Sinus arrhythmia code ICD. Permanent form of atrial fibrillation: treatment and prognosis. Ventricular extrasystole: symptoms and treatment

Atrial fibrillation characterized by chaotic twitching muscle fibers atria and impaired conduction of electrical impulses in the myocardium. Due to a rhythm failure, the heart rate in this pathology can fluctuate between 200-300 beats per minute for several hours or even days. In normal operation, the excitation of the atria is followed by contractions of the ventricles, but with atrial fibrillation one phase of this cycle disappears, as a result of which a full systolic contraction of the heart does not occur. This disease most often occurs in adulthood and old age, and is much less often detected in adolescents and children, who, as a rule, have congenital malformations of the heart muscle.

Characteristics of attacks

With paroxysmal atrial fibrillation, the normal algorithm of the heart is disrupted, as a result of which only two of the four chambers of the organ function - the ventricles. In this situation, problems with blood circulation are also observed. If a severe attack of fibrillation occurs, other muscle cells located in them begin to do the work of the atria.

There are several types of paroxysmal arrhythmia. Classification by ventricular contractions:

tachysystolic - heart rate goes beyond 90 beats per minute.
normosystolic - the number of contractions ranges from 60-90 beats.
bradysystolic - heart rate drops to 60 beats per minute or less.

Classification by atrial contractions:

Flutter. Heart rate reaches 200 beats per minute, there is no tendency to increase.
Flicker. The number of beats exceeds 300 per minute.

If the above symptoms last for seven or more days, then we are talking about chronic type diseases. If several pathological foci of increased impulse are detected at once, then according to the form of localization the arrhythmia is called mixed.

Paroxysmal arrhythmia almost never acts as an independent disease and is a marker of other disorders of the respiratory and cardiovascular systems, ICD10 code - 148 (atrial fibrillation and flutter). The onset of paroxysms is usually sudden. This condition can be relieved in some cases with medications at home, but if symptoms are severe, emergency treatment is required health care. Sometimes atrial fibrillation goes away on its own, but it is important to remember that the outcome of such an attack cannot be predicted. This form illness is often the cause various complications, and therefore it is better to immediately go to the hospital, where doctors, if necessary, will carry out resuscitation actions.

Symptoms of the disease

In the normosystolic form of the pathology external manifestations are moderate in nature, in rare cases practically absent. With tachysystolic, on the contrary, they have a pronounced clinical picture, in which the following are observed:

sweat on forehead;
noticeable interruptions in the work of the heart, its fading;
dizziness;
severe pain behind the sternum;
shallow breathing (inability to take a full breath);
muscle atony;
panic attacks;
fainting and loss of consciousness;
shortness of breath even in a state of complete rest;
suffocation;

shiver;
numbness of the limbs;
cyanosis;
hypotension;
general weakness and lack of air.

The bradysystolic form of the disease is no less dangerous than the tachysystolic form, since, leading to a decrease in heart rate to a critical level, it can cause fainting and complete cardiac arrest. This is due to rapidly developing hypoxia during an attack. Brain and heart don't receive sufficient quantity oxygen, their functioning slows down or stops altogether.

Reasons for the development of pathology

The causes of the paroxysmal form of atrial fibrillation are always associated with cardiovascular diseases. Therefore, people with any heart pathologies are at risk. According to statistics, atrial fibrillation occurs in approximately 9% of all elderly people and in most cases it is provoked by ischemic heart disease (CHD). At the age of 40 to 55 years, the pathology is detected in 6% of the population; before 30 it appears extremely rarely. In young people, only congenital heart defects or alcohol abuse or drug addiction can cause impulse conduction disturbances.

The main reasons leading to the development of paroxysmal arrhythmia include:

valvular heart failure;
hypertrophic cardiomyopathy;
inflammation of the heart of infectious origin;
chronic hypertension;
rheumatism;
previous heart attack or ischemic stroke;

lung cancer, embolism, pneumonia;
amyloidosis;
severe forms of anemia;
thyrotoxicosis;
hemochromatosis;
chemical poisoning; drug overdose;
myxoma of the heart;
emphysema;
electric shock;
weakness sinus node.

In addition to the diseases listed above, the onset of the disease can be triggered by the following factors:

exhaustion of the nervous system;
abuse of energy drinks, tobacco products;
pathological changes in the respiratory system;

regular stress;
infectious invasion;
chronic renal failure;
obesity of the third degree.

Paroxysmal atrial fibrillation sometimes occurs some time after heart surgery. In all cases where the attack was not associated with diseases and did not occur under the influence of certain negative factors, the paroxysm is called idiopathic.

Emergency care at home

If one of the family members has previously had attacks of atrial fibrillation or had a tendency to this disease, his relatives should learn several first aid rules. You need to be prepared for such a development of events and not get confused at a crucial moment. At the first manifestations of paroxysms, it is required:

Lay down, or better yet, make the person sit down.
Provide access to fresh air by opening all windows in the house.
Get it from the patient next steps: do deep breath, hold your nose and hold your breath for a while. In some cases, this helps to stop the attack, as it affects the vagus nerve.
To avoid blood clots, give the patient the medicine previously prescribed by the doctor. If the attack occurs for the first time, then it is preferable to take Warfarin. If such a drug is not available, you can use “Propafenone” or “Cordarone” in tablets.
Call an emergency team to your home.

With a normosystolic form of arrhythmia, as well as weak paroxysmal pain, can be accepted pharmaceutical drugs or any prescription drugs traditional medicine. With moderate symptoms, they can stop dangerous condition without visiting a doctor. Can be used:

Dill decoction. Dosage: 100 ml 3 times a day.
A decoction of viburnum berries. It effectively stops attacks of arrhythmia of any etiology. 200 ml before meals, no more than three times in 12 hours.
Infusion of yarrow. Take one teaspoon twice a day.

The main task of the patient himself and his relatives is to get to the hospital as soon as possible and get the first prehospital care. The critical period is 48 hours from the onset of the attack, since after this the active formation of blood clots begins and the risk of death due to ischemic infarction or cerebral hemorrhage increases significantly.

For what symptoms should you call an ambulance?

In case of paroxysm of atrial fibrillation, it is better to call the emergency team in advance, since prolonged ventricular and atrial fibrillation never goes away without serious consequences. During an attack, blood flow deteriorates, the brain suffers from a lack of oxygen.

Important! Even if a person is accustomed to such phenomena and has a proven action plan, this does not mean that next time everything will go as before. In the event of an unexpected cardiac arrest, loved ones have only 6 minutes to resuscitate the patient.

How do you know when it’s time to call an ambulance? For paroxysmal atrial fibrillation urgent Care is required if, despite all attempts to relieve the attack, the pulse continues to accelerate or, conversely, rapidly drop. The patient experiences severe chest pain and clouding of consciousness - this indicates a critical condition. To restore sinus rhythm, resuscitation is required, which can only be provided by a doctor within the walls of a hospital.

Treatment

Treatment of paroxysmal arrhythmia begins with diagnostic procedures that allow us to identify the etiology of this pathology (ECG, MRI, ultrasound of the heart). The main actions will be aimed at eliminating acute symptoms and the root causes of the disease. The fight against atrial fibrillation can be carried out using the following methods:

Drug therapy. The type of medication, dose and course of treatment are selected by the observing cardiologist.
Electropulse therapy. This procedure carried out under general anesthesia. Doctors install a special defibrillator in the collarbone area, which, by sending a powerful electrical impulse, reboots the heart.
Surgery. A powerful current discharge is sent to areas where pathological changes are observed, which should destroy them.

When a patient is admitted in critical condition, drugs are administered intravenously (Ritmilen, Aymalin, Novocainamide), which reduce the rhythm of ventricular and atrial contractions. Emergency treatment primarily aimed at restoring sinus rhythm and proper blood circulation, since a long course of pathology can lead to the formation of blood clots.

Prevention of paroxysms

It is extremely difficult to completely cure atrial fibrillation, so it is wiser to prevent it. The main preventive measures are aimed at:

treatment of diseases of the cardiovascular and respiratory systems;
performance mild therapeutic physical education; breathing exercises;
refusal bad habits;
elimination of provoking factors;
replenishment of elements necessary for the body (potassium, magnesium).

In addition, you need to independently monitor your blood pressure and pulse using a home blood pressure monitor. At least once a year you should undergo an electrocardiogram and examination by a cardiologist.

The disease has a favorable prognosis provided timely treatment causes of atrial fibrillation, as well as prevention. Many people with this diagnosis live to old age, but it is necessary to follow a special diet, give up bad habits and strictly follow all the doctor’s recommendations regarding lifestyle.

In cases where a person has a severe form of paroxysmal arrhythmia with a pronounced clinical picture, the prognosis cannot be called satisfactory. Prolonged attacks can lead to thromboembolism, pulmonary edema, myocardial infarction and stroke.

What is an ischemic attack?

A TIA (transient ischemic attack) is an acute but short-term episode of neurological dysfunction caused by damage to the blood supply to one part of the brain.

If we talk about the concept of ischemia in general, then it is a violation of blood flow in a certain part of the body or in the entire organ. This pathology can suddenly occur in the intestines, cartilaginous and bone structures, but the most severe cases occur in the heart and brain.

TIA is popularly called a microstroke due to the similarity of symptoms, but this is not entirely true. The average duration of an ischemic attack is 12 minutes, and if the symptoms do not go away within 24 hours, then this is another diagnosis - ischemic stroke. The difference between them is well described in various medical literature. An ischemic attack has obvious symptoms.

It is most correct to call a transient ischemic attack a harbinger of an acute stroke, which can occur very soon, within a couple of months.

Classification of TIA - frequency, severity, ICD-10

Based on how mild or severe the disease is, the following types are distinguished:

mild form of TIA (after 10 minutes the patient feels as usual);
a form of moderate severity (the manifestations of TIA do not go away for several hours);
severe form of TIA (signs persist for a day).

Based on the frequency of TIA, the following types are distinguished:

rare (no more than 2 times a year);
average frequency (every 2 months);
frequent (more than once a month).

According to ICD-10 (this is an international disease classification system in which each type of disease is assigned a code), TIA has the following classification:

G 45.0 - vertebrobasilar arterial system syndrome.
G 45.4 - TGA syndrome. This syndrome, by the way, is considered by many researchers to be part of epileptic disorders and is not classified as ischemia.
G 45.1 - carotid artery syndrome (in the carotid region).
G 45.2 - multiple and bilateral arterial syndromes.
G 45.3 - transient blindness syndrome.
G 459 - unspecified TIA.
G 45.8 - other TIAs pass under this code.

Symptoms of the disease

The manifestations of an ischemic attack will depend on the area in which artery the violation occurred. General symptoms are:

weakness, paralysis of the face or limbs, usually on one side of the body;
distorted slurred speech;
blindness in one or both eyes, double vision;
dizziness;
difficulty swallowing;
tinnitus and sharp deterioration hearing

Symptoms by type of TIA

If there is a violation of the passage of a vessel in the carotid artery basin (TIA in the carotid basin), then this will result in the following manifestations:

lack or decreased ability to control the limbs (usually on one side);
slurred speech, lack of understanding of spoken speech (dysarthria and aphasia);
impaired fine motor skills;
severe visual impairment;
constant desire to sleep;
confusion.

TIA in the vertebral artery system (in the vertebrobasilar region) manifests itself in the following:

vomit;
dizziness;
lack of coordination;
hemianopsia, photopsia;
double vision;
facial paralysis

Transient monocular blindness is characterized by a feeling as if there is a curtain in front of the eyes, covering one eye. a short time. This form of TIA can occur suddenly, or can be caused by bright light, a too hot bath or bath, or a sharp turn. In addition, coordination and motor skills may be impaired.

Transient global amnesia is another type of TIA. She has only one symptom: loss of memory for recent events. Moreover, the patient remembers what happened a long time ago. In this case, the person is confused, repeats the same questions, disoriented in time and space.

Causes of TIA

Blood clots are the most common culprit of transient ischemic attack. Blood clots can form as a result of previous atherosclerosis or heart disease. vascular system(myocardial infarction, atrial fibrillation, atrial myxoma). A blood clot can block blood flow to part of the brain. Brain cells are affected within seconds of blockage. This causes symptoms in the parts of the body controlled by these cells. After this, blood flow returns and the symptoms disappear.

Impairment of blood flow can occur in one of the vascular pools, which in human body there are two types:

vertebrobasilar;
carotid.

The first one is between vertebral arteries. It supplies blood to brain stem. The second is located between the two carotid arteries. It supplies blood to the hemispheres of the brain.

Sometimes a TIA is caused by a sudden drop in blood pressure, which reduces blood flow to the brain.

Well, and the undoubted “companions” of any vascular pathology, which sharply increase the chances of a transient ischemic attack:

smoking;
high cholesterol;
excessive alcohol consumption;
diabetes;
overweight.

Diagnosis of TIA

TIA is insidious in that it lasts several minutes, and when the ambulance arrives, the patient, as a rule, refuses hospitalization, since all the symptoms have passed. But you must definitely go to the hospital, as an ischemic attack may recur.

The following tests are considered on an emergency basis:

biochemical blood test to determine glucose and cholesterol levels;
complete blood count;
analysis of the level of electrolytes in the blood serum (iron, calcium, potassium, sodium, magnesium, chlorine, phosphorus);
coagulation studies, or coagulogram;

The following tests are useful and can often be performed urgently:

erythrocyte sedimentation rate;
cardiac enzymes - proteins that are released into the blood when the heart malfunctions;
lipid profile, or lipidogram, is a special blood test that reflects the level of concentration of fats and lipoproteins.

Additional lab tests, ordered as needed (based on medical history), include the following:

screening for hypercoagulable conditions (especially in young patients without known vascular factors risk);
serological reaction to syphilis;
analysis for the presence of antiphospholipid antibodies;
hemoglobin electrophoresis;
serum protein electrophoresis;
examination of cerebrospinal fluid.

The following examinations must be carried out within 24 hours:

Magnetic resonance imaging (MRI), modern, but already very well studied and widely used safe way radiology diagnostics.
Low contrast CT scan- this is one of the types of CT scans, but done without intravenous infusion radiopaque substances.
Carotid Dopplerography of the neck, also called duplex scanning or ultrasonography, is a precise, completely painless and harmless procedure that examines the shape of blood vessels.
CT angiography (CTA) - this use of computed tomography gives good visibility of blood vessels and blood flow features.
Magnetic resonance angiography (MRA) is a type of MRI to obtain images of the lumen of blood vessels for the presence of plaques.
USDG ( Doppler ultrasound), today this is one of the safest methods that provides maximum information about the state of the vascular system.
To check your heart shape and its blood flow, an echocardiogram is an ultrasound technique that examines the heart and heart valves.
PET brain scan stands for positron emission tomography. This is the latest diagnostic method used to assess not the structure of brain tissue, as magnetic resonance and computed tomography does, but the functional functioning of the brain.

Various types of treatment for the disease

Many doctors agree that it is not TIA that needs to be treated, but the main culprit - atherosclerosis. The disease must be treated with medication, sometimes surgery.

It is also necessary to change your lifestyle in favor of a healthy one.

Drug treatment, i.e. Treatment with drugs should be started urgently and include taking the following groups of drugs:

medications that lower the level of “bad” cholesterol (Caduet, Mevacor);
nootropics and neuroprotectors (Baclofen, Pronoran, Cinnarizine, Pantogam);
blood thinning medications (Curantil, Trental);
drugs that reduce arterial pressure(Enalapril, Micardis, Valsacor);
antioxidants (Mexidol);
metabolites (Cytoflavin);
sedatives (Pipolfen, Validol, Proroksan);
sleeping pills (Melaxen, Donormil);
drugs to lower sugar (Maninil, Siofor).

After completing a comprehensive course of treatment, the patient must be under the supervision of a local doctor.

Surgery may be warranted if a person has a narrowing of the carotid artery, which is located in the neck. When medications don't help, your doctor may recommend a procedure called a carotid endarterectomy. What this operation is can be described quite simply. This intervention is the process of clearing the carotid arteries of fatty deposits and plaques. In this way, blood flow is restored, and the risk of a recurrence of an ischemic attack is significantly reduced. This operation is very effective, but also has risks: stroke and re-blockage of the carotid artery, bleeding, infections.

Surgical treatment of ischemic stroke cannot be prescribed to everyone.

There are quite a lot of contraindications for its implementation, including hypertension, acute heart failure, Alzheimer's disease, oncology late stages, recent myocardial infarction.

Disease prevention

How can you prevent TIA? If you look for data on the topic “ischemic attack treatment”, then almost every medical manual talks about the necessary prevention of ischemic stroke. It is imperative to take precautions to prevent TIAs. If you have already been the victim of an ischemic attack, then you are doubly at risk of having a stroke.

You can do the following to prevent a transient ischemic attack:

avoid active and passive smoking;
follow the principles proper nutrition: vegetables and fruits with a minimum of unhealthy fatty foods;
engage in physical activity;
limit or eliminate alcohol consumption;
limit your salt intake;
control your sugar levels;
control blood pressure;
eliminate stressful situations.

Consequences of ischemic attack

The prognosis here is quite unfavorable. Usually, more than 2-3 ischemic attacks do not occur, then a severe stroke necessarily occurs, which can lead to disability or even death. 10% of those who experience an ischemic attack during the first or second day receive a blow in the form of a cerebral stroke or myocardial infarction. Unfortunately, a huge number of people after suffering an ischemic stroke do not turn to doctors, which makes the prognosis for recovery sharply negative and subsequently leads to serious problems.

A TIA is not life-threatening, but it is a warning sign of a more serious problem. If this pathology is not treated, then in the near future a powerful ischemic attack of the brain may occur again.

Paroxysmal atrial fibrillation or PMA, paroxysmal atrial fibrillation (ICD-10 code: I48) is a common disorder of atrial contraction. It is a condition in which the heart rhythm remains correct, and the heart rate (HR) fluctuates between 120-240 beats/min. The problem is quite common and is often a manifestation of other types of pathologies.

Features of the condition

PMA attacks usually begin suddenly and also stop suddenly; their duration can last from a couple of minutes to several days.

More often, older people (60 years or more) are affected by this disease - more than 6% of the population.
The number of patients with PMA who have not reached their 60th birthday is less than 1%.

Typically, PMA is not easily tolerated due to high heart rate, because the “engine” has to work under increased load. If the pathology takes on a permanent form, then there is a possibility of appearance in the atria, as well. People with this type of arrhythmia are 5 percent more likely to have an ischemic stroke.

Is the group indicated for paroxysmal atrial fibrillation? Disability is not given for PMA alone, but it is prescribed for the development of certain diseases associated with arrhythmia.

Electrocardiogram for paroxysmal atrial fibrillation

Forms

It is customary to distinguish three forms of violation:

ventricular In this case, there is a pronounced deformation of the QRST, there are frequent cases of changes in the contour of the isoelectric line, and heart rhythm disturbances are possible;
atrial. Patients have a conduction disorder of the Hiss bundle branch (right);
mixed. Has manifestations of the previous two forms.

If the cause of PMA has not been established, then we are dealing with its idiopathic form, which is more common in young people.

A well-known specialist will talk about the features of the paroxysmal form of atrial fibrillation in the video below:

Classification

Based on the frequency of atrial contractions, the following types of PMA can be distinguished:

direct flickering, when the heart rate is more than 300 per minute;
fluttering, in which the heart rate does not exceed the “200” mark.

Depending on the frequency of ventricular contraction, experts distinguish the following forms:

tachysystolic. The ventricles contract at a frequency of more than 90 per minute;
Bradysystolic. The reductions are less than 60;
normosystolic (intermediate).

If attacks of PMA are repeated, this indicates the presence of a recurrent form.

The paroxysmal form of atrial fibrillation also has its own causes, which we will discuss later.

Causes

One of the main reasons for the appearance of PMA is considered to be the presence of diseases of the cardiovascular system (CVS) in the patient, namely:

heart failure;
heart defects, both and (especially often) which are accompanied by expansion of the chambers;
essential hypertension with an increase in the mass of the heart muscle (myocardium);
inflammatory heart diseases, such as, and;
and/or ;
, and .

The following can also cause the development of PMA:

lack of potassium and magnesium in the body due to electrolyte disturbances;
endocrine system disorders (eg thyrotoxicosis);
diabetes;
heavy infectious diseases;
pathologies of the lungs with compensatory changes in the structure of the heart;
postoperative condition.

In addition to diseases, the development of PMA is also affected by:

taking cardiac glycosides, adrenergic agonists;
nervous exhaustion;
frequent stress.

The next section will tell you about the symptoms of the paroxysmal form of atrial fibrillation (atrial fibrillation).

Symptoms

The symptoms of the disease vary from case to case. Thus, some patients experience only discomfort in the area of the heart. But for most people the symptoms are as follows:

sudden attack of heartbeat;
severe general weakness;
lack of air;
coldness of the upper and lower extremities;
sweating;
sometimes trembling.

You may also experience pale skin and blue lips (cyanosis).

If we are talking about severe case, then the following may occur:

dizziness;
loss of consciousness or fainting state;
panic attacks or similar less drastic conditions, because a person’s condition sharply and severely deteriorates, which can cause him great fear for his life.

But you shouldn’t immediately panic, such symptoms are typical for many ailments, and without an ECG, the doctor will not be able to determine their exact cause.

At the end of an attack of PMA, the patient usually experiences increased intestinal motility and copious urination. When there is a decrease in heart rate below a critical level, the patient may experience a severe deterioration in blood supply to the brain. This can manifest itself in the form of loss of consciousness, and sometimes cessation of breathing; the pulse cannot be determined. In this case, urgent resuscitation is required.

Diagnostics

As already mentioned, the first and main diagnostic method is electrocardiography. Signs of paroxysmal atrial fibrillation on the ECG will be the absence of the P wave in all leads, instead chaotic f waves are observed. The R-R intervals will vary in duration.

With ventricular PMA, an ST shift remains for several days after an attack. and negative wave T. And, since there is a high probability of small-focal occurrence, monitoring the patient over time is simply necessary.
If an atrial form of ACA is observed, then the electrocardiogram will indicate a noticeable deformation of the R wave.

Also for the diagnosis of PMA can be used:

Holter monitoring.
An exercise test on an electrocardiogram will help reveal the true heart rate.
The doctor should also listen to the patient's heart using a stethoscope.
The patient may be prescribed an ultrasound examination of the heart (ECHO-CG), with the help of which the size of the atria and the condition of the valve apparatus are determined.
Transesophageal ultrasound of the heart, which is rarely performed due to the lack of special equipment, will help doctors more accurately determine the presence/absence of blood clots in the atrial cavity.

The next section will tell you what treatment the paroxysmal form of atrial fibrillation (atrial fibrillation) requires.

Treatment

Treatment of PMA depends, first of all, on the timing of the attack.

If it is less than 2 days old (48 hours), doctors do everything possible to restore sinus rhythm.
If more than 48 hours have passed, complications of an embolic nature are too likely. Therefore, doctors direct treatment to control heart rate, through, for example, anticoagulants (warfarin), which prevent the formation of blood clots by thinning the blood. After three weeks, the specialist returns to the issue of restoring the rhythm.

Therapeutic and medicinal

Most often, medications such as:

digoxin, helps control heart rate;
cordarone, characterized by the presence of a minimal amount side effects from its use;
procainamide, which, when administered rapidly, sometimes causes a sharp decrease in blood pressure.

These medications are given intravenously in a hospital setting or by emergency physicians. Typically this treatment is effective in 95% of cases.

During attacks of paroxysmal atrial fibrillation, the doctor may prescribe the patient to take propanorm, which is in tablet form and can therefore be used by the patient independently.

Electropulse therapy

If the previous method is ineffective, the doctor may prescribe electropulse therapy (electric discharge).

The procedure is as follows:

The patient is put under anesthesia;
Two electrodes are installed under the right collarbone and near the top of the “motor”;
The specialist sets the synchronization mode on the device so that the discharge corresponds to the contraction of the ventricles;
Sets the required current value (100-360 J);
Produces an electrical discharge.

In this way, the conduction system of the heart is rebooted, and the effectiveness of the method is almost 100 percent.

Operation

Surgical intervention is indicated for people with frequent relapses of PMA and consists of cauterizing foci of pathological excitation of the heart muscle with a laser. To carry out treatment, a puncture is made in the artery using special catheters.

Read on to find out whether the paroxysmal form of atrial fibrillation (atrial fibrillation) can be treated with folk remedies.

About in a unique way The video below will tell you about the surgical treatment of paroxysmal atrial fibrillation:

Folk remedies

First of all, consult your doctor before taking any folk remedy. These could be:

Hawthorn and his alcohol tinctures with motherwort and valerian. Mix 3 bottles of each product in one bowl, shake well, and place in the refrigerator for a day. After a day, start taking 30 minutes before meals, 1 teaspoon three times a day.
Lemon. Cut 0.5 kg of fruit, pour honey, add 20 apricot kernels to the mixture. Use 2 times a day (morning and evening) 1 tablespoon.
Adonis grass. Boil 0.25 liters of water in an enamel bowl. Reduce heat to low, add 4 grams. herbs, boil the mixture for 3 minutes. Cover the finished drink with a lid and leave for at least 20 minutes in a warm place. Take a tablespoon three times a day.

Emergency care for paroxysmal atrial fibrillation

As such, the doctor can:

administer medications:

ajmaline (gilurythmal);
procainamide;
rhythmylene.

It is not advisable to use these drugs when pronounced violations hemodynamics, so as not to aggravate the condition. Therefore, electropulse therapy can be used, as well as intravenous administration digoxin.

An attack of PMA can be relieved on your own:

Squeeze your abdominals;
Hold your breath;
Press on eyeballs.

If this technique does not help, call an ambulance immediately.

Disease prevention

First of all, it is necessary to prevent such heart ailments as heart failure and arterial hypertension. In addition to this you need:

reduce (or better yet eliminate) the consumption of alcoholic beverages;
exclude serious physical exercise, it is better to replace them with leisurely walks in the park;
Eliminate fatty and spicy foods from your diet, give preference to foods rich in magnesium and potassium.
As preventive measures The following medications may also be prescribed:
sulfate,
asparaginate (pr. "Panangin").

Complications

As already mentioned, the most frequent sight complications of PMA are the development of heart failure, as well as the appearance of blood clots (eg thromboembolism). Such ailments can cause and lead to cardiac arrest, and with it death. PMA is especially dangerous for diabetics and patients suffering from high blood pressure.

Read about the prognosis for the medical history of “atrial fibrillation, paroxysmal atrial fibrillation” at the end of the article.

Forecast

In general, the prognosis cannot be called negative, especially if an attack of PMA has not provoked more serious diseases. With proper treatment, a person can usually live more than 10 years (sometimes 20).

The incidence of ischemic stroke in people with PMA is about 5% per year, that is, every 6th stroke occurs in patients with atrial fibrillation.

The following video will tell you about another very unusual method of treating atrial fibrillation:

Arrhythmia is a condition in which the frequency, strength and sequence of heart contraction changes. In the International Classification of Diseases, 10th revision (ICD-10), arrhythmia is assigned class 149 - Other cardiac arrhythmias. According to ICD-10, we can distinguish:

Ventricular fibrillation and flutter - 149.0 (ICD-10 code).
Premature atrial depolarization - 149.1.
Premature depolarization emanating from the atrioventricular junction - 149.2.
Premature ventricular depolarization - 149.3.
Other and unspecified premature depolarization - 149.4.
Sick sinus syndrome (bradycardia, tachycardia) - 149.5.
Other specified heart rhythm disturbances (ectopic, nodular, coronary sinus) - 149.8.
Unspecified rhythm disturbance - 149.9.

This ICD-10 class excludes unspecified bradycardia (code R00.1), arrhythmia in newborns (P29.1), as well as arrhythmia complicating pregnancy, abortion (O00-O07) and obstetric operations (O75.4).

In most cases, arrhythmia involves an abnormal heart rhythm even when the heart rate is normal. Bradyarrhythmia is an abnormal rhythm accompanied by a slow heart rate not exceeding 60 beats per minute. If the contraction frequency exceeds 100 beats per minute, then we are talking about tachyarrhythmia.

Types of arrhythmia and reasons for their development

To find out the causes of rhythm disturbances, it is necessary to understand the nature of the normal rhythm of the heart. The latter is provided by a conducting system consisting of a system of successive nodes formed from highly functional cells. These cells provide the ability to create electrical impulses passing along each fiber and bundle of the heart muscle. Such impulses ensure its reduction. The sinus node, located in the upper part of the right atrium, is responsible for the generation of impulses to a greater extent. Heart contraction occurs in several stages:

Impulses from the sinus node spread to the atria and the atrioventricular node.
At the atrioventricular node, the impulse slows down, allowing the atria to contract and pump blood into the ventricles.
Next, the impulse passes through the branches of the His bundle: the right one conducts impulses passing through the Purkinje fibers to the right ventricle, the left one - to the left ventricle. As a result, the mechanism of excitation and contraction of the ventricles is triggered.

If all structures of the heart function smoothly, the rhythm will be normal. Rhythm disturbances occur due to pathology of one of the components of the conduction system or due to problems with the conduction of impulses along the muscle fibers of the heart.

There are the following types of arrhythmia:

Extrasystoles are premature contractions of the heart, the impulse in which does not come from the sinus node.
Atrial fibrillation, or atrial fibrillation, is a heart rhythm disturbance caused by disordered excitation and contraction of atrial fibers.
Sinus arrhythmia is caused by an abnormal sinus rhythm, accompanied by alternating deceleration and acceleration.
Atrial flutter is an increase in the frequency of atrial contractions up to 400 beats per minute, combined with their regular rhythm.
Supraventricular tachycardia forms within a small area of atrium tissue. Atrial conduction disturbance is observed.
Ventricular tachycardia is an acceleration of the heart rate coming from the ventricles, due to which they do not have time to fill with blood normally.
Ventricular fibrillation is a chaotic flutter of the ventricles, provoked by a flow of impulses from them. This condition makes it impossible for the ventricles to contract and, accordingly, further pumping blood. This is the most dangerous look rhythm disturbances, so a person falls into a state within a few minutes clinical death.
Sinus node dysfunction syndrome is a violation of the formation of an impulse in the sinus node and its transition to the atria. This type of arrhythmia can provoke cardiac arrest.
The blockade occurs against the background of a slowdown in the conduction of the impulse or its cessation. They can manifest themselves in both the ventricles and atria.

The causes of arrhythmia include:

Organic organ damage: congenital or acquired defects, myocardial infarction, etc.
Violation water-salt balance, which occurred due to intoxication or loss of potassium (magnesium, sodium) by the body.
Thyroid diseases: due to increased thyroid function, the synthesis of hormones increases. It increases metabolism in the body, which increases heart rate. When the thyroid gland produces insufficient hormones, the rhythm weakens.
Diabetes mellitus increases the risk of developing cardiac ischemia. With a sharp drop in sugar levels, the rhythm of its contractions is disrupted.
Hypertension provokes thickening of the wall of the left ventricle, thereby reducing its conductivity.
Consumption of caffeine, nicotine and narcotic substances.

Symptoms

Each type of rhythm disorder is characterized by certain symptoms. During extrasystoles, a person practically does not feel any discomfort. Sometimes a strong shock may be felt coming from the heart.

With atrial fibrillation, symptoms such as chest pain, shortness of breath, weakness, darkening of the eyes and characteristic bubbling in the heart area are observed. Atrial fibrillation can manifest itself in the form of attacks that last several minutes, hours, days, or be constant.

Symptoms of sinus arrhythmia are as follows: increased (slow) pulse, extremely rarely, pain in the left side of the chest, fainting, darkening of the eyes, shortness of breath.

With atrial flutter, blood pressure rapidly drops, the heart rate increases, and dizziness and weakness are felt. There is also an increase in pulse in the neck veins.

As for supraventricular tachycardia, some people who have a similar heart rhythm disorder do not feel any symptoms at all. However, most often such arrhythmia is manifested by increased heart rate, shallow breathing, profuse sweating, pressure in the left side of the chest, throat spasm, frequent urination and dizziness.

When unstable ventricular tachycardia Symptoms such as palpitations, dizziness, and fainting are observed. With persistent arrhythmia of this type, there is a weakening of the pulse in the neck veins, impaired consciousness, and an increase in heart rate up to 200 beats per minute.

Ventricular fibrillation is characterized by cessation of blood circulation with all the ensuing consequences. The patient immediately loses consciousness, he also experiences severe convulsions, absence of pulse in large arteries and involuntary urination (defecation). The victim's pupils do not react to light. If resuscitation measures are not implemented within 10 minutes after the onset of clinical death, death occurs.

Sinus node dysfunction syndrome is manifested by cerebral and cardiac symptoms. The first group includes:

fatigue, emotional instability, amnesia;
feeling of cardiac arrest;
noise in ears;
episodes of loss of consciousness;
hypotension.

Cardiac symptoms:

slow heart rate;
pain in the left side of the chest;
increased heart rate.

A dysfunction of the sinus node may also be indicated by a disorder of the gastrointestinal tract, muscle weakness, or insufficient amount of urine excreted.

Symptoms of heart block include a decrease in heart rate to 40 beats per minute, fainting, and convulsions. Possible development of heart failure and angina pectoris. The blockage can also cause the death of the patient.

Signs of arrhythmia cannot be ignored. Rhythm disturbances significantly increase the risk of developing such serious illnesses, such as thrombosis, ischemic stroke and congestive heart failure. Selection adequate therapy impossible without preliminary diagnosis.

Diagnostics

First of all, the cardiologist examines the complaints of a patient who suspects a heart rhythm disorder. The following diagnostic procedures are indicated for the subject:

Electrocardiography allows you to study the intervals and duration of the phases of heart contraction.
Daily monitoring of electrocardiography according to Holter: a portable heart rate recorder is installed on the patient’s chest, which records rhythm disturbances throughout the day.
Echocardiography allows you to study images of the chambers of the heart, as well as evaluate the movement of the walls and valves.
Exercise testing makes it possible to evaluate rhythm disturbances during physical activity. The subject is asked to exercise on an exercise bike or treadmill. At this time, the heart rhythm is monitored using an electrocardiograph. If physical activity is contraindicated for the patient, it is replaced with medications that stimulate the heart.
Tilt table test: performed when there are frequent episodes of loss of consciousness. The person is fixed on a table in a horizontal position, and the pulse and blood pressure of the subject are measured. The table is then moved to a vertical position, and the doctor re-measures the patient's pulse and blood pressure.
Electrophysiological study: electrodes are inserted into the heart cavity, thanks to which it is possible to study the conductivity of the impulse through the heart, thereby determining the arrhythmia and its nature.

Treatment

This type of heart rhythm disorder, such as ventricular fibrillation, can cause instant death. In this case, the patient is advised to undergo immediate hospitalization. intensive care unit. A person is given an indirect cardiac massage. Connection to a ventilator is also shown. Ventricular defibrillation is performed until the rhythm disturbances are eliminated. After the rhythm is restored, it is shown symptomatic therapy, aimed at normalizing the acid-base balance and preventing a recurrent attack.

If disturbances in the rhythm of heart contractions do not threaten a person’s life, we can limit ourselves to drug therapy combined with in a healthy way life. Heart rhythm disturbances are corrected with antiarrhythmic drugs: Ritmonorm, Etatsizin, Quinidine, Novocainamide. For any cardiac arrhythmia, medication is indicated to prevent the formation of blood clots. These include Aspirin Cardio and Clopidogrel.

It is also worth paying attention to strengthening the heart muscle. For this purpose, the doctor prescribes Mildronate and Riboxin. The patient may be prescribed blockers calcium channels(Finoptin, Adalat, Diazem) and diuretics (Furosemide, Veroshpiron). Correctly selected drugs can stop the progression of arrhythmia and improve the patient’s well-being.

If heart rhythm disturbances provoke heart failure and threaten serious consequences for a person’s life, including death, the decision is made in favor of surgical treatment. For arrhythmia, the following types of operations are performed:

Implantation of a cardioverter-defibrillator: implantation of an automatic device into the heart that helps normalize the rhythm.
Electropulse therapy: delivering an electrical discharge to the heart to normalize the rhythm. The electrode is inserted through a vein into the heart or esophagus. External use of the electrode is also possible.
Catheter destruction: an operation that involves eliminating the source of arrhythmia.

Lifestyle

People who have heart rhythm disturbances must follow all recommendations of their cardiologist. Controlling body weight, limiting the consumption of salty, fatty and smoked foods, moderate physical activity and quitting smoking and alcohol will help enhance the effectiveness of treatment. It is also important to monitor your blood pressure daily. Patients with arrhythmia should be regularly examined by a cardiologist and have an electrocardiogram performed at least once a year. All medications must be taken in consultation with your doctor.

Atrial fibrillation is a disorder of normal heart rhythm, which is characterized by rapid, erratic excitation and contraction of the myocardium. I 49.0 – according to ICD 10, the code for atrial fibrillation, which belongs to class IX “Diseases of the circulatory system”.

Consequences of arrhythmia

Normally, healthy person With each contraction of the heart, the atria must first contract, and then the ventricles. Only in this way is it possible to adequately ensure hemodynamics. If this rhythm is disturbed, arrhythmic and asynchronous contraction of the atria occurs, and the functioning of the ventricles is disrupted. Such fibrillations lead to exhaustion of the heart muscle, which can no longer work effectively. Restrictive and then dilated cardiomyopathy may develop.

Heart rhythm disturbances in ICD 10 are coded as follows:

I 49.0 – “Ventricular fibrillation and flutter”;
I 49.1 – “Premature contraction of the ventricles”;
I 49.2 – “Premature depolarization emanating from the junction”;
I 49.3 – “Premature atrial depolarization”;
I 49.4 – “Other, unspecified premature reductions”;
I 49.5 – “Sick sinus syndrome”;
I 49.7 – “Other specified heart rhythm disturbances”;
I 49.8 – “Heart rhythm disturbances, unspecified.”

In accordance with established diagnosis, the required code is indicated on the title page of the medical history. This encryption is the official and uniform standard for all medical institutions, it is used in the future to obtain statistical data on the prevalence of mortality and morbidity from specific nosological units, which has prognostic and practical significance.

Reasons for the development of rhythm pathology

Atrial fibrillation may occur due to various reasons, however the most common are:

congenital and acquired heart defects;
infectious myocarditis (bacterial, viral, fungal heart disease);
IHD atrial fibrillation (usually as a serious complication acute heart attack myocardium);
hyperproduction of thyroid hormones - thyroxine and triiodothyronine, which have an inotropic effect;
use large quantity alcohol;
as a consequence surgical interventions or conducting invasive research methods (for example, with fibrogastroduodenoscopy);
arrhythmias after strokes;
when exposed to acute or chronic stress;
in the presence of dysmetabolic syndrome - obesity, arterial hypertension, diabetes mellitus, dyslipidemia.

Attacks of arrhythmia are usually accompanied by a feeling of interruptions in the heart and an arrhythmic pulse. Although often a person may not feel anything, in such cases the diagnosis of pathology will be based on ECG data.

Consequences of arrhythmia

Atrial fibrillation in ICD 10 is quite common and has a poor prognosis, subject to inadequate monitoring and treatment. The disease can be complicated by the formation of blood clots and the development of chronic heart failure.

Arrhythmia is especially dangerous in coronary heart disease, arterial hypertension and diabetes mellitus– in these cases, thromboembolism can lead to cardiac arrest, heart attack or stroke.

Heart failure can develop quite quickly and manifest itself as hypertrophy of the myocardial walls, which will aggravate existing ischemia. Arrhythmia in ICD 10 is a common complication of acute myocardial infarction, which can be a direct cause of death. The above facts indicate the seriousness of the disease and show the need for constant and correct therapy. Various types of treatment are used antiarrhythmic drugs, potassium-containing drugs, antihypertensive drugs. Great value is given to taking anticoagulants and antiplatelet agents. Warfarin and acetylsalicylic acid are used for these purposes - they prevent the development of blood clots and change the rheology of the blood. It is very important to install primary cause development of atrial fibrillation and block its action in order to prevent all kinds of complications.

mkbkody.ru

Atrial fibrillation - code according to ICD-10

Irregular heart rhythm or arrhythmia is the most common disease. What it is? An abnormal heart rhythm indicates a change in the normal sequence of heart contractions, namely a disorder of the functions of contractility, conduction and excitability. The pathology complicates the course of many heart diseases.

Classification of arrhythmia

Arrhythmias according to the International Classification of Diseases (ICD) 10 are assigned code 149. This pathology develops due to existing organic lesions of the myocardium, impaired water-salt balance or intoxication of the body. Depending on the cause of occurrence, the mechanism of development, the manifestation of the clinical picture, prognosis and method of treatment, the ICD 10 code varies.

Normally, in a healthy person, with each contraction of the heart, the atria should first contract, and then the ventricles

Heart rhythm disturbances are accompanied by changes in heart rate. The rhythm is irregular. The following types are distinguished from the cause that caused changes in the functioning of the heart:

automaticity;
conductivity;
excitability.

Below is a table that shows the forms of arrhythmia.

Table of arrhythmia forms

The ICD code for cardiac arrhythmia is divided depending on the type of arrhythmia. IN medical practice distinguish:

bradycardia;
tachycardia;
heart block.

Bradycardia is a decrease in heart rate. Bradycardia has a code according to ICD 10 - 149.8. It is characterized by a heart rate of less than 60 beats/min. Tachycardia – increased heart rate (more than 90 beats/min.). Increased heart rate ICD 10 is indicated under code 147.1. Heart block develops as a result of aging of the heart muscle. It represents a complete stop of the passage of excitation impulses. Heart block is assigned code 145 according to ICD 10.

Atrial fibrillation, what is it?

Atrial fibrillation (AF) is a violation of the rhythm of heart contractions, which is accompanied by frequent and sudden excitation (250–650 beats/min) throughout the entire cycle. With MA, the effect of “flickering” of tissues is created. In medical practice, this pathology is called atrial fibrillation. Arrhythmia code according to ICD 10 – 148. Atrial fibrillation most often develops in people over 50 years of age.

Such fibrillations lead to exhaustion of the heart muscle, which can no longer work effectively.

The prerequisites for the development of MA are:

age;
organic diseases;
chronic diseases;
alcohol abuse.

At a young age, atrial fibrillation develops against the background birth defects valve apparatus, high blood pressure, coronary disease, cardiosclerosis. TO causal factors also include:

thyroid diseases;
poisoning with chemicals or drugs;
stress;
diabetes;
obesity.

MA can be recognized by rapid heartbeat, heart pain, shortness of breath, increased sweating, increased urination, dizziness and inexplicable feeling panic and fear. Without treatment, atrial fibrillation begins to progress. Attacks become frequent and prolonged. This can lead to heart failure, thromboembolism and complete cardiac arrest.

Attacks of arrhythmia are usually accompanied by a feeling of interruptions in the heart and an arrhythmic pulse

To reduce heart rate, doctors prescribe beta blockers. To prevent the development of a stroke, anticoagulants are prescribed. At severe course diseases is carried out surgical treatment. There are two methods:

Catheter ablation.
Pacemaker implantation.

Sinus arrhythmia

Sinus arrhythmia (SA) is a violation of the rhythm of the heartbeat and the frequency of its contractions. In SA, contractions occur at different intervals. The reason may be:

myocardial infarction;
heart failure;
heart defects;
myocarditis;
drug overdose.

Sinus arrhythmia can develop against the background vegetative-vascular dystonia, with hypothermia, thyroid dysfunction, hormonal imbalance, anemia, increased stress and during pregnancy. Depending on the heart rate, symptoms may vary. With increased frequency, pain is observed in chest, pulsation in the temples and a feeling of lack of air. With slow heart contractions, patients complain of weakness, drowsiness, and dizziness.

Treatment is prescribed by a cardiologist depending on the individual characteristics of the body. The patient is prescribed Novopassit, motherwort tincture, and Corvalol. In severe cases, therapy is carried out with tranquilizers and antipsychotics.

Heart failure can develop quite quickly and manifest itself as hypertrophy of the myocardial walls, which will aggravate existing ischemia

Paroxysmal arrhythmia

With paroxysmal atrial fibrillation (PAF), an attack of rapid heart rate with a regular rhythm and a frequency of 120–140 beats/min is observed. Paroxysmal atrial fibrillation is characterized by a sudden nature. In medicine, there are 3 forms of it:

Ventricular It is characterized by a clear deformation of the QRST complex, an altered isoelectric line, and an abnormal heart rhythm.
Atrial. Recognized by the deformation of the R wave and impaired conduction of the right branch of the Hiss bundle.
Mixed.

The prerequisites for PMA are:

rheumatic heart disease;
sepsis;
thyrotoxicosis;
pneumonia;
diphtheria;
the effect of diuretics taken.

The attack begins suddenly and is often accompanied by noise in the head, dizziness and chest pain. Sometimes it may be accompanied by nausea, sweating, and flatulence. If the patient is not provided with timely emergency assistance, Blood pressure may drop and the person will lose consciousness. As a result of prolonged paroxysm, ischemia of the heart muscle and heart failure can develop.

The best remedy for PMA is Propafenone and Propanorm. If tachycardia is severe, it is prescribed surgery as:

destruction additional paths impulse;
radiofrequency ablation;
implantation of an electrical pacemaker.

sosudoff.ru

ICD code 10 arrhythmia

Under physiological conditions, the cells of the sinus node have the most pronounced automaticity compared to other cells of the heart, providing a resting heart rate (HR) in the range of 60-100 per minute in a state of wakefulness.

Fluctuations in the frequency of sinus rhythm are caused by reflex changes in the activity of the sympathetic and parasympathetic parts of the autonomic nervous system in accordance with the needs of body tissues, as well as local factors - pH, concentration of K + and Ca 2+. P0 2.

Sinus tachycardia is an increase in heart rate to 100 beats/min or more while maintaining the correct sinus rhythm, which occurs when the automatism of the sinus node increases.

Sinus bradycardia.

Sinus bradycardia is characterized by a decrease in heart rate less than 60 beats/min while maintaining the correct sinus rhythm, which is due to a decrease in the automaticity of the sinus node.

Sinus arrhythmia.

Sinus arrhythmia is a sinus rhythm characterized by periods of acceleration and deceleration, with fluctuations in the P-P interval exceeding 160 ms, or 10%.

Sinus tachycardia and bradycardia may occur with certain conditions in healthy people, and also caused by various extra- and intracardiac reasons. There are three options sinus tachycardia and bradycardia: physiological, pharmacological and pathological.

Sinus arrhythmia is based on changes in the automaticity and conductivity of the cells of the sinus node. There are two forms of sinus arrhythmia - respiratory and non-respiratory. Respiratory sinus arrhythmia caused by physiological reflex fluctuations in the tone of the autonomic nervous system; not related to breathing, it usually develops with heart disease.

Diagnosis of all disorders of sinus node automatism is based on identifying ECG signs.

For physiological sinus tachycardia and bradycardia, as well as for respiratory sinus arrhythmia, no treatment is required. In pathological situations, treatment is aimed primarily at the underlying disease; when inducing these conditions with pharmacological agents, the approach is individual.

Epidemiology of sinus node automatism disorders

The prevalence of sinus tachycardia is high at any age, both in healthy people and in people with various cardiac and non-cardiac diseases.

Sinus bradycardia is common in athletes and well-trained people, as well as in older people and people with various cardiac and non-cardiac diseases.

Respiratory sinus arrhythmia is extremely common in children, adolescents and individuals young; Non-breathing sinus arrhythmia is quite rare.

One for all disorders of sinus node automaticity.

I49.8 Other specified cardiac arrhythmias.

Atrial fibrillation ICD 10

Atrial fibrillation or atrial fibrillation ICD 10 is the most common type of arrhythmia. For example, in the United States, approximately 2.2 million people suffer from it. They often experience ailments such as fatigue, lack of energy, dizziness, shortness of breath and rapid heartbeat.

What is the danger of atrial fibrillation ICD 10?

Many people for a long time live with atrial fibrillation and do not feel much discomfort. However, they do not even suspect that instability of the blood system leads to the formation of a blood clot, which, when it enters the brain, causes a stroke.

In addition, the clot can enter other parts of the body (kidneys, lungs, intestines) and provoke various types of abnormalities.

Atrial fibrillation, ICD code 10 (I48) reduces the heart's ability to pump blood by 25%. In addition, it can lead to heart failure and heart rate fluctuations.

How to detect atrial fibrillation?

For diagnosis, specialists use 4 main methods:

Electrocardiogram.
Holter monitor.
A portable monitor that transmits necessary and vital data about the patient’s condition.
Echocardiography

These devices help doctors know if you have heart problems, how long they last, and what causes them.

There is also a so-called persistent form of atrial fibrillation. you need to know what it means.

Treatment of atrial fibrillation

Specialists select a treatment option based on the examination results, but most often the patient should undergo 4 important stages:

Restore normal heart rhythm.
Stabilize and control heart rate.
Prevent the formation of blood clots.
Reduce the risk of stroke.

CHAPTER 18. DISORDERS OF RHYTHM AND CONDUCTION OF THE HEART

SUPRAVENTRICULAR ARRHYTHMIAS

SUPRAVENTRICULAR EXTRASYSTOLE

SYNONYMS

Supraventricular extrasystole.

DEFINITION

Supraventricular extrasystole is a premature excitation and contraction of the heart relative to the main rhythm (usually sinus), caused by an electrical impulse occurring above the level of the branching of the His bundle (i.e. in the atria, AV node, trunk of the His bundle). Repeated supraventricular extrasystoles are called supraventricular extrasystoles.

ICD-10 CODE

EPIDEMIOLOGY

The frequency of detection of supraventricular extrasystole in healthy people during the day ranges from 43 to 91-100% and increases slightly with age; frequent supraventricular extrasystole (more than 30 per hour) occurs only in 2-5% of healthy people.

PREVENTION

Prevention is mainly secondary and consists of eliminating extra-cardiac causes and treating heart diseases that lead to supraventricular extrasystole.

SCREENING

Active detection of supraventricular extrasystole is carried out in patients with potentially high significance or in the presence of typical complaints using ECG and Holter ECG monitoring throughout the day.

CLASSIFICATION

There is no prognostic classification of supraventricular extrasystole. Supraventricular extrasystole can be classified:

By frequency of occurrence: frequent (more than 30 per hour, i.e. more than 720 per day) and rare (less than 30 per hour);

According to the regularity of occurrence: bigeminy (every 2nd impulse is premature), trigeminy (every 3rd), quadrigeminy (every 4th); in general, these forms of supraventricular extrasystole are called allorhythmia;

According to the number of extrasystoles occurring in a row: paired supraventricular extrasystoles or couplets (two supraventricular extrasystoles in a row), triplets (three supraventricular extrasystoles in a row), while the latter are regarded as episodes of unstable supraventricular tachycardia;

Registration is required to continue.

Spinal osteochondrosis code ICD 10

heal-cardio.ru

Heart rhythm disturbance: code according to ICD 10

To optimize international disease statistics, the World Health Organization created the International Classification of Diseases (ICD). Doctors use the tenth revision of the edition. In the category of cardiovascular pathology, atrial fibrillation is listed under the name “atrial fibrillation and flutter” (ICD code 10 - I 48).

Arrhythmia ICD code: I 44 - I 49 - violation of the speed of heart contractions, their regularity as a result of functional or organic damage specialized conducting myocardiocytes. IN in good condition electrical impulses transmitted from the sinus to the atrioventricular node and to the fibers of the heart muscle through bundles of conducting muscle fibers.

Damage can affect any of these structures and is manifested by characteristic changes in the ECG line and clinical picture. Most often, sinus arrhythmia develops with regular heart contractions (ICD 10 code - I 49.8).

The most common type of arrhythmia is sinus arrhythmia.

What is flicker and flutter

Atrial fibrillation is a disordered contraction of the atria with varying levels of blood filling during diastole. Most of conductive waves, due to their large number, do not extend to the ventricular myocardium.

A circular conduction wave causes atrial flutter with a contraction rate ranging from 0 to 350 per minute. This condition occurs 30 times less frequently than flickering. Waves during flutter can reach the conduction system of the ventricles, causing them to contract in the correct or incorrect rhythm.

Depending on the speed of the heart rate, atrial fibrillation can be bradysystolic (with a slowdown of the rhythm below 60 beats), normosystolic (from 60 to 90 beats per minute) and tachysystolic (over 90 beats).

Reasons for development

Heart rhythm disturbances in the form of atrial fibrillation develop as a result of morphological changes in the myocardial conduction system, with endogenous and exogenous intoxication, and some other diseases. A rare option is idiopathic (causeless) atrial fibrillation, when a visible background for its development has not been established.

Diffuse myocardial sclerosis

Diseases and conditions leading to atrial fibrillation:

Diffuse myocardial sclerosis (atherosclerotic, myocardial, rheumatic).
Focal myocardial sclerosis (post-infarction, myocardial, rheumatic).
Heart valve defects (congenital, acquired).
Myocarditis.
Cardiomyopathies.
Hypertonic disease.
Hyperthyroidism.
Alcohol intoxication.
Diseases with severe disturbances of water-salt balance.
Severe infectious diseases.
Syndrome of premature excitation of ventricles.
Hereditary factors also play a role.

Alcohol intoxication

Classification

By duration:

newly identified - a single attack that occurred for the first time;
paroxysm of atrial fibrillation - lasts up to a week (but more often up to 2 days), restores itself to the correct rhythm;
persistent - atrial fibrillation lasts more than a week;
long-term persistent - lasts more than 12 months, but it is possible to restore the rhythm using cardioversion;
constant - lasts more than 12 months, restoration of sinus rhythm is ineffective or has not been carried out.

According to severity:

Asymptomatic form.
Light form- does not affect the patient’s life activity.
The expressed form is a violation of vital functions.
The severe form is disabling.

There are different types of atrial fibrillation

Clinical picture

With uncontrolled contraction of the atria, their full blood supply does not occur; during diastole, a deficit of blood flow into the ventricles occurs by 20-30%, which leads to a decrease in ventricular shock output. Accordingly, less blood flows to peripheral tissues and blood pressure in them is reduced. Hypoxia develops in structures distant from the heart.

The nature of the pathology:

Insufficient coronary circulation aggravates the work of the heart. Installed " vicious circle": myocardial hypoxia leads to the progression of atrial fibrillation, which, in turn, deepens hypoxia. Characteristic manifestations from the heart: discomfort and squeezing pain in the chest, palpitations, arrhythmic pulse with uneven filling.
Paroxysm of atrial fibrillation leads to oxygen starvation of the brain, which is manifested by dizziness, fainting, a feeling of fear, and sweating.
With insufficient pulmonary blood flow, shortness of breath develops.
Hypoxia peripheral vessels manifested by cold skin of the fingers, acrocyanosis.

Shortness of breath develops when there is insufficient pulmonary blood flow

Complications

Atrial fibrillation disrupts normal blood flow, promoting the formation of wall thrombi in the heart. They are a source of thromboembolism of the arteries of the systemic (less often small) circulation. Most often, blockage of cerebral vessels by thromboembolism occurs with the development of ischemic stroke.

To others dangerous complication atrial fibrillation is a progressive heart failure.

Diagnostics

When collecting anamnesis, patients with constant atrial fibrillation may not have characteristic complaints. The symptoms of the underlying disease come to the fore, and only with an ECG is the form of the arrhythmia determined.

With paroxysmal atrial fibrillation, the patient presents typical complaints. When examining him skin pale, acrocyanosis is observed, the pulse is abnormal on palpation, uneven blood filling, and the heart rhythm is abnormal on auscultation.

The main diagnostic criterion for atrial fibrillation is a typical electrocardiogram curve:

with multiple weak, non-cooperative contractions of the atria, their total electrical potential is not recorded - the P wave is absent;

The main diagnostic criterion for atrial fibrillation is a typical electrocardiogram curve

atrial fibrillation is displayed in the form of small random waves f along the entire length of the ECG line;
ventricular QRS complexes not changed, but irregular;
in the bradysystolic form, QRS complexes are recorded less than 60 per minute;
in the tachysystolic form, QRS complexes are recorded more often than 90 per minute.

When formulating clinical diagnosis Doctors use ICD codes for heart rhythm disorders - the International Classification of Diseases, 10th revision.

Relief of paroxysm of atrial fibrillation must begin immediately: within the first 48 hours, restoration of the rhythm sharply reduces the risk of developing thromboembolic complications. If therapy is started more than late dates, requires the use of anticoagulants for a month under the control of coagulation.

For tachyform, Cordarone tablets are prescribed

Therapy methods:

Reflex methods - pressure on the eyeballs, compression of the carotid artery - are not currently practiced. The only one possible variant- holding your breath while exhaling.
From drug treatment for tachyform, antiarrhythmic drugs are prescribed: Verapamil, Cordarone, Obzidan.
Having established the cause of the rhythm disturbance, the underlying disease is treated.
Complete restoration of heart rhythm is carried out in the hospital. In the absence of contraindications, cardioversion is performed - pharmacological or electrical. Complications of electrical cardioversion can include thromboembolism, sinus arrhythmia, and rarely other types of arrhythmias, including ventricular fibrillation and asystole.

IN for preventive purposes If your heart rhythm is abnormal, ICD code I 44 - I 49, follow the principles of proper nutrition, lead an active lifestyle (recommended by your doctor), give up bad habits, and spend time in the fresh air. If you already have a pathology that is included in the list of causes of atrial fibrillation, do not allow an exacerbation, which will increase the risk of developing a rhythm disorder.

Normally, in a healthy person, with each contraction of the heart, the atria should first contract, and then the ventricles. Only in this way is it possible to adequately ensure hemodynamics. If this rhythm is disturbed, arrhythmic and asynchronous contraction of the atria occurs, and the functioning of the ventricles is disrupted. Such fibrillations lead to exhaustion of the heart muscle, which can no longer work effectively. Restrictive and then dilated cardiomyopathy may develop.

Heart rhythm disturbances in ICD 10 are coded as follows:

I 49.0 – “Ventricular fibrillation and flutter”;
I 49.1 – “Premature contraction of the ventricles”;
I 49.2 – “Premature depolarization emanating from the junction”;
I 49.3 – “Premature atrial depolarization”;
I 49.4 – “Other, unspecified premature reductions”;
I 49.5 – “Sick sinus syndrome”;
I 49.7 – “Other specified heart rhythm disturbances”;
I 49.8 – “Heart rhythm disturbances, unspecified.”

In accordance with the established diagnosis, the necessary code is indicated on the title page of the medical history. This encryption is the official and uniform standard for all medical institutions; it is used in the future to obtain statistical data on the prevalence of mortality and morbidity from specific nosological units, which has prognostic and practical significance.

Reasons for the development of rhythm pathology

Atrial fibrillation can occur for various reasons, but the most common are:

congenital and acquired heart defects;
infectious myocarditis (bacterial, viral, fungal heart disease);
IBS atrial fibrillation (usually as a serious complication of acute myocardial infarction);
hyperproduction of thyroid hormones - thyroxine and triiodothyronine, which have an inotropic effect;
drinking large amounts of alcohol;
as a consequence of surgical interventions or invasive research methods (for example, fibrogastroduodenoscopy);
arrhythmias after strokes;
when exposed to acute or chronic stress;
in the presence of dysmetabolic syndrome - obesity, arterial hypertension, diabetes mellitus, dyslipidemia.

Consequences of arrhythmia

Arrhythmia is especially dangerous in coronary heart disease, arterial hypertension and diabetes mellitus - in these cases, thromboembolism can lead to cardiac arrest, heart attack or stroke.

Heart failure can develop quite quickly and manifest itself as hypertrophy of the myocardial walls, which will aggravate existing ischemia. Arrhythmia in ICD 10 is a common complication of acute myocardial infarction, which can be a direct cause of death.

The above facts indicate the seriousness of the disease and show the need for constant and correct therapy. All kinds of antiarrhythmic drugs, potassium-containing drugs, and antihypertensive drugs are used for treatment. Great importance is given to taking anticoagulants and antiplatelet agents. Warfarin and acetylsalicylic acid are used for these purposes - they prevent the development of blood clots and change the rheology of the blood. It is very important to establish the primary cause of the development of atrial fibrillation and block its action in order to prevent all sorts of complications.