Cardiac Arrhythmias. Classification. Extrasystoly. Paroxismal tachycardia. Heart blocks. Atrial fibrillation. Etiology. Pathogenesis. Clinical pattern of an attack. ECG signs. Cardiac rrhythm disorders dangerous for patient’s life. Principles of treatment and prophylaxis Department of propedeutics of internal medicine Ass. Prof. N.Z. Yarema

Etiology. Violations of rhythm of cardiac activity cause such defeats of myocardium: organic: IHD,defects of heart, AH, myocarditis, cardiomyopathy; · toxic: medicines, alcohol; · hormonal : thyrotoxicosis, myxedema, pheochromocytoma, climax; · functional : neurogenic, sporting; · anomalies of development of heart - more frequent all WPW.

Pathogenesis Theories of origin of arrhythmias: Pathological automatism (presence of ectopic focuses) Mechanism of re-entry trigern (starting) activity.

Classification of violations of rhythm and conductivity of heart I. Violations of formation of impulse Sinus tachycardia (more than 90 complexes are for a minute) Sinus bradycardia (less than 60 complexes are for a minute ) Sinus arrhythmia Stop (refuse) of sinus node Migration of supraventricular driver of rhythm

Extrasystolia (a synonym is premature depolarization): auricle (atrial) auricle-ventrical (atrioventricular) ventrical

Tachycardia: supraventricular: sino - auricle (sinoatrial) auricle (atrial) auricle - ventrical (atrioventrical) ordinary(to 30 in a hour) frequent (30 and anymore in a hour) allorythmia(bi-, thre-, quadrigeminia) polymorphic twin early(R on T) chronic paroxysmal noudle

ІІ. VIOLATION OF LEADTHROUGH OF IMPULSE - Sinoauricular of blockade - Atrioventricular blockades: І st. ІІ st. ІІІ st.

Description of normal sinus rhythm correct rhythm with frequency of heartbeats per 1 min. the P wave is positive in II, III, AVF leads, negative - in the AVR leads, permanent form of P wave a complex QRS follows by every P waveR (if there is not а-v-blockade). Interval of P-Q>0.12 (if there are not additional ways of leadthrough).

Sinus tachycardia ECG is criteria: correct rhythm sinus P waves are ordinary configuration beats per 1 min. gradual beginning and completion Reasons: physical and emotional loading, pain, fever, hypovolumia, hypotension, anaemia, thyrotoxicosis, action of certain matters (coffeine, alcohol)

Sinus bradycardia ECG is criteria: correct rhythm less than 60 beats per 1 min sinus P waves interval of PQ >0,12 sec. Reasons: increase of parasympatic tonus, myocarditis, myxedema, hypothermia, mechanical icterus, syndrome of weakness of sinus knot.

a-normal sinus rhythm б- sinus tachycardia в- sinus bradycardia г- sinus arrhythmia

Extrasystolia  premature excitation and reduction of heart or his separate parts is as a result of increase of activity of hearths of ectopic automatism.

Auricle extrasystolia ECG of sign: premature reduction after which incomplete scray pause the P wave is changed, negative a complex QRS is not changed or aberrant.

a- from the overhead departments of auricle б- from the middle departments of auricle в- from the lower departments of auricle г- is blocked auricle extrasystole

А-V- extrasystoles with simultaneous excitation of atriums and ventricles. EKG-signs: the P wave is not determined an extraordinary complex QRS is not extended incomplete scray pause

With previous excitation of ventricles EKG-signs: an extraordinary complex QRS is not extended P wave is after QRS complete scray pause

Ventrical extrasystolia EKG of sign: complex QRS wide without a previous P wave complete scray pause Treatments need frequent monotopic, politopic, group and early as R/T extrasystoles.

a- sinistroventrical extrasystole b- dextraventrical extrasystole

Paroxysmal tachycardia Supraventricular tachycardia EKG is signs: frequency of reductions of atriums per 1 min. auricle complexes are preceded the complexes of QRS the complexes of QRS are not changed

Atrioventricular tachycardia EKG-signs: heart beats per 1 min. retrograde P wave (negative) after QRS or accumulates on him

a- auricle paroxysmal tachycardia б - atrioventricular tachycardia with previous excitation of ventricles в - atrioventricular tachycardia with simultaneous excitation of atriums and ventricles

Ventrical tachycardia EKG is criteria: - >140 hearts beats per 1 min. - the complexes of QRS are extended

 EKG is at paroxysmal ventrical tachycardia

Trembling and fibrilation of atriums EKG is criteria of trembling: frequency of auricle waves per 1 min. ( waves of f) EKG is criteria of fibrilation: waves of f wrong rhythm (different R-R) absence of P wave

Trembling and fibrilation of ventricles EKG is criteria: Sinus wave curve with frequent, rhythmic, wide and high waves, excitation of ventricles with frequency per 1 min. it is not possible to distinguish the elements of ventrical complex Treatment: electric cardioversion Dzh. At unefficiency the repeated cardioversion

a- trembling of ventricles b- blinking and fibrilation of ventricles

Sinoauricular blockade EKG is criteria: periodic fall of cardiac cycles increase of pause between the waves of Р-Р in 2 times

Atrioventricular blockade І st permanent lengthening of interval of P-Q anymore as on 0,20s a- auricle form б- key form в- distal form blockade

А-v blockade ІІ ст the periodic stopping of leadthrough of impulse is from an auricle to the ventricles. There are three types: I type (Mobit I) is the gradual lengthening of interval of P-Q with the subsequent fall of QRST ( periods of Samoylov-Venkenbach) ІІ type (Mobit ІІ) is a fall of complexes of QRST without the gradual lengthening of interval of P-Q ІІІ type (Mobit ІІІ) of fall every second, or 2 and more complexes successively

А-v blockade ІІІ ст  complete autonomy of reduction of auricle and ventricles.The intervals of P-P and R-R are permanent, but R-R>P-P.

EKG is at the complete blockade of right bundle of bunch of Hiss

EKG is at the complete blockade of left bundle of bunch of Hiss

Syndrome of Wolf-Parkinson- White reduction of interval of P-Q (R) a presence in composition a complex QRS of additional wave of excitation is d-wave deformation and increase of duration of complex QRS discordant displacement of RS-T and change of polarity of wave T (inconstant sign)

EKG is at the syndrome of WPW

Conclusions It is necessary to know for successful diagnostics and treatment of arrhythmias: basic nosotropic mechanisms of their development · to own the methods of diagnostics of arrhythmias · to distinguish of high quality, potentially malignant and malignant arrhythmias · to understand algorithms diagnostic at the therapeutic going near the different types of arrhythmias

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