Violation of the heart rhythm and conduction (cardiac arrhythmias). Characteristics of the syndrome of cardiac arrhythmia and methods of combating pathology

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.
• crash heart rate any origin.
• Any ectopic (not originating from the sinus node) source of impulses.
• Violation of conduct electrical impulse in any part 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 heart is an important human organ that acts as a pump. In a healthy body, the heart rate remains constant and even. Various deviations cause a violation of the heart rhythm. This disease is called arrhythmia. The normal heart rate (HR) is considered to be between 60 and 80 beats per minute. An increase or decrease in this indicator indicates diseases of the cardiovascular system.

The contraction of the heart is carried out by the conduction system of the body. It includes the sinus node (the place where the electrical impulse appears), the atrioventricular node (serves to transmit a signal to the bundle of His), and the Purkinje fibers (required for contraction of the ventricular muscles). In the normal state, the heartbeat is sinus. Those. each impulsive signal that provokes a contraction of the heart muscle leaves the sinus node and passes down the conducting passages. Correct heart contraction occurs with equal frequency.

Heart rhythm disturbances are divided into two types according to the frequency of heart contractions.

1. Tachycardia (with a heart rate of more than 80 beats per minute): characterized by the body's response to external conditions (stress, overstrain, emotional impact, fever). An increase in heart rate at rest indicates significant abnormalities in the work of the heart. In such a situation, timely medical attention is needed.
2. Bradycardia (with heart rate less than 60 beats per minute): develops at rest in completely healthy people.

Bradycardia and tachycardia occur without the development of heart pathologies.

A separate classification of cardiac arrhythmia includes three types of arrhythmias.

1. Deviations when an impulse occurs. If the impulse is generated in sinus node, then this type includes bradycardia and tachycardia. And when a signal occurs from other parts of the conducting mechanism, an ectopic excitation node is formed (i.e., a focus that is located in the wrong place). It is usually located in the atrioventricular node, in the atria or ventricles. In this case, the impulse transmission is carried out either along descending paths or along ascending paths. IN this group cardiac arrhythmias included certain conditions: slow (slip) and fast (ectopic) rhythms, extrasystole and paroxysmal tachycardia. Due to ectopic foci of excitation, fibrillation (flicker) develops in both the ventricles.
2. Conduction disorders in the heart. This condition is called blockade. On different parts of the conducting mechanism, blocks appear that prevent the passage of the impulse. The classification implies several types of blockades: intra-atrial, atrioventricular, sinoatrial, and bundle branch block. This type includes (cardiac arrest) and Wolff-Parkinson-White syndrome (SVC syndrome).
3. Combined types. This classification implies a division into atrioventricular dissociation, parasystole and ectopic rhombuses with exit block. In this case, an additional (ectopic) focus of excitation and the sinus node work in isolation (due to the blockade). As a result, there is a double formation of rhythm, the ventricles and atria work in a different rhythm.

In the presence of cardiac pathologies, most patients suffer from ventricular and atrial extrasystoles. In this case, a premature contraction is added to the normal rhythm. Violation of the heart rhythm is manifested in vegetative-vascular dystonia, tonsillitis, severe stress, smoking abuse, after myocarditis.

Another common type of heart rhythm disorder is atrial fibrillation (classified by a violation in the occurrence of an impulse). In this case, there is no phase of atrial contraction. At the same time, muscle fibers lose their synchrony in work, and the atria twitch chaotically.

Reasons for the development of arrhythmia

Heart rhythm disturbances are not always considered a pathology. In certain situations, bradycardia, single extrasystoles of the ventricles and atria, occur during sleep. The reasons for the slowdown in heart rate can be caused by vagal effects on the heart (slow heart rate under the influence of vagus nerve). Tachycardia often occurs against the background of emotional impact, stress and strong physical exertion. Active heart contractions appear when there are disturbances in the functioning of the autonomic nervous system(with an increase in the concentration of adrenaline in the blood - the stress hormone). Bad habits and abuse of stimulating drinks (coffee, energy drinks) also lead to tachycardia and extrasystole.

The reasons for the deterioration of the work of the heart and the condition of the vessels are associated with a change in the electrolyte composition of the blood. When the balance of certain trace elements in the body (potassium, sodium, magnesium) changes under the influence of inflammatory processes, fever, hypothermia and overheating, poisoning, single episodes of heart rhythm disturbances occur. When the cause of this condition of the patient is eliminated, the heart rate returns to normal. No special treatment is required.

Risk factors for arrhythmias:

• age (people over 45);
• hereditary predisposition;
• abuse of bad habits;
• excess weight.

Severe forms of arrhythmia occur against the background of concomitant diseases. In this case, the causes of cardiac contractions are associated with the presence of certain pathologies:

• and vessels (myocardial infarction, ischemia, arterial hypertension, heart defects, endocarditis, myocarditis, heart failure);
• neurological problems and diseases (brain injuries, tumor formations, vegetative-vascular dystonia, neuroses, problems in the blood circulation of the brain);
• endocrine problems (premenstrual syndrome in women, menopause, diabetes, hypothyroidism, hyperthyroidism, adrenal tumor);
• diseases of the gastrointestinal tract (chronic cholecystitis, pancreatitis, stomach ulcer, esophageal hernia).

In some situations, the causes of the development of the disease cannot be established. In this case, an idiopathic violation of heart contractions is diagnosed.

Symptoms of the disease

Clinical picture various kinds arrhythmias manifest themselves in different ways, depending on the characteristics of the patient's body. In rare cases, symptoms of heart rate disorders are not observed at all, and the disease can be diagnosed only during a routine examination by a cardiologist. But most often, heart rhythm disturbances are accompanied by obvious signs.

The main symptoms of arrhythmia:

• increased heart rate (with tachycardia) and slowing of heart rate (with bradycardia);
• feeling of heartbeat;
• noticeable interruptions in the work of the heart ("fading" of the heartbeat with extrasystole);
• weakness, dizziness, fainting;
• shortness of breath and pain in the chest area;
• feeling of anxiety, panic and other disorders of a neurotic nature.

Features of arrhythmia in children

Unlike adults, in whom arrhythmia is diagnosed against the background of concomitant diseases, cardiac arrhythmias in children are equally associated with congenital developmental pathologies and with conditions during the normal functioning of the cardiovascular system.

According to statistics, about 27% of children suffer from various kinds of heart rate disorders. Children at puberty are most at risk, when there is a functional change in almost all body systems.

Often occurs against the background of excessive psychological stress. By identifying the causes and eliminating them, the symptoms and signs of heart rhythm disturbances in children are almost completely eliminated.

The main feature of arrhythmia in children is the latent course of the disease. Quite often problems of contractility of heart come to light at more mature age at inspection. Children do not complain of standard symptoms of arrhythmia, and clinical picture the disease usually manifests itself in psychomotor behavior (increased nervousness, tearfulness, irritability, sleep disturbances, short-term loss of consciousness).

Pronounced violations of the heart in children significantly affect the well-being, and require medical intervention. With timely diagnosis of the disease, the prognosis for life in children with arrhythmia is quite favorable.

Special treatment of cardiac arrhythmias in children not associated with organic pathologies is not required. As a rule, this condition regresses over time on its own. Treatment of other forms of arrhythmia begins with the correction of the daily regimen in children (work, study and rest), nutrition, as well as the use of elements conservative therapy. In especially severe forms, surgical intervention is required.

Conservative treatment of arrhythmia in children involves taking the following drugs:

• beta-blockers;
• sedatives;
• cardiac glycosides (in the presence of concomitant heart failure).

Treatment with conventional antiarrhythmic drugs in children is carried out with caution, with a clear selection of dosage and drug regimen. Timely started treatment contributes to the complete blocking of attacks of cardiac arrhythmias, and also reduces the risk of complications in adulthood.

Diagnosis and treatment of the disease

If a patient complains of typical symptoms of arrhythmia during a doctor's examination, then diagnosing the disease is not difficult. The specific type of cardiac arrhythmias is established only by the results of an electrocardiogram (ECG).

Extrasystole is characterized by changes ventricular complexes, tachycardia - small intervals between contractions, atrial fibrillation - irregular rhythm and frequency of contractions.

Additional methods for diagnosing arrhythmias include:

• monitoring of blood pressure and heart rate during the day (Holter diagnostics);
• measurements under load (cycling, walking up stairs, treadmill);
• ECG through the esophagus (specifies the location of the arrhythmia);
• electrophysiological study through the esophagus (when stimulating heart contractions to identify a specific type of arrhythmia).

In some cases, ultrasound of the heart and MRI (to detect tumor formations) are performed.

Depending on the type of arrhythmia and the condition of the patient, treatment is prescribed. Short-term disorders of the rhythm of heart contractions are treated on an outpatient basis. In especially severe cases, treatment is carried out in a hospital. Methods such as defibrillation, pacing, catheter ablation are used.

Among the drugs for arrhythmia can be distinguished:

• blood thinners;
• remedies for high cholesterol;
• antihypertensive drugs for high blood pressure;
• diuretics (with chronic heart failure);
• antiarrhythmic drugs (to normalize heart rate).

Heart blocks and bradycardia require different treatment. Drugs are prescribed to "accelerate" the heart rate and increase heart rate.

After completing the treatment, the patient is referred to a cardiologist. Regular examinations, ECG, and monitoring of heart contraction indicators are necessary.

Possible complications and long-term prognosis

Against the background of the development of various types of arrhythmias, serious complications may occur:

• collapse: a sharp drop in blood pressure below 100 mm. rt. Art., weakness, fainting;
• ischemic stroke (with increased formation of blood clots in the heart cavity): sudden speech impairment, balance problems, partial or complete paralysis of the limbs;
• arrhythmogenic shock (with a sharp decrease in blood flow in the brain, organs): loss of consciousness, cyanosis of the skin, low blood pressure, rare pulse, serious condition of the patient;
• acute myocardial infarction (with a lack of oxygen in the tissues of the heart, necrosis of myocardial cells occurs): a sharp strong pain in the region of the heart;
• pulmonary embolism (a condition that occurs when an artery is blocked by a thrombus): sudden shortness of breath, a feeling of suffocation, blue skin;
• fibrillation,

- any violation of the regularity or frequency of the normal heart rhythm, as well as the electrical conduction of the heart. Arrhythmia may be asymptomatic or be felt as a heartbeat, fading, or interruptions in the work of the heart. Sometimes arrhythmias are accompanied by dizziness, fainting, pain in the heart, a feeling of lack of air. Arrhythmias are recognized in the process of physical and instrumental diagnostics (heart auscultation, ECG, PECG, Holter monitoring, stress tests). In the treatment of various types of arrhythmias, drug therapy and cardiosurgical methods (RFA, installation of an electrocardiostimulator, cardioverter-defibrillator) are used.

General information

The term "arrhythmias" combines various disorders in the mechanism of occurrence, manifestations and prognosis of the origin and conduction of electrical impulses of the heart. They arise as a result of violations of the conduction system of the heart, which provides consistent and regular contractions of the myocardium - sinus rhythm. Arrhythmias can cause severe disturbances in the activity of the heart or the functions of other organs, and can themselves be complications of various serious pathologies. Manifested by a feeling of palpitations, interruptions, fading of the heart, weakness, dizziness, pain or pressure in the chest, shortness of breath, fainting. In the absence of timely treatment, arrhythmias cause angina attacks, pulmonary edema, thromboembolism, acute heart failure, cardiac arrest.

According to statistics, conduction and heart rhythm disorders in 10-15% of cases are the cause of death from heart disease. The study and diagnosis of arrhythmias is carried out by a specialized section of cardiology - arrhythmology. Forms of arrhythmias: tachycardia (rapid heartbeat more than 90 beats per minute), bradycardia (slow heartbeat less than 60 beats per minute), extrasystole (extraordinary heart contractions), atrial fibrillation (chaotic contractions of individual muscle fibers), blockade of the conduction system and others

Rhythmic sequential contraction of the heart is provided by special muscle fibers of the myocardium, which form the conduction system of the heart. In this system, the first-order pacemaker is the sinus node: it is in it that excitation arises at a frequency of 60-80 times per minute. Through the myocardium of the right atrium, it spreads to the atrioventricular node, but it turns out to be less excitable and gives a delay, so the atria contract first and only then, as the excitation spreads along the bundle of His and other parts of the conduction system, the ventricles. Thus, the conducting system provides a certain rhythm, frequency and sequence of contractions: first the atria, and then the ventricles. Damage to the conduction system of the myocardium leads to the development of rhythm disturbances (arrhythmias), and its individual links (atrioventricular node, bundle or legs of His) lead to conduction disturbances (blockades). In this case, the coordinated work of the atria and ventricles can be sharply disrupted.

Causes of arrhythmias

The development of organic arrhythmias is based on damage (ischemic, inflammatory, morphological) of the heart muscle. They make it difficult for the normal distribution of an electrical impulse through the conduction system of the heart to its various departments. Sometimes damage also affects the sinus node - the main pacemaker. In the formation of cardiosclerosis, scar tissue prevents the conduction function of the myocardium, which contributes to the emergence of arrhythmogenic foci and the development of conduction and rhythm disturbances.

The group of functional arrhythmias includes neurogenic, dyselectrolyte, iatrogenic, mechanical and idiopathic arrhythmias.

The development of sympathetic arrhythmias of neurogenic origin is facilitated by excessive activation of the tone of the sympathetic nervous system under the influence of stress, strong emotions, intense mental or physical work, smoking, drinking alcohol, strong tea and coffee, spicy food, neurosis, etc. Activation of the sympathetic tone is also caused by diseases thyroid gland (thyrotoxicosis), intoxication, feverish conditions, blood diseases, viral and bacterial toxins, industrial and other intoxications, hypoxia. In women suffering from premenstrual syndrome, sympathetic arrhythmias, pain in the heart, sensations of suffocation may occur.

Vagodependent neurogenic arrhythmias are caused by activation of the parasympathetic system, in particular, the vagus nerve. Vago-dependent rhythm disturbances usually develop at night and can be caused by diseases of the gallbladder, intestines, peptic ulcer of the duodenum and stomach, diseases Bladder which increase the activity of the vagus nerve.

Diselectrolyte arrhythmias develop with electrolyte imbalances, especially magnesium, potassium, sodium and calcium in the blood and myocardium. Iatrogenic rhythm disturbances result from the arrhythmogenic action of certain drugs (cardiac glycosides, β-blockers, sympathomimetics, diuretics, etc.).

The development of mechanical arrhythmias is facilitated by chest injuries, falls, blows, electric shocks, etc. Rhythm disturbances without an established cause are considered idiopathic arrhythmias. In the development of arrhythmias, hereditary predisposition plays a role.

Classification of arrhythmias

Etiological, pathogenetic, symptomatic and prognostic heterogeneity of arrhythmias causes discussions about their unified classification. According to the anatomical principle, arrhythmias are divided into atrial, ventricular, sinus and atrioventricular. Taking into account the frequency and rhythm of heart contractions, it is proposed to distinguish three groups of rhythm disturbances: bradycardia, tachycardia and arrhythmias.

The most complete classification is based on the electrophysiological parameters of rhythm disturbance, according to which arrhythmias are distinguished:

• I. Caused by a violation of the formation of an electrical impulse.

This group of arrhythmias includes nomotopic and heterotopic (ectopic) arrhythmias.

Nomotopic arrhythmias are caused by dysfunction of the automatism of the sinus node and include sinus tachycardia, bradycardia and arrhythmia.

Separately, in this group, sick sinus syndrome (SSS) is distinguished.

Heterotopic arrhythmias are characterized by the formation of passive and active ectopic complexes of myocardial excitation located outside the sinus node.

With passive heterotopic arrhythmias, the occurrence of an ectopic impulse is due to a slowdown or disruption in the conduction of the main impulse. Passive ectopic complexes and rhythms include atrial, ventricular, disorders of the atrioventricular junction, migration of the supraventricular pacemaker, and jumping contractions.

With active heterotopias, the emerging ectopic impulse excites the myocardium before the impulse formed in the main pacemaker, and ectopic contractions "interrupt" the sinus rhythm of the heart. Active complexes and rhythms include: extrasystole (atrial, ventricular, coming from the atrioventricular junction), paroxysmal and non-paroxysmal tachycardia (coming from the atrioventricular junction, atrial and ventricular forms), flutter and flicker (fibrillation) of the atria and ventricles.

• II. Arrhythmias caused by dysfunction of intracardiac conduction.

This group of arrhythmias occurs as a result of a decrease or cessation of the propagation of an impulse along the conduction system. Conduction disorders include: sinoatrial, intra-atrial, atrioventricular (I, II and III degree) blocks, premature ventricular excitation syndromes, intraventricular blocks of the bundle of His bundle (one-, two- and three-beam).

• III. Combined arrhythmias.

Arrhythmias that combine conduction and rhythm disturbances include ectopic rhythms with exit blockade, parasystole, and atrioventricular dissociations.

Symptoms of arrhythmias

The manifestations of arrhythmias can be very different and are determined by the frequency and rhythm of heart contractions, their effect on intracardiac, cerebral, renal hemodynamics, as well as the function of the myocardium of the left ventricle. There are so-called "silent" arrhythmias that do not manifest themselves clinically. They are usually identified by physical examination or electrocardiography.

The main manifestations of arrhythmias are palpitations or a feeling of interruptions, fading during the work of the heart. The course of arrhythmias may be accompanied by suffocation, angina pectoris, dizziness, weakness, fainting, and the development of cardiogenic shock. Palpitations are usually associated with sinus tachycardia, attacks of dizziness and fainting - with sinus bradycardia or sick sinus syndrome, fading of cardiac activity and discomfort in the region of the heart - with sinus arrhythmia.

With extrasystole, patients complain of sensations of fading, pushing and interruptions in the work of the heart. Paroxysmal tachycardia is characterized by suddenly developing and stopping heart attacks up to 140-220 beats. in min. Sensations of frequent, irregular heartbeat are noted with atrial fibrillation.

Complications of arrhythmias

The course of any arrhythmia can be complicated by ventricular fibrillation and flutter, which is tantamount to circulatory arrest, and lead to the death of the patient. Already in the first seconds, dizziness, weakness develop, then - loss of consciousness, involuntary urination and convulsions. Blood pressure and pulse are not determined, breathing stops, pupils dilate - a state of clinical death occurs. In patients with chronic insufficiency blood circulation (angina pectoris, mitral stenosis), during paroxysms of tachyarrhythmia, shortness of breath occurs and pulmonary edema may develop.

With complete atrioventricular blockade or asystole, syncope may develop (Morgagni-Adems-Stokes attacks, characterized by episodes of loss of consciousness), caused by a sharp decrease in cardiac output and blood pressure and a decrease in blood supply to the brain. Thromboembolic complications in atrial fibrillation in every sixth case lead to a cerebral stroke.

Diagnosis of arrhythmias

The initial stage of diagnosing arrhythmia can be carried out by a therapist or cardiologist. It includes the analysis of the patient's complaints and the determination of the peripheral pulse characteristic of cardiac arrhythmias. At the next stage, instrumental non-invasive (ECG, ECG monitoring), and invasive (ChpEFI, VEI) research methods are carried out:

An electrocardiogram records the heart rhythm and frequency for several minutes, so only constant, stable arrhythmias are detected by an ECG. Rhythm disturbances that are paroxysmal (temporary) in nature are diagnosed by the Holter 24-hour ECG monitoring method, which records the daily heart rhythm.

To identify the organic causes of arrhythmias, Echo-KG and stress Echo-KG are performed. Invasive diagnostic methods make it possible to artificially induce the development of arrhythmia and determine the mechanism of its occurrence. During an intracardiac electrophysiological study, catheter electrodes are brought to the heart, recording an endocardial electrogram in various parts of the heart. The endocardial ECG is compared with the result of an external electrocardiogram recording performed simultaneously.

Forecast

In prognostic terms, arrhythmias are extremely ambiguous. Some of them (supraventricular extrasystoles, rare extrasystoles ventricles), not associated with organic pathology of the heart, do not pose a threat to health and life. Atrial fibrillation, on the contrary, can cause life-threatening complications: ischemic stroke, severe heart failure.

The most severe arrhythmias are flutter and ventricular fibrillation: they pose an immediate threat to life and require resuscitation.

Prevention

The main direction of prevention of arrhythmias is the treatment of cardiac pathology, almost always complicated by a violation of the rhythm and conduction of the heart. It is also necessary to exclude extracardiac causes of arrhythmia (thyrotoxicosis, intoxication and febrile conditions, autonomic dysfunction, electrolyte imbalance, stress, etc.). It is recommended to limit the intake of stimulants (caffeine), the exclusion of smoking and alcohol, self-selection of antiarrhythmic and other drugs.

Under the term "cardiac arrhythmias" understand arrhythmias and heart blocks. Arrhythmias are a violation of the frequency, regularity and sequence of heartbeats. Violations of the conduction of excitation cause the development of heart blocks.

All arrhythmias are the result of changes in the basic functions of the heart: automatism, excitability and conduction. They develop when the formation of the action potential of the cell is disturbed and the speed of its conduction changes as a result of changes in potassium, sodium and calcium channels. Violation of the activity of potassium, sodium and calcium channels depends on sympathetic activity, the level of acetylcholine, muscarinic M 2 receptors, ATP.

Classification of cardiac arrhythmias

Arrhythmias are divided into supraventricular and ventricular. There are a large number of classifications of cardiac arrhythmias, of which the classification proposed by M.S. Kushakovsky, N.B. Zhuravleva modified by A.V. Strutynsky et al.

I. Violation of the formation of an impulse.

A. Violation of the automatism of the SA node (nomotopic arrhythmias):

sinus tachycardia,

sinus bradycardia,

sinus arrhythmia,

B. Ectopic (heterotopic) rhythms due to the predominance of automatism of ectopic centers:

slow (replacement) escape rhythms: atrial, from the AV connection, ventricular;

accelerated ectopic rhythms (non-paroxysmal tachycardia): atrial, from the AV connection, ventricular;

migration of the supraventricular pacemaker.

C. Ectopic (heterotopic) rhythms, mainly due to the mechanism of re-entry of the excitation wave:

extrasystole (atrial, from the AV connection, ventricular);

paroxysmal tachycardia (atrial, from the AV connection, ventricular);

atrial flutter;

flicker (fibrillation) of the atria;

flutter and flicker (fibrillation) of the ventricles.

II. Conduction disorders:

sinoatrial blockade;

intra-atrial (inter-atrial) blockade;

atrioventricular blockade: I degree, II degree, III degree (complete blockade);

intraventricular blockade (blockade of the branches of the His bundle): one branch, two branches, three branches;

ventricular asystole;

ventricular preexcitation syndrome (PVZh): Wolf-Parkinson-White syndrome (WPW), short PQ (R) interval syndrome (CLC).

III. Combined arrhythmias:

parasystole;

ectopic rhythms with exit block;

atrioventricular dissociations.

The nature clinical course heart rhythm disturbances can be acute and chronic, transient and permanent. To characterize the clinical course of tachyarrhythmias, such definitions as "paroxysmal", "recurrent", "continuously recurrent" are used.

Diagnosis examples:

1. IHD, ventricular extrasystole.

2. IHD (PIM 2002), atrioventricular block II degree.

3. IHD, chronic form atrial fibrillation, tachyform.

Etiology

myocardial damage of any etiology: atherosclerosis of the coronary arteries, myocarditis, dilated and hypertrophic cardiomyopathy, heart defects, diabetes mellitus, thyroid disease, menopause, amyloidosis, sarcoidosis, hemochromatosis, myocardial hypertrophy in arterial hypertension and chronic cor pulmonale, intoxication (alcohol, nicotine, drugs, industrial substances (mercury, arsenic, cobalt, organochlorine and phosphorus compounds), closed heart injuries, involutive processes during aging;

damage to the SU and the conduction system of the heart of congenital and acquired genesis, for example, SSS, sclerosis and calcification of the fibrous skeleton of the heart and primary sclerodegenerative damage to the conduction system of the heart with the development of AV and intraventricular blockade, additional pathways (for example, WPW, CLC syndromes);

prolapse of the heart valves;

heart tumors (myxomas, etc.);

diseases of the pericardium: pericarditis, pleuropericardial adhesions, metastases to the pericardium, etc.;

electrolyte disturbances (disturbances in the balance of potassium, calcium, sodium, magnesium);

mechanical irritation of the heart (catheterization, angiography, heart surgery);

reflex influences from internal organs when swallowing, straining, changing body position, etc.;

violations of the nervous regulation of the heart (vegetative dystonia syndrome, organic lesions of the central nervous system);

under stress (with the development of hyperadrenalemia, hypokalemia, stress ischemia);

idiopathic cardiac arrhythmias.

Normal heart activity is called contractions in the range of 60-80 beats per minute. The pulses must go at regular intervals. Such work is given to cardiomyocytes by pacemaker cells. Under the influence of certain reasons, their function changes. Heart rhythm disorder manifests itself in the form various options. When an arrhythmia occurs, patients are concerned about symptoms, the severity of which is determined by the severity of the condition.

Why does heart rhythm disturbance occur and what is it? The term "arrhythmia" refers to changes accompanied by a disorder in the sequence and regularity of myocardial contractions. The beats per minute will be variable.

The heart rate becomes different from sinus. It is observed normally in a healthy person. Any cause that provokes arrhythmia can lead to a violation of the vital functions for which the heart is responsible.

The classification of rhythm disturbances according to Zhuravleva and Kushavsky from 1981 has received the greatest distribution. It includes the following options for the pathology of the cardiovascular system:

1. Change in automatism in the sinus node (nomotopic arrhythmia):
   1. sinus bradycardia;
   2. sinus tachycardia;
   3. weakness of the conduction of the sinus node;
   4. sinus arrhythmia.
2. Ectopic rhythm (heterotopic arrhythmia):
   1. atrial heart rate;
   2. atrioventricular (nodal) rhythm;
   3. dissociation of function of the atrioventricular type;
   4. idioventricular rhythm (ventricular);
   5. migration of the supraventricular pacemaker;
3. Rhythm disturbance associated with changes in myocardial excitability:
   1. paroxysmal variant of tachycardia;
   2. extrasystole.
4. Rhythm disturbances by type of conduction and excitability changes:
   1. flickering (fibrillation, flutter) of the ventricles;
   2. atrial fibrillation (atrial fibrillation);
   3. atrial flutter;
5. Rhythm disturbance associated with a change in conduction:
   1. interatrial blockade;
   2. sinoatrial blockade.
6. Atrioventricular blockade:
   1. premature excitation of the ventricles;
   2. blockade of the ventricles (branches of the bundle of His).

Each disease from the listed classification has its own causes, treatment. Symptoms of cardiac arrhythmia are expressed depending on the severity of the condition and the therapy.

Causes of irregular heart rhythm

When failures of the heart rhythm appear, the main importance is given to finding the cause. Many variants of arrhythmia are similar. You can figure out what type of disorder the patient has with the help of a comprehensive examination.

Endogenous factors

Some diseases pose a danger to the cardiovascular system. These include the following causes of heart rhythm disturbances:

1. Chronic diseases of the cardiovascular system. When symptoms of arrhythmia appear, the main importance is attached to ischemic processes in the myocardium, myocarditis, myocardial infarction, congenital and acquired defects. In people over 40, atherosclerosis plays an important role. The deposition of cholesterol in the form of plaques on the walls of blood vessels does not allow them to retain their elasticity properties.
2. Pathology of the nervous system.
3. Violation of metabolic processes in the form of hypokalemia or hyperkalemia.
4. Hormonal changes associated with thyroid diseases (hypothyroidism and thyrotoxicosis).
5. Violation of the heart rhythm as one of the manifestations of cancer pathology.

In some cases, patients with glomerulonephritis or pyelonephritis also complain of interruptions in the work of the heart. For this reason, it is important to remember that pathology from other organ systems can disrupt the normal rhythm.

Exogenous factors

Some environmental factors (or active human activity) negatively affect the body. They cause a heart rhythm disturbance, the symptoms of which may not bother a person for a long time. External factors include:

1. Age over 40 years. Most often, people in this category begin to feel unpleasant symptoms in the region of the heart, which are characteristic of arrhythmias.
2. Tobacco smoking, drinking alcohol. Toxic substances adversely affect blood vessels and myocardium.
3. Traumatic brain injuries lead to damage to the central or autonomic nervous system. Any symptom can have a negative effect on the heart.
4. It is not recommended to drink more than 3 cups of coffee. Due to the content of a large amount of caffeine, acceleration of contractions is noted, blood pressure rises. Changes in the state of the cardiovascular system can lead to arrhythmia.
5. Under the influence of anesthetics, the load on the myocardium increases. This becomes one of the reasons for the disruption of his work.

In some cases, the cause cannot be determined. If the factor is not fully understood, then it is idiopathic. Predisposing phenomena are considered a violation of the regime of work and rest, obesity, a sedentary lifestyle.

Both an adult and a teenager can get sick. The main causes of arrhythmia in a child at an early age are defects, diseases and poor heredity. In pediatrics, they give individual recommendations, depending on age.

Diseases in which rhythm disturbances occur

Not only the pathology of the cardiovascular system leads to a disorder of the functions of the heart. The appearance of signs of the disease is possible if the patient has:

• atherosclerosis;
• myocarditis;
• congenital anomalies of the structure;
• dystrophic processes in the myocardium;
• heart attack;
• heart failure;
• pheochromocytoma;
• arterial hypertension;
• hernia in the esophageal opening of the diaphragm;
• cardiomyopathy.

Among patients, arrhythmia is more common, the main cause of which is a dysfunction of the cardiovascular system.

Myocarditis

Myocarditis is inflammation of the muscle. This occurs after the defeat of cardiomyocytes by infection. Violation of the heart rhythm occurs under the influence of toxic substances released by microorganisms.

The clinical picture depends on the degree of change in the walls of the organ and the severity of the process. The onset may be asymptomatic. Based on pathophysiology data, even slightly affected heart cells cause arrhythmia.

myocardial infarction

Violation of the blood circulation of the coronary vessels leads to myocardial necrosis. In the local area, foci are formed that cease to be active. In some cases, with spasm of the arteries, the same outcome occurs. The right algorithm emergency care reduces the risk of complications.

One of the consequences of the post-infarction state is a violation of the heart rhythm. Necrotic areas in the myocardium can be large and small.

Pheochromocytoma

Education is a tumor with localization in the adrenal medulla. It is found in early childhood, adolescence and adulthood. Cells begin to produce large amounts of catecholamines. These include epinephrine and norepinephrine. In rare cases, the tumor becomes malignant. This type of cell spreads through the bloodstream to other organs.

Pheochromocytoma always occurs with an increase in blood pressure. During a crisis provoked by catecholamines, it increases sharply. In the interictal period, it remains stable at high numbers, or may decrease. With the formation of even a small tumor, the heart rhythm changes. On the prehospital stage help to normalize the pressure. The patient is taken to the hospital and operated on after the examination.

Manifestations of cardiac arrhythmias

Manifestations and signs of arrhythmia depend on the variant of the disease according to the classification. Some patients feel satisfactorily and in rare cases there are unpleasant signs in the heart area. Prolonged asymptomatic course adversely affects the myocardium, and such a condition is difficult to detect at an early stage.

When the normal function of the atrioventricular node is disrupted, an imbalance occurs between the atria and ventricles. Impulse conduction becomes difficult, and the heartbeat slows down. The frequency of myocardial contractions is about 25-45 per minute. The following symptoms are characteristic:

• severe weakness on the background of bradycardia;
• dyspnea;
• dizziness;
• darkening in the eyes;
• fainting;

For atrioventricular blockade, episodes of loss of consciousness are characteristic. The fainting lasts for about a few seconds.

Atrial fibrillation (flicker)

This variant of arrhythmia is more common than others. She was assigned the ICD code - I 48. The heart rate can be up to 600 beats per minute. The process is not accompanied by the coordinated work of the atria and ventricles. Patients describe a sharp deterioration in well-being. Some of them indicate the minutes of such changes.

It all starts with sensations of a strong heartbeat, interruptions and weakness. Gradually joins the lack of air, a feeling of fear and pain in the area chest. When atrial fibrillation occurs, the condition worsens dramatically. Everything takes a matter of minutes. During this time, the feeling that "the heart will soon jump out of the chest" does not leave.

Sick sinus syndrome

This variant of arrhythmia is associated with a disorder in the formation of an impulse in the sinus node and further conduction in the atria. Bradycardia appears in the norm and in healthy people who are athletically trained.

People feel pauses during the work of the heart, and the pulse is harvested. With a pronounced syndrome, there is a tendency to fainting, which is preceded by darkening in the eyes or a feeling of heat.

Extrasystole

Under the influence of various factors, the conduction system of the heart generates extraordinary contractions of the myocardium (extrasystoles). Single manifestations are not life-threatening and are rarely felt by people. When there are a lot of them or they become group, patients begin to complain. They experience a strong heartbeat, and between individual beats there is a pause, which is described by people as a fading.

Diagnosis of pathology

Before starting to treat the patient, a complete examination is carried out. It includes the implementation of laboratory and instrumental methods. After receiving the conclusion, the doctor determines the further tactics of managing the patient, depending on the individual characteristics.

Blood test

This survey option is one of the most accessible methods. It includes parameters by which the probability of an inflammatory process is determined. This can be done by assessing the level of leukocytes in the blood and the erythrocyte sedimentation rate (ESR). It is important to study and biochemical analysis. The electrolyte composition plays an important role for the normal functioning of the myocardium. An imbalance of potassium and magnesium in the bloodstream leads to arrhythmia.

Lipid profile

This type of examination is necessary for all patients. If the rhythm is disturbed, it is necessary to assess the state of the vascular wall. Based on the results obtained, the doctor begins treatment. If there are very few high-density lipids, and the limits of bad cholesterol exceed the allowable values, therapy is necessary.

ECG (electrocardiography)

The instrumental method is considered one of the main methods for determining cardiac arrhythmias. Any disorders occurring in the myocardium will be reflected on the film. Electrocardiography (ECG) detects the following:

1. The source of rhythm, whose task is to generate impulses.
2. Heart rate.
3. Impaired conduction from the atria to the ventricles.
4. Possible extraordinary contractions of the myocardium.
5. Fibrillation or flutter of the ventricles and atria.

In a number of patients, with the help of this examination, it was possible to detect changes that did not manifest themselves in any way.

Holter ECG

Via modern method research can detect the changes that the electrocardiogram detected. The advantage is that it can be done within 24 hours. All this time, a sensor is attached to the patient, which takes all indicators of cardiac activity.

The patient is advised to lead a normal life. So that he does not miss any little thing related to activity, a diary is started. On its pages, the subject fixes his workload, stress and other parameters that the doctor will recommend. The next day, he returns to his cardiologist to evaluate the results.

Event monitoring

This type of study is carried out using a portable device for recording an electrocardiogram. The convenience of the method lies in its use only when necessary. The indications are:

• pain in the region of the heart;
• strong heartbeat;
• feeling interrupted;
• feeling of fading;
• the appearance of dizziness and a sharp headache;
• pre-fainting state.

After recording the data at the right time, the patient can use the sound sensor to transmit information to his doctor by phone.

During physical activity in the usual mode or with severe tension, patients experience pain. Sometimes it is difficult to evaluate the indicator, and for this reason stress tests are prescribed.
The patient gets on the treadmill, and the doctor sets the required pace.

If there are no changes, then the angle of its inclination is changed, the speed is increased. If pain, interruptions and other unpleasant sensations occur, the procedure is completed and the data obtained is evaluated. When a violation of the heart rhythm is confirmed, treatment is prescribed.

Tilt test

This procedure is a variation of the one described above. Its essence lies in carrying out an orthostatic load. Before the start of the study, the patient is placed on a special table. It is fixed with straps and transferred from horizontal position to vertical. In the process of implementation, the following indicators are evaluated:

• blood pressure level;
• ECG changes;
• cerebral hemodynamics.

When fainting, with the help of a tilt test, the cause is established.

EchoCG (echocardiography)

The study makes it possible to assess the state of the structural elements of the heart, the level of blood flow, pressure in the vessels. In the presence of changes associated with age or infectious disease, even minor deviations can be considered.

Electrophysiological research method

To assess the state of the heart, an electrode is inserted through the nasal passage into the esophagus (transesophageal echocardiography). If it is impossible to perform it in the indicated way, the procedure is done intravenously. The sensor enters the cavity, and the doctor gives a slight impulse. It provokes an attack of arrhythmia.

The presented method is assigned to each patient with arrhythmia. The reason for this condition may be due to an altered thyroid function. If the patient has it reduced, then bradycardia and blockade occur, which is easy to detect using an ECG. With hyperthyroidism, tachycardia and extrasystoles are noted.

Treatment of cardiac arrhythmias

The choice of method of therapy is based on the causes of the arrhythmia, clinical manifestations, comorbidities. It includes several options:

• medication;
• non-drug.

In the absence of effect, the treatment of cardiac arrhythmias is carried out by cardiac surgeons.

Medical method

To choose the right tool, a comprehensive examination is carried out. Under the control of electrocardiography, the results of treatment with antiarrhythmic drugs are evaluated. The following classes of drugs are prescribed (depending on the indications):

1. Drugs that stabilize cell membranes (class 1) - Lidocaine, Quinidine, Propafenone.
2. Beta-blockers (grade 2) - "Metoprolol", "Atenolol".
3. Potassium channel blockers (grade 3) - Amiodarone, Sotalol.
4. Calcium channel blockers (grade 4) - Verapamil, Diltiazem.

The patient is under the control of the doctor, if necessary, he must take tests. Depending on the psychosomatics and the patient's attitude to his health, a consultation of other specialists is prescribed. According to indications, it may be necessary additional funds. They should go well with arrhythmia pills.

Non-drug treatment

If therapy is carried out successfully and the condition returns to normal, then folk remedies. For this, medicinal herbs are used, which are mixed in a certain ratio. Valerian root, lemon balm, motherwort and anise are widely used. The ingredients are combined, poured with boiling water and insisted for about half an hour. Then the resulting infusion is taken at a dose of ½ cup three times a day.

One of the healing methods is the right lifestyle and nutrition. It is necessary to give up tobacco, alcoholic beverages and junk food. To maintain a healthy heart, it is recommended to drink water (1.5-2 liters per day). If there is swelling, then this issue is resolved with the attending physician.

The diet should contain a lot of fresh vegetables and fruits. For the myocardium, bananas, dried fruits and baked potatoes are considered especially useful. They are richer than other foods in potassium, which is needed for heart function.

In the absence of dynamics from treatment at home, the patient is referred for surgical intervention. The most common and effective are:

• cardioversion;
• setting an artificial pacemaker;
• ablation;

Cardioversion is indicated for patients with ventricular arrhythmias. The method is based on the application of a discharge of electricity. It is important to do it right differential diagnosis. If the form of conduction disturbance turns out to be atrial, then the procedure will be contraindicated. This is due to the high likelihood of blood clots.

If the heart cannot cope with the problem on its own, then an artificial pacemaker is installed under the skin. When an arrhythmia focus is detected, a catheter is inserted, the task of which is to destroy it - ablation. This method of treatment will return the patient to a full life.