the polyclinic at the place of residence.

Of the additional diagnostic methods, the most frequently prescribed and informative is daily monitoring of ECG and blood pressure. This method allows you to register even short runs of arrhythmias that are not “caught” on a standard cardiogram, and also helps to assess the quality of the treatment.

(echocardioscopy). It is the "gold standard" in the imaging diagnosis of heart disease, as it allows you to detect
significant violations of myocardial contractility, its structural disorders and evaluate the ejection fraction of the left ventricle, which is a decisive criterion for evaluating the effectiveness of therapy for heart failure with a constant form of atrial fibrillation.

(ChPEFI)- is a method based on artificial stimulation of the myocardium and provoking flicker, which can immediately be fixed on the ECG. It is carried out in order to register an arrhythmia, which clinically worries the patient with subjective sensations, but was not registered on the ECG (including with the help).

X-ray of the chest organs used to examine patients with a paroxysmal form (suspicion of) and with a permanent form (to assess venous congestion in the lungs due to chronic heart failure).

General and biochemical blood tests, the study of the level of thyroid hormones in the blood, ultrasound of the thyroid gland - helps in the differential diagnosis of cardiomyopathy.

In principle, for the diagnosis of atrial fibrillation, characteristic complaints (interruptions in the heart, chest pain, dyspnea), history (acute or long-term), and ECG with signs of atrial fibrillation or flutter are sufficient. However to find out the cause of such a rhythm disturbance should only be in the process of a thorough examination of the patient.

Tactics for the treatment of atrial fibrillation

Therapy for paroxysmal and constant forms of atrial fibrillation differs. The purpose of care in the first form is to provide emergency care and to conduct rhythm-restoring therapy. In the second form, the priority is the appointment of rhythm-reducing therapy with the constant use of medications. The persistent form can be subject to both rhythm-restoring therapy, and, in case of unsuccessful implementation of the latter, to the transfer of the persistent form to a permanent one using rhythm-reducing drugs.

Treatment of paroxysmal atrial fibrillation

The relief of paroxysm of flickering or fluttering is carried out already at the pre-hospital stage - by ambulance or in the clinic.

Of the main drugs for an arrhythmia attack, the following are used intravenously:

Polarizing mixture - potassium chloride solution 4% + glucose 5% 400 ml + insulin 5 units. In patients with diabetes, physical therapy is used instead of a glucose-insulin mixture. solution (sodium chloride 0.9%) 200 or 400 ml.

Panangin or asparkam solution 10 ml intravenously.

A solution of novocainamide 10% 5 or 10 ml in saline. With a tendency to hypotension (low pressure), it should be administered simultaneously with mezaton to prevent drug-induced hypotension, collapse and loss of consciousness.

Cordarone at a dosage of 5 mg/kg of body weight is administered in a 5% glucose solution intravenously slowly or drip. Should be used in isolation from other antiarrhythmic drugs.

Strofantin 0.025% 1 ml in 10 ml of saline solution intravenously slowly or in 200 ml of saline solution intravenously drip. It can be used only in the absence of glycoside intoxication (chronic overdose of digoxin, corglycon, strophanthin, etc.).

After the administration of the drugs, after 20-30 minutes, the patient is retaken the ECG and, in the absence of sinus rhythm, he must be taken to the emergency department of the hospital to resolve the issue of hospitalization. Restoration of the rhythm at the level of the emergency department is not carried out, the patient is hospitalized in the department, where the started treatment continues.

Indications for hospitalization:

The first identified paroxysmal form of arrhythmia,

Protracted paroxysm (from three to seven days), since there is a high probability of developing thromboembolic complications,

Paroxysm not stopped at the prehospital stage,

Paroxysm with developing complications (acute heart failure, pulmonary edema, pulmonary embolism, heart attack or stroke),

Decompensation of heart failure with a constant form of flicker.

Treatment of persistent form of atrial fibrillation

In the case of a persistent form of flickering, the doctor should strive to restoration of sinus rhythm with medication and/or cardioversion. This is explained by the fact that with restored sinus rhythm, the risk of developing thromboembolic complications is much lower than with a permanent form, and chronic heart failure progresses less. In case of successful restoration of sinus rhythm, the patient should constantly take antiarrhythmic drugs, such as amiodarone, cordarone or propafenone (propanorm, ritmonorm).

Thus, the tactics for the persistent form is as follows - the patient is observed in the clinic with atrial fibrillation for more than seven days, for example, after discharge from the hospital with failed relief of the paroxysm and with the ineffectiveness of the pills taken by the patient. If the doctor decides to try to restore sinus rhythm, he again refers the patient to the hospital for planned hospitalization for the purpose of medical rhythm restoration or for cardioversion. If the patient has contraindications (past heart attacks and strokes, blood clots in the heart cavity according to the results of echocardioscopy, untreated hyperthyroidism, severe chronic heart failure, arrhythmia prescription for more than two years), the persistent form is transferred to a permanent form with other groups of drugs.

Treatment of a permanent form of atrial fibrillation

With this form, the patient is prescribed tablet preparations that slow down the heart rate. The main ones here are the group and, for example, concor 5 mg x 1 time per day, coronal 5 mg x 1 time per day, egilok 25 mg x 2 times a day, betalok ZOK 25-50 mg x 1 time per day, etc. From the heart glycosides, digoxin 0.025 mg is used, 1/2 tablet x 2 times a day - 5 days, a break - 2 days (Sat, Sun).

It is mandatory to prescribe and, for example, cardiomagnyl 100 mg at lunch, or clopidogrel 75 mg at lunch, or warfarin 2.5-5 mg x 1 time per day (mandatory under the control of INR - a parameter of the blood coagulation system, usually 2.0-2.5 is recommended). These drugs prevent increased blood clots and reduce the risk of heart attacks and strokes.

Chronic heart failure should be treated with diuretics (indapamide 1.5 mg in the morning, veroshpiron 25 mg in the morning) and (prestarium 5 mg in the morning, enalapril 5 mg x 2 times a day, lisinopril 5 mg in the morning), which have an organoprotective effect on blood vessels and the heart.

When is cardioversion indicated?

This is the restoration of the original heart rate in a patient with atrial fibrillation with the help of medications(see above) or electric current passed through the chest and affecting the electrical activity of the heart.

Electrical cardioversion is performed on an emergency or elective basis using a defibrillator. This type of assistance should be provided only in the intensive care unit with the use of anesthesia.

The indication for emergency cardioversion is a paroxysm of atrial fibrillation not more than two days old with the development of arrhythmogenic shock.

The indication for planned cardioversion is a paroxysm more than two days old, not stopped by medication, in the absence of blood clots in the atrial cavity, confirmed by transesophageal ultrasound of the heart. If a thrombus in the heart is detected, the patient takes warfarin at the outpatient stage for a month, during which, in most cases, the thrombus dissolves, and then after repeated ultrasound of the heart in the absence of a thrombus, he is again sent to the hospital to decide on cardioversion.

Thus, planned cardioversion is carried out mainly when the doctor strives to restore sinus rhythm in the persistent form of atrial fibrillation.

Technically, cardioversion is performed by applying defibrillator electrodes to the anterior chest wall after the patient has been placed under intravenous anesthesia. After that, the defibrillator delivers a shock, which affects the rhythm of the heart. The success rate is very high, accounting for more than 90% of successful restoration of sinus rhythm. However, cardioversion is not suitable for all patient groups, in many cases (for example, in the elderly) AF will quickly develop again.

Thromboembolic complications after cardioversion are about 5% among patients who did not take anticoagulants and antiplatelet agents, as well as about 1% among patients receiving such drugs from the onset of arrhythmia.

When is surgery indicated?

Surgical treatment for atrial fibrillation can have several goals. So, for example, with heart defects as the main cause of arrhythmia, surgical correction of the defect as an independent operation in a larger percentage of cases prevents further recurrences of atrial fibrillation.

RFA

For other heart diseases, it is justified to carry out in the following cases:

Ineffectiveness of antiarrhythmic therapy with frequent paroxysms of atrial fibrillation,

Permanent form of flickering with rapid progression of heart failure,

Intolerance to antiarrhythmic drugs.

Radiofrequency ablation consists in the fact that the areas of the atria involved in the pathological circulation of the impulse are exposed to an electrode with a radio sensor at the end. The electrode is inserted into the patient under general anesthesia through the femoral artery under X-ray television control. The operation is safe and less traumatic, takes a short period of time and is not a source of discomfort for the patient. RFA can be performed according to quotas from the Ministry of Health of the Russian Federation or at the patient's own expense.

Is it possible to treat with folk remedies?

Some patients may ignore the recommendations of their doctor and begin to be treated on their own, using traditional medicine methods. As an independent therapy, taking herbs and decoctions, of course, Not recommended. But as an auxiliary method, in addition to the main drug therapy, the patient can take decoctions of soothing plants that have a beneficial effect on the nervous and cardiovascular systems. For example, decoctions and infusions of valerian, hawthorn, clover, chamomile, mint and lemon balm are often used. In any case, the patient should notify the treating doctor about taking such herbs.

Are complications of atrial fibrillation possible?

The most common complications are pulmonary embolism (PE), acute heart attack and acute stroke, as well as arrhythmogenic shock and acute heart failure (pulmonary edema).

The most significant complication is stroke. An ischemic-type stroke caused by a thrombus shooting into the cerebral vessels (for example, when a paroxysm stops) occurs in 5% of patients in the first five years after the onset of atrial fibrillation.

Prevention of thromboembolic complications (stroke and PE) is continuous use of anticoagulants and antiplatelet agents. However, even here there are some nuances. So, for example, with an increased risk of bleeding, the patient is likely to bleed into the brain with the development of a hemorrhagic stroke. The risk of developing such a condition is more than 1% in patients in the first year from the start of anticoagulant therapy. Prevention of increased bleeding is p regular control of INR(at least once a month) with timely adjustment of the anticoagulant dose.

Video: how a stroke occurs due to atrial fibrillation

Forecast

The prognosis for life with atrial fibrillation is determined primarily by the causes of the disease. For example, in survivors of acute myocardial infarction and significant cardiosclerosis short-term prognosis for life may be favorable, but for health and in the medium term unfavorable, since in a short period of time the patient develops chronic heart failure, which worsens the quality of life and reduces its duration.

Nevertheless, with regular intake of drugs prescribed by a doctor, the prognosis for life and health undoubtedly improves. And patients with a permanent form of MA registered at a young age, with proper compensation, live with it even up to 20-40 years.

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It is known that normally (at rest), the human heart beats at a frequency of 60-80 beats per minute. A healthy heart can vary these values over a wide range.

So, if you first measure at rest, and then, closing your eyes, press on your own eyeballs with your thumbs and hold them for 10-15 seconds, then after re-measuring you will get 45-50 contractions per minute. Has arisen.

This happened because you activated the vagus parasympathetic nerve, which "slowed down" the work of the heart, because the intraocular pressure became too high. And since it has grown, why "pump" so much blood?

The acceleration of the rhythm (tachycardia) occurs in a healthy person with emotional and physical stress, as well as with an increase in temperature, for example, in a bath and sauna.

It is known that with an increase in body temperature by only 1 degree, the heart rate increases by 10 beats / min.

But sometimes there are painful pathological conditions in which the correct rhythm of the heart is disturbed, and one of the most common types of rhythm disorder is atrial fibrillation, "flicker", or atrial fibrillation. What is it, why does it appear, how does it proceed and how is it treated?

Atrial fibrillation - what is it?

Before talking about atrial fibrillation, you need to briefly, “on the fingers”, explain how the heart rhythm occurs. The thing is that the heart muscle is not like the others. All its cells are combined into a special functional syncytium, which can contract in certain portions with great efficiency, without interfering with each other.

After all, the reduction cycle must be organized just as precisely as the operation of the engine, even much more perfect. For example, the atria and ventricles should contract and relax strictly in turn:

The ventricles contract, with force ejecting arterial scarlet blood into the aorta, to organs and tissues, and dark and venous blood into the lungs. At the same time, the atria relax and passively fill with blood: oxygen-enriched blood from the lungs enters the left atrium, and venous blood from the whole body enters the right atrium;

After ejection, the ventricles are relaxed and at rest, and the atria contract and push blood into the ventricles.

After that, the whole cycle is repeated, and the system of cuspid and semilunar valves does not allow the blood to change its direction.

This is possible because the heart has its own “roads and crossroads” along which an impulse runs, forcing the chambers of the heart to contract in the right order, and this is the conduction system of the heart.

The most basic and highest regulator is the nodus sinuatrialis, or atriosinus node. It is arranged in such a way that its cells do not know rest at all, and can spontaneously generate impulses, like a radioactive element - radiation quanta.

This process is called spontaneous diastolic depolarization. Then this impulse is transmitted lower and lower, first to the atria, and then to the ventricles.

What happens if the rhythm is disturbed?

The optimal frequency of 60-80 beats per minute (in the range of 30 to 150) allows the right groups of myocardial fibers to rest and contract in order to conduct an effective cardiac output. Imagine what will happen if the chambers of the heart contract at the same time? That's right - the effect will be zero, as in full asystole.

And if, for example, the atria sharply increase their rate of contraction? Say, up to 200, 400 or 600 beats per minute? You say it's impossible. It is very possible, only at this rate the efficiency of the ejection is very negligible.

In the first case, you can still notice how the atria flutter, and at a frequency of 350 - 600 beats per minute, only their "flicker" is visible. This is exactly what they called this form of arrhythmia - atrial fibrillation.

What is atrial fibrillation?

Atrial fibrillation, or “flicker”, atrial fibrillation is a chaotic and unorganized excitation of individual fibers of the atrial muscles with a frequency exceeding 350-600 per minute.

In this case, atrial systole is inefficient, and this leads to an irregular and chaotic ventricular rhythm.

It is clear that when the "supply is ruined", then everyone is looking for himself. But the ventricles, even under such conditions, at the very least work, and the person does not lose consciousness, but if the ventricles flicker, this causes the cessation of their organized work, cardiac output, blood circulation and clinical death.

"Flicker" is very common. Suffice it to say that its slower "sister" - atrial flutter, with a frequency of 200-300 times per minute, is for some reason 20 times less common. According to statistics, if you are reading this article and you are under 40 years old, then only one in a thousand will “fall” into this type of arrhythmia this year.

If you are over 60 years old, but not 75, then this fate awaits every 25th person. And finally, people over 75 years of age in 10% of cases suffer from this rhythm disorder. In terms of prevalence, "flicker" ranks first among all types of arrhythmias that require hospitalization.

What diseases lead to atrial fibrillation?

myocardial infarction (cardiac necrosis develops);

cardiosclerosis, when the pathways are replaced by connective tissue;

pericarditis, myocarditis;

chronic and congestive heart failure (failure overload);

Causes of atrial fibrillation can be temporary:

hypokalemia (excess diuretics);

pulmonary embolism;

heart surgery.

Sometimes there are extracardiac, or non-cardiac causes. These include:

thyrotoxicosis;

diabetes;

metabolic syndrome and obesity;

chronic alcoholism.

Women are more likely to develop daytime atrial fibrillation. This occurs against the background of emotional stress, after tea with cognac or coffee. And the male form of atrial fibrillation often occurs at night, and especially often - with alcohol intoxication.

As you can see, the causes of fibrillation are different. Arrhythmologists also distinguish several varieties within this disease.

Forms and symptoms of atrial fibrillation

There are the following forms of atrial fibrillation:

According to the duration of the flow:

Paroxysmal atrial fibrillation. The paroxysm lasts no more than a week, and usually goes away on its own;

Persistent atrial fibrillation. It is not stopped by drugs, as well as electropulse therapy;

persistent form. Lasts more than a week, but is treatable.

Also, atrial fibrillation can be new-onset or recurrent.

Finally, the ventricular contractions that are present in the background of atrial fibrillation can divide this arrhythmia into:

Bradysystolic (bradyform), the frequency of contractions of the ventricles is less than 60 per minute;

Normoform (60-80);

Tachysystolic form of flicker (heart rate over 90).

Signs of atrial fibrillation of the heart

How does atrial fibrillation of the heart manifest itself, and what are its symptoms?

When a paroxysm occurs, complaints of a sudden, chaotic heartbeat, the disappearance of the correct pulse are characteristic. Sometimes there is shortness of breath and chest pain, which can lead to an imitation of an angina attack. Symptoms of atrial fibrillation are manifested by the occurrence of weakness, dizziness, fainting or pre-syncope.

In the event that atrial fibrillation is of a prolonged nature, then it is characterized by simply non-rhythmic work of the heart during exercise, with the development of shortness of breath.

Sometimes patients say that "the heart is beating in the throat", weakness appears.

Why is atrial fibrillation dangerous?

It is impossible to talk about the unconditional danger of the symptoms of atrial fibrillation, since it sometimes occurs in healthy people, for external reasons, but in some cases, atrial fibrillation can be dangerous:

With tachyarrhythmia in weakened individuals, hypotension and angina pectoris may occur;

With a sharp cessation of the paroxysm of flickering, fainting may occur;

Patients with rheumatism may experience embolic events such as cardioembolic strokes;

In chronic cardiac patients, fibrillation can cause progression of insufficiency and the appearance of pulmonary edema, especially in patients with mitral stenosis.

Flicker attack - emergency

With atrial fibrillation, emergency care will consist of laying the patient down, unbuttoning his collar and calling a doctor. The fact is that almost 30% of all flicker attacks go completely unnoticed, and it is impossible to guess the time of their occurrence.

In severe atrial fibrillation, either thromboembolic complications (PE, strokes) or heart failure develop, but these are already different and independent conditions, and the stages of emergency care are described when presenting the relevant topics.

The question remains: when to hospitalize a patient with atrial fibrillation? In the following cases:

With the first paroxysm;

With paroxysm with severe tachysystole (the ventricles contract more than 150 times per minute);

If there is a drop in blood pressure.

Diagnosis of arrhythmia

With this arrhythmia, the pulse and heart sounds do not have any rhythm, but the true diagnosis is determined using a conventional ECG. Sometimes Holter monitoring, transesophageal stimulation of the heart, and echocardiography are required.

It is necessary to treat atrial fibrillation, starting with the underlying disease, for example, thyrotoxicosis or. The principles of drug therapy are:

Restoration of sinus rhythm and its maintenance;

If it was not possible to restore it, then it is necessary to transfer ventricular contractions from the tachyform to the normoform, in combination with full-fledged anticoagulant therapy.

Non-drug therapies include avoiding stimulants (spicy foods, coffee), avoiding alcohol, and stopping smoking and drug use.

The drugs of choice for atrial fibrillation are as follows:

amiodarone;

procainamide;

propafenone.

For the prevention of thrombosis, heparin, fraxiparin, warfarin are administered under the control of INR. With a decrease in pressure, signs of pulmonary edema and intolerance to antiarrhythmic drugs, electrical impulse therapy is performed.

With resistance to treatment and the appearance of frequent paroxysms, surgical treatment of atrial fibrillation is indicated - radiofrequency ablation. If ablation was also ineffective, then the issue of prescribing cardiac glycosides to slow down the rhythm is being considered.

It is important to know that the treatment of atrial fibrillation is the lot of professionals, and not only cardiologists, but cardiologists - arrhythmologists. It is very dangerous to take antiarrhythmic drugs on your own.

Forecast

In the case of a combination of atrial fibrillation with another pathology (cardiosclerosis, diabetes), the prognosis depends entirely on the course of the underlying disease. But at the same time, the mere presence of atrial fibrillation already increases overall mortality by 1.7 times, and cardio-vascular mortality doubles.

In the event that atrial fibrillation develops in patients with heart defects associated with a violation of the valvular apparatus, the risk of developing a stroke increases by 17 times.

Therefore, atrial fibrillation "acts" often, "by the hands" of the underlying disease. Our task is to cope with it and prevent a relapse.

Atrial fibrillation (atrial fibrillation) is the most common heart rhythm disorder, which occurs in 1 - 2% of the world's population. The frequency of occurrence strongly depends on age, under 40 years of age is 0.5% of the entire population, over 65 - 5%, and in those over 80 - 10%. The pathogenesis of the disease is based on a change in the automatism of myocardial cells, in which the sinus node ceases to be the main source of heart rhythm. With this pathology, pathological nerve impulses are generated in the muscle tissue of the atria, which "manage" the work of the heart. It is believed that with atrial fibrillation there are from 350 to 800 signals per minute.
The disease got its name because of its specific reflection on the ECG, where instead of P waves, asymmetric different-amplitude f waves with a very high frequency appear. Looking at them gives the impression of atrial fibrillation.

Causes of the disease
Atrial fibrillation, like any other disease, can develop against the background of an already existing pathology. The main precursor diseases are:
IHD (ischemic heart disease);
mitral valve defects (located between the left atrium and ventricle);
WPW syndrome (Wolf-Parkinson-White);
arterial hypertension;
diabetes;
thyrotoxicosis;
alcoholic myocardial dystrophy (heart damage due to constant alcohol consumption);
electrolyte deficiency - in most cases - a lack of magnesium and potassium.

Often provoke an attack of atrial fibrillation can:
increased physical activity or emotional arousal;
drinking alcohol, coffee;
smoking;
plentiful food intake.

Rarely enough, the cause of the disease and provoking factors cannot be identified. In this case, atrial fibrillation is considered idiopathic.
The nervous system plays an important role in the occurrence of pathology. The increased tone of its particular department can provoke seizures. The vagal type of atrial fibrillation develops with the active influence of the parasympathetic link. The sympathetic division causes hyperadrenergic atrial fibrillation.
The mechanism of development of atrial fibrillation
The disease occurs when heterogeneity of the atrial myocardium. Because of this, pathological foci appear in certain areas of the muscle tissue, in which nerve signals are generated. Unlike atrial flutter, in this case there is not one or two foci, but a much larger number of them. As a result of the joint conduction of excitation from all these sources through the atrial myocardium, an uncoordinated and inefficient contraction of the latter occurs.
If all these impulses were transmitted to the underlying sections, then the ventricles would contract by analogy with the atria: ventricular fibrillation would develop. This would lead to a violation of the ejection of blood from the heart and death.
To prevent such a situation, the conduction system of the heart is equipped with a special "filter". It is the atrioventricular node located between the atria and ventricles. Due to this structure, there is a special delay in the excess amount of nerve signals and the frequency of contractions of the ventricles is much lower than that of the atria. This protects the body from sudden death during ventricular fibrillation.
Classification
Depending on the mechanism of occurrence, as mentioned above, there are two types of atrial fibrillation:
Hyperdrenergic.
Vagus.

Characteristics of the vagal type of atrial fibrillation:
more often occurs in the male half of the population;
attacks begin with food or at night;
no dependence on physical activity or stress;
provoking factors may be a tightly tied tie or scarf, a state of rest or a horizontal position of the body, a tightly tightened belt or bloating.

The hyperdrenergic variant is characterized by:
the occurrence of seizures at any time of the day, rarely at night;
the dependence of the attack on the physical or emotional state of the body;
frequent occurrence in women.

The course of the disease can take the following forms:
Permanent - chronic atrial fibrillation without restoration of sinus rhythm.
Paroxysmal - periodic "breaks" of the rhythm with its subsequent restoration.

Clinical manifestations, symptoms of atrial fibrillation
Paroxysmal form
The peculiarity of this variant of the course of atrial fibrillation is the alternation of normal heart function with the leading source of rhythm from the sinus node and atrial fibrillation. The frequency of seizures can range from one during a lifetime to several during a day. Sometimes this form eventually becomes permanent.
With this variant of arrhythmia outside the attack, due to the normal functioning of the heart, the person feels as usual. During a sharp arrhythmia of the type of atrial fibrillation, the condition deteriorates sharply. With self- or medication restoration of a normal heartbeat, the state of health again becomes normal.
When an attack (paroxysm) of atrial fibrillation occurs, the heart begins to contract inefficiently and quickly. As a result, there is insufficient pumping of blood and its delivery to vital organs. This leads to ischemia of tissues and body systems.
With frequent paroxysms or long periods (episodes) of abnormal heartbeat, the whole body gradually adapts to such work of the heart. Subjectively, the state of health worsens at the time of transition to arrhythmia from normal sinus rhythm. During an already disturbed rhythm, a person’s condition and his sensations improve slightly.
Atrial fibrillation can manifest itself with completely different symptoms. The common ones are:
an attack of a sharp rapid heartbeat;
discomfort in the region of the heart;
severe weakness, malaise;
increased sweating, cold extremities;
feeling of fear;
dizziness up to loss of consciousness.

The above symptoms can disturb a person not only with atrial fibrillation. Almost all types of cardiac arrhythmias are accompanied by similar manifestations.
permanent form
This course of atrial fibrillation is characterized by the absence of impulse generation in the sinus node. All idiopathic sources of rhythm are located in the atrial myocardium. Often the paroxysmal form becomes permanent. This happens either when it is impossible to restore sinus rhythm, or when paroxysms are too frequent, when restoring a normal heartbeat is not justified.
The condition and well-being of patients with this variant of the course is determined by the heart rate (HR). If it is as close as possible to 80 beats per minute, then a person may not feel this disease at all. With a significantly increased or decreased heart rate, the state of health worsens.
The concept of "heart rate with atrial fibrillation" includes the number of ventricular contractions per minute. With this pathology, it is not possible to change the number of atrial contractions.
Diagnosis of atrial fibrillation
Normal sinus rhythm and atrial fibrillation on the ECG The main methods for determining atrial fibrillation is an ECG study and Holter monitoring. An important criterion for diagnosing and prescribing further treatment is the heart rate at rest. This value is the starting point for choosing the dosage of the drug. Sometimes it is important to know how fast the heart beats during exercise. For this, stress tests are additionally assigned.
By interpreting the ECG, the diagnosis of atrial fibrillation can be made based on the following changes:
There is not a single P wave.
Instead, fibrillation waves f are recorded.
Different amplitude and shape of ventricular QRS complexes.
QRS complexes are located at different distances from each other (unequal R-R distances).

All these data indicate an inferior contraction and relaxation of individual atrial myocardial fibers.
Treatment
The treatment option for the disease depends on the course and degree of developing complications. The permanent form does not require the restoration of a normal heartbeat, but implies a correction of the heart rate and an increase in the contractile function of the ventricles. The paroxysmal form requires the restoration of sinus rhythm as soon as possible.
Treatment of paroxysm of atrial fibrillation(stopping an attack in a paroxysmal form):
Provide access to fresh air.
Take a horizontal position of the body.
Take Corvalol. If the attack has not developed for the first time, take the antiarrhythmic drug recommended by the doctor.
In case of a sharp deterioration in well-being or no effect within a few hours, it is necessary to seek qualified medical help.

When providing assistance in a hospital, the rhythm is restored in two main ways:
The introduction of an antiarrhythmic drug intravenously.
The use of electropulse therapy (the use of an electric discharge).

To the choice of tactics treatment of a permanent form of atrial fibrillation must be approached with extreme caution. In some cases, we can still talk about restoring normal sinus rhythm.
The main task of treating persistent arrhythmia is to ensure adequate blood supply to all organs of the body. To do this, you need to create the optimal number of heartbeats. At an increased frequency, drugs are used that help the atrioventricular node to pass a smaller number of nerve impulses to the ventricles. With a ventricular contraction rate of less than 40 beats per minute, drug treatment is practically useless. In this case, surgical intervention is necessary. In view of the increased risk of thrombus formation in the atrial cavities, additional therapy is aimed at preventing their occurrence.
Main drugs used for atrial fibrillation:
Antiarrhythmic drugs (Novocainamide, Amiodarone).
Beta-blockers (Anaprilin, Metoprolol).
Calcium channel blockers (verapamil).
Antiplatelet agents (Aspirin, Polocard).
Minerals and trace elements - preparations containing potassium and magnesium (Asparkam, Magnevit, Panangin).
Cardiac glycosides (prescribed with the addition of heart failure - Digoxin, Strofantin).

Surgical treatment of the disease
In view of the active development of science and medicine, the surgical method for the treatment of arrhythmias is very promising. There are several different approaches:
Physical destruction of an element of an atrioventricular node or a pathological bundle of conduction of a nerve impulse to the ventricles from the atrium. This option is resorted to in the absence of the effect of drug treatment. As a result of the operation, a decrease in heart rate is achieved by normalizing the number of signals conducted to the ventricles. In this case, quite often the atrioventricular connection is completely blocked, and for normal contraction of the ventricles, a pacemaker (IVR - artificial pacemaker) is implanted in them.
Implantation of a mini cardioverter defibrillator. This treatment option is more suitable for people who have paroxysms of atrial fibrillation infrequently. Such a device automatically recognizes a violation of the rhythm and produces an electrical impulse that can restore normal cardiac activity.

Prevention of atrial fibrillation
If there is a history of at least one episode of paroxysmal atrial fibrillation, it is important to identify its cause. This is necessary to prevent their recurrence. The general plan of measures aimed at preventing arrhythmia attacks:
Treatment of the disease that caused the rhythm disorder.
Taking magnesium and potassium supplements. Eating foods rich in them (pumpkin, watermelon, bananas).
Continuous intake of small doses of antiarrhythmic substances (only on the recommendation of a cardiologist).
Exclusion of the influence of increased tone of the nervous system.

The last point of prevention is effective in the presence of evidence of a vagal or hyperadrenergic form of arrhythmia.
Prevention of attacks of the vagal type of atrial fibrillation:
reduction of excess body weight;
avoid constipation and bloating;
exclusion of the horizontal position of the body after eating. Exclusion of excessive eating at night;
avoidance of sharp bends of the body.

Prevention of the hyperadrenergic type:
increase in rest and sleep time;
avoidance of stress and strong physical exertion;
the maximum possible reduction in the use of coffee, strong tea, nicotine;
taking sedative herbal preparations (tincture of motherwort or valerian).

Possible Complications
Speaking about the possible complications of atrial fibrillation, it is necessary to understand that they are divided into two types:
Developing with paroxysm.
Developing with a long course of constant arrhythmias.

The first group includes:
OLZHN - acute left ventricular failure (cardiogenic pulmonary edema);
ONMK - an acute violation of cerebral circulation due to a lack of oxygen and nutrients;
violations of the blood supply to any organ of the body.

The second group includes the so-called. late complications:
chronic heart failure with all its manifestations;
increased thrombosis and thrombosis of various organs (myocardial infarction, thromboembolic strokes).

Forecast of atrial fibrillation
The prognosis of the disease depends entirely on the timely diagnosis and treatment of pathology. Adequate treatment, which contributes to the normalization of heart rate and full blood supply to the organs of the body, leads to complications to the least extent. However, even with proper treatment, there is an increased risk of thrombosis and its complications.
Thus, with atrial fibrillation, it is quite possible to maintain a normal lifestyle for a long time.

Atrial fibrillation is most often determined in old age. It is of great clinical importance, as it leads to serious complications in the form of stroke and acute heart failure. Women are more prone to the disease than men, therefore, after 60 years, a regular scheduled examination by the attending doctor is recommended.

In a normal state, the heart contracts sequentially (atria, then ventricles) and with the same rhythm. For this, an electrical impulse formed in the sinus node enters the atrioventricular (atrioventricular) node. If on its way there are areas of necrosis, inflammation or other destruction, then a block occurs that the impulse cannot bypass. It returns along the fibers back and again excites the previously contracted atria. Such propagation of the impulse takes the form of a constant circulation (re-entry), which forms a pathological focus of atrial contractions.

Normal impulse conduction

Atrial fibrillation type

Atrial fibrillation is characterized by frequent contraction, but in addition, chaotic and irregular atrial work is noted. This is due to the fact that the circulating impulse from the pathological focus extends to other parts of the myocardium. In addition, the ventricles also begin to contract incorrectly and irregularly, since the excitation signal does not reach them in full.

Description of atrial fibrillation

Atrial fibrillation refers to a mixed group of heart rhythm disorders, in which there is an increase in cardiac activity from 350 to 700 beats per minute. The name of the disease comes from Latin and means "madness of the heart." It can manifest itself in adults, children, men and women, but the risk group for the disease is people over 60 years old, since it is degenerative changes in the myocardium that lead to supraventricular tachycardia.

Up to 60 years of age, atrial fibrillation is diagnosed in 1% of patients, in the elderly it is determined in 6-10% of cases.

Why is atrial fibrillation dangerous? First of all - insufficient cardiac output, since the ventricles cannot provide a sufficient volume of blood to the organs through the pulmonary and systemic circulation. At first, the disorder is compensated, but with a long course of the disease, acute circulatory failure occurs. With some ailments, like mitral stenosis or hypertrophic cardiomyopathy, heart failure develops very quickly.

A strong drop in cardiac output causes an arrhythmogenic form of cardiogenic shock. In the absence of emergency medical care, a fatal outcome is possible.

Asynchronous contraction of the atria leads to stagnation of blood. Against this background, the risk of thrombosis increases, especially in the left atrium, from where they easily enter the cerebral vessels and cause an ischemic stroke. An unstopped attack of atrial fibrillation, lasting more than 2 days, first of all threatens with acute thrombosis of the vessels located in the brain.

Video: Atrial fibrillation, why is it dangerous

Symptoms of atrial fibrillation

The clinic of the disease is primarily determined by its form of development. If this is paroxysmal atrial fibrillation, then bright characteristic symptoms are observed:

the heartbeat increases sharply;

there is an attack of suffocation;

not enough air;

it becomes difficult to inhale and exhale;

there is weakness and trembling in the whole body;

increased urination;

increased sweating;

hands and feet become cold;

the patient may panic.

Heart rate is the main criterion for the patient's condition. The greater the number of beats per minute, the worse the patient will feel. In some cases, due to acute failure of cardiac output, an arrhythmogenic collapse develops when a person loses consciousness due to poor blood supply to the brain.

Before the appearance of a pronounced clinic for a long time, there may be slight retrosternal pain, shortness of breath, and a feeling of nausea. Such signs can be considered harbingers of atrial fibrillation.

Pathology can manifest itself in the form of small attacks, which at first are either not felt by the patient at all, or are perceived as temporary discomfort. The lack of treatment of arrhythmia in the early stages affects the decrease in efficiency and the appearance of complications in the form of angina pectoris, shortness of breath, swelling of the extremities, liver enlargement, and problematic breathing. Atrial fibrillation therapy prescribed in a timely manner will help to avoid premature wear of the myocardium.

Causes of atrial fibrillation

Often the disease is a consequence of coronary heart disease. Areas of the myocardium deprived of nutrition and oxygen can occur both in the ventricles and in the atria. With extensive ischemia, atrial fibrillation develops faster and has a more pronounced clinic.

Arterial hypertension is in second place after coronary artery disease among the factors in the development of atrial fibrillation. With long-term hypertension, the left ventricle does not function well during diastole. In addition, its myocardium increases, which contributes to left atrial hypertrophy and the occurrence of atrial fibrillation. In addition, other equally important internal and external causes of the development of atrial fibrillation are distinguished.

Internal causes of atrial fibrillation

Associated with the state of the heart and its functioning. Mainly represented by the following diseases:

heart defects (acquired and congenital), in which there is an expansion (dilatation) of the atria;

cardiomyopathies (hypertrophic, and more often, dilated);

infective endocarditis;

constrictive pericarditis;

myocardial dystrophy, which developed against the background of alcoholism and hormonal disorders (during menopause);

myxoma of the left atrium;

mitral valve prolapse, in which left atrial hypertrophy is observed;

primary amyloidosis of the heart, which developed after 70 years.

Structural changes in the heart are a common cause of atrial fibrillation

External factors for the appearance of atrial fibrillation

They are much smaller than internal ones. Atrial fibrillation is most often provoked by pulmonary diseases that contribute to the development of chronic cor pulmonale.

The cause may be hemochromatosis, manifested by diabetes mellitus and pigmentation. With thyrotoxicosis, atrial arrhythmia also occurs. Some athletes have MA against the background of increased stress on the heart.

If it is impossible to identify external or internal causes of the development of pathology in a patient, then an idiopathic form of atrial fibrillation is diagnosed.

Types of atrial fibrillation

The following clinical types of atrial fibrillation are distinguished

Paroxysmal supraventricular tachycardia - signs of the disease are observed for 7 days.

Persistent atrial fibrillation - the duration of the disease is more than 7 days.

Permanent form - the clinical picture can be more or less pronounced, but practically without attenuation of the process.

The severity of the clinic contributes to the division of the pathological process according to the severity of the course into four classes;

the first is characterized by the absence of signs;

the second - some symptoms may be observed, but there are no complications and the usual way of life of a person is practically not disturbed.

the third - the clinical picture is pronounced, complications appear.

the fourth - the patient is given disability due to severe complications and loss of working capacity.

In the development of atrial fibrillation, it is also customary to distinguish two main forms.

Atrial fibrillation or fibrillation . The mechanism of development is the previously mentioned re-entry, in which there is frequent and irregular contraction of the atria and ventricles. The latter in diastole can be filled with blood, but due to their chaotic work they are not able to make a normal ejection of blood. In severe cases, atrial fibrillation progresses to ventricular fibrillation, which can subsequently lead to cardiac arrest.

atrial flutter is a rhythmic form of cardiac dysfunction, in which the atria contract to 400 beats per minute, and the ventricles to 200 beats per minute. In diastole, the atria practically do not relax, therefore, almost no blood enters the ventricles, which does not allow normal blood circulation throughout the body.

Sometimes in one patient there may be an alternation of flutter and atrial fibrillation. This is due to the great similarity of the mechanisms of occurrence of these two pathological conditions.

Diagnosis of atrial fibrillation

An external examination of the patient determines the pallor of the skin and mucous membranes, cyanosis near the nose and mouth, an agitated state. Counting the heart rate will indicate tachycardia, and an irregular pulse, with a possible pulsation in the area of large arteries, will tell you the direction of making the correct diagnosis.

The next stage is electrocardiography, which is available at almost all levels of hospitalization of patients. The first cardiogram can be done in an ambulance or when a patient visits a clinic.

The main manifestations of atrial fibrillation on the electrocardiogram:

the P wave does not appear, which indicates the absence of sinus rhythm;

different intervals are visible between the ventricular complexes, which confirms the irregularity of heart contractions;

teeth can be large-wave (indicate flutter) or small-wave (indicate atrial fibrillation).

A 12-lead ECG study helps to identify acute atrial fibrillation. Paroxysmal attacks of atrial fibrillation are detected using Holter monitoring, when ECG and blood pressure are monitored throughout the day.

Additional methods for diagnosing atrial fibrillation:

Echo KG (echocardioscopy) together with ultrasound of the heart are prescribed for suspected left ventricular failure. The methods allow you to visually see organic disturbances and make the most accurate calculation of the ejection fraction.

Transesophageal examination using an electrocardiograph - is used in case of unproven atrial fibrillation using ECG and Holter monitoring. During the study, an arrhythmia attack is provoked, which is determined on the cardiogram.

X-ray examination is indicated for the appointment of patients with paroxysmal and permanent forms. In the first variant, it is effective for suspected PE - pulmonary embolism, in the second - for assessing pulmonary congestion that has developed due to chronic heart failure.

Biochemistry and complete blood count - is prescribed to determine hormonal parameters and markers of a disease such as cardiomyopathy.

In typical cases, the diagnosis of atrial fibrillation is made on the basis of complaints received, external examination data, patient interviews and electrocardiographic studies.

Treatment of atrial fibrillation

In acute cases, first aid should be provided. To do this, an ambulance team is called, and before it arrives, the patient is laid down horizontally. If they were taking antiarrhythmic drugs, they should be drunk at the dose indicated by the doctor. After the team establishes a preliminary diagnosis of atrial fibrillation, hospitalization is carried out.

Indications for hospitalization:

Paroxysmal arrhythmia was detected for the first time.

The attack lasted up to seven days, which threatens the development of pulmonary embolism.

The paroxysm was not stopped at the prehospital stage.

A permanent form is determined, against the background of which heart failure has developed.

During the attack, complications appeared in the form of a stroke, heart attack, pulmonary edema, and acute heart failure.

In the hospital, the causes of the pathology are clarified, and the form of flickering is specified. Further, the treatment tactics depend on the final diagnosis, confirmed by additional research methods and analyses.

Therapy for paroxysmal and persistent forms of atrial fibrillation

Drugs are used that slow down the heart rate and restore the work of the sinus node. If necessary, cardioversion is used, which is primarily indicated for acute left ventricular failure. Successful restoration of sinus rhythm prevents the development of PE. After the patient is prescribed antiarrhythmic drugs.

Electrocardioversion - treatment of atrial fibrillation with electric current, used to restore sinus rhythm. It is carried out in emergency and planned cases with the use of a defibrillator and anesthesia. Emergency electrocardioversion is used for paroxysms lasting up to 2 days and arrhythmic collapse. Planned - performed in a hospital most often with persistent atrial fibrillation. A transesophageal ultrasound of the heart is preliminarily performed to exclude the possibility of the presence of blood clots in the atria. Taking anticoagulants before starting the procedure helps to avoid complications from electrocardioversion.

Contraindications for electrocardioversion:

long-standing arrhythmia (more than 2 years);

severe heart failure with chronic course;

untreated thyrotoxicosis;

stroke or heart attack in the history of the patient;

in the cavity of the heart, thromboembolic formations are determined on the Echo-cardioscope.

Sometimes persistent atrial fibrillation is not amenable to medical treatment and cannot be treated with electrocardioversion due to contraindications. In such cases, it is transferred to a permanent form with further treatment according to the protocol for this disease.

Therapy of a permanent form of atrial fibrillation

Patients with this form of the disease are treated with cardiac glycosides and beta-blockers. The first group of drugs includes egilok, coronar, concor. To the second - digoxin. With the help of drug therapy, the heart rate slows down.

In all forms of atrial fibrillation, anticoagulants and antiaggregants are indicated. Especially in the presence of high risks of PE. The standard dose of aspirin in cases not at risk of thromboembolism is 325 mg/day.

Surgical treatment of atrial fibrillation

It is used in the case of heart defects and other diseases, when antiarrhythmic drugs are not perceived by patients or their effectiveness is shown.

Radiofrequency ablation (RFA) is a low-traumatic operation performed to cauterize areas in the atria in which a circulating impulse is detected. For this, a radio sensor is used, located on the electrode, inserted through the femoral artery. The intervention is performed under anesthesia and X-ray television control. The operation is performed for a small amount of time and is considered relatively safe.

Operation labyrinth. An abdominal intervention is performed, in which labyrinth-like incisions are made on the open heart. They help redirect impulses, while the body functions normally.

Installation of special devices, cardioverter-defibrillator or pacemaker. These devices are used as a last resort when other treatments for atrial fibrillation fail.

Video: Atrial fibrillation. What makes the heart flutter

Preparations

Relief of attacks of paroxysmal AF is carried out with the help of intravenous administration of the following drugs:

Novocainamide 10%, administered in saline at a dose of 5 or 10 ml. The tool can dramatically lower blood pressure, so it is usually prescribed with mezaton.

Asparkam or Panangin at a dose of 10 ml.

Strofantin 0.025% is used in a dose of 1 ml for drip injection on the physical. solution or for inkjet.

Cordarone at a dose of 5 mg/kg is administered drip or very slowly in 5% glucose.

Polarizing mixture consisting of glucose, insulin and potassium solution. In diabetes mellitus, the glucose-insulin mixture is replaced with saline.

Of the anticoagulants and antiplatelet agents, the following are most often used:

Cardiomagnyl at a dose of 100 mg, once, at lunch.

Warfarin is taken once a day at a dose of 2.5-5 mg.

Clopidogrel at a dose of 75 mg, once, in the afternoon.

The listed drugs are taken under strict control of the parameters of the blood coagulation system.

The use of folk remedies for atrial fibrillation

If a flickering arrhythmia of the heart is diagnosed and what the doctor explained in detail what it is, then you can use not only medicines, but also folk remedies for treating the disease. In particular, it is recommended to coordinate with your doctor and take:

Chopped yarrow herb, from which tincture is prepared and taken in small quantities for no more than a month.

Walnuts are crushed and taken with honey before meals. The course of treatment is at least a month.

Dill seeds are poured with boiling water and infused, after which the broth is filtered and taken before meals in a third of a glass.

Soothing decoctions and infusions of valerian, hawthorn, lemon balm will help calm the nervous system, strengthen the cardiovascular system.

It is strongly not recommended to treat acute paroxysm with folk remedies!

Dietary nutrition is an important factor in the treatment of atrial fibrillation. The disease can progress with frequent use of fried, fatty foods, smoked foods and butter. Excess vinegar, salt, sugar, spices have a negative effect on cardiac activity. Therefore, the diet should be built sparing, rich in vitamins, minerals, heart-healthy components (linseed oil, grapefruit, apples, fish, mushrooms, cereals, beans and beans).

Prevention of atrial fibrillation

quitting smoking, drinking alcohol;

avoidance of stressful situations and physical overstrain;

therapy of diseases associated with the cardiovascular system;

taking sedatives in case of excitement or irritability;

strengthening the body with vitamin and mineral complexes suitable for the heart of training.

The human heart creates and conducts electrical impulses through a special system. Normally, the organ contracts 60-80 times per minute with approximately the same frequency. Some diseases of the heart and other body systems lead to conduction and rhythm disturbances, resulting in asynchronous myocardial contractions. The disease that leads to such pathological changes is called arrhythmia. There are many types of arrhythmias, and some of them are quite dangerous for human life. Atrial fibrillation, or atrial fibrillation, is a serious heart disorder that requires urgent diagnosis and treatment.

What is atrial fibrillation

Atrial fibrillation in Latin means "madness of the heart." The term "atrial fibrillation" is a synonym, and the definition of the disease is as follows: atrial fibrillation is a type of supraventricular tachycardia characterized by chaotic atrial activity with their contraction at a frequency of 350-700 per minute. This heart rhythm disorder is quite common and can occur at any age - in children, the elderly, men and women of middle and young age. Up to 30% of cases of need for emergency care and hospitalization for rhythm disturbances are associated precisely with the consequences of atrial fibrillation. With age, the frequency of the disease increases: if up to 60 years it is observed in 1% of patients, then later the disease is recorded already in 6-10% of people.

With atrial fibrillation, atrial contraction occurs in the form of their twitching, the atria seem to tremble, flickering ripples go through them, while individual groups of fibers work uncoordinated with respect to each other. The disease leads to a regular violation of the activity of the right and left ventricles, which cannot eject a sufficient amount of blood into the aorta. Therefore, with atrial fibrillation, the patient often has a pulse deficit in large vessels and heart rate irregularity. The final diagnosis can be made by ECG, which reflects the pathological electrical activity of the atria, and also reveals the random, inadequate nature of the cardiac cycles.

The pathogenesis of the disease, that is, the mechanism of its development, is as follows. The pathology is based on the re-entry of excitation into the heart muscle, while the primary and re-entry occur along different paths. Atrial fibrillation is due to the circulation of excitation in the region of the Purkinje fibers, and atrial flutter is due to the circulation of impulses along the conducting paths. For a repeated impulse to take place, it is necessary to have a zone with impaired conduction in the myocardium. Triggering of atrial fibrillation occurs after the occurrence of an atrial extrasystole, when it appears after a normal atrial contraction, but not in all fibers. Due to the peculiarities of the functioning of the atrioventricular node, there is also an irregularity in the work of the ventricles with atrial fibrillation. Weak impulses in the AV node fade as they move along it, and therefore only the strongest impulses that come from the atria enter the ventricles. As a result, the contraction of the ventricles is not complete, there are various complications of atrial fibrillation.

What is the danger of the disease

Since patients with atrial fibrillation have a lack of cardiac output, over time this can cause heart failure. As the arrhythmia persists, chronic circulatory failure progresses and can become acute. Especially often there is heart failure in individuals with hypertrophic cardiomyopathy and heart defects, in particular, with mitral stenosis. It is very difficult and can be accompanied by pulmonary edema, cardiac asthma, sudden cardiac arrest and death. A lethal outcome can also occur against the background of an arrhythmogenic form of cardiogenic shock due to a serious drop in cardiac output.

Against the background of asynchronous atrial contraction, blood can stagnate, which creates serious prerequisites for thrombosis. Usually, blood clots form in the left atrium, from where they easily enter the cerebral vessels and provoke an ischemic stroke. If it is not possible to stop atrial fibrillation at an early stage, then the risk of stroke is up to 6% per year. Such strokes are a very serious disease and cause serious consequences in the future. Acute thrombosis of cerebral vessels can develop with prolonged paroxysm of arrhythmia (over 2 days), if it is not possible to relieve the attack in time.

Risk factors for the development of severe complications of atrial fibrillation are the presence of diabetes mellitus in a patient, age over 70 years, previous pulmonary embolism or thromboembolism of other localizations, severe arterial hypertension, congestive heart failure.

Types of atrial fibrillation

There are several classifications of atrial fibrillation that are used in modern cardiology. According to the nature of the course, arrhythmia can be:

chronic (permanent or permanent form) - continues until surgical treatment and is determined by the ineffectiveness of electrical cardioversion;

persistent - lasts more than 7 days;

transient (a form with attacks of paroxysm) - the development of the disease occurs within 1-6 days, while an attack of paroxysmal atrial fibrillation can be primary and recurrent.

According to the type of atrial rhythm disorder, the disease is divided into two forms:

Atrial fibrillation, or atrial fibrillation. This pathology is caused by the contraction of individual groups of myocardial fibers so that there is no overall coordinated contraction of the entire atrium. Part of the impulses is delayed in the atrioventricular junction, the other part passes into the heart muscle of the ventricles, forcing them to also contract with an irregular rhythm. Paroxysm of atrial fibrillation leads to inefficient contraction of the atria, the ventricles are filled with blood in diastole, so there is no normal discharge of blood into the aorta. Frequent atrial fibrillation carries a high risk of developing ventricular fibrillation - in fact, cardiac arrest.

Atrial flutter. It is an increase in the heartbeat up to 400 beats per minute, at which the atria contract correctly, while maintaining the correct, coordinated rhythm. There is no diastolic rest during flutter, the atria contract almost continuously. The flow of blood into the ventricles is sharply reduced, the ejection of blood into the aorta is disturbed.

Forms of atrial fibrillation, which are differentiated by the frequency of contraction of the ventricles following the malfunction of the atria, are as follows:

tachysystolic form, or tachyform (ventricular contractions from 90 per minute);

normosystolic form (ventricular contractions 60-90 per minute);

bradysystolic form, or bradyform (ventricular contractions occur according to the type of bradyarrhythmia - less than 60 per minute).

Atrial fibrillation can be assigned one of four classes according to the severity of its course:

first class - no symptoms;

the second class - minor signs of the disease, there are no complications, vital activity is not disturbed;

the third class - the way of life is changed, pronounced symptoms of pathology are observed;

fourth grade - severe arrhythmia, causing disability, ordinary life becomes impossible.

Causes of arrhythmia

Not all causes of the disease are due to cardiac pathologies and other severe disorders. Up to 10% of all cases of atrial fibrillation in the form of paroxysmal seizures are due to simultaneous causes, and the leading one concerns those people who prefer to drink alcohol in large quantities. Wine, strong alcohol, and coffee are drinks that disturb the balance of electrolytes and metabolism, which entails a kind of pathology - the so-called "holiday arrhythmia."

In addition, atrial fibrillation often occurs after severe overexertion and against the background of chronic stress, after operations, a stroke, with too fatty, abundant food and overeating at night, with prolonged constipation, an insect bite, wearing too tight clothes, heavy and regular physical exertion . Fans of dieting, taking diuretic drugs in excess also run the risk of getting atrial fibrillation. In a child and adolescent, the disease often occurs hidden, lubricated and provoked by mitral valve prolapse or other congenital heart defects.

And yet, in most cases, atrial fibrillation is caused by cardiogenic causes and diseases of the vascular system. These include:

cardiosclerosis of various etiologies;

acute myocarditis;

myocardial dystrophy;

rheumatic heart disease;

valvular insufficiency (valvular defects);

cardiomyopathy;

sometimes - myocardial infarction;

arterial hypertension;

damage to the coronary arteries by atherosclerosis;

pericarditis;

damage to the sinus node - pacemaker;

heart failure;

heart tumors - angiosarcomas, myxomas.

Non-cardiac causes of atrial fibrillation and flutter can be:

thyrotoxicosis (hyperthyroidism);

pheochromocytoma;

other hormonal disorders;

poisoning with poisons, toxic substances, carbon monoxide and other poisonous gases;

overdose of drugs - antiarrhythmics, cardiac glycosides;

VSD (rarely);

severe neuropsychic stress;

obstructive pulmonary disease;

serious viral, bacterial infections;

electric shock.

Risk factors for the development of atrial fibrillation are obesity, diabetes mellitus, high blood pressure, chronic kidney disease, especially when they are combined with each other. Often, under the guise of atrial fibrillation, another pathology appears - SSS - a syndrome of weakness of the sinus node, when it ceases to fully carry out its work. Up to 30% of people with atrial fibrillation and flutter have a family history of the disease, meaning it could theoretically be inherited. In some cases, it is not possible to establish the cause of the disease, so the arrhythmia is considered idiopathic.

Symptoms of manifestation

The initial stages of the disease often do not give any clinical picture. Sometimes some manifestations are observed after exercise, for example, during exercise. Objective signs of atrial fibrillation, even at this stage, can only be detected during the examination. As the pathology progresses, characteristic symptoms appear, which will largely depend on the form of atrial fibrillation and on whether the disease is constant or manifested by seizures.

The tachysystolic form of the disease is much worse tolerated by a person. The chronic course leads to the fact that a person adapts to live with arrhythmia and notices little of its symptoms. Usually, the patient initially has paroxysmal forms of atrial fibrillation, and then its permanent form is established. Occasionally, throughout life, as the provoking factors influence, rare attacks of the disease can occur, and a permanent disease is never established.

Sensations during the development of arrhythmia may be as follows (the specific list of signs depends on the individual characteristics of the organism and the type of disease that caused flickering or fluttering):

feeling of lack of air;

heaviness, tingling in the heart;

sharp, chaotic twitching of the heart;

shiver;

weakness;

severe sweating;

cold hands and feet;

strong fear, panic;

increase in the amount of urine;

disordered pulse, heart rate.

Paroxysm of atrial fibrillation can lead to dizziness, nausea, fainting and the occurrence of an attack of Morgagni-Adams-Stokes, which is quickly stopped by taking antiarrhythmic drugs. With the complication of atrial fibrillation with heart failure, the patient develops swelling of the extremities, angina pectoris pain in the heart, decreased performance, shortness of breath, difficulty breathing, enlarged liver. Due to the wear and tear of the myocardium, this development of events is natural, so it is important to start urgent treatment of the disease as early as possible.

Carrying out diagnostics

Usually, an experienced cardiologist can make a presumptive diagnosis already during an external examination, counting the pulse, and auscultation of the heart. A differential diagnosis already at an early stage of the examination should be made with frequent extrasystoles. The characteristic signs of atrial fibrillation are as follows:

irregularity of the pulse, which is much rarer than the heart rate;

significant fluctuations in the volume of heart sounds;

moist rales in the lungs (with edema, congestive heart failure);

The tonometer reflects normal or lowering pressure during an attack.

Differential diagnosis with other types of arrhythmias is possible after an ECG examination. The decoding of the cardiogram with atrial fibrillation is as follows: the absence of a P wave, a different distance between the complexes of ventricular contractions, small waves of fibrillation instead of normal contractions. In flutter, on the contrary, large waves of flutter are noted, the same periodicity of ventricular complexes. Sometimes the ECG shows signs of myocardial ischemia, as the vessels of the heart cannot cope with its need for oxygen.

In addition to the standard 12-lead ECG, Holter monitoring is performed to more accurately formulate the diagnosis and to search for the paroxysmal form. It allows you to identify short atrial fibrillations or flutters that are not recorded on a simple ECG.

Other methods for diagnosing atrial fibrillation and its causes are:

Ultrasound of the heart with dopplerography. Necessary for finding organic lesions of the heart, valvular disorders, blood clots. A more informative diagnostic method is transesophageal ultrasound.

Tests for thyroid hormones. It is definitely recommended for implementation in case of newly diagnosed atrial fibrillation, as well as in case of recurrence of the disease after cardioversion.

Chest x-ray, MRI, CT. Necessary to exclude stagnation in the lungs, search for blood clots, assess the configuration of the heart.

First aid

Methods of treatment of permanent and paroxysmal forms of the disease differ greatly. With the development of an attack, emergency relief of paroxysms should be performed to restore heart rhythms. It is necessary to restore the heart rhythm as early as possible from its onset, because any attack is potentially dangerous for the development of severe complications and death.

First aid at home should include calling an ambulance, before the arrival of which the person should be laid in a horizontal position. If necessary, it is necessary to do an indirect heart massage. It is allowed to take antiarrhythmic drugs prescribed by the doctor in the usual dosage. Standards of treatment for all patients with an attack of atrial fibrillation suggest hospitalization to search for the cause of the pathology and differentiation from the chronic form of arrhythmia.

You can stop the attack with such drugs:

Quinidine (there are many contraindications to the drug, so it is not used in every case and only under ECG control);

Disopyramide (you can not give it with prostate adenoma, glaucoma);

Novocainamide;

Bancor;

Alapinin;

Ethacizin.

To prevent acute heart failure, the patient is usually prescribed cardiac glycosides (Korglikon). The treatment protocol for an attack of atrial flutter involves the intravenous administration of Finoptin, Isoptin, but with atrial fibrillation this will not be an effective treatment. Other antiarrhythmic drugs will not be able to normalize the heart rhythm, so they are not used.

A painful but much more effective procedure for restoring sinus rhythm is electrical cardioversion. It is usually used if the arrhythmia does not go away after taking medication, as well as to stop the paroxysm of arrhythmia with acute left ventricular failure. Before such treatment, sedatives are administered or general anesthesia is given for a short time. Discharges start at 100 J, increasing each by 50 J. Cardioversion helps restart the heart and eliminate an attack of atrial fibrillation.

Treatment Methods

Etiotropic therapy for hyperthyroidism and some other diseases helps to stop the development of atrial fibrillation, but under other conditions, symptomatic treatment is required for its occurrence. Clinical recommendations for the asymptomatic form of pathology suggest observational tactics, but only in the absence of a pulse deficit and the presence of a heart rate not higher than 100 beats per minute.

Medical treatment

With the development of heart failure, organic heart pathologies, a pronounced degree of atrial fibrillation, it is necessary to treat pathologies more actively, therefore, such pills and injections can be prescribed:

cardiac glycosides for the prevention of heart failure and its treatment;

beta-blockers to reduce stagnation in the small and large circles of blood circulation;

anticoagulants to thin the blood and prevent thrombosis, as well as before the planned treatment of arrhythmias;

thrombolytic enzymes with existing thrombosis;

diuretics and vasodilators for pulmonary edema and cardiac asthma.

Anti-relapse treatment of this disease is carried out for a long time - sometimes for several years. The patient needs to take the drugs prescribed by the doctor, the only reason for stopping the intake is intolerance and lack of effect.

Operations and other treatments

After the restoration of sinus rhythm, many patients are recommended to conduct breathing exercises, which will help improve the heartbeat and normalize conduction. Special therapeutic exercises are also recommended, and you can play sports only if there is no recurrence of the disease for a long time.

Surgical treatment is planned in the absence of results from conservative therapy, that is, when taking pills is ineffective. The following types of surgical interventions are used:

Radiofrequency catheter ablation. This method is a cauterization of the pathological area in the myocardium, which is the source of the arrhythmia. During treatment, the doctor leads the conductor through the femoral artery directly to the heart, gives an electrical impulse that eliminates all disorders.

Ablation with the installation of a pacemaker. It is required for serious types of arrhythmia, in which the sinus rhythm is disturbed. Before sewing in the pacemaker, the bundle of His or the atrioventricular node is destroyed, causing a complete blockade, and only then an artificial pacemaker is implanted.

Installation of a cardioverter-defibrillator. This device is sewn into the upper chest subcutaneously and is used to immediately stop an arrhythmia attack.

Operation labyrinth. This intervention is performed on an open heart. Incisions are made in the atria in the form of a labyrinth, which will redirect electrical impulses, and the organ will continue to work normally.

Nutrition and folk remedies

After the approval of the doctor, you can not be limited to conservative medicine and apply alternative treatment for atrial fibrillation. Below are the most effective folk recipes for this disease:

Collect and dry viburnum berries. Daily brew a glass of berries with 2 cups of boiling water, put on fire, cook for 3 minutes. Then leave the decoction for an hour, take 150 ml three times a day for at least a month.

Grind the yarrow grass, fill half the bottle with it, fill it with vodka to the top. Leave the product for 10 days in a dark place. Take a teaspoon of tincture against atrial fibrillation twice a day before meals for a month.

Brew 1/3 cup of dill seeds with 250 ml of boiling water, leave in a thermos for an hour. Strain the infusion, drink, divided into 3 parts, three times a day before meals. The course of therapy is 14 days.

Grind 100 g of walnuts, add half a liter of honey. Consume on an empty stomach a tablespoon every morning for at least a month.

Grind a small onion and 1 apple with a blender, take a tablespoon of the mixture three times a day after meals for 14 days.

Very important for atrial fibrillation is dietary nutrition, the consumption of only the right foods. Changing the diet often helps to reduce the clinical manifestations of the disease. You should refuse fatty meat, smoked meats, an abundance of butter, since this food only contributes to the development of atherosclerosis and the progression of arrhythmia. Spicy foods, vinegar, excess salt, and sweet foods negatively affect the heart. The diet should include lean meat, fish, vegetables, fruits, dairy products. The number of meals per day - 4-6, in small portions.

What Not to Do

In no case should patients with atrial fibrillation independently stop taking the drugs prescribed by their doctor. It is also not recommended to do the following:

ignore the daily routine;

forget about sufficient sleep and rest;

take alcohol;

smoke;

practice sports and other physical activities;

allow stress, moral overstrain;

plan pregnancy without prior health monitoring by a cardiologist and obstetrician;

try to relieve an acute attack of arrhythmia with folk remedies.

Forecast and prevention

If there are no organic pathologies of the heart, the functional state of the myocardium is normal, then the prognosis is favorable.

For the prevention of atrial fibrillation and flutter, the following measures are important:

timely treatment of all cardiac and non-cardiac diseases that can cause arrhythmia;

quitting smoking, alcohol, junk food;

reduction of physical and moral stress, regular rest;

consumption of a large amount of plant foods, intake of vitamins, minerals;

moderate physical activity;

avoiding stress, mastering the technique of auto-training;

if necessary - taking sedative drugs;

control of cholesterol and blood glucose.