How not to guess the diagnosis? We undergo an ECG if sinus arrhythmia is suspected. Atrial fibrillation on the ECG: description and signs Types of arrhythmias on the ECG

The basis of the body's circulatory system is the cardiac cycle. The heart pumps blood in a complex pattern, which can be described as follows: one cardiac cycle includes atrial contraction, ventricular contraction, and relaxation of the entire heart muscle.

To work in this rhythm, the heart must be controlled by something. This process is led by the pacemakers of the heart - the areas of the heart muscle that generate impulses that trigger the heart rhythm.

The main driver is the sinoatrial node, which is called the first order driver. It is located in the right atrium at the confluence of the superior vena cava in the heart. According to its structure, the sinus-atrial node is a bundle of endings of neurons of the autonomic nervous system.

The impulses that the sinoatrial node generates suppress the impulses of the lower order drivers, which is why, in a normal state, it controls the heart rate.
And only in case of problems in its work, control passes to the atrioventricular node, the bundle of His or Purkin's fibers.

By the name of the first-order driver, the normal heart rhythm was called sinus. Such an inscription can be found on cardiograms of people without heart pathologies.

What does sinus arrhythmia mean?

If sinus rhythm is disturbed, sinus arrhythmia occurs. It differs from other arrhythmias in that the sinoatrial node remains the driver, the correct sequence of contractions and relaxations is maintained, but their rhythm (intervals between contractions) is disrupted.

Sinus arrhythmia is not always a pathology. Often this condition occurs under stress - physical or emotional, and disappears immediately after the cessation of the external factor.

Stages of sinus arrhythmia

The degree of development of sinus rhythm disturbance is moderate and severe.

A moderate form of impairment, in most cases, is not a pathology, but a physiological feature of the organism or its reaction to the influence of external temporary factors.
Often the moderate form develops during puberty in adolescents, in people in old age. This is a consequence of normal changes in the body.
At the same time, consultation with a cardiologist is necessary even with a moderate form of arrhythmia in order to prevent the development of pathological conditions.

Severe sinus arrhythmia can be of three degrees of development: from the mildest first, to the most pronounced and complex third.
The pronounced form of the first degree is in many ways similar to the moderate one and is also often the result of physiological reasons: physical and emotional stress, age characteristics. The course is usually asymptomatic, but any manifestations already require specialist advice.

The second degree of sinus rhythm disturbance is determined by severe symptoms and the presence of diseases that can cause it. Most often, cardiac. Concurrent manifestations of the second degree of a pronounced form:

  • general weakness
  • shortness of breath at rest.

Arrhythmia of the third degree is a manifestation of a complex of provoking pathologies. It is accompanied by many symptoms and requires immediate clinical diagnosis to identify the causes of cardiac dysfunction and eliminate them.

Reasons for development

Violation of sinus rhythm can provoke dozens of reasons. They can be physiological and pathological.

Physiological causes

Sinus arrhythmia is often not a pathology. Normal is when there is a slight difference in heart rate at rest. The margin is about ten percent for almost everyone.

It is difficult to notice such an arrhythmia without an ECG. But this is already a violation of the rhythm of the heart.
In addition to natural arrhythmia, there are physiological reasons for the violation of sinus rhythm:

  • physical exercise,
  • emotional stress,
  • relaxation during sleep,

The disorders caused by these reasons are not pathology. This is a physiological feature of the functioning of life systems.

Pathological causes

Pathological (those associated with health problems) causes of sinus rhythm disturbance are of six subgroups:

  • cardiac,
  • noncardiac,
  • medicinal,
  • poisonous,
  • electrolyte,
  • idiopathic.

Cardiac or cardiac causes are diseases of the cardiovascular system that cause changes in the normal rhythm of the heart. Let's give them and their relationship with the work of the heart, in the table:

Cardiac cause of sinus arrhythmia Impact on sinus rhythm
The death of a part of the heart muscle and its replacement with scar tissue leads to a decrease in the efficiency of the heart, which is why more frequent heart cycles are needed to pump blood.
Against its background, oxygen starvation develops and the blood supply to the heart deteriorates, which disrupts its normal functioning.
Inflammation of the myocardium with disruption of its normal functioning.
Heart failure A problem pumping blood, causing your heart rate to rise.
Cardiomyopathy Structural changes to the heart muscle lead to an imbalance in the normal sinus rhythm.
Pathologies in any area of ​​the heart provoke disturbances in the heart rhythm.

Non-cardiac causes include pathologies that do not concern the heart, but that have an indirect effect on its work. The main ones are:

  • pathology of the endocrine system (diabetes, diseases of the adrenal glands and thyroid gland);
  • dysfunction of the nervous system (vegetative-vascular dystonia);
  • problems with blood oxygen saturation (asthma, anemia, chronic bronchitis).

Poisonous causes are smoking and alcohol abuse. It leads to oxygen starvation, vascular problems, and disturbances in the functioning of the nervous system. This is a common cause of sinus arrhythmias.

For people who smoke and those who abuse alcohol, the risk of developing pathological forms of the disease increases several times.
As a prevention of this problem, a healthy lifestyle is the best solution.

Sinus rhythm can be affected by taking certain drug groups. This effect is possessed by:

  • drugs to stimulate the heart;
  • drugs for regulating heart rate;
  • drugs to stimulate urinary function.

The group of medicinal causes of sinus arrhythmia once again emphasizes that any medications are prescribed only on the recommendation of a doctor. Any uncontrolled drug therapy can provoke the development of third-party pathologies and the harm from it will exceed the expected benefit.

Electrolyte causes of disturbance are changes in the body's level of electrolytes (potassium, calcium and magnesium), which are clearly reflected in the cardiogram. This group of causes affects not only sinus rhythm, but for this problem it is one of the most influential factors.

Those cases of the disease, the causes of which could not be determined during the examination, are called idiopathic. Often there are medical histories, at the origins of which are unexplored factors affecting the heart rate.

Symptoms

Symptoms of sinus rhythm disturbances are nonspecific. It is impossible to accurately diagnose the disease by its external manifestations. But there are several signs by which one can suspect a problem and send the patient for an in-depth diagnosis.

The most clear evidence of pathology is the feeling of heart sinking. It is difficult to describe it to someone who is not familiar with the problem, but the patient has characteristic sensations, which he describes in this way. The feeling of a sinking heart is manifested with arrhythmias with increased intervals between cardiac cycles. If the intervals are decreasing, palpitations are characteristic.

Any option will be accompanied by:

  • panic (often fear of death);
  • discomfort or pain in the chest area;
  • emotionally unstable state;
  • shiver;
  • feeling short of breath.

Two or more of these signs at the same time are a reason for clinical diagnosis.

Diagnostics

Diagnosis of a disease in a clinical setting includes a whole range of methods.
The main therapeutic method for determining this heart pathology is an electrocardiogram.

Sinus arrhythmia on ECG

A specialist can almost accurately determine sinus rhythm disturbances from an electrocardiogram.
Its primary task is to establish a heart rate driver. The fact that this function is performed by the sinus-atrial node is indicated by the "P" waves in all leads. These teeth confirm the presence of bioelectricity in the atria. Their positive and negative manifestations alternate according to the scheme.
After confirming this, the doctor determines the arrhythmia.

It is indicated by a change in the intervals between cardiac cycles. If the interval between the "R" waves on the cardiogram exceeds 0.15 seconds, this indicates a pathological form of the disease. The same problem is confirmed by the difference in the duration of the alternating intervals of more than 0.1 seconds.

Another marker of the problem is abrupt changes in the height of the "R" waves on the electrocardiogram. Smooth changes indicate the physiological nature of the arrhythmia, abrupt changes indicate a pathological one.

In addition to ECG, the following can be used for diagnosis:

  • electrophysiological research;
  • echocardiogram;
  • Holter and episodic observation;
  • stress testing;
  • orthostatic test;
  • complex of blood tests.

Such a complex of studies gives a complete picture of the pathology and determines its etiology.

How is sinus arrhythmia treated?

Treatment of arrhythmias depends on the course of each individual case of the disease. The main task of therapy is to eliminate the cause of the development of disorders in the work of the heart.
If the disease is provoked by another disease, then its manifestations are eliminated by its treatment. Medicinal causes of the disorder are eliminated by correcting treatment, poisonous ones - by changing the lifestyle, electrolytic ones - by correcting the electrolyte balance.
Treatment tactics are tailored for each patient.

The second most important task of treating a disease is to stop its manifestations.
Often it is enough to make a lifestyle correction for this:

  • switch to a special diet;
  • normalize the alternation of stress and rest.

These are general tips for dealing with symptoms, but they are fundamental to solving this problem.

Drug treatment

Based on the characteristics of each case of the disease, the doctor can make an additional appointment. Often this is a drug correction of the heart. It uses the following groups of drugs:

A wide group of drugs for the normalization of the heart rate. There are several groups that are effective for specific types of violations. Affect the myocardium or the innervation of the heart. They are prescribed in extreme cases, since they have many side effects, and an inaccurate dosage can disrupt the rhythm in the opposite direction to the problem.

Group of drugs Basic drugs and price Description
Antiarrhythmic drugs
Glycosides Digitoxin (from 27 rubles), Gitoxin (from 180 rubles), Korglikon (from 39 rubles) A group of drugs with cardiotonic and antiarrhythmic effects. Mostly of vegetable origin. Glycosides normalize the work of the heart and stimulate the work of the myocardium.
Beta blockers Alprenolol (from 395 rubles), Atenolol (from 19 rubles), Carvedilol (from 86 rubles) Medicines for blocking beta-adrenergic receptors with a complex of cardiac effects: they reduce the force of contractions, reduce their frequency, and inhibit cardiac conduction.
ACE inhibitors Lisinopril (from 100 rubles), Prestarium (from 384 rubles), Valz (from 339 rubles), Lorista (from 138 rubles) Angiotensin-converting enzyme inhibitors are an effective treatment for heart failure. The action is based on the suppression of ACE.
Diuretics Indapamide (from 120 rubles), Veroshpiron (from 80 rubles) A group of diuretic drugs that slow down the process of reabsorption of water and salts, and accelerate their excretion.

It must be remembered that sinus arrhythmia is an increase or decrease in the intervals between individual cycles. And for its correction, drugs with the opposite effect may be required. Self-medication of manifestations of violation of the rhythm of the work of the heart muscle is prohibited. Only a doctor can prescribe medications after a comprehensive diagnosis.

Surgery

In a complex scenario of the course of the disease or in the absence of the expected effect of drug therapy, surgical treatment may be prescribed to normalize the sinus rhythm. There are several options here, the choice of a specific one depends on the characteristics of the disease and the patient's history.
The main options for surgical intervention are as follows:

  • installation of a pacemaker to correct bradycardia - a low heart rate with abnormal pauses between cycles;
  • coronary artery bypass grafting to bring the coronary circulation to normal;
  • thyroid surgery to normalize hormone levels.

Treatment prognosis

With arrhythmias of a physiological nature and moderate arrhythmias of pathological etiology, the prognosis of treatment is almost always favorable. Successful relief of the disease that caused the problem allows you to successfully cope with the pathology without affecting the patient's health and quality of life.

With a pronounced form of the disease, the prognosis depends on the cause of the development of the problem. But here there are often options in which the violation of the rhythm of the heart is stopped poorly or, without radical therapy, is not eliminated at all.
In severe cases, sinus arrhythmia can cause the development of:

  • heart attack,
  • problems with the blood supply to the brain.

In rare cases, there is a risk of coma and sudden death.
Therefore, any heart rhythm disturbances are a reason for clinical examination and treatment. Procrastination and lack of attention can cause big problems.

Prevention

Arrhythmia prevention rules should become part of everyone's image. They consist in simple tips that have a positive effect on the quality of life. To prevent the development of this problem, you need:

  • to refuse from bad habits;
  • pay due attention to the correct diet;
  • correctly alternate loads and rest;
  • avoid physical and emotional overload;
  • monitor your health.

The tips are simple and they help not only in the prevention of sinus arrhythmia. Thanks to them, you can help the heart to work normally for many years.

Based on the results of the ECG, the doctor will be able to identify the cause of the arrhythmia.

The number of factors causing manifestations of arrhythmia is great, ranging from neuropsychic disorder and ending with severe organic damage to the heart. The main groups of etiological factors are distinguished:

  • Organic or functional diseases of the CVS (myocardial infarction, coronary artery disease, pericarditis).
  • Extracardiac factors - disorders of nervous regulation, stress conditions, hormonal disorders.
  • Bad habits - alcohol abuse, smoking, drug addiction.
  • Traumatic injury, hypothermia, or vice versa, overheating, oxygen deficiency.
  • Taking certain types of drugs - diuretics, cardiac glycosides as side effects cause arrhythmias.
  • Idiopathic (independent) arrhythmias - in this case, there are no changes in the heart, arrhythmia acts as an independent disease.

From this article you will learn: how and for what reason sinus arrhythmia develops, and what symptoms are typical for it. How pathology is treated, and what needs to be done so that arrhythmia does not occur.

With a problem, you can contact a therapist, however, the treatment of this disease, depending on the cause, may be in the competence of a cardiologist, neurologist, or even a psychotherapist.

In the heart wall there is a sinus node, which is a source of electrical impulses that provide contraction of the muscular system of the heart - the myocardium. After generation, the impulse is transmitted through the fibers to each muscle cell of the organ, as a result, they contract.

This process occurs at regular intervals, and normally has a frequency of 60–90 beats per minute. It is this impulse conduction that ensures a uniform, consistent and consistent contraction of the ventricles and atria.

When, as a result of the action of unfavorable factors, the activity of the conducting system of the heart is disturbed, arrhythmia occurs - a violation of the rhythm of the contractions of the heart (it can be of varying severity).

Causes of the disease

Sinus arrhythmia can occur for three groups of causes.

Data from the World Health Organization show that about one percent of all people suffer from atrial fibrillation, and more often the pathology is recorded in male Europeans. Violation of cardiac activity is immediately reflected in the results of the cardiogram. Atrial fibrillation on the ECG differs in the typical symptoms by which doctors can determine the irregular heart rhythm.

In pathology, the number of chaotic contractions is impressive - in patients it can occur up to eight hundred times per minute. The impulses that enter the atrioventricular node differ in different frequency and strength, often such impulses simply do not reach the ventricles. In this case, the frequency of ventricular contractions will not exceed two hundred times, and on average, this parameter is in the range from 80 to 130 contractions. With an irregular contraction of the departments, the so-called absolute arrhythmia occurs - a severe cardiac pathology.

Depending on the heart rate, the following types of atrial fibrillation are distinguished:

  • tachysystolic;
  • normosystolic;
  • bradystolic.

If the bradystolic pathology, then the number of contractions is less than sixty, with normosystole, the indicator reaches ninety beats / min, and the tachysystolic appearance is the number of contractions over ninety beats per minute.

On the cardiogram, arrhythmia is manifested by typical signs:

  • absence of a P wave - instead of it, signs of irregular excitations appear;
  • violation of the complex

Causes of pathology

Atrial fibrillation refers to severe pathologies, it has a significant cause, which must be treated along with the arrhythmia itself.

Among the causes of the disease are:

  • dysfunction in the endocrine system;
  • atherosclerotic changes in the vessels;
  • cardiovascular insufficiency;
  • disturbances in the body of water-salt balance;
  • cardiosclerosis;
  • violations of acid-base balance;
  • congenital or acquired heart defects;
  • cardiomyopathy;
  • hypertension;
  • neoplasms of the heart;
  • renal failure;
  • surgical interventions on the heart and blood vessels;
  • myocarditis.

It is possible to find out the cause of the disease after a comprehensive examination of the patient, and an ECG in atrial fibrillation will play an important role in this issue - the doctor will notice the characteristic signs of pathology on it.

Symptoms of pathology

Clinical manifestations of pathology largely depend on hemodynamic and heart rate disorders. Patients complain mainly of shortness of breath, disturbances in the functioning of the organ, which mainly occur even with the slightest physical activity. Less often, patients feel a dull and aching pain behind the breastbone.

Important! The symptomatology of pathology when examining patients is very diverse. Not all patients complain of poor health - a fairly large number of patients do not consider themselves sick or indicate only minor violations. Patients are diagnosed with heart failure, atrial fibrillation provokes pale skin, swelling of veins, swelling of the legs, blue lips.

When listening, patients have abnormal heart contractions with an irregular rhythm, different tonality, which depends on the duration of diastole. The preceding short pause provokes the first loud tone, and the second either significantly weakens or completely disappears. Atrial fibrillation does not give hypertension or hypotension, the pulse remains rhythmic, but in the tachysystolic form, the pulse lags behind the heart rate.

Doctors, when decoding the electrocardiogram of patients with suspected atrial fibrillation, pay attention to the following analysis features:

  1. The absence of a P-wave in the abduction sites.
  2. The presence of flickering waves, which are frequent and irregular, which is triggered by chaotic arousal and atrial contractions. The large-wave and small-wave forms of the f-wave amplitude are distinguished. The large-wave form with an indicator of more than one millimeter is noted in people with chronic cor pulmonale, as well as in those who suffer from mitral stenosis. The small-wave form is inherent in patients with myocarditis, myocardial infarction, thyrotoxicosis, intoxication, cardiosclerosis.

There are several main groups of causes of arrhythmias, namely cardiac, noncardiac and drug causes.

Cardiac causes are when arrhythmia occurs due to diseases of the cardiovascular system:

  • myocardial infarction and coronary artery disease;
  • cardiomyopathy;
  • heart defects;
  • myocarditis;
  • heart failure;

Noncardiac causes:

  • vegetative dystonia;
  • broncho-pulmonary diseases;
  • anemia;
  • endocrine system diseases.

Human endocrine system

This occurs only if the medication is taken without the supervision of a doctor for a long time, with an independent increase in the dose of the drug, etc. Also, electrolyte disturbances can cause arrhythmia, that is, if the ratio in the body of potassium, magnesium and sodium changes.

It should be noted that the following factors can cause this pathology:

  • smoking;
  • alcohol abuse;
  • insufficient sleep;
  • malnutrition.

The main symptoms of arrhythmic disorders are:

    Pain on the left side in the region of the heart, especially when inhaling, or discomfort.

    The patient feels irregular heartbeats, there is a feeling that the heart is turning over, compressed, it does not work rhythmically;

  • general weakness of the body;
  • dizziness, fainting;
  • shortness of breath, rapid breathing.

Heart disease is very insidious. For a very long period of time, they may not show themselves in anything, and the person will not even suspect that he has a pathology. Arrhythmia is no exception. As a rule, it becomes obvious already at a severe stage. Only control of your own blood pressure and heart rate will help to recognize alarm signals in time.

Decoding of ECG indicators for arrhythmia

Arrhythmia is the general name for all those conditions where heart rate, strength, rhythm and consistency are disrupted. That is, these are all deviations from the normal heart rhythm, which is called sinus.

With normal heart function, the heart rate is 50-100 beats / min, it depends on the person's physical activity at the moment. The development of arrhythmia is preceded by a variety of reasons. Arrhythmia will be considered such conditions in which the heart rate becomes less than 60 beats per minute or more frequent than 100. Arrhythmia on the ECG is visible in different ways, depending on the type of syndrome.

Important information!

The decoding of the main indicators on the ECG is described below in case an electrocardiogram has been performed, but has not yet been decrypted by a cardiologist.

Table-decoding of indicators on the ECG

ECG requires mandatory decoding by a cardiologist.

Influence of extrasystoles

These are reductions made prematurely. The electrical impulses do not come from the sinus node. This type most often occurs due to various factors not associated with heart disease. The main reasons for this type of arrhythmia include:

  • unstable psycho-emotional state;
  • treatment with separate groups of drugs;
  • smoking abuse;
  • vegetative disorders.

It looks like an extrasystole on an ECG

Extrasystoles- this is exactly the case when the patient may not feel anything for a long time. Sometimes there can be a kind of impulse in the heart, or its short-term fading. If such signs are isolated, this may be even with the normal work of the heart. But if they occur more and more often, this may indicate an exacerbation of diseases - ischemia, myocarditis. The most dangerous are ventricular extrasystoles. This is when the impulse comes from one of the ventricles. This can be the initial symptom of ventricular fibrillation.

How to determine on the ECG. On the ECG, the extraordinary contraction of the heart looks like a different wave from the others.

Atrial fibrillation

This type is atrial fibrillation. This is in itself a complication that occurs during ischemia. This same type is the most common heart rhythm disorder. Often the cause of this type is thyroid disease, when its activity is disrupted.

Atrial fibrillation is characterized by heart failure of varying severity, fainting and darkening in the eyes. Often, these symptoms are accompanied by severe weakness, shortness of breath, chest pain and a feeling of increasing fear. Sometimes attacks start suddenly and end spontaneously without any intervention. But it is most likely that the attack will be prolonged, in several hours, and maybe even days, and will require compulsory medical attention.

How to determine on the ECG. On the ECG, large or small atrial waves, deformed disordered complexes can be indicated. One patient has both atrial flutter and atrial fibrillation. With a cardiogram of a healthy person, chaotic waves are absent, the rhythm is even.

Sinus arrhythmia

Despite the sinus rhythm, it is distinguished by its irregularity. Heartbeats slow down, then become more frequent. It is especially noticeable when breathing: on exhalation, the heart rate is almost doubled, and on inhalation, it decreases greatly. The patient feels severe fatigue, dizziness, fainting may occur. Intensification of symptoms requires close attention and treatment.

The causes of sinus arrhythmia are heart diseases, infectious processes involving the myocardium, heart defects. From external factors, arrhythmias of this type are most often provoked by hormonal disorders in the body, diseases of the nervous system.

How to determine on the ECG. On the ECG, abnormal cardiac activity is indicated by the difference in PR intervals by at least 10%.

Atrial flutter

With this, the diagnosis of the heart rate increases already up to 200-400 contractions, for example, against the background of the correct atrial rhythm.

The reasons here, as a rule, are organic heart disease, heart surgery (especially the first week after the intervention). Often, atrial flutter can be triggered by hypertension, myocardial dystrophy.

The risk group includes men over 60 years of age, smokers, people with a lack of potassium or excessive production of thyroid hormones. An attack of such arrhythmias can be caused by intense heat, physical strain, stress, the use of alcohol or drugs.

Symptoms are a strong increase in heart rate, weakness, a sharp decrease in pressure with the development of a semi-fainting state, dizziness. Along with this, pulsation of the veins in the neck is often observed.

How to determine on the ECG. On the ECG, flutter is indicated by F-waves that appear instead of the P wave. Heart rate at the same time is 240-350 beats per minute. There is also atypical flutter, in which the same waves occur at a heart rate of 340-430 beats.

Supraventricular tachycardia

This type of arrhythmia is formed on a fairly small area of ​​atrial tissue. Because of this, inflammation of the heart soon begins. This inflammation is characterized by its periodicity. The frequency can last for days or even months. Most often it happens that not one area of ​​the heart becomes inflamed, but several.

This arrhythmia implies an increase in heart rate for no apparent reason. Symptoms are quite varied, but the very first sign is a strong pulsation in the chest. In addition to other symptoms, sweating, throat tightness, increased urination, nausea and vomiting may occur.

How to determine on the ECG. This is noticeable by an increase in the frequency of P waves and QRC complexes, as well as small intervals between them.

Ventricular tachycardia

Pathology is expressed in the acceleration of the rhythm coming from the ventricles. The heart rate is about 100 beats, but the ventricular impulses can follow each other. The main feature of this species is surprise. The heart rate begins to increase to 200, the heart can no longer fill normally with blood and, accordingly, much less of it is released into the body. This pathology is difficult for patients, especially with concomitant heart disease.

Persistent gastric tachycardia manifests itself in a strong change in systolic pressure. At this moment, the patient has decreased venous pulsation.

Unstable gastric tachycardia passes imperceptibly, if at this moment it is not caught on the ECG.

If the heart rate is 220 beats per minute, everything indicates ventricular flutter. Here, there may be a decrease in blood pressure, sweating, severe agitation, or, conversely, deafness, fainting. Sometimes there is swelling, difficulty breathing, shortness of breath - everything indicates acute heart failure.

How to determine. The ECG shows the expansion or deformation of the QRC complexes, their change in amplitude and directions. The deviation of the electric axis to the left is noticeable.

Occurrence of ventricular fibrillation

Here, the impulses coming from the ventricles are chaotic and incorrect. Because of this, ventricular flutter is observed and the absence of their contractions is possible. For this reason, blood cannot be pumped normally throughout the body. This condition is extremely dangerous, requires urgent hospitalization, resuscitation measures with defibrillation. If all this is not done within 10 minutes after the onset of the attack, then everything can end in death.

If we talk about the symptoms, then they all correspond to the cessation of blood circulation, and, accordingly, clinical death. The patient loses consciousness, he has convulsions, spontaneous urination and defecation, the pupils do not respond to light, there is no pulse and breathing, and they are not palpable in the arteries, the skin may turn blue.

Decryption. On the ECG, this can be:

  • large-wave fibrillation (stages 1 and 2) with rather large waves and a frequency of 300-600. This is the best prognosis and indicates that the medical intervention will be effective;
  • small-wave fibrillation (late stage, 3 and 4) - the waves are wider and acquire an uneven amplitude. The heart rate is also uneven - at first it increases to 600, and then drops to 400 per minute.

This condition is dangerous due to the occurrence of vascular thromboembolism and abnormal expansion of all parts of the heart.

Features of sinus node dysfunction syndrome

SDSU - rhythm failures due to weakening of the function of automatism or its complete cessation. A decrease in heart rate is observed, and cardiac arrest may occur.

Symptoms may be absent altogether, or present in full, as in other arrhythmias. With SDSU, fainting occurs most often, and they can go away on their own - the skin becomes pale and cold, sweating. There may be a violation of the gastrointestinal tract, muscle weakness.

Most often, SDSU occurs in persons 60-70 years old, and with equal probability in men and women. This is a very rare species - 0.03-0.05% of them all.

Heart block

The patient's impulse conduction slows down, sometimes it stops completely. Blockades can also be persistent and transitory. They are caused by heart disease, the use of certain medications, and high blood pressure. The blockade can even be congenital, but this is extremely rare (then the heart rate drops to 40 per minute).

The clinical picture is characterized by the absence of pulse and heart sounds. The body has a very slow blood circulation, there are convulsions and fainting, oxygen starvation of internal organs. Heart block often ends in the death of the patient.

How to determine. On the ECG, the P wave is always deformed and exceeds the norm in width, the height is within 0.11 seconds. The PQ interval is lengthened.

Arrhythmia indicators on the tonometer

When it comes to arrhythmia, the tonometer may give incorrect values. Due to the lack of indication of heartbeat failures, the readings can be severely distorted. Now there are good blood pressure monitors on the market that can perfectly recognize arrhythmias. Such devices immediately determine the violation of the pulse, the sequence of contractions. As a rule, cardiac malfunctions are expressed by a heart at the bottom of the device monitor. Arrhythmia on the latest blood pressure monitors is displayed as follows:

Arrhythmia indicators on the tonometer

  • first, there are several measurements with pauses between them;
  • if two of them passed without failures, then the process does not go any further;
  • the pulse is displayed on the screen;
  • at the very bottom of the screen, the arrhythmia indicator lights up.

There is no need to worry that the device does not identify serious malfunctions from minor irritations - all this is perfectly distinguished by a modern device. It is quite possible to trust such a device, and if it has revealed signs of arrhythmia, it is necessary to urgently consult a doctor. If the tonometer showed arrhythmia once, then the result may be incorrect, and you need to make another measurement.

How to choose a tonometer

It is very important for a person who periodically has interruptions in the heart rate to have a good tonometer on hand that can detect signs of arrhythmia. New generation devices deliver results based on data mining. They can work on two principles:

  • some tonometers give the result by calculating the average value of the last three measurements;
  • others themselves carry out the required number of measurements and, having processed their indicators, give the final result.

Tonometers of this type are able to determine blood pressure even more accurately. This is a great way to keep your blood pressure, heart rate, and heart rate under control at the same time.

Do not worry if sometimes the arrhythmia icon appears during normal blood pressure measurements. A constantly appearing indicator should cause an alarm - this means that it is time to visit a doctor. If the atrial fibrillation sign is flashing on the screen, then it is no longer possible to postpone the visit. When choosing a device, you need to focus on the following parameters:

  • the size of the cuff: it must strictly correspond to the circumference of the arm;
  • the size of the screen must be sufficient for all indicators to be clearly visible;
  • the arrhythmia indicator should be backlit, in some cases - with sound;
  • built-in memory can contain up to 90 records;
  • function of calculating the average;
  • a sound signal that notifies the end of the measurement process;
  • tonometers can be for the whole family - in this case, the indicators of each person are recorded separately;
  • there are devices with power supply, both from the network and from batteries at the same time.

Modern blood pressure monitors are well suited for all people, they are easy to use and do not require any specific skills. They can even be used by patients with hearing and vision problems. You just need to press a button, and the device does the rest without pain and discomfort in the form of a strong tug on the forearm.

Pulse counting for arrhythmia

People suffering from heart disease must be able to correctly calculate and estimate their heart rate. This is equally important with a fast or slow heartbeat. Sometimes this is what can prevent a heart attack in time.

To correctly determine the pulse, you need to find the radial artery near the base of the hand near the thumb. It is important to consider the fact that left and right hand performance may be slightly different. In order to detect the pulse, you need to lightly press your fingers on the wrist, clasping it from the back. It is the fingertips that will feel the heartbeat.

How to measure your pulse

The standard time is 15 seconds. Then the number of beats produced during this time must be multiplied by 4. The pulse counting time for arrhythmias is one minute, you need to count, squeezing the artery with 3-4 fingers for the best detection of beats. Remember that every finger also pulsates, so it can be mistaken for a pulse. When measuring the pulse, the hand should be as relaxed as possible and put with an open palm up. On a watch with a second hand, you need to wait for an even value and you can start counting. With different types of arrhythmias, there will be completely different heart rate indicators. For example, with tachycardia, over 80 strokes, with bradycardia - less than 60, paroxysms are characterized by a very frequent pulse - more than 200, with heart blockages it can reach 250-300.

The purpose of the lesson: To teach clinical and ECG diagnostics of the main types of cardiac arrhythmias.

For the lesson, the student should know:

    Arrhythmia classification.

    Arrhythmias associated with dysfunction of automatism.

    Arrhythmias associated with impaired excitability.

    Arrhythmias associated with impaired conduction function.

    Complex types of cardiac arrhythmias.

As a result of the lesson, the student should be able to:

    Correctly recognize different types of arrhythmias based on clinical signs.

    Correctly recognize different types of arrhythmias by ECG.

Motivation. Arrhythmias are a common complication of heart disease. They aggravate the course of the disease. Therefore, timely accurate diagnosis of arrhythmias is essential for the treatment of patients.

Initial data.

Educational elements.

Basic functions of the heart ... The work of the heart is carried out thanks to 4 main functions: automatism, excitability, conduction, contractility.

Classification of cardiac arrhythmias ... Arrhythmias are divided into groups depending on the violation of a particular function of the heart: automatism, excitability, conduction and contractility.

    Violations of the function of automatism. The most common are sinus tachycardia, sinus bradycardia, and sinus arrhythmia. On the ECG, a sign of sinus rhythm is the presence of a positive P wave in front of the QRS complex.

    Sinus tachycardia ... It is caused by increased activity of the sinus node as a result of physical or nervous stress, fever, when taking stimulants, thyrotoxicosis, heart failure. Patients complain of palpitations, rapid and rhythmic pulse. On the ECG, the RR and TP intervals are shortened.

    Sinus bradycardia ... It is caused by a rare generation of impulses from the sinus node. It is observed with hypothyroidism, the action of a number of medications, with an increase in the tone of the vagus nerve during sleep, in patients with liver and gastrointestinal tract diseases, in athletes. The pulse is rhythmic and infrequent. On the ECG, the RR and TP intervals are lengthened.

    Sinus arrhythmia ... It is caused by the irregular production of impulses from the sinus node. There are 2 forms: respiratory (youthful) and non-respiratory (with myocardial diseases). ECG shows different duration of RR intervals in sinus rhythm.

    Excitability dysfunction. It is manifested by extrasystole and paroxysmal tachycardia. It is caused by the emergence of ectopic foci of excitation in some parts of the myocardium, which can generate an impulse leading to an extraordinary contraction of the heart. Such heterotopic foci occur with diseases of the myocardium, with an overdose of a number of medications, with increased nervous excitability, etc.

Diagnostic signs of extrasystole :

    extraordinary reduction;

    full or incomplete compensatory pause;

    drawing of an extrasystolic complex on an ECG.

In addition to single ones, there are group extrasystoles, and sometimes there is a regularity of extrasystoles, which is called allorhythmia. The types of allorhythmias are as follows:

    bigeminia (extrasystoles are repeated after each normal sinus complex);

    trigeminia (every two sinus complexes are followed by an extrasystole);

    quadrigeminia (extrasystole follows every three normal cycles).

    Atrial premature beats ... The ectopic focus of excitation is in the atrium. In this case, excitation to the ventricles spreads in the usual way, so the QRS-T ventricular complex will not be changed, some changes in the P wave may be observed. time interval.

    Atrioventricular extrasystole ... In this case, an extraordinary impulse leaves the atrioventricular node. Excitation covers the ventricles in the usual way, therefore the QRS complex is not changed. On the atria, excitation goes from the bottom up, one hundred leads to a negative P wave. Depending on the conditions of the conduction of the impulse in the affected myocardium, excitation may reach the atria earlier and negative P will then be recorded in front of the normal QRS complex ("superior nodal" extrasystole). Or excitement will reach the ventricles earlier, and the atria will be excited later, then the negative P will move after the QRS complex ("nodular" extrasystole). In cases of simultaneous excitation of the atria and ventricles, there is a layering of negative P on the QRS, which deforms the ventricular complex ("mid-node" extrasystole).

    Ventricular extrasystole due to the release of excitation from the ectopic focus in any of the ventricles. At the same time, at first, the ventricle in which the ectopic focus is located is excited, to the other, the excitement reaches later along the Purkinje fibers through the interventricular septum. The impulse does not reach the atria in the opposite direction, therefore the extrasystolic complex does not have a P wave, and the QRS complex is expanded and deformed.

    Paroxysmal tachycardia. This is a long chain of extrasystoles, due to the high activity of the ectopic focus, which produces 160-220 or more impulses per minute. The sinus node is suppressed and not working. There is a supraventricular form of paroxysmal tachycardia (ectopic focus - in the atrium), when all the complexes are normal, since excitation to the ventricles goes in the usual way from top to bottom. There is a ventricular form of paroxysmal tachycardia (an ectopic focus in one of the ventricles), when all the complexes are expanded and deformed due to the contraction of the ventricles at different times.

    Conduction dysfunction- blockades. A blockade is a slowdown or a complete break in the conduction of an impulse, therefore, incomplete and complete blockades are distinguished. They are caused by a "lack of energy" to conduct an impulse in myocardial diseases, the presence of cicatricial, dystrophic, inflammatory changes in the heart muscle.

    Sinoauricular block It is expressed in the fact that periodically there is a loss of the entire cardiac cycle P-QRS-T, since "energy is quickly consumed" when conducting impulses from the sinus node to the atria.

    Intra atrial block it is noted with an increase in the size of the atria, there is a right atrial (P –pulmonale) and left atrial (P – mitrale). Due to the fact that the P wave is caused by the excitation of first the right and then the left atrium, with an enlarged right atrium, the P wave grows, becomes high and pointed. With an increase in the left atrium, the P wave is expanded, often bumpy.

    Atrioventricular block subdivided into 3 degrees.

1st degree manifests itself in the lengthening of the PQ interval by more than 0.20 s.

2nd degree atrioventricular block is associated with an even greater slowdown in the conduction of the impulse from the atria to the ventricles due to a greater lack of energy. There are 2 types according to Mobitz. With atrioventricular block of 2 degrees according to Mobitz type 1, there is a gradual lengthening of the PQ interval with periodic prolapse of the ventricular complex - the Samoilov-Wenckebach periods.

At grade 3 there is a complete break in the movement of the impulse from the atria to the ventricles. This is a complete transverse block. In this case, the atria work from the sinus node (pacemaker of the 1st order) and P waves will be rhythmically present on the ECG. ... Since the underlying pacemakers have less automatism, the ventricles contract less often than the atria, and on the ECG, QRS complexes will be recorded less often than P waves. With complete atrioventricular blockade, the pacemaker for the ventricles periodically changes, which leads to short-term cardiac arrest. Clinically it manifests itself Morgani-Edems-Stokes syndrome... There is a temporary cessation of cardiac activity, loss of consciousness, cyanosis and seizure. In the treatment of these patients, an artificial pacemaker.

    His bundle branch block ... With a complete blockade of one of the legs of the bundle of His, the impulse from the atria passes to the unblocked leg, and to the other ventricle, excitation goes along the Purkinje fibers through the interventricular septum. As a result, the ventricles contract alternately and after the P wave, a widened and deformed QRS will be recorded.

    Complex rhythm disturbances - atrial fibrillation and atrial flutter. Most often observed in a triad of diseases: mitral stenosis, cardiosclerosis, thyrotoxicosis. In this case, all 4 functions of the heart are violated. Initially, the function of excitability is impaired, since in connection with pronounced dystrophic changes in the atria, many ectopic foci with high activity arise. For 1 minute, from 600 to 900 impulses are generated. At the same time, the sinus node is suppressed and does not work. Due to the very large number of impulses, the atria do not contract, but fibrillar twitching of individual muscle fibers is observed (the atria "flicker"). The atrioventricular node irregularly conducts only part of the impulses, and blocks the majority. The ventricles work irregularly, therefore, with different blood supply and contraction force. Clinical signs: irregular and irregular pulse, irregular heartbeat with varying volume of tones.

ECG atrial fibrillation manifests itself in 4 signs: different duration of the R-R interval, different heights of the R wave in the same lead, the absence of the P wave, the presence of a wavy isoelectric line, especially noticeable in 1-2 chest leads.

Atrial flutter has the same mechanism, but less impulses are produced from ectopic foci in the atria (300-400 per minute). Therefore, instead of a wavy isoline, step-like teeth are recorded on it, due to defective weak contractions of the atria.

Control questions:

    List the main functions in the work of the heart.

    Tell us the classification of cardiac arrhythmias.

    What are the signs of sinus rhythm on the ECG?

    What are the clinical and ECG signs of sinus tachycardia?

    What are the clinical and ECG signs of sinus bradycardia?

    What are the clinical and ECG signs of sinus arrhythmia?

    Give the definition of extrasystole.

    The mechanism of development of extrasystole.

    What are the clinical and ECG signs of various types of extrasystoles?

    What is paroxysmal tachycardia?

    What is the manifestation of a violation of the conduction function?

    Describe the sinoauricular block.

    What is the manifestation of intra-atrial blockade?

    What is the manifestation of atrioventricular block?

    What degrees of atrioventricular block and their manifestations do you know?

    How is the bundle branch blockade manifested?

    What functions of the heart are impaired in atrial fibrillation?

    What is the mechanism of atrial fibrillation?

    What are the clinical and ECG signs of atrial fibrillation?

Situational tasks.

Objective 1. The patient complains of palpitations. There is a rapid and rhythmic pulse. On the ECG, the R-R and T-P intervals are shortened, the positive P wave precedes the QRS complex.

Diagnosis of a disease such as atrial fibrillation is impossible without an ECG. The pathology is characterized by an abnormal heart rhythm, chaotic contraction and excitation of the atria, the so-called atrial fibrillation. The diagnostic procedure provides an opportunity to get acquainted with the full picture of the course of the pathological process, thanks to which the doctor manages to establish the correct diagnosis. Based on the data obtained, the cardiologist prescribes a course of therapy.

Atrial fibrillation is a rhythm disturbance in which during one cardiac cycle there is an irregular excitement and contraction of individual muscle fibers of the atria

Heart disease requires a comprehensive study. These include cardiac arrhythmias. The first diagnostic measure to which a cardiologist refers a patient is an ECG.

On the electrocardiogram, the bioelectric activity of the heart is reflected in the form of teeth, intervals and sections. Their length, width, distance between the teeth normally have certain values. Changing these parameters allows the doctor to determine abnormalities in the work of the heart muscle.

In most cases, it is sufficient to conduct an ECG so that the cardiologist can correctly diagnose the patient. Additional types of research are carried out to determine the type of pathological process.

Changes in the ECG make it possible to determine whether the patient suffers from atrial fibrillation (flickering) or atrial flutter. Deciphering the result will make it clear exactly what worries the patient. Atrial flutter is characterized by an accelerated, but correct rhythm of heart contractions, while during fibrillation the rhythm is disturbed, different groups of muscle fibers in the atria contract inconsistently with each other. Since the heart rate reaches high numbers with these violations (up to 200 beats per minute), it is impossible to determine by ear, using a phonendoscope, the form of arrhythmia. Only the ECG gives the doctor the information he needs.

First signs

The electrocardiogram displays the characteristic signs of the disease. Atrial fibrillation on the ECG will look like this:

  1. There is no P wave on any electrocardiographic lead (this wave is an obligatory component of a normal ECG).
  2. The presence of irregular f waves throughout the entire cardiac cycle. They differ from each other in amplitude and shape. In certain leads, these waves are recorded best. These include V1, V2, II, III. aVF. These waves are caused by atrial fibrillation.
  3. Irregularity of R-R ventricular complexes (irregularity, different length of R-R intervals). It indicates an abnormal ventricular rhythm;
  4. QRS complexes differ in their unchanged appearance and in the absence of signs of deformity.

On the ECG, a small or large-wave form of atrial fibrillation is distinguished (depending on the scale of the waves f).

Symptoms as the disease progresses


Chest pain is one of the possible symptoms of atrial fibrillation

Clinical symptoms of atrial fibrillation become more pronounced as the disease progresses. They can vary significantly from patient to patient.

The signs of atrial fibrillation, which appear on the electrocardiogram, are supplemented by symptoms that are palpable for the patient himself. We are talking about such painful conditions:

  • profuse sweating;
  • weakness;
  • cardiopalmus;
  • chest pain.

A patient with chronic atrial fibrillation may not even be aware of his illness if it is characterized by an asymptomatic course. In this case, only the result of an electrocardiographic study can determine the presence of pathology.

The types of electrocardiographic manifestations, that is, the symptoms that are seen on the ECG, correspond to the clinical signs of the patient's disease. Thanks to this competent specialist, it is possible to unmistakably understand what exactly worries the patient and what kind of help he needs to provide.

The procedure for taking an electrocardiogram is not difficult. It is only required to adhere to the step-by-step implementation of the action plan, which each specialist is familiar with. He will explain in detail what the patient should do at the time of diagnosis. The total duration of the procedure does not exceed 10 minutes on average.

Electrodes are fixed on the patient's body, the position of which is changed by the doctor or laboratory assistant to obtain various ECG leads.

It is very important that the patient lies still and still during the ECG. In this case, you can guarantee the receipt of an informative result. Any movement, coughing, sneezing negatively affects the results of the electrocardiogram, and they can no longer be called reliable.

ECG decoding


Arrhythmia of heart contractions can only be recognized by a competent specialist who conducts a description of the ECG in atrial fibrillation. Decoding of the results obtained is available only to a doctor. If the case is urgent, then the task can be assigned to a paramedic, who repeatedly had to remove and decipher the ECG.

The patient can also try to decipher his cardiogram. To do this, he needs to study the medical literature in order to assess the location and height of the teeth, the size of the intervals between them. Without basic knowledge of the ECG, a person runs the risk of making a serious mistake.

Patients who need to have an electrocardiogram are interested in the cost of this diagnosis. In Russian clinics, this service costs from 650 to 2300 rubles. Additionally, you may need to pay for the decoding of the ECG results obtained.

Other diagnostic methods

In standard situations, a person is diagnosed with atrial fibrillation based on his complaints and the symptoms of the disease identified during the initial diagnosis. Interviewing the patient and the result of electrocardiographic diagnostics is quite enough if there are no serious complications of the disease.

If the ECG does not provide sufficient information about the patient's condition, then the cardiologist directs him to additional studies:

  1. Echocardioscopy.
  2. Radiography.
  3. Biochemical analyzes of blood and urine.
  4. Transesophageal study of the cardiac conduction system.

An important stage in the study of a patient with atrial fibrillation is differential diagnosis: it is necessary to distinguish the disease from other pathological conditions that may have similar symptoms with it. Differential diagnosis is carried out with the following pathologies:

  • sinus tachycardia;
  • atrial flutter;
  • supraventricular paroxysmal tachycardia;
  • ventricular paroxysmal tachycardia.

The ECG results allow the cardiologist to distinguish atrial fibrillation from the above-mentioned heart conditions.

ECG frequency


Regular examination by a cardiologist will promptly identify the presence of violations in the work of the heart

Patients may ask questions about the frequency of electrocardiography in order to check the status of the cardiovascular system. This diagnostic option is absolutely safe for human health. During the procedure, the indicators of the bioelectric activity of the heart are simply taken. In this case, no negative effects on the body occur.

The frequency of the ECG is dependent on several factors. Doctors recommend that all people get tested for the prevention of atrial fibrillation about 1 time per year. If a person's profession is associated with serious stress, then he should visit a cardiologist once every six months. Seniors should be checked every 3 months. They fall into a risk group, so regular checking of the cardiovascular system is mandatory for them.

Routine examination by a cardiologist and ECG recording allows you to timely identify the presence of a person's heart disorders.

If a patient has atrial fibrillation, then he will have to repeat the ECG procedure at the frequency indicated by the cardiologist.

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