Department faculty and hospital therapy of medical faculty and department internal diseases of medical prophylactic faculty. Cardiac arrhythmia Docent Matchanov S.H.

Infringements rhythm heart — One of the most common clinical syndromes, which is revealed not only in organic diseases of the heart muscle (coronary artery disease, myocardial infarction, acquired and congenital heart disease, cardiomyopathy, etc.), but also for violations of neurohumoral regulation, electrolyte shifts, toxic effects on the heart and even healthy individuals.

Conduction system of the heart

Sinus tachycardia (ST) - the increase in heart rate to 100 bpm. per minute or more while maintaining the right sinus rhythm. ST is due to increased automaticity CA site. Sinus bradycardia (SB) - is slowing of heart rate below 60 bpm. per minute while maintaining the correct sinus rhythm. Sinus automaticity bradikradiya due to a decrease in the SA-node. Sinus arrhythmia (SA) is called the wrong sinus rhythm, characterized by periods of acceleration and deceleration rate. Sinus arrhythmia is caused by the formation of an irregular pulse in the SA-node, due to: 1) the reflex changes in vagal tone in relation to the phases of respiration, 2) spontaneous changes in tone n.vagi out of touch with the breath, and 3) organic damage to the CA site. Distinguish non- respiratory and respiratory sinus arrhythmia form

Sinus tachycardia, bradycardia and arrhythmia

Migration of supraventricular pacemaker

Migration of supraventricular pacemaker is characterized by gradual, from cycle to cycle, moving the source of rhythm from the SA-node to the AV-connection and back.

Extrasystoles

Extrasystole (ES) is a premature excitation of the heart or any of his department, due to the extraordinary momentum that comes from the atria, AV connections, or ventricles. Allodromy is a regular alternation of extrasystoles and normal contractions: 1) bigeminy (every normal after reduction should ES), 2) trigeminy (ES should be after every two normal contractions), 3) kvadrigimeniya etc. Monotopnye ES extrasystoles originating from the same ectopic source. Politopnye ES extrasystoles originating from different ectopic foci. Group (volley), the presence of beats in the ECG of three or more consecutive premature beats.

Allorhythmic extrasystoles

Atrial extrasystoles

Atrial extrasystoles - are preexcitation of the heart under the influence of an extraordinary impulse of the atria. ECG signs: 1. Premature emergence of an extraordinary wave P 'followed by a set of QRST'. 2. Deformation or change the polarity of the P wave 'beats. 3. The presence of unchanged systolic ventricular extra set of QRST ', similar in shape to the conventional normal QRST complexes of sinus origin (except in cases of aberration of the complex QRS). 4. The presence of incomplete compensatory pause.

Extrasystoles of AV connection

Ectopic impulses arising in the AV connection extends in two directions: from top to bottom on the conduction system of the ventricles and from the bottom up (retrograde) on the atria. ECG signs: 1. Premature extraordinary appearance on the ECG ventricular complex unchanged QRS ', similar in shape to the other QRS complexes of sinus origin (except in cases of aberration of the complex). 2. Negative P wave 'in leads II, III and aVF after extra-systolic complex QRS' or lack of P wave '(through the merger of P' and QRS '). 3. The presence of incomplete compensatory pause.

Ventricular extrasystoles

Ventricular premature beats (PVCs) - is the heart preexcitation that occurs under the influence of impulses coming from different parts of the conducting system of the ventricles. An important feature is the lack of PVCs before extra systolic P wave QRS complex and the presence of a full compensatory pause.

Supraventricular paroxysmal tachycardia

Paroxysmal tachycardia (PT) - is suddenly beginning and ending as abruptly increased frequency of heart attack up to per minute, while maintaining most of the right of a regular rhythm.

Ventricular paroxysmal tachycardia

Ventricular tachycardia (VT) - in most cases it starts suddenly and as suddenly ending the attack increased frequency of ventricular contractions to bpm. per minute (at least - more than 200 bpm. in minutes or within bpm. per minute), usually while retaining the correct regular heart rhythm.

Atrial flutter

Auricular fibrillation

Fibrillation (flicker) and atrial flutter - two close to its mechanism of cardiac arrhythmias, which are often transformed into each other in the same patient. More frequent atrial fibrillation (AF) or atrial fibrillation, which may be paroxysmal or chronic

Flutter and fibrillation of ventricles

Ventricular flutter (VF) - a frequent (up to per minute) and rhythmic excitement and their reduction. Fibrillation (flicker) ventricles (VF) - an equally frequent (up to per minute), but random, irregular excitation and reduction of individual muscle fibers, leading to the cessation of ventricular systole (ventricular asystole). The main ECG signs of severe cardiac arrhythmias are: 1. When ventricular flutter - Frequent (up to min), regular and uniform in shape and amplitude of the wave flutter resembling a sine curve. 2. Fibrillation (blink) ventricles - Frequent (up to per minute), but irregular random waves, which differ from each other by varying the shape and amplitude.

Treatment Modern methods of treating heart rhythm disorders are divided into: Pharmacological (use of antiarhythmic drugs); Electrical; Surgical; Physical, etc.

Drugs with antiarhythmic action is divided into four groups according to their predominant influence on the individual parameters PD: Class I - sodium channel blockers ("membrane- stabilizing" medications), which suppress the initial depolarization of the cardiac fibers (phase 0 TD); Class II - b-adrenergic blockers; Class III - blockers of potassium channels, prolonging the duration of PD and ERP, mainly due to the oppression of the repolarization phase of cardiac fiber; Class IV - Calcium channel blockers slow ("calcium antagonists"); depress phase 0 action potential and spontaneous diastolic depolarization in tissues with a "slow response" (SA-node, AV connection).