Arrhythmia: classification, causes, symptoms, diagnosis and treatment. Varieties of heart rhythm disturbance and their treatment Heart rhythm disturbance definition

Often fail heart rate does not manifest itself in any way in patients, but is diagnosed by chance, during a planned cardiogram. It happens on the contrary, in the presence of all the above symptoms, only a minor malfunction of the heart can be detected, which does not require therapy. It all depends on the general condition of the patient.

The main symptoms of pathology

Symptoms that characterize the failure of the heart rhythm:

• Rapid or slow heartbeat.
• Pain, cutting in the chest.
• Tremors, sensations of the heart hitting the chest.
• Sweating.
• Lack of air.
• The appearance of severe (weak) shortness of breath.
• Dizziness.
• Distinct heartbeat, broken rhythm.
• Pre-fainting state, fainting.

The characteristic of heart rhythm failures in a child is slightly different in symptoms:

• There is pallor, blueness on the skin.
• Unreasonable anxiety.
• Loss of appetite.
• Weight loss, underweight.
• Frequent fainting.
• Weakness.
• Constant fatigue.

The diagnosis - extrasystole - is made not only on the basis of patient complaints. The presence of the above signs cannot give a 100% guarantee of this particular disease.

Additional examinations are being carried out

• Conducting an ECG.
• Blood tests.
• Ultrasound examination of the heart.
• Echocardioscopy.
• BP monitoring (during the day).
• Transesophageal ECG (to determine the focus of rhythm disturbance).
• MRI of the heart (in extremely difficult situations).

Sources of heart rate imbalance

Failure of the heart rhythm suggests many causes of origin, from ordinary fatigue to complex organic damage to the heart.

Attention! Not necessarily any failure of the beat is considered a pathology! Let's say a night's sleep is accompanied by a moderate hitch in the heart rate!

Short-term stressful situations, emotional stress, or significant coffee consumption also contribute to an increase in heart rate - the result of the release of adrenaline into the blood.

Minor causes affecting the rhythm

• Fast walk.
• Sports.
• Short-term excessive emotions (fear, delight).
• Terrible, tragic movie.

Violation of the heartbeat occurs insignificant, and goes away on its own after the cause is eliminated.

Main reasons

• Psychogenic disorders - psycho-emotional stress, psychosis, neurosis, stress, depression.
• Excessive physical activity.
• Frequent use of coffee, alcohol.
• Smoking.
• Organic heart disorders - myocardial diseases of various etiologies, inflammation of the heart muscle, heart defects, coronary artery disease.
• Toxic myocardial damage - incorrect dosage of antibiotics.
• Heart injury.
• Anomalies of the endocrine glands - hypothyroidism, pheochromocytoma, thyrotoxicosis.
• Shifts in the electrolyte balance of the body - indicators of sodium, magnesium and potassium (the change can occur as a result of chills, fever, food poisoning, low hemoglobin, significant bleeding, shock, dehydration and inflammatory processes in the body).
• Age changes.
• Heredity.
• Excess weight.
• Bad habits.
• Hormonal (pregnancy).

Also, existing diseases can lead to a heart rhythm failure.

• Cardiovascular system: congenital and acquired defects, myocardial damage, high blood pressure, left ventricular hypertrophy, heart failure, inflammation of the internal and serous membranes of the heart, rheumatic heart disease.
• Central and peripheral nervous system: injuries and tumors of the brain, vegetovascular dystonia (VVD), neurosis, circulatory anomalies in the brain (encephalopathy, stroke).
• Endocrine system: menopause and menstruation in women, diabetes, hyperthyroidism, hypothyroidism.
• Gastrointestinal: diseases of the gallbladder and pancreas.

Attention! Rhythm failure is possible from elementary fatigue, and does not require therapy. But, if the symptomatology is repeated systematically, you should immediately contact a cardiologist!

First aid during an attack

Immediate actions in case of failure depend directly on the form of the disorder, and the cause of the occurrence. Severe cases require urgent hospitalization in a hospital, and sometimes just one pill is enough.

During a heart rhythm failure, be sure to call ambulance regardless of the general health of the patient.

If there is any suspicion of a heart rhythm failure, such manipulations should be performed before the arrival of emergency help

• Completely calm down: if necessary, use a sedative - valerian, corvalol.
• Take a horizontal position, lie down (lay the patient): an increased pulse - put a pillow under your head, a reduced pace - under your knees.
• Increase air intake: open a window, balcony, loosen clothing around the neck.
• Measure pressure.
• Take a drug that relieves attacks of heart rhythm failure (if the patient has already been prescribed medication by a doctor).
• With concomitant pain in the heart, use nitroglycerin (under the tongue).
• Suffocation, sputum with foam requires the use of furosemide, lasix (if possible).
• Cardiac or respiratory arrest - immediate implementation of cardiopulmonary resuscitation ( indirect massage heart and mouth-to-mouth breathing).

The arriving ambulance will most likely require emergency hospitalization for a complete examination. The main indicator is the result of the ECG - the most accurate definition of the deviation and its type.

Forms of cardiac arrhythmias

A healthy body generates a correct cardiac sinus rhythm, i.e., every impulse occurs in sinus node and moves forward with a clear periodicity. And any violation causes either an increase or decrease in these impulses.

Heart rhythm disturbances are divided into three subdividing forms: blockades, disturbances in the appearance of an impulse, and combined types.

blockades

Or conduction disorders in the heart. A blockade that prevents the passage of an impulse occurs in any region of the conducting system. Depending on the site of occurrence, intra-atrial, sinoatrial, atrioventricular and blockade of the legs of the His bundle are noted. And also this includes cardiac arrest (ventricular asystole), Wolff-Parkinson-White syndrome.

Violation of the appearance of an impulse

With impulses formed in the sinus node, they secrete

• Sinus tachycardia - too frequent formation of impulses (heart rate ≥90 per minute).
• Sinus bradycardia - too rare formation of impulses (heart rate ≤60 per minute).

Sinus respiratory arrhythmia is a malfunction in the functionality of the heart, characterized by a violation of the rate of heart contractions.

With impulses that occur in other parts of the conduction system, they are distinguished (usually atrioventricular node, atria and ventricles):

Paroxysmal tachycardia- an attack of rapid heartbeat (≥130-200 per minute). The focus of increased generation of impulses is the atrioventricular node.

Extrasystole- a kind of arrhythmia, characterized by a series (or single) of sudden contractions of the heart muscle. It occurs as a result of the formation of ectopic foci, characterized by increased activity and localization outside the boundaries of the sinus node. Excessive impulses formed in these foci begin to circulate along the heart muscle, causing extraordinary heart contractions.

Combined views

These are atrioventricular dissociation, parasystole and ectopic rhombuses with exit block . With them, the sinus node and the ectopic focus function disconnected, incoherently, due to the blockade. The consequence of this is the development of double rhythm, the ventricles work in their own mode, and the atria in their own.

Possible complications

Possible complications directly depend on the course of the disease, the selected treatment, concomitant, acute and chronic diseases and current state of health of the patient.

The most dangerous are interruptions in the heart rhythm, which are formed as a result of: heart attack, cardiomyopathy, organic myocardial damage.

May occur

1. Collapse (a rapid drop in pressure and deterioration of the blood supply to the most important organs).
2. Chronic insufficiency of renal, cerebral and coronary vessels.
3. Arrhythmogenic shock (impaired circulation as a result of an imbalance in the rate of heart contractions).
4. Thromboembolism of the pulmonary artery (blockage of the vessel by a thrombus).
5. Ischemic stroke (damage to brain tissue due to improper blood circulation).
6. Ventricular fibrillation (chaotic contractions of myocardial muscle fibers, leading to the ineffectiveness of the heart).
7. Cardiac arrest (rapid and absolute termination of the work of the heart, assistance is required within a few minutes).
8. Clinical death (reversible process, transitional stage from life to biological death).
9. Biological death (cessation of all physiological processes in the cells of the body).

The occurrence of complications can be prevented if, if a heart rhythm failure is suspected, immediately consult a doctor and begin qualified therapy. It is impossible to ignore any changes that occur in the heart. Otherwise, the consequences can be dire.

Prevention of pathology

Prevention of the formation of failures in the work of the heart is

• In properly selected physical activity (excessive activity negatively affects the organ).
• In a full sleep (at least 8 hours).
• Regular walks in the fresh air.
• Emotional stability.
• Proper nutrition (more fresh fruits and vegetables, avoiding fatty, high-calorie foods).
• Refusal of bad habits.

If the disease has already been diagnosed, then care should be taken to prevent the consequences, this will help:

• Regular visits to a cardiologist.
• Correct treatment of the primary disease.
• Healthy lifestyle.

Any disease is easier to prevent than to cure. And the main condition for this is a healthy lifestyle. Physical activity, proper and balanced nutrition is a huge contribution to health.

Treatment is prescribed directly by the doctor, you should not resort to folk methods treatments, although they are often effective. But without consulting a doctor, you can only aggravate the condition of the body.

The heart is the most important organ in our body and deserves to be treated with care.

Heart rhythm disorder is clinical manifestation, which in most cases indicates the course of a disease in the body. Both adults and children can face a similar manifestation. Gender also does not play a role. A large number of factors that are not always associated with pathologies of the heart can lead to the occurrence of such a symptom. In addition, there is a group of completely harmless reasons.

The clinical picture will be determined by the condition that led to a change in rhythm, an increase or slowdown in heart rate. The main symptoms are considered to be shortness of breath, dizziness, fluctuations in blood pressure, weakness and pain in the region of the heart.

It is possible to identify the causes of heart rhythm disturbances using laboratory and instrumental methods of examination. Therapy will be individual in nature, but the basis is medication and treatment with folk remedies.

Heart rhythm disturbance in the International Classification of Diseases is encoded by several values. ICD-10 code - І49.0-І49.8.

Etiology

Clinicians identify a huge number of causes of cardiac dysfunction, both pathological and physiological.

Pathologies from the cardiovascular side, which entail the appearance of the main symptom:

• malformations and character;
• hypertrophy of the ventricles of the heart;

• and other conditions that are characterized by a violation cerebral circulation;
• neoplasms of any genesis in the brain;
• traumatic brain injury.

Causes of heart rhythm disturbances associated with other internal organs:

• low or high hormone levels thyroid gland;
• damage to the adrenal glands;
• a wide range of diseases of the respiratory system;
• or .

Physiological sources of this symptom:

• - the most common cause of development in adolescent girls;
• prolonged influence of stressful situations or nervous strains;
• the period of bearing a child - during pregnancy, an increase in heart rate is often observed;
• abuse of bad habits;
• malnutrition, in particular, the use of large amounts of coffee;
• insufficient amount of sleep;
• prolonged hypothermia or overheating of the body.

In addition, uncontrolled intake of certain groups can cause heart rhythm disturbances. medicines, for example:

• diuretics;
• hormonal substances;
• antidepressants;
• antibiotics;
• caffeinated drugs.

Violation of the heart rhythm in children, and in some cases in adolescents, may be due to:

• congenital heart defects;
• genetic predisposition;
• severe food poisoning;
• drug overdose;
• dysfunction of the central nervous system;
• the course of diseases of an infectious nature;
• other pathologies internal organs above.

It is worth noting that the main risk group includes people who are prone to obesity and people over the age of forty-five.

In some cases, the causes of such a symptom cannot be found out.

Classification

In medicine, it is customary to distinguish the following types of cardiac arrhythmias:

• sinus tachycardia is a condition in which the heart rate reaches one hundred and fifty beats or more per minute. In a healthy person, it can occur against the background of stress or strong physical exertion;
• sinus bradycardia - in such cases, there is a completely opposite situation compared to the previous one. The heart rate drops below sixty beats per minute. A similar disturbance occurs in healthy adults during sleep;
• - Heart rate varies from one hundred and forty to two hundred beats per minute, provided that the person is at rest. This condition requires urgent first aid;
• - a violation is characterized by the fact that some parts of the heart are reduced out of time. It is formed with any problems with the heart, in cases of overdose of drugs, drugs or alcohol. It should be noted that in children, extrasystole can be fatal;
• - differs from extrasystole in that the contraction of some groups of cardiac muscles occurs in a chaotic manner. The frequency of contractions of the ventricles can reach one hundred and fifty beats per minute, and the atria at this time may not contract at all;
• idioventricular heart rhythm, which has the opposite direction of the impulse - from the ventricles to the atria;
• nodal form of rhythm - is a rather rare type of heart rhythm disturbance, but in most cases it is observed in children.

Symptoms

The danger of arrhythmia lies in the fact that it may not manifest itself at all, which is why a person may not even suspect that he has such a violation. It is for this reason that cardiac arrhythmias are very often detected during preventive examinations.

However, in some cases, failures in the rhythm of heart contractions are accompanied by the following symptoms:

• , which appears either with minor physical exertion, or at rest;
• sensation of "bumps" in the chest;
• intensive;
• decreased visual acuity or;
• causeless and;
• the child does not show the usual activity and interest in surrounding things or people;
• in the region of the heart. Such a manifestation may have a different character, for example, stabbing or pressing;
• irradiation of pain in left hand and the area of ​​the scapula;
• change in the behavior of the patient;
• feeling of lack of air;

It should be noted that these are not all signs of cardiac arrhythmias, their presence and intensity of manifestation will differ from patient to patient.

In cases of the appearance of one or more symptoms, the victim must be given first aid. First of all, it is worth calling an ambulance, and while they are waiting, follow the first aid rules:

• calm the patient and lay him down so that the upper body is higher lower extremities- with a rapid heart rate, with a rare pulse, the position of a person should be opposite;
• ensure the flow of fresh air into the room;
• release the patient from narrow and tight clothing;
• measure blood pressure and heart rate every fifteen minutes, write them down for subsequent presentation to visiting doctors;
• Give the patient a sedative to drink. If the attack does not develop for the first time, then give those medications that are intended to normalize the condition, but on condition that they are prescribed by the attending physician.

Diagnostics

To identify the causes and type of heart rhythm disturbance, the doctor must:

• to study the medical history and anamnesis of the patient's life - sometimes he will be able to point out the factors leading to a violation of the heart rhythm;
• conduct an objective examination - to determine the increase or slowdown in heart rate, as well as to measure blood pressure;
• carefully interrogate the patient, if he is conscious, for the frequency of occurrence of arrhythmia attacks, the presence and intensity of symptoms.

Among the instrumental methods of examination in violation of the heart rhythm, it is worth highlighting:

• ECG, including daily monitoring;
• treadmill test and bicycle ergometry;
• transesophageal ECG;
• dopplerography;

Among laboratory tests, specific blood tests have diagnostic value, thanks to which inflammatory damage to the heart can be determined.

In a calm state, the human heart contracts in an uninterrupted, even rhythm. Within 24 hours, the number of pulsations reaches 100,000 beats, which is 60 to 90 contractions per minute. Such accuracy and debugging is regulated by the sinus node, which contains pacemaker cells that irritate the atrioventricular node and the bundle of His in the tissues of the ventricles with an electrical impulse. A strict distribution of functionality plays an important role in the variety of diseases that lead to a violation of the heart rhythm, which lies in wait for the heart muscle in these segments.

The concept of arrhythmia is understood to mean just such failures from a normal rhythm, when, and slow down, varying the frequency of beats outside the normal range in one direction or another. Heart rhythm disturbance is an irregularity of the heart rhythm, that is, its outflow from any segment of the conduction system, except for the correct, sinus one.

The statistics of such violations is kept in percentage terms:

1. The main part of failures from the rhythm falls on atrial and ventricular extrasystole, seen in almost 85% of cases with coronary artery disease.
2. The next, according to statistics, is the paroxysmal and constant form of atrial fibrillation, dividing 15% of cases by 5% in patients older than 60 years, and 10%, respectively, in patients older than 80 years.
3. There are also non-statistical data without exact numerical ratios regarding bradycardia not caused by pathological cardiac disorders. These are the so-called emotional bursts of increased rhythm, periodically observed in every person.

Classification

Any types of heart rhythm disturbances fit the classification of two main, distinguished groups:

• Violation of the heart rhythm;
• Cardiac conduction disorders.

The differences between the two groups are cardinal - if the first includes intermittent, uneven contraction of the heart muscle with rapid pulsation, then the second is characterized by several degrees of slowing the rhythm, or the absence of it.

Collectively, the first type of cardiac arrhythmia combines unnatural origin and transmission of impulse signals:

• The process of impulses passing through the heart is normal;
• In the S-U node - tachyarrhythmia or;
• According to the atrial tissue, expressed by atrial extrasystole and paroxysmal atrial tachycardia;
• According to the atrioventricular node, expressed by atrioventricular extrasystole and paroxysmal tachycardia;
• On the fibers of the ventricles, expressed by ventricular extrasystole and paroxysmal ventricular tachycardia;
• In the sinoatrial node and along the membrane of the atria or ventricles, expressed by atrial and ventricular fibrillation.

The next set of conduction disorders includes the sequence of impulses, expressed as sinus blockade, intra-atrial blockade, atrioventricular blockade of all three levels.

Causes

Any causes of cardiac arrhythmia are equally characterized by anomalies of the heart, and the individual state of the body. That is, sinus tachycardia may well be facilitated by classes active species activities, rapid movement, emotional outbursts.

Respiratory bradyarrhythmia refers to the varieties of the norm, due to an increase in pulsation during inspiration, and, accordingly, slowing down during expiration.

Nevertheless, such rhythm failures, accompanied by atrial fibrillation and paroxysmal types of tachycardia, most often speak of serious, as well as other organs.

Accompanying illnesses

Diseases associated with heart disorders:

• Ischemia, angina pectoris, history, or its acute form;
• Hypertension that has become chronic or with intermittent attacks;
• General defects of the heart muscle;
• Structural changes in the myocardium as a result of the named past diseases;
• Diseases not related to the heart:
• Gastrointestinal tract;
• Intoxication, botulism;
• Hormonal disorders of the thyroid gland;
• Severe hypothermia, concomitant fever;
• Alcohol intoxication.

In addition to the above, there are third-party aspects that often provoke heart rhythm disturbances:

• Overweight at various stages;
• Smoking, addiction to alcohol;
• Age threshold over 45 years;
• Diseases of the endocrine system.

none heart disease may not be the same in all patients. It happens that the symptoms of cardiac arrhythmia do not manifest themselves in any way for a sufficiently long period, and only an examination gives a clear picture of the violations. However, the vast majority of patients note obvious deviations from the norm, which is the reason for their appeal to medical institutions.

The symptoms of cardiac arrhythmias themselves, expressed by a sudden lack of air, acute pain chest, lost heart rhythm, it is impossible not to notice, or write off the usual manifestations of excitement, or physical fatigue.

The same goes for sinus blocks in-depth, second and third degree, often outwardly shown as repeating fainting spells. Patients, in parallel with a strong one, often feel sudden weakness, nausea.

For a preliminary diagnosis of a heart rhythm disorder, it is usually enough for a doctor to evaluate the complaints expressed by the patient and summarize the intensity of their manifestation, but the result of the ECG examination will form the basis for an accurate diagnosis.

In no case should a person self-diagnose and take medicines corresponding to the conclusions drawn. Only an experienced cardiologist or general practitioner, having studied all the nuances and taking into account the individual characteristics of the patient, can prescribe treatment for cardiac arrhythmias with concomitant control in the process.

An ECG is the primary type of examination performed on an emergency basis; except for him, immediately after a planned or urgent hospitalization in the cardiology department.

The patient may be assigned additional studies for a more accurate diagnosis:

• and ECG within 24 hours;
• Samples with varying degrees of physical activity;
• Other non-invasive diagnostic methods related to transesophageal - such as TEE.
• In special cases, especially if you suspect a tumor disease, or post-infarction scarring, you may need an MRI of the heart.

Treatment

In accordance with the established origin of the disease, appropriate treatment of cardiac arrhythmias is prescribed:

• When they include the use of nitroglycerin, as well as blood thinners and helping to regulate cholesterol levels.
• Hypertension causes antihypertensive drugs; when chronic forms heart disease, diuretics and cardiac glycosides are also prescribed. In rare cases, surgery is recommended.
• Sinoatrial tachycardia is stopped by taking anaprilin.
• Diagnosed blockades need a different approach. Requires the introduction of intravenous drugs, such as prednisolone, atropine, that is, actively stimulating contractions of the heart muscle.

Complications

Heart diseases associated with rhythm disturbance are expressed by interruption of the non-stop movement of blood throughout the body, and also threaten with a fairly large number of complications.

It happens that with an untimely diagnosis or delay in treatment, patients develop:

• Collapse.
• arrhythmogenic shock;
• Pulmonary embolism;
• Acute myocardial infarction;
• complete cessation of the heartbeat.

With timely diagnosis of arrhythmia, timely treatment and compliance with all medical recommendations, the patient develops a complication of heart rhythm disturbance extremely rarely, which practically guarantees a complete cure and a return to a normal lifestyle.

In cases of non-examination, or neglect of symptoms, the prognosis is based on the data obtained on the severity of the disease. In such cases, medicine does not give a high percentage of the possibility of restoring all the primary functions of the body.

Violation of the rhythm and conduction of the heart is a fairly common diagnosis. Cardiac arrhythmias cause disturbances in the cardiovascular system, which can lead to the development of serious complications, such as thromboembolism, fatal arrhythmias with the development of an unstable state, and even to sudden death. According to statistics, 75-80% of cases of sudden death are associated with the development of arrhythmias (the so-called arrhythmogenic death).

Reasons for the development of arrhythmias

Arrhythmias are a group of disturbances in the rhythm of the heart or the conduction of its impulses, manifested as a change in the frequency and strength of heart contractions. Arrhythmia is characterized by the occurrence of early or occurring outside the normal rhythm of contractions or changes in the order of excitation and contraction of the heart.

The causes of arrhythmias are changes in the main functions of the heart:

• automatism (the ability to rhythmically contract the heart muscle when exposed to an impulse generated in the heart itself, without external extraneous influences);
• excitability (the ability to respond with the formation of an action potential in response to any external stimulus);
• conduction (the ability to conduct an impulse through the heart muscle).

Violations occur for the following reasons:

• Primary heart disease: IHD (including after myocardial infarction), congenital and acquired heart defects, cardiomyopathies, congenital pathologies of the conduction system, trauma, the use of cardiotoxic drugs (glycosides, antiarrhythmic therapy).
• Secondary damage: consequences of bad habits (smoking, alcohol abuse, drug use, strong tea, coffee, chocolate), unhealthy lifestyle (frequent stress, overwork, chronic lack of sleep), diseases of other organs and systems (endocrine and metabolic disorders, kidney disorders) , electrolyte changes in the main components of blood serum.

Signs of a heart rhythm disorder

Signs of cardiac arrhythmias are:

• An increase in heart rate (HR) above 90 or a decrease below 60 beats per minute.
• Failure of the heart rhythm of any origin.
• Any ectopic (not originating from the sinus node) source of impulses.
• Violation of the conduction of an electrical impulse along any of the sections of the conduction system of the heart.

Arrhythmias are based on a change in electrophysiological mechanisms according to the principle of ectopic automatism and the so-called re-entry, that is, the reverse circular entry of impulse waves. Normally, cardiac activity is regulated by the sinus node. In the case of cardiac arrhythmias, the node does not control individual parts of the myocardium. The table shows the types of rhythm disturbance and their signs:

Symptoms and Diagnosis

Symptoms of arrhythmias are varied, but most often manifested by a feeling of rapid or, conversely, a rare heartbeat, interruptions in the work of the heart, chest pain, shortness of breath, feeling short of breath, dizziness up to loss of consciousness.

Diagnosis of rhythm disturbances is based on a thorough history taking, physical examination (measurement of frequency and study of pulse parameters, measurement of blood pressure) and objective data of electrocardiography (ECG) in 12 leads (according to indications, a larger number of leads are used, including intraesophageal).

ECG signs of the main arrhythmias are presented in the table:

The human heart is a continuously working pump that performs about a hundred thousand contractions a day. The conduction system helps to maintain the contractile function of the heart. It includes the sinus node, where the electrical impulse originates; the atrioventricular node, which transmits an impulse to the bundle of His in the interventricular septum and the Purkinje fibers, which are responsible for contractions of the ventricular muscle. The normal frequency of contractions is from 60 to 90 beats per minute.

The heart rate is sinus and regular. Sinus rhythm means that each impulse that causes a contraction of the heart muscle comes from the sinus node and is transmitted further downstream. The correct rhythm is regular contractions of the heart with the same frequency.

Deviations from the normal heart rhythm are called rhythm and conduction disturbances, or arrhythmias. In this case, the frequency of contractions may increase or decrease, and the rhythm may be sinus and correct or not. Some rhythm disorders are not dangerous for humans and can occur even in a young healthy body, and some threaten health and life and require long-term treatment.

Rhythm disturbances are divided into the following types:

1. Violations of the formation of an impulse. If impulses are formed in the sinus node, but too often, sinus tachycardia develops (heart rate over 90 per minute), if rarely - sinus bradycardia (heart rate less than 60 per minute). Sinus (respiratory) arrhythmia also belongs to this type of disturbance.

If impulses arise from the sections of the conducting system located below, an ectopic (located in the wrong place) focus of excitation is formed. Such a focus can be located in the atria, the atrioventricular node, or in the ventricles, and can send impulses both above and below its location. This type of rhythm disturbance includes slow escape and accelerated ectopic (non-paroxysmal tachycardia) rhythms, extrasystole and paroxysmal tachycardia. Each of these disorders can be atrial, atrioventricular and ventricular. Also, due to the existence of ectopic foci, flicker (fibrillation) and atrial flutter, flicker and ventricular flutter can develop.

2. Violations of conduction in the heart are called blockades. An impulse conduction block can occur in any part of the conduction system, therefore, sinoatrial, intra-atrial, atrioventricular blockade, blockade of the legs of the His bundle are distinguished. In addition, the same group includes Wolff-Parkinson-White syndrome (WPW-syndrome), short PQ syndrome, ventricular asystole (cardiac arrest).

3. Combined views- parasystoles, atrioventricular dissociations, ectopic rhythms with exit blockade. These are conditions in which an additional, ectopic pacemaker works in parallel with the sinus pacemaker, but they are separated from each other by blockade. In the heart, a double rhythm formation occurs, that is, the atria work in their own rhythm, and the ventricles in their own.

Causes of heart rhythm disturbance

What conditions can cause heart rhythm disturbances?

Not always the presence of deviations from the normal heart rhythm is a pathology. So, for example, people during a night's sleep experience a moderate slowdown in the heart rate, that is, bradycardia, due to the predominant vagal influences on the heart ( nervus vagus slows down the heart rate, the night is the “kingdom of the vagus”). Also during sleep, sinus arrhythmia, atrioventricular blockade of the 1st degree, single atrial and ventricular extrasystoles are common. Bradycardia can also occur in athletes who are well trained not only in skeletal muscles, but also in the heart muscle.

Under conditions such as psycho-emotional stress, stress, exercise stress develops tachycardia. This is due to an imbalance in the functioning of the autonomic nervous system and the release of the stress hormone adrenaline into the bloodstream, which stimulates heart contractions for better blood supply to the muscles and brain. Drinking large amounts of coffee, alcohol, nicotine can lead to tachycardia, extrasystole. Malignant, daily alcohol abuse can cause paroxysms of atrial fibrillation and supraventricular tachycardia.

Changes in the electrolyte composition of the blood (disturbances in the balance of sodium, potassium and magnesium), changes in blood viscosity cause deterioration in the work of the heart and blood vessels. Such changes can be caused by febrile conditions accompanying inflammatory processes in the body, overheating or hypothermia of the body, food poisoning, anemia, blood loss, shock, collapse, dehydration due to vomiting or diarrhea.

Rhythm disturbances that occur in the described conditions are usually transient, disappearing when the cause is eliminated, and do not require treatment.

More dangerous are rhythm disturbances that occur with an overdose of drugs. For example, with glycoside intoxication (digoxin, strophanthin, corglicon), an overdose of antiarrhythmics (propafenone, ethmozine), beta-agonists (salbutamol, berodual), frequent ventricular extrasystoles and paroxysmal tachycardia may develop.

Risk factors for developing arrhythmias include elderly age, burdened heredity, overweight, bad habits.

Diseases that lead to heart rhythm disorders

Rhythm disturbances can occur as a result of many diseases not only of the heart, but also of other organs. Everything possible reasons can be divided into the following groups.

1. Diseases of the heart and blood vessels
- congenital and acquired defects
- cardiomyopathy
- myocardial infarction
- arterial hypertension
- left ventricular hypertrophy
- endocarditis, myocarditis, pericarditis
- rheumatic heart disease
- cardiosclerosis of post-infarction, post-myocardial genesis
- heart failure
2. Diseases of the nervous system
- vegetative dystonia
- neuroses, neurasthenia
- disorders of cerebral circulation (strokes, discirculatory encephalopathy)
- brain tumors
- brain injury
3. Diseases of the endocrine system
- diabetes
- hypo- and hyperthyroidism - a decrease or increase in the activity of thyroid hormones
- pheochromocytoma - a tumor of the adrenal glands
- menopause and premenstrual syndrome in women
4. Diseases of the gastrointestinal tract
- hiatal hernia
- cholecystitis
- pancreatitis

As a rule, as a result of non-cardiac causes, sinus tachy- and bradycardia, supraventricular tachycardia, atrial extrasystole, rare and moderate-frequency ventricular extrasystole, atrioventricular blockade of 1-2 degrees, single-beam blockade of the His bundle develop.

Dangerous rhythm disturbances (frequent ventricular extrasystoles, complete blockades, paroxysmal ventricular tachycardia, ventricular fibrillation) occur with severe organic lesion hearts.

First aid for heart rhythm disorders

The type of assistance provided for this or that rhythm disturbance depends on its type and on the reason that led to this. In some cases, it is enough to drink a couple of pills, and in some cases, hospitalization with a full examination and treatment will be required.

Before providing first aid to a patient at home, it is necessary to evaluate complaints, general state and the need to call an ambulance. Even if the patient as a whole feels satisfactory, an ambulance still needs to be called for an ECG recording and analysis by her doctor. If the general condition suffers, signs such as a drop in pressure, fainting, pallor of the skin, impaired speech and vision, paralysis of the limbs appear, then it is all the more necessary to call an ambulance as soon as possible by dialing the number "03" and describing all the symptoms to the dispatcher.

General measures for rhythm disturbances are as follows:

Calm and lay the patient down with a pillow under the head for a fast heart rate and under the knees for a slow heart rate (to decrease and increase blood flow to the heart, respectively)
- open the window, unbutton the collar of the clothes for oxygen access
- measure blood pressure, count the pulse
- call an ambulance
- the patient should drink a sedative drug - tincture of valerian, corvalol, valoserdin, etc.
- if the attack has not developed for the first time, and the patient uses drugs prescribed by a doctor (NOT independently) to stop it, take this medicine
- if you are worried about heart pain, take nitroglycerin under the tongue
- if there are signs of pulmonary edema (severe choking, wheezing, frothy sputum), take a tablet of furosemide or lasix (if any)
- apply one of the vagal tests with a rapid pulse. These include straining on a deep breath, pressing on the eyelids of closed eyes for 10 to 30 seconds, causing a cough or gag reflex. With a rare pulse, tests cannot be performed
- if severe rhythm disturbances have developed that caused cardiac arrest and clinical death (lack of consciousness, breathing and pulse for carotid artery on the neck, there is no pupillary response to light), start cardiopulmonary resuscitation. Lay the patient on a hard surface on his back, tilt his head back, put a roller under his neck, start an indirect heart massage and mouth-to-mouth artificial respiration. One cycle includes 15 quick presses with two locked palms of straightened arms on the lower part of the sternum and 2 inhalations of air into the mouth, pinching the patient's nose. After three cycles, assess the presence of a pulse on the carotid artery. If there is no pulse, continue resuscitation until the ambulance arrives, but no more than 30 minutes, since brain death develops during this time.

The ambulance team, after making an ECG and assessing the situation, may resort to medical methods of treating arrhythmia, such as:
- with bradyarrhythmias - atropine 0.1% - 1 ml intravenously by stream or slowly ( daily dose not more than 4 ml), dopamine (dopamine, dopmin) 200 mg per 200 ml of saline intravenously, eufillin 2.4% - 5-10 ml intravenously by stream
- with paroxysm of atrial fibrillation - digoxin 0.025% 1-2 ml intravenously bolus, Panangin 10 ml intravenous bolus, novocainamide 10% - 10 ml intravenously slowly
- with paroxysm of supraventricular tachycardia - vagal tests, adenosine triphosphoric acid (ATP) 1% - 1 - 2 ml intravenously by stream, strophanthin (digoxin) 0.025% - 1 ml intravenously slowly, novocainamide
- with paroxysm of ventricular tachycardia - lidocaine 2% - 6 ml intravenously bolus, novocainamide, mezaton 1% - 0.3 - 0.5 ml with reduced blood pressure, cordarone (amiodarone) 5% - from 3 to 9 ml intravenously by stream, aymalin 2.5% - 2 ml intravenously slowly or by stream
- if there is no effect, temporary pacing with a defibrillator can be performed if necessary (if the equipment allows)

Which doctor should I contact for heart rhythm disorders?

Upon the arrival of the ambulance, the doctor interprets the electrocardiogram, assesses the patient's condition and the need for hospitalization in the department of therapy, cardiology or arrhythmology.

In the case of relief of complaints by vagal techniques or medication, restoration of a normal rhythm according to the ECG data, and the absence of expected complications, the patient can be left at home under the supervision of the attending physician. Sinus and supraventricular tachycardia, rare extrasystoles, incomplete blockades without loss of consciousness can be treated at the outpatient clinic at the place of residence, where the patient will be examined on an outpatient basis. To do this, the patient must immediately visit a therapist in the clinic, who will refer him to an arrhythmologist and / or a cardiologist.

Indications for rhythm restoration in a hospital setting are:

Any arrhythmias accompanied by a general severe condition of the patient, heart failure, pulmonary edema, symptoms of a heart attack, stroke and other severe complications
- any rhythm disturbances with signs of myocardial ischemia on the ECG, as myocardial infarction may develop
- paroxysm of atrial fibrillation, frequent ventricular extrasystole, ventricular tachycardia, especially for the first time
- first appeared complete blockade left leg of His or long-standing, but with pain in the heart or other uncharacteristic symptoms
- bradycardia, accompanied by Morgagni-Edems-Stokes attacks (loss of consciousness)

After discharge from the hospital, the patient is also observed by a cardiologist and arrhythmologist. If a patient suffers from rhythm disturbances for a long time, and cardiac surgery is planned for him, he is observed by a cardiac surgeon.

In any case, the patient was treated in a hospital or was left under the supervision of a doctor from a polyclinic, he must regularly visit a doctor, take prescribed drugs and in no case engage in self-diagnosis and self-treatment, as this is dangerous to health and life.

Therapist Sazykina O.Yu.