Excitation of the heart does not come from the suture system, but from certain parts of the left or right atrium, therefore, with this rhythm disturbance, the P wave is deformed, of an unusual shape (P), and the QRS complex is not changed. V.N. Orlov (1983) highlights:
1) right atrial ectopic rhythms (RAER),
2) coronary sinus rhythm (CSR),
3) left atrial ectopic rhythms (LAER).
Electrocardiographic criteria for left atrial rhythm:
1) –Р in II, III, aVF and from V 3 to V 6;
2) Р in V 1 in the form of “shield and sword”;
3)PQ is normal;
4) QRST is not changed.
When the pacemaker is located in the lower parts of the right or left atria, the same picture is observed on the ECG, i.e. –P in II, III, aVF and +P in aVR. In such cases, we can talk about the lower atrial rhythm (Fig. 74).
Rice. 74. Inferior atrial rhythm.
Ectopic av-rhythm
Excitation of the heart comes from the AV junction. There are “upper”, “middle” and “lower” atrioventricular or nodal rhythms. The “upper” nodal rhythm is virtually indistinguishable from the lower atrial rhythm. Therefore, it is advisable to talk about only two options for nodal rhythm. In option I, the impulses come from the middle sections of the AV junction. As a result, the impulse to the atria goes retrograde, and they are excited simultaneously with the ventricles (Fig. 75). In option II, the impulses come from the lower parts of the AV junction, while the atria are excited retrogradely and later than the ventricles (Fig. 76).
Rice. 76. Inferior nodal rhythm: Heart rate = 46 per minute, at V = 25 mm/s RR = RR, Р(–) follows QRS.
Electrocardiographic criteria of AV rhythm (Fig. 75, 76):
1) heart rate 40–60 per minute, the distance between R–R is equal;
2) QRST is not changed;
3) Р is absent in option I and –Р follows after QRS in option II;
4) RP is equal to 0.1–0.2 s in option II.
Ectopic ventricular (idioventricular) rhythm
With this rhythm, the excitation and contraction of the ventricles is carried out from a center located in the ventricles themselves. Most often, this center is localized in the interventricular septum, in one of the bundle branches or branches, and less often in Purkinje fibers.
Electrocardiographic criteria for ventricular rhythm (Fig. 77):
1) widened and sharply deformed (blocked) QRS. Moreover, the duration of this complex is more than 0.12 s;
2) heart rate 30–40 per 1 min, with a terminal rhythm less than 30 per 1 min;
3) R–R are equal, but may be different in the presence of several ectopic foci of excitation;
4) almost always the atrial rhythm does not depend on the ventricular rhythm, i.e. there is complete atrioventricular dissociation. Atrial rhythm can be sinus, ectopic, atrial fibrillation or flutter, atrial asystole; Retrograde atrial excitation is extremely rare.
Rice. 77. Idioventricular rhythm: Heart rate = 36 per 1 min, with V = 25 mm/s QRS - wide; R - absent.
Escaped (jumping, replacing) complexes or contractions
Just like slow rhythms, they can be atrial, from the AV junction (most often) and ventricular. This rhythm disturbance is compensatory and occurs against the background of a rare rhythm, periods of asystole, and therefore is also called passive.
Electrocardiographic criteria for escape complexes (Fig. 78):
1) the R–R interval before the jumping contraction is always longer than usual;
2) the R–R interval after the jump-out contraction is of normal duration or shorter.
Rice. 78. Slipping complexes.
There is a weakened heart rate, with heart beats ranging from 90–160 per minute. This article explains how atrial rhythm is determined on an ECG.
What are we talking about?
Many people who are diagnosed with atrial rhythm do not understand what this means. A healthy person has a single path for the transmission of electrical impulses that cause sequential excitation of all parts of the heart. Due to this, a productive contraction occurs, leading to a satisfactory blood release into the arteries.
This route originates in the right atrium. After which it passes to the most distant ventricular tissues through the conduction system. However, for various reasons, the sinus node loses the ability to generate electricity necessary to release impulses to distant sections.
There is a change in the process of transmission of cardiac excitation. A replacement contraction is formed. It turns out that the impulse arises out of place. For information, atrial rhythm is the appearance of much-needed excitation anywhere in the heart, only in the non-location of the sinus node.
How does atrial rhythm occur?
Outside the border of the sinus node, an extraneous impulse appears, exciting the heart before the signal emanating from the main one. This situation indicates an advance of the secondary atrial contraction. Based on the reentry theory, there is no parallel excitation. This is influenced by local blocking of nerve impulses. During activation, this area experiences an extra extraordinary contraction, which disrupts the main cardiac impulse.
Diagnostics allows you to determine the presence of pathologies of the heart muscle
According to some theories, the endocrine, vegetative nature of the formation of the precardiac impulse is assumed. Typically, this situation occurs in a child in adolescence or in an adult suffering from hormonal changes, which may occur due to age or pathological manifestations.
In addition, there is a theory of the occurrence of an impulse formed by the atria as a result of hypoxic, inflammatory processes occurring in the myocardium. This pathology can occur with regular inflammatory diseases. It has been noted that in children suffering from influenza and tonsillitis, the likelihood of myocarditis with further changes in atrial contraction increases.
The heart, which is the main muscle of the body, has a special property. It has the ability to contract regardless of the nerve impulse emanating from the main organ of the central nervous system. Since it is he who controls the activity of the neurohumoral system. The correct route originates in the region of the right atrium. Then spread along the septum occurs. Impulses that do not pass along this route are called ectopic.
Types of atrial contraction
Based on the unevenness of the intervals, atrial rhythm is of the following types:
- Extrasystole is characterized by extraordinary contractions that occur during normal heart rhythm. This condition does not always have a clinical picture. It happens that a healthy person, for one reason or another, experiences extrasystole. In this case, sometimes there is no need to contact a cardiologist. It manifests itself as fear, tingling in the area of the heart and stomach.
- With atrial fibrillation, heartbeats can reach up to 600 per minute. The atrial muscles are characterized by a lack of rhythm, flickering appears, with characteristic chaotic behavior. As a result, the ventricles of the heart completely go out of rhythm. This condition is quite serious and can lead to a heart attack. With this pathology, the patient suffers from shortness of breath, panic, dizziness, sweating, and fear of death. Loss of consciousness may occur.
- When the pacemaker migrates, the source of contraction seems to move through the atria. There is a manifestation of successive impulses emanating from different atrial sections. The patient experiences tremors, fear, and stomach emptiness.
- Atrial flutter is characterized by frequent regular atrial contractions and systematic ventricular contractions. In this condition, more than 200 beats per minute occur. It is more easily tolerated by the patient than flickering, since it has a less pronounced circulatory disorder. It manifests itself as a rapid heartbeat, swollen neck veins, increased sweating, and lack of strength.
The ECG results are deciphered by a cardiologist who, based on obvious signs, confirms or denies the presence of extrasystoles
How to distinguish atrial rhythm from sinus rhythm
The atrial rhythm is slow, replacing. It occurs during suppression of the sinus node. Usually, with this arrangement, the heart contracts less than normal. In addition, there are accelerated impulses, during which the pathological activity of the center of atrial automation increases. In this situation, the heart rate is higher than the heart rate.
Based on where the activity of the ectopic center occurs, left atrial and right atrial contractions are distinguished. To alleviate the patient’s condition, electrocardiography does not necessarily have to determine which atrium is producing the pathological impulse. The doctor will need to diagnose the altered contractions.
The atrial rhythm on a replacement ECG has the following signs:
- correct contraction of the ventricles at regular intervals;
- contraction frequency varies from 45 to 60 per minute;
- each ventricular complex has a deformed, negative wave;
- intervals are characterized by shortness or normal duration;
- the ventricular complex is not changed.
Accelerated atrial rhythm has the following signs on the ECG:
- cardiac impulses range from 120 to 130 per minute;
- each ventricular contraction has a deformed, biphasic, negative, jagged wave;
- intervals are lengthened;
- the ventricular complex is unchanged.
Atrial extrasystole is determined by a premature, extraordinary contraction. Ventricular extrasystole is characterized by a change in the contractile complex followed by a compensatory pause.
Features of atrial and ventricular rhythm that should be differentiated from each other
Signs on ECG
On an electrocardiogram, the doctor judges the atrial rhythm by the presence of deformation of the P wave. Diagnostics records the disturbed amplitude and its direction in comparison with the normal impulse. Usually this tooth is shortened. Right atrial contraction appears negative on the ECG. The left atrial rhythm has a positive wave and a rather bizarre shape. It looks like a shield with a sword.
If the patient suffers from migration of the driving rhythm, then the electrocardiogram shows a changed wave shape and a longer P Q segment. Moreover, this change is cyclical. Atrial fibrillation is characterized by the complete absence of a wave. Which is explained by the inferiority of systole.
However, the ECG shows an F wave, characterized by uneven amplitude. Using these waves, ectopic contractions are determined. There are cases when the atrial rhythm is asymptomatic, appearing only on the ECG. However, if a patient has this pathology, he requires specialist supervision.
Atrial rhythm
Every day, without fatigue and rest, the heart does a tremendous job - through muscle contractions it forces blood to flow throughout the body. The heart contracts at a certain frequency, about beats per minute.
The peculiarity of the heart muscle is that it has its own automatic function, which is not subject to anyone else. This means that there are certain cells in the heart that are grouped into centers of automaticity.
The cells that produce impulses that make the heart beat are called the conduction system. Thanks to these centers, an impulse is generated, which is transmitted to the underlying centers.
The heart contracts as fast as the impulses occur. The most important center of first-order automatism is the sinus or sinoatrial node. It is located in the right atrium. It is there, in a healthy heart, that an impulse arises, leading to contraction of the atria and then the ventricles. But situations arise when the work of the sinus node stops or is disrupted. Then other atypical heart cells are activated, which are also capable of producing impulses, but are inactive during normal operation of the sinus node.
These cells or groups of cells are called ectopic centers. They set the pace for the heart. If the function of the pacemaker is taken over by the cells of the atria, then the ectopic rhythm that they produce is called atrial. That is, the source of impulse are special cells of the atria, which became active and began to produce ectopic rhythms as a result of disruption or cessation of the work of the center of first-order automaticity - the sinus node.
1 Causes of occurrence
Cardiac ischemia
Why does atrial rhythm occur? Due to suppression of work or cessation of the production of impulses in the sinus node. This can occur with organic heart lesions (coronary heart disease, arterial hypertension, cardiomyopathies, sick sinus syndrome, myocarditis, cardiosclerosis), heart defects, rheumatism, an imbalance of electrolytes in the body, dysfunction of the autonomic nervous system, intoxication with alcohol, nicotine, carbon monoxide , some medications.
Atrial rhythm can accompany endocrine disorders (diabetes mellitus), chest injuries, and can occur in children at birth. It can also be detected in a healthy person as an accidental finding on an ECG during a medical examination. It should be noted that atrial ectopic contractions can be either single with most contractions from the sinus node, or only atrial contractions can be observed if the sinus node is completely blocked. The atrial rhythm may be constant or may occur for a longer or shorter period of time.
2 Differences between atrial rhythm and sinus rhythm
ECG signs of atrial escape rhythm
Atrial rhythms can be slow, substitutive. They occur when the function of the sinus node is suppressed. With such rhythms, the heart rate is less than normal. And accelerated ones can be observed, when there is an increase in the pathological activity of the ectopic centers of atrial automaticity. In this case, the heart rate will be higher than normal. Depending on where the activity of the ectopic centers is observed, a right atrial or left atrial rhythm is distinguished. But it is not necessary for a doctor to know from which atrium the impulse originates; it is enough to simply diagnose the rhythm from the atria.
ECG signs of atrial escape rhythm:
- ventricular contractions are correct, R-R intervals are the same, heart rate beats per minute;
- each ventricular complex is preceded by a P wave, but it is deformed or negative;
- the P-Q interval is shortened or of normal duration;
ECG signs of atrial accelerated rhythm:
- Heart rate in min, R-R intervals are the same
- each ventricular complex is preceded by a P wave, but it is deformed, biphasic or negative, jagged or reduced
- P-Q interval may be prolonged
- ventricular complexes are not changed.
These are the main differences between atrial rhythm and sinus rhythm on the ECG.
3 Symptoms of atrial rhythm
Chest pain
The atrial rhythm may not manifest itself clinically and is detected accidentally during an ECG. There are no specific complaints or symptoms. More often, symptoms are associated with the manifestation of the underlying disease. Complaints may include a feeling of palpitations, interruptions in heart function, or cardiac arrest. I am concerned about general weakness and fatigue. If the heart is damaged, there may be an increase in shortness of breath, chest pain of varying severity and duration, and swelling. It should be noted that if the patient has no complaints, no diseases of the heart or other organs are detected, then the atrial rhythm should be considered as a normal variant.
4 Children and atrial rhythm
In a newborn child, the conduction system of the heart is not perfect, as is the regulation of the autonomic nervous system. This leads to the fact that the child at birth, or in young children, may experience an atrial rhythm. This may be a variant of the norm and when the centers of automatism mature, as well as when adjusting the balance of the autonomic nervous system, the atrial rhythm can be replaced by the sinus one.
Atrial rhythm can be observed in children with minor anomalies of cardiac development - the presence of an accessory chord, mitral valve prolapse. But sometimes atrial rhythm in a newborn baby or in young children may not be a harmless symptom, but evidence of more serious heart problems - heart defects, infectious lesions of the heart muscle, intoxication, hypoxia. In this case, we can talk about pathology.
It is observed in newborns who have had infections in utero, who have been exposed to nicotine or alcohol intoxication by the mother, in premature babies, with an unfavorable course of pregnancy, or complications during childbirth. Children diagnosed with atrial rhythm must be examined and consulted with a cardiologist. Very often, the rhythm from the atria is functional in nature and accompanies disorders of the autonomic nervous system.
Symptoms of an imbalance of the autonomic nervous system
With an imbalance of the autonomic nervous system, a predominance of the sympathetic department - sympathicotonia, or the parasympathetic department - vagotonia can be observed. With sympathicotonia, there will be complaints of rapid heartbeat, pale skin, chills, headache, and anxiety. ECG signs of atrial rhythm with a predominance of the sympathetic part of the ANS: the R-R intervals are the same, the heart rate depends on the age of the child, there is an increase in heart rate relative to the norm, high P waves, a shortening of the P-Q interval.
With vagotonia, children may complain of interruptions in the functioning of the heart, dizziness, nausea, fainting, sweating, disturbances in the functioning of the gastrointestinal tract may be observed, and blood pressure may decrease. ECG signs with a predominance of the parasympathetic part of the ANS: normal ventricular contractions, heart rate less than normal, flattened P waves, prolongation of the P-Q interval.
To determine the cause of rhythm disturbances, pediatricians or cardiologists conduct functional tests that allow them to determine the nature of the disturbances - functional (imbalance of the autonomic nervous system) or organic (heart damage). If the disorders are functional, then tests with physical activity, orthostatic, and atropine will be positive.
Whatever the cause of heart rhythm disturbances in children, it requires active examination and consultation with a doctor.
5 Diagnostics
Transesophageal electrophysiological study
The most accessible instrumental method is an ECG. An ECG is included in the mandatory list of examinations during medical examination. Allows you to evaluate the work of the heart and identify the source of disturbances, the state of the myocardium, and assess conductivity. For more accurate diagnosis use:
- 24-hour Holter ECG monitoring,
- transesophageal electrophysiological study.
6 Treatment of atrial rhythm
Drug treatment according to a doctor's prescription
If the atrial rhythm is not accompanied by any other pathology of the cardiovascular system or other organs and systems, the patient feels well and is completely healthy - this is the norm, and no treatment is required. In all other cases, the underlying disease is treated. If disturbances of the autonomic nervous system occur, sedatives and adaptogens may be prescribed.
If the patient has tachycardia, the doctor may prescribe drugs that reduce heart rate, for example, b-blockers. If you have a tendency to slow your heart rate, take medications that can increase heart contractions: atropine preparations, tincture of Eleutherococcus, ginseng, sodium caffeine benzoate. You must remember that you cannot self-medicate. Treatment for both adults and children should be prescribed only by a specialist, after a full examination and an accurate diagnosis, taking into account contraindications and concomitant pathologies.
Sinus tachyarrhythmia - normal or pathological?
Sinus rhythm of the heart, what does it mean and ECG
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Atrial rhythm and causes of its occurrence
Atrial rhythm is a special condition in which the function of the sinus node weakens, and the source of impulses is the lower premedian centers. The heart rate decreases significantly. The number of blows ranges from 90 to 160 per minute.
Origin of the disease
The source of the atrial rhythm is the so-called ectopic focus located in the fibers of the atria. In cases where the functioning of the sinus node is disrupted, other parts of the heart are activated that are capable of producing impulses, but are not active during normal heart function. Such areas are called ectopic centers.
Automatic centers located in the atria can provoke an ectopic rhythm, which is characterized by a decrease in sinus and an increase in atrial impulse. The heart rate during atrial rhythm is similar to sinus rhythm. But with atrial bradycardia the pulse slows down, and with atrial tachycardia, on the contrary, it increases.
The left atrial rhythm comes from the lower part of the left atrium, the right atrial rhythm comes from the right atrium. This factor is not important when prescribing treatment. The mere fact of the presence of an atrial rhythm will be sufficient.
Causes of the disease
Atrial rhythm is a disease that can develop in people of any age, it occurs even in children. In rare cases, the illness drags on for several days or even months. However, this illness usually lasts no more than a day.
There are often cases when the disease is hereditary. In this case, changes in the myocardium occur during intrauterine development. In children at birth, ectopic foci are noted in the atria. An ectopic rhythm in a child can occur under the influence of certain cardiotropic viral diseases.
Ectopic rhythms can also occur in completely healthy people under the influence of external factors. Such disturbances are not dangerous and are transient.
The following ailments lead to ectopic contractions:
- inflammatory processes;
- ischemic changes;
- sclerotic processes.
Ectopic atrial rhythm can be caused by several diseases, including:
- rheumatism;
- cardiac ischemia;
- heart disease;
- hypertension;
- cardiopsychoneurosis;
- diabetes.
Additional diagnostic procedures will allow you to determine the exact cause of the pathology and allow you to create a course of treatment for the disease.
Symptoms
Symptoms of atrial rhythm can be expressed in different ways, depending on the underlying disease. There are no characteristic signs of ectopic rhythm. The patient may not feel any disturbances. And yet, several main symptoms accompanying the disease can be noted:
- unexpected manifestation of abnormal heart rate;
- dizziness and shortness of breath with prolonged course of the disease;
- profuse sweating;
- pain in the chest area;
- nausea;
- paleness of the skin;
- darkening of the eyes.
The patient may worry and feel panic; an uneasy feeling does not leave him.
Short-term attacks are characterized by failure of heart contractions and subsequent cardiac arrest. Such conditions do not last long and usually occur at night. The disease is accompanied by minor pain. Your head may feel hot.
The painful condition can pass quickly, or it can drag on for a long time. With a prolonged course of the disease, a blood clot may begin to form in the atrium. There is a high risk of it entering the systemic circulation. As a result, a stroke or heart attack may occur.
In some cases, the pathology may not manifest itself in any way and can only be determined on an ECG and be irregular. If the patient has no complaints about his health, no heart disease, then this condition is not classified as a pathological manifestation and is considered as a normal phenomenon.
Diagnostics
Diagnosis of atrial rhythm is made based on ECG readings. This method is the most informative. An electrocardiogram allows you to clarify the diagnosis and study ectopic rhythms in more detail. On the ECG, this disorder is expressed quite specifically.
The atrial rhythm may be expressed at a slow pace. This condition is observed when the sinus node is depressed. Accelerated atrial rhythm is diagnosed with increased activity of ectopic centers.
For a more detailed study of the disease, the doctor may prescribe a Holter ECG.
Treatment
Atrial rhythm does not always require treatment. In cases where a person does not experience any pain and his heart is functioning smoothly, no therapy is required. The doctor diagnoses the condition as normal.
In other cases, treatment is prescribed for concomitant diseases that contributed to the development of the disease. Treatment is carried out in the following areas:
- elimination of vegetative-vascular disorders using sedatives;
- accelerated atrial rhythm is treated with beta-blockers;
- heart rate stabilization;
- prevention of myocardial infarction.
If therapeutic measures do not bring the desired result, and the patient’s condition worsens, then doctors prescribe electropulse therapy.
In some cases, atrial rhythm is the cause of a malfunction of the heart. To prevent this from happening, you should consult a doctor for any heart-related ailments. It is important to have an electrocardiogram regularly. This is the only way to prevent unwanted complications of the disease.
Traditional methods
Atrial rhythm can be treated using traditional methods. You can start treatment only after consulting your doctor. It is also important to know the cause that caused the disease.
A medicinal plant such as calendula can help with atrial rhythm. For treatment, an infusion is prepared, for which 2 tsp is taken. calendula flowers and pour a glass of boiling water. The medicine must infuse well. This will take an hour or two. The finished product is consumed twice a day, drinking half a glass at a time.
Cornflower infusion also helps eliminate the unpleasant consequences of the disease. The medicine is prepared from 1/3 tablespoon of cornflower flowers; you can also use the leaves of the plant. The raw materials are poured with a glass of boiling water. They also drink the infusion - twice a day, half a glass in the morning and evening.
Medicinal plants such as:
During therapy, stressful situations and emotional turmoil should be avoided. Otherwise, the treatment will not bring the desired results.
To keep your heart healthy, it is important to give up bad habits. Alcohol and smoking are contraindicated. Breathing exercises have a general strengthening effect.
Proper nutrition also plays an important role in the treatment of heart disease. To normalize cardiac activity, it is important to consume foods rich in calcium. The diet must certainly include cereals, vegetables and fruits. But it is better to avoid spicy food, coffee and strong tea.
In order for the treatment of atrial rhythm to be effective, it is important to know the reasons that provoked the disease and, first of all, to address the symptoms of concomitant diseases.
Atrial rhythm: why does it occur and what to do?
The correct functioning of a healthy heart is normally affected by sinus rhythm. Its source is the main point of the conduction system - the sinoatrial node. But this doesn't always happen. If the center of automatism of the first level for some reason cannot fully perform its function, or it completely falls out of the general scheme of pathways, another source of generation of contractile signals appears - ectopic. What is ectopic atrial rhythm? This is a situation in which electrical impulses begin to be produced by atypical cardiomyocytes. These muscle cells also have the ability to generate a wave of excitation. They are grouped into special foci called ectopic zones. If such areas are localized in the atria, then the sinus rhythm is replaced by the atrial rhythm.
Origin of the disease
Atrial rhythm is a type of ectopic contraction. Ectopia is an abnormal arrangement of something. That is, the source of excitation of the heart muscle does not appear where it is supposed to be. Such foci can form in any part of the myocardium, causing a disruption in the normal sequence and frequency of contractions of the organ. The ectopic rhythm of the heart is otherwise called a replacement rhythm, since it takes on the function of the main automatic center.
There are two possible types of atrial rhythm: slow (it causes a decrease in myocardial contractility) and accelerated (the heart rate increases).
The first occurs when sinus node blockade causes weak impulse generation. The second is the result of increased pathological excitability of the ectopic centers; it overlaps the main rhythm of the heart.
Abnormal contractions are rare, then they are combined with sinus rhythm. Or the pre-sulfur rhythm becomes the leading one, and the participation of the first-order automatic driver is completely canceled. Such violations can be typical for different time periods: from a day to a month or more. Sometimes the heart works constantly under the start of ectopic foci.
What is inferior atrial rhythm? Active atypical connections of myocardial cells can be located both in the left and right atrium, and in the lower parts of these chambers. Accordingly, lower right atrial and left atrial rhythms are distinguished. But when making a diagnosis, there is no particular need to distinguish between these two types; it is only important to establish that the excitatory signals come from the atria.
The source of impulse generation can change its location within the myocardium. This phenomenon is called rhythm migration.
Causes of the disease
Inferior atrial ectopic rhythm occurs under the influence of various external and internal conditions. A similar conclusion can be given to patients of all age categories. Such a malfunction in the functioning of the heart muscle is not always considered a deviation. Physiological arrhythmia, as a variant of the norm, does not require treatment and goes away on its own.
Types of disorders caused by lower atrial rhythm:
- tachycardia of paroxysmal and chronic nature;
- extrasystoles;
- flutters and fibrillation.
Sometimes the right atrial rhythm is no different from the sinus rhythm and adequately organizes the work of the myocardium. Such a failure can be detected completely by accident using an ECG during the next routine medical examination. At the same time, the person is completely unaware of the existing pathology.
The main reasons for the development of ectopic inferior atrial rhythm:
- myocarditis;
- weakness of the sinus node;
- high blood pressure;
- myocardial ischemia;
- sclerotic processes in muscle tissue;
- cardiomyopathy;
- rheumatism;
- heart defect;
- exposure to nicotine and ethanol;
- carbon monoxide poisoning;
- side effects of medications;
- congenital feature;
- vegetative-vascular dystonia;
- diabetes.
Inferior atrial rhythm in children can be either congenital or acquired. In the first case, the child is already born with the presence of ectopic foci. This is the result of oxygen starvation during childbirth or a consequence of intrauterine development abnormalities. Functional immaturity of the cardiovascular system, especially in premature infants, is also the cause of the formation of ectopic rhythm. Such disorders can normalize on their own with age. However, such babies need medical supervision.
Another situation is adolescence. During this period, boys and girls experience serious changes in the body, hormonal levels are disrupted, and the sinus heart rhythm can be temporarily replaced by the atrial one. With the end of puberty, all health problems usually end. In adults, hormonal problems may be associated with aging (for example, menopause in women), which also affects the appearance of ectopic heart rhythms.
Professional sports can also be considered as a cause of the development of atrial rhythm. This symptom is a consequence of degenerative processes in the myocardium that occur under the influence of excessive stress in athletes.
Symptoms
Inferior atrial abnormal rhythm may develop asymptomatically. If signs of cardiac dysfunction are present, they will reflect the disease that caused this condition.
- A person begins to feel contractions of the myocardium and “hear” its tremors.
- The number of minute beats of the organ is growing.
- The heart seems to “freeze” for a while.
- There is increased sweat production.
- A dark, continuous veil appears before your eyes.
- My head suddenly began to spin.
- The skin became pale, a blue tint appeared on the lips and fingertips.
- It became difficult to breathe.
- Pain appeared in the chest area.
- Frequent urination bothers me.
- The person experiences great fear for his life.
- Nausea or vomiting may occur.
- Disorders of the gastrointestinal tract.
- Fainting develops.
Short attacks take the patient by surprise, but end as quickly as they begin. Often such rhythm disturbances occur at night during sleep. A person wakes up in panic, feeling tachycardia, chest pain or heat in the head.
Diagnostics
The presence of atrial rhythm can be detected based on data obtained during an ultrasound of the heart or an electrocardiogram.
Since the pathology can manifest itself from time to time, and often this happens at night, Holter ECG monitoring is used to obtain a more complete clinical picture. Special sensors are attached to the patient’s body and record changes occurring in the heart chambers around the clock. Based on the results of such a study, the doctor draws up a protocol for monitoring the state of the myocardium, which makes it possible to detect both daytime and nighttime paroxysms of rhythm disturbances.
Transesophageal electrophysiological examination, coronary angiography, and ECG recording under stress are also used. A standard analysis of biological fluids of the body is required: general and biochemical examination of blood and urine.
Signs on the electrocardiogram
An ECG is an accessible, simple and fairly informative way to obtain data on various heart rhythm disorders. What does the doctor evaluate on the cardiogram?
- The state of the P wave, reflecting the process of depolarization (appearance of an electrical impulse) in the atria.
- The P-Q region demonstrates the features of the excitation wave traveling from the atria to the ventricles.
- The Q wave marks the initial stage of ventricular excitation.
- The R element displays the maximum level of ventricular depolarization.
- The S tooth indicates the final stage of propagation of the electrical signal.
- The QRS complex is called the ventricular complex; it shows all stages of the development of excitation in these sections.
- The T element registers the phase of decline in electrical activity (repolarization).
Using the available information, the specialist determines the characteristics of the heart rhythm (frequency and periodicity of contractions), the source of impulse generation, and the location of the electrical axis of the heart (EOS).
The presence of atrial rhythm is indicated by the following signs on the ECG:
- negative P wave with unchanged ventricular complexes;
- the right atrial rhythm is reflected by the deformation of the P wave and its amplitude in additional leads V1-V4, the left atrial rhythm - in leads V5-V6;
- teeth and intervals have increased duration.
EOS displays electrical parameters of cardiac activity. The position of the heart as an organ with a three-dimensional volumetric structure can be represented in a virtual coordinate system. To do this, the data obtained by the electrodes during the ECG is projected onto a coordinate grid to calculate the direction and angle of the electrical axis. These parameters correspond to the localization of the excitation source.
Normally, it has a vertical (from +70 to +90 degrees), horizontal (from 0 to +30 degrees), intermediate (from +30 to + 70 degrees) position. A deviation of the EOS to the right (over +90 degrees) indicates the development of an ectopic abnormal right atrial rhythm; a deviation to the left (up to -30 degrees and beyond) is an indicator of a left atrial rhythm.
Treatment
Treatment measures will not be required if the adult or child does not experience any discomfort when the anomaly develops, and they do not have heart or other diseases. The occurrence of atrial rhythm in this situation is not dangerous to health.
Otherwise, the therapeutic effect is carried out in the following directions:
- Accelerated pathological atrial rhythm is treated with beta blockers (Propranalol, Anaprilin) and other drugs that reduce heart rate.
- For bradycardia, medications are prescribed that can accelerate the slow rhythm: drugs based on atropine, sodium caffeine benzoate, and plant extracts (Eleutherococcus, ginseng).
- Vegetative-vascular disorders that cause ectopic rhythm require the use of sedatives “Novopassit”, “Valocordin”, motherwort tincture, valerian.
- To prevent heart attack, it is proposed to use Panangin.
- In addition to antiarrhythmic drugs (“Novocainamide”, “Verapamil”), in case of irregular rhythm, specific treatment is prescribed after establishing the specific cause of the disorders that have developed.
- In severe cases that are not amenable to standard drug treatment, cardioversion and installation of an artificial pacemaker are used.
Traditional methods
Atrial rhythm, as one of the types of cardiac disorders, requires constant monitoring by a doctor. Even the absence of alarming symptoms is not a reason to be negligent about such a condition. If the development of ectopic contractions is caused by diseases, it is imperative to find out the cause of the pathology and treat it with all seriousness. Advanced severe forms of atrial arrhythmias can threaten human life.
Atrial rhythm on ECG
The heart, being one of the main muscles in the human body, has a number of special properties. It can contract regardless of nerve impulses coming from the brain and taking part in the control of the neurohumoral system. The correct route for transmitting information in the heart muscle begins in the area of the right atrium (sinus node), continues in the area of the atrioventricular node and then spreads across the entire area of the septum. All other contractions that do not follow this route are considered an ectopic rhythm.
How do atrial rhythms appear?
An ectopic impulse, appearing outside the sinus node, is formed and excites the heart muscle before the signal is transmitted from the main pacemaker. Such situations allow us to say that an accelerated atrial rhythm appears due to the “advanced” of the main rhythm by a secondary contraction of the ectopic type.
The theoretical basis for the ectopic rhythm is the re-entry theory, according to which a certain area of the atrium is not excited in parallel with others due to the fact that there is a local blocking of the propagation of the nerve impulse. At the time of its activation, this area experiences an additional contraction - thus, it goes out of turn and thereby disrupts the overall rhythm of the heart.
Some theories suggest the autonomic and endocrine nature of the occurrence of atrial rhythms. As a rule, such phenomena occur in children during puberty or in adults with certain hormonal changes (age-related or resulting from pathologies).
There is also a version of the following type: hypoxic and inflammatory processes in the myocardium during cardiopathy and inflammatory diseases can cause atrial rhythms. Thus, in children who suffer from a sore throat or flu, there is a risk of myocarditis with a subsequent change in atrial rhythm.
The heart, being one of the main muscles in the human body, is endowed with special properties. It can contract regardless of the nerve impulses coming from the brain, which control the neurohumoral system. The correct route for receiving information in the heart muscle begins in the area of the right atrium (sinus node), passes in the area of the atrioventricular node and then spreads along the septum. All other beats that do not follow this route are called ectopic rhythm.
Etiology of atrial rhythm
As noted above, the reasons for changes in atrial rhythm are changes that take place in the sinus node. All changes are divided into ischemic, inflammatory and sclerotic. Non-sinus rhythms that appear as a result of such changes appear in the following forms:
- Supraventricular ectopic rhythm;
- Ventricular rhythm;
- Atrial rhythm.
An accelerated atrial rhythm is usually formed in people who suffer from rheumatic diseases, various heart diseases, dystonia, diabetes, coronary artery disease or hypertension. In some cases, atrial rhythm can appear even in healthy adults and children, and can also be congenital in nature.
Impulses can come from different parts of the heart, since the source of the emerging impulses moves through the atrium. In medical practice, this phenomenon is called migrating rhythm. When measuring such an atrial rhythm, the amplitude on the ECG changes according to the source of the location of the impulses.
Clinical picture
Atrial rhythm has a direct relationship with the specific disease that caused it. This means that there are no specific symptoms. The clinical picture is directly determined by the pathological picture in the patient’s body. This rule applies only to short-term attacks of rhythm disturbance. With prolonged attacks, the following symptoms are possible:
- Initially there is a feeling of anxiety and fear. The person tries to take the most comfortable position that would stop the further development of the attack.
- The next stage is accompanied by severe tremor (shaking) in the limbs, and in some cases, dizziness.
- The next step is the appearance of pronounced symptoms - increased sweating, dyspeptic disorders manifested in the form of bloating and nausea, and frequent urge to urinate.
Short attacks may be accompanied by an increase in heart rate and shortness of breath, after which the heart stops for a moment and a noticeable jolt is felt. A similar impulse in the heart indicates that sinus rhythm has been restored - this can also be confirmed by minor painful sensations in the chest and heart area.
The change in atrial rhythm resembles paroxysmal tachycardia. Patients themselves can determine that they have an abnormal heart rhythm. If the heart rate is high, these changes will not be noticeable. An ECG examination helps to accurately determine this condition. In the case of atrial fibrillation, patients may complain of chest pain characteristic of angina pectoris.
Long-term attacks of atrial rhythm disturbance are dangerous for a person - at this moment, blood clots can form in the heart muscle, which, if they enter the blood vessels, can cause a heart attack or stroke. The danger also lies in the fact that when the disease is latent, patients may ignore the above symptoms, and therefore are not able to determine its further development.
Diagnosis of atrial rhythm
The main method for studying atrial rhythm is ECG. A cardiogram allows you to accurately determine where the rhythm disturbance occurs, as well as accurately determine the nature of such a rhythm. An ECG allows you to determine the following types of atrial escape rhythm:
- Left atrial rhythm: aVL is negative, aVF, PII, III are positive, PI, in some cases, smoothed. PV1/PV2 are positive and PV5-6 are negative. According to Mirovski et al., the P wave in left atrial rhythm consists of two parts: the first has a low-voltage and dome-shaped rise (affected by depolarization of the left atrium), the second part is characterized by a narrow and high peak (the right atrium is depolarized).
- Right atrial rhythm: characterized by a negative P wave in the area of the third standard branch, in the first and second - positive. This phenomenon is characteristic of a mid-lateral right atrial rhythm. The lower rhythm of this form is characterized by the indication of the P wave, negative in the second and third branches, as well as aVF, smoothed in the 5-6 thoracic.
- The lower atrial rhythm is characterized by a shortening of the PQ interval, in which its value is less than 0.12 seconds, and the P wave is negative in branches II, III and aVF.
We can draw the following conclusion: based on electrocardiogram data, the doctor can determine a change in atrial rhythm based on changes in the P wave, which has an amplitude and polarity different from the physiological norm.
Note that to determine the right atrial rhythm, a specialist must have extensive experience, since ECG data with such a rhythm are blurry and difficult to differentiate. In view of this, Holter monitoring can be used to form the most complete and accurate picture of cardiac activity.
What happens with ectopic heart rhythm?
In a normal human heart, there is only one path for conducting an electrical impulse, leading to sequential excitation of different parts of the heart and to productive cardiac contraction with sufficient release of blood into large vessels. This path begins in the right atrial appendage, where the sinus node (1st order pacemaker) is located, then passes through the atrial conduction system to the atrioventricular (atrioventricular) junction, and then through the His system and Purkinje fibers reaches the most distant fibers in the tissue of the ventricles.
But sometimes, due to the action of various reasons on the cardiac tissue, the cells of the sinus node are not able to generate electricity and release impulses to the underlying sections. Then the process of transmitting excitation through the heart changes - after all, in order for the heart not to stop completely, it should develop a compensatory, replacement system for generating and transmitting impulses. This is how ectopic or replacement rhythms arise.
So, ectopic rhythm is the occurrence of electrical excitation in any part of the conducting fibers of the myocardium, but not in the sinus node. Literally, ectopia means the appearance of something in the wrong place.
The ectopic rhythm can originate from the tissue of the atria (atrial ectopic rhythm), in the cells between the atria and the ventricles (rhythm from the AV junction), and also from the tissue of the ventricles (ventricular idioventricular rhythm).
Why does ectopic rhythm appear?
Ectopic rhythm occurs due to a weakening of the rhythmic functioning of the sinus node, or a complete cessation of its activity.
In turn, complete or partial inhibition of the sinus node is the result of various diseases and conditions:
- Inflammation. Inflammatory processes in the heart muscle can affect both the cells of the sinus node and the muscle fibers in the atria and ventricles. As a result, the ability of cells to produce impulses and transmit them to underlying sections is impaired. At the same time, the atrial tissue begins to intensively generate excitation, which is supplied to the atrioventricular node at a frequency higher or lower than usual. Such processes are caused mainly by viral myocarditis.
- Ischemia. Acute and chronic myocardial ischemia also contributes to impaired activity of the sinus node, since cells deprived of sufficient oxygen cannot function normally. Therefore, myocardial ischemia occupies one of the leading places in the statistics of the occurrence of rhythm disturbances, including ectopic rhythms.
- Cardiosclerosis. The replacement of normal myocardium with growing scar tissue due to previous myocarditis and infarctions interferes with the normal transmission of impulses. In this case, in persons with ischemia and post-infarction cardiosclerosis (PICS), for example, the risk of ectopic heart rhythm increases significantly.
In addition to pathology of the cardiovascular system, vegetative-vascular dystonia, as well as hormonal imbalances in the body - diabetes mellitus, pathology of the adrenal glands, thyroid gland, etc., can lead to ectopic rhythm.
Symptoms of ectopic rhythm
The clinical picture of replacement heart rhythms can be clearly expressed or not manifested at all. Usually, the symptoms of the underlying disease come first in the clinical picture, for example, shortness of breath on exertion, attacks of burning pain in the chest, swelling of the lower extremities, etc. Depending on the nature of the ectopic rhythm, the symptoms may be different:
- With ectopic atrial rhythm, when the source of impulse generation is located entirely in one of the atria, in most cases there are no symptoms, and disturbances are detected by the cardiogram.
- With a rhythm from the AV junction, a heart rate is observed that is close to normal - beats per minute, or below normal. In the first case, no symptoms are observed, but in the second, attacks of dizziness, a feeling of lightheadedness and muscle weakness are noted.
- With extrasystole, the patient notes a feeling of fading, cardiac arrest, followed by a sharp jolt in the chest and a further absence of sensations in the chest. The more often or less often the extrasystoles, the more varied the symptoms in duration and intensity.
- With atrial bradycardia, as a rule, the heart rate is not much lower than normal, within a minute, as a result of which the patient may not notice any complaints. Sometimes he is bothered by attacks of weakness and sudden fatigue, which is caused by a reduced flow of blood to the skeletal muscles and brain cells.
- Paroxysmal tachycardia manifests itself much more clearly. During paroxysm, the patient notes a sharp and sudden sensation of accelerated heartbeat. According to many patients, the heart flutters in the chest like a “hare’s tail.” The heart rate can reach 150 beats per minute. The pulse is rhythmic, and may remain around 100 per minute, due to the fact that not all heartbeats reach the peripheral arteries at the wrist. In addition, there is a feeling of lack of air and chest pain caused by insufficient oxygen supply to the heart muscle.
- Atrial fibrillation and flutter can be paroxysmal or permanent. The basis of atrial fibrillation is a chaotic, non-rhythmic contraction of different parts of the atrium tissue, and the heart rate in the paroxysmal form is more than 150 per minute. However, there are normo- and bradysystolic variants, in which the heart rate is within the normal range or less than 55 per minute. The symptoms of the paroxysmal form resemble an attack of tachycardia, only with an irregular pulse, as well as a feeling of irregular heartbeat and interruptions in heart function. The bradysystolic form may be accompanied by dizziness and lightheadedness. With a permanent form of arrhythmia, the symptoms of the underlying disease that led to it come to the fore.
- Idioventricular rhythm is almost always a sign of serious cardiac pathology, such as severe acute myocardial infarction. In most cases, symptoms are noted, since the myocardium in the ventricles is capable of generating electricity at a frequency that does not last more than a minute. In this regard, the patient may experience Morgagni-Edams-Stokes (MES) episodes - attacks of loss of consciousness lasting several seconds, but no more than one or two minutes, since during this time the heart “turns on” compensatory mechanisms and begins to contract again. In such cases, they say that the patient is “massing.” Such conditions are very dangerous due to the possibility of complete cardiac arrest. Patients with idioventricular rhythm are at risk of developing sudden cardiac death.
Ectopic rhythms in children
In children, this type of arrhythmia can be congenital or acquired.
Thus, ectopic atrial rhythm occurs most often with vegetative-vascular dystonia, with hormonal changes during puberty (in adolescents), as well as with pathology of the thyroid gland.
In newborns and young children, a right atrial, left or lower atrial rhythm may be a consequence of prematurity, hypoxia or pathology during childbirth. In addition, the neurohumoral regulation of heart activity in very young children is immature, and as the baby grows, all heart rate indicators can return to normal.
If the child does not have any pathology of the heart or central nervous system, then the atrial rhythm should be considered a transient, functional disorder, but the baby should be regularly monitored by a cardiologist.
But the presence of more serious ectopic rhythms - paroxysmal tachycardia, atrial fibrillation, atrioventricular and ventricular rhythms - require more detailed diagnosis, as this may be due to congenital cardiomyopathy, congenital and acquired heart defects, rheumatic fever, viral myocarditis.
Diagnosis of ectopic rhythm
The leading diagnostic method is the electrocardiogram. If an ectopic rhythm is detected on the ECG, the doctor should prescribe a further examination plan, which includes cardiac ultrasound (ECHO-CS) and daily ECG monitoring. In addition, patients with myocardial ischemia are prescribed coronary angiography (CAG), and patients with other arrhythmias are prescribed transesophageal electrophysiological examination (TEPE).
ECG signs for different types of ectopic rhythm differ:
- With an atrial rhythm, negative, high, or biphasic P waves appear, with a right atrial rhythm - in additional leads V1-V4, with a left atrial rhythm - in V5-V6, which may precede or overlap the QRST complexes.
- The rhythm from the AV junction is characterized by the presence of a negative P wave, superimposed on the QRST complexes, or present after them.
- Idioventricular rhythm is characterized by a low heart rate (30-40 per minute) and the presence of altered, deformed and widened QRST complexes. There is no P wave.
- With atrial extrasystole, premature, extraordinary, unchanged PQRST complexes appear, and with ventricular extrasystole, altered QRST complexes appear followed by a compensatory pause.
- Paroxysmal tachycardia is characterized by a regular rhythm with a high frequency of contractions (per minute), P waves are often quite difficult to detect.
- Atrial fibrillation and flutter on the ECG are characterized by an irregular rhythm, the P wave is absent, and fibrillation f waves or flutter waves F are characteristic.
Treatment of ectopic rhythm
Treatment is not carried out in cases where the patient has an ectopic atrial rhythm that does not cause unpleasant symptoms, and pathologies of the heart, hormonal and nervous systems have not been identified.
In the case of moderate extrasystole, the prescription of sedatives and restorative drugs (adaptogens) is indicated.
Therapy for bradycardia, for example, with an atrial rhythm with a low contraction frequency, with the bradyform of atrial fibrillation, consists of prescribing atropine, ginseng preparations, Eleutherococcus, Schisandra and other adaptogens. In severe cases, with a heart rate of less than a minute, with attacks of MES, implantation of an artificial pacemaker (pacemaker) is justified.
Accelerated ectopic rhythm, for example, paroxysms of tachycardia and atrial fibrillation-flutter require emergency assistance, for example, the administration of a 4% solution of potassium chloride (panangin) intravenously, or a 10% solution of novocainamide intravenously. Subsequently, the patient is prescribed beta blockers or antiarrhythmic drugs - Concor, Coronal, verapamil, propanorm, digoxin, etc.
In both cases - both slow and accelerated rhythms, treatment of the underlying disease, if any, is indicated.
Forecast
The prognosis in the presence of an ectopic rhythm is determined by the presence and nature of the underlying disease. For example, if a patient has an atrial rhythm on an ECG, but no heart disease is detected, the prognosis is favorable. But the appearance of paroxysmal accelerated rhythms against the background of acute myocardial infarction puts the prognostic value of ectopia in the category of relatively unfavorable.
In any case, the prognosis improves with timely consultation with a doctor, as well as with the fulfillment of all medical prescriptions in terms of examination and treatment. Sometimes medications have to be taken for the rest of your life, but this greatly improves the quality of life and increases its duration.
Types of atrial arrhythmia
Since the manifestations of ectopic rhythms are a direct derivative of disturbances in the functioning of the sinus node, their occurrence occurs under the influence of changes in the rhythm of cardiac impulses or myocardial rhythm. The following diseases are common causes of ectopic rhythm:
- Cardiac ischemia.
- Inflammatory processes.
- Diabetes.
- High pressure in the heart area.
- Rheumatism.
- Neurocircular dystonia.
- Sclerosis and its manifestations.
Other heart defects, such as hypertension, can also trigger the development of the disease. A strange pattern of occurrence of ectopic right atrial rhythms appears in people with excellent health. The disease is transient, but there are cases of congenital pathology.
Among the features of the ectopic rhythm, a characteristic heart rate is noted. In people with this defect, elevated heart rates are detected during diagnosis.
With routine pressure measurements, it is easy to confuse ectopic atrial rhythm with an increase in the number of heart contractions due to high temperature, inflammatory diseases, or normal tachycardia.
If the arrhythmia does not go away for a long time, the disorder is said to be permanent. Paroxysmal disturbances of accelerated atrial rhythm are noted as a separate item. A feature of this type of disease is its sudden development, the pulse can reach a minute.
A feature of such ectopic rhythms is the sudden onset of an attack and unexpected termination. Most often occurs with atrial tachycardia.
On the cardiogram, such contractions are reflected at regular intervals, but some forms of ectopia look different. The question: is this normal or pathological can be answered by studying different types of deviations.
There are two types of uneven changes in the intervals between atrial rhythms:
- Extrasystole is an extraordinary atrial contraction against the background of a normal heart rhythm. The patient may physically feel a pause in the rhythm that occurs due to myocarditis, a nervous breakdown, or bad habits. There are cases of manifestations of causeless extrasystole. A healthy person can feel up to 1500 extrasystoles per day without harm to health, and there is no need to seek medical help.
- Atrial fibrillation is one of the cyclic stages of the heart. There may be no symptoms at all. The atrium muscles stop contracting rhythmically, and chaotic flicker occurs. The ventricles, under the influence of flickering, are knocked out of rhythm.
The danger of developing an atrial rhythm exists regardless of age and can occur in a child. Knowing that this abnormality can occur over a period of days or months will make it easier to identify. Although medicine treats such deviations as a temporary manifestation of an illness.
In childhood, the appearance of ectopic atrial rhythm can occur under the influence of a virus. This is the most dangerous form of the disease, usually the patient is in serious condition, and exacerbations of atrial heart rhythm in children can occur even with changes in body position.
Symptoms of atrial rhythm
External manifestations of the disease appear only against the background of arrhythmia and another complication. The ectopic rhythm itself does not have characteristic symptoms. Although it is possible to pay attention to long-term disturbances in the rhythm of heart contractions. If you discover such a deviation, you should immediately consult a doctor.
Among the indirect symptoms indicating heart problems are:
- Frequent attacks of shortness of breath.
- Dizziness.
- Chest pain.
- Increased feeling of anxiety and panic.
Important! A characteristic sign of the onset of an attack of ectopic rhythm is the patient’s desire to take a body position in which the discomfort will go away.
If the attack does not go away for a long time, profuse sweating, blurred vision, bloating, and hands may begin to shake.
There are deviations in heart rate that cause problems with the digestive system, sudden vomiting and the desire to urinate. The urge to empty your bladder occurs every minute, regardless of the amount of fluid you drink. As soon as the attack stops, the urge will stop and your overall health will improve.
An attack of extrasystole can occur at night and be provoked by a dream. As soon as it is completed, the heart may freeze, after which its operation will return to normal. Symptoms of fever and a burning sensation in the throat may occur during sleep.
Diagnostic techniques
Identification is made based on data obtained during the anamnesis. After this, the patient is sent to an electrocardiogram to detail the obtained data. Based on the patient’s internal feelings, one can draw conclusions about the nature of the disease.
With the help of an ECG, the features of the disease are revealed; with ectopic heart rhythm, they are of a specific nature. Characteristic signs are manifested by changes in readings on the “P” wave; they can be positive or negative depending on the lesion.
The presence of atrial rhythm on an ECG can be determined based on the following indicators:
- The compensatory pause does not have a full form.
- The P-Q interval is shorter than it should be.
- The “P” wave configuration is uncharacteristic.
- The ventricular complex is excessively narrow.
Treatment of ectopic rhythm
To select an appropriate treatment, an accurate diagnosis of the abnormality must be established. Inferior atrial rhythm can affect heart disease to varying degrees, causing treatment tactics to change.
Sedatives are prescribed to combat vegetative-vascular disorders. Increased heart rate suggests the use of beta-blockers. To stop extrasystoles, Panalgin and Potassium chloride are used.
Manifestations of atrial fibrillation are determined by the prescription of drugs that stop the manifestation of arrhythmia during attacks. Controlling the contraction of cardiac impulses with medications depends on the age group of the patient.
Massage of the carotid sinus, located near the carotid artery, is necessary after diagnosing the supraventricular form of heart rhythm disturbance. To carry out the massage, apply gentle pressure in the neck area on the carotid artery for 20 seconds. Rotational movements on the eyeballs will help relieve the manifestation of unpleasant symptoms during an attack.
If the attacks are not stopped by massage of the carotid artery and pressure on the eyeballs, a specialist may prescribe medication treatment.
Important! Repetition of attacks 4 times in a row or more, severe deterioration of the patient’s condition can lead to serious consequences. Therefore, to restore normal heart function, the doctor uses electromagnetic therapy.
Although the extrasystole defect can be irregular, the appearance of ectopic arrhythmia is a dangerous form of development of heart damage, as it entails serious complications. To avoid becoming a victim of unforeseen attacks that result in an abnormal heart rhythm, you should regularly undergo examinations and diagnostics of the functioning of the cardiovascular system. Adherence to this approach allows you to avoid the development of dangerous diseases.
Treatment
When choosing a drug for treatment, it is first necessary to study the effect of cardiac glycosides (digoxin, isolanide). As a rule, these drugs do not stop the accelerated supraventricular rhythm, but provide a decrease in the frequency of the atrial rhythm and a slowdown in the ventricular rhythm due to deterioration of conduction in the atrioventricular node (incomplete blockade).
This effect should be considered satisfactory, since treatment can be carried out over a long period of time without causing any severe adverse reactions and, at the same time, hemodynamic parameters are significantly improved. In case of insufficient effect of cardiac glycosides, a trial treatment with beta-receptor blockers or their combination with cardiac glycosides is prescribed.
Novocainamide and quinidine are ineffective in this group of patients. Isoptin, affecting conductivity in the atrioventricular node, like glycosides, also slows down the ventricular rhythm in some patients. However, due to the short half-life of isoptin, it is more difficult to ensure a constant decrease in rhythm with its help.
Stopping the accelerated rhythm of the atrioventricular junction by frequent stimulation of the atria. I, III - standard ECG leads; EPP and EPG - electrograms of the right atrium and His bundle; S—electrical stimuli; As—atrial potentials evoked by electrical stimulation; C, A - potential of the right atrium of sinus origin; Ae - atrial potential of ectopic origin. The second and fourth electrical stimuli, applied immediately after the ventricular complex, are blocked at the atrioventricular node and interrupt the ectopic rhythm, which resumes after a single sinus complex. For other features of this type of arrhythmia, see the figure above.
In some patients we observed, suppression of arrhythmia was noted with the help of the anticonvulsant drug finlepsin when prescribed according to the regimen accepted in neurological practice. However, it should be noted that the mechanism of the antiarrhythmic action of the drug has not yet been studied.
In patients with exertional angina, treatment should begin with the prescription of antianginal drugs. Sometimes the use of, for example, only long-acting nitroglycerin preparations can improve the course of arrhythmia.
Forecast
This form of rhythm disturbance is characterized by an asymptomatic course in most patients and sometimes stops spontaneously. Despite its relative benignity, such patients should be regularly monitored and treated with individually selected drugs.
“Paroxysmal tachycardia”, N.A. Mazur
Ectopic, also characterized as replacement, rhythms are contractions of the heart caused by automatism manifested in other parts of the myocardium or conduction system. Arise if the activity of the sinus node is stopped or weakened, which can happen either permanently or temporarily. The further away the source of a non-sinus rhythm is (we will apply this name to rhythms of an ectopic nature), the frequency is usually lower and the frequency of impulses of the sinus node is less frequent.
Reasons for rhythm changes
- sclerotic;
- ischemic;
- inflammatory.
- active: and extrasystole;
begin to develop in cases of cardiac organic pathology. It is very rare, but there are cases when this type can be diagnosed in a healthy child, even a newborn.
Symptoms of the disease
- increased sweating;
- nausea;
- bloating;
- interruptions in cardiac function;
- a feeling of “fading” of the heart;
- fainting;
- feeling of tension and anxiety;
- dizziness;
- pallor;
- dyspnea;
- stomach ache.
Diagnosis of the disease
Treatment methods
Intoxication with digitalis can lead to the occurrence of polytopic extrasystoles, which is why. In this case, you need to urgently stop the drug, and use potassium preparations, Inderal, and lidocaine as treatment. To relieve intoxication associated with cardiac glycosides, the doctor may prescribe diuretics and unithiol.
Sinus pacemaker migration- this is a disturbance of the heart rhythm (arrhythmia), for which typical is a gradual movement of the source of the pacemaker from the sinus node (Kisse-Fleck node) from the sinus node (Kisse-Fleck node) to the atrioventricular connection (Aschoff-Tavara node) from cardio cycle to cardio cycle (Fig. 1). This is typical passive ectopic rhythm.
Rice. 1 Sinus pacemaker migration
Electrocardiographic signs of sinus pacemaker migration:
- the P wave is changed in shape and polarity from cardiac cycle to cardiac cycle (positive, smoothed, isoelectric, negative);
- the PQ interval is varied in duration and depends on the location of the pacemaker;
- arrhythmia severity index (PSA) more than 10%;
- presence of respiratory arrhythmia.
Atrial rhythm
Atrial rhythm. At atrial rhythm the cardiac impulse to excite the entire myocardium is formed from ectopic areas of the right or left atrium (Fig. 2).
Legend:
- sources of ectopic rhythms in the left atrium;
- sources of ectopic rhythms in the right atrium.
Rice. 2 Atrial rhythm
- the heart rate is usually less than normal (the exception is accelerated atrial rhythms, in which the heart rate can be either normal or accelerated);
- the P wave is recorded before each ventricular QRS complex;
- the P wave is constant in shape, but non-sinus. If a negative P wave is recorded in leads II, III, aVF, then the presence of a left atrial rhythm is stated. If a negative P wave appears in leads I, II, aVL, Vm5, Vm6, then an inferior atrial rhythm is diagnosed.
Atrioventricular (nodal) rhythm
Atrioventricular (nodal) rhythm. In this case, the source of the pacemaker for the entire heart becomes the atrioventricular node, which generates an impulse with a frequency lower than the automatic center of the sinus node (Fig. 3).
Rice. 3 Nodal rhythm
Note:- rhythm from the atrioventricular junction with simultaneous excitation of the ventricles and atria;
- rhythm from the atrioventricular junction during ventricular excitation preceding atrial depolarization.
It is characterized by the following electrocardiographic signs:
- the P wave is absent;
- decreased heart rate.
Electrocardiographic signs:
- the negative P wave is recorded after the QRS complex;
- the ventricular QRS complex is not changed;
- heart rate is below normal (the exception is an accelerated nodal rhythm, in which the heart rate can be either normal or accelerated).
Idioventricular rhythm
Idioventricular rhythm (ventricular ectopic rhythm). This is a severe heart rhythm disturbance, when the source of the driver of the heart rhythm becomes an automatic center of the third order, which is located in the ventricles of the heart (Fig. 4).
Ectopic rhythms. When the activity of the sinus node weakens or ceases, replacement ectopic rhythms may occur (from time to time or constantly), that is, heart contractions caused by the manifestation of automatism in other parts of the conduction system or myocardium. Their frequency is usually less than the frequency of sinus rhythm. As a rule, the more distal the source of the ectopic rhythm, the lower the frequency of its impulses. Ectopic rhythms can occur with inflammatory, ischemic, sclerotic changes in the area of the sinus node and in other parts of the conduction system; they can be one of the manifestations of sick sinus syndrome (see below). Supraventricular ectopic rhythm may be associated with autonomic dysfunction and overdose of cardiac glycosides.
Occasionally, the ectopic rhythm is caused by an increase in the automaticity of the ectopic center; in this case, the heart rate is higher than with a replacement ectopic rhythm (accelerated ectopic rhythm).
The presence of an ectopic rhythm and its source are determined only by the ECG.
The atrial rhythm is characterized by changes in the configuration of wave I. Its diagnostic signs are unclear. Sometimes the shape of the P wave and the duration of P-Q changes from cycle to cycle, which is associated with migration of the pacemaker through the atria. Atrioventricular rhythm (rhythm from the atrioventricular junction) is characterized by inversion of the P wave, which can be recorded near the ventricular complex or superimposed on it. The frequency of the replacement atrium-ventricular rhythm is 40-50 per 1 min, for the accelerated one - 60-100 per 1 min. If the ectopic center is slightly more active than the sinus node, and the reverse conduction of the impulse is blocked, then conditions arise for incomplete atrioventricular dissociation; in this case, periods of sinus rhythm alternate with periods of replacement atrium-ventricular (rarely ventricular) rhythm, the feature of which is a rarer atrial rhythm (P) and an independent, but more frequent ventricular rhythm (QRST). Ectopic ventricular rhythm (no regular P wave, ventricular complexes are deformed, frequency 20-50 per minute) usually indicates significant changes in the myocardium; at a very low frequency of ventricular contractions, it can contribute to the occurrence of ischemia of vital organs.
Treatment
Extrasystoles- premature contractions of the heart caused by the occurrence of an impulse outside the sinus node. Extrasystole can accompany any heart disease. In no less than half of the cases, extrasystole is not associated with heart disease, but is caused by vegetative and psycho-emotional disorders, drug treatment (especially cardiac glycosides), electrolyte imbalances of various nature, consumption of alcohol and stimulants, smoking, and reflex effects from internal organs. Occasionally, extrasystopia is detected in apparently healthy individuals with high functional capabilities, for example, in athletes. Physical activity generally provokes extrasystole associated with heart disease and metabolic disorders, and suppresses extrasystole caused by autonomic dysregulation.
Extrasystoles may occur in a row, two or more - paired and group extrasystoles.
tm, in which each normal systole is followed by an extrasystole, is called bigeminy. Especially unfavorable are hemodynamically ineffective early extrasystoles that occur simultaneously with the T wave of the previous cycle or no later than 0.05 s after its end. If ectopic impulses are formed in different foci or at different levels, then polytopic extrasystoles arise, which differ from each other in the shape of the extrasystolic complex on the ECG (within one lead) and in the size of the pre-extrasystolic interval. Such extrasystoles are often caused by significant changes in the myocardium. Sometimes long-term rhythmic functioning of the ectopic focus is possible along with the functioning of the sinus pacemaker - parasystole. Parasystolic impulses follow a regular (usually rarer) rhythm, independent of sinus rhythm, but some of them coincide with the refractory period of the surrounding tissue and are not realized.
On the ECG, atrial extrasystoles are characterized by a change in the shape and direction of the P wave and a normal ventricular complex. The post-extrasystolic interval may not be increased. With early atrial extrasystoles, there is often a violation of atrioventricular and intraventricular conduction (usually in the form of right leg block) in the extrasystolic cycle. Atrioventricular (from the area of the atrioventricular junction) extrasystoles are characterized by the fact that the inverted P wave is located near the unchanged ventricular complex or superimposed on it.
There may be a violation of intraventricular conduction in the extrasystolic cycle. The post-extrasystolic pause is usually increased. Ventricular extrasystoles are distinguished by a more or less pronounced deformation of the QRST complex, which is not preceded by a P wave (with the exception of very late ventricular extrasystoles, in which a normal P wave is recorded, but the P-Q interval is shortened). The sum of the pre- and post-extrasystolic intervals is equal to or slightly exceeds the duration of the two intervals between sinus contractions. With early extrasystoles against the background of bradycardia, there may be no post-extrasystolic pause (intercalated extrasystoles). With left ventricular extrasystoles in the QRS complex in lead V1, the largest is the R wave directed upward, with right ventricular extrasystoles the largest is the S wave directed downward.
Symptoms. Patients either do not feel extrasystoles, or feel them as an increased push in the heart or cardiac arrest. When examining the pulse, extrasystole corresponds to a premature weakened pulse wave or loss of the next pulse wave, and during auscultation - premature heart sounds.
The clinical significance of extrasystoles may vary. Rare extrasystoles in the absence of heart disease usually do not have significant clinical significance.
The presence of extrasystoles sometimes indicates an exacerbation of an existing disease (coronary heart disease, myocarditis, etc.) or glycoside intoxication. Frequent atrial extrasystoles often foreshadow atrial fibrillation. Particularly unfavorable are frequent early, as well as polytopic and group ventricular extrasystoles, which in the acute period of myocardial infarction and during intoxication with cardiac glycosides can be a harbinger of ventricular fibrillation. Frequent extrasystoles (6 or more per minute) can themselves contribute to the worsening of coronary insufficiency.
Treatment. The factors that led to extrasystole should be identified and, if possible, eliminated. If extrasystole is associated with a specific disease (myocarditis, thyrotoxicosis, alcoholism, etc.), then treatment of this disease is of decisive importance for eliminating arrhythmia. If extrasystoles are combined with severe psycho-emotional disorders (regardless of the presence or absence of heart disease), sedative treatment is important. Extrasystoles due to sinus bradycardia, as a rule, do not require antiarrhythmic treatment; sometimes they can be eliminated with belloid (1 tablet 1-3 times a day). Rare extrasystoles in the absence of heart disease also usually do not require treatment. If treatment is considered indicated, then an antiarrhythmic drug is selected taking into account contraindications, starting with lower doses, having.
b) and disopyramide (200 mg 2-4 times a day) - for both.
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Cardiac arrhythmias- any heart rhythm that is not a regular sinus rhythm of normal frequency, as well as a violation of the conduction of electrical impulses through different parts of the conduction system of the heart. Arrhythmias are divided mainly into dysfunctions of automaticity, excitability and conductivity.
Arrhythmias caused by dysfunctions of automaticity include sinus tachycardia, bradycardia, arrhythmia, sick sinus syndrome (SSNS).
and the appearance of ectopic complexes or rhythms, impulses come from a focus located outside the sinus node. They can be active - extrasystole, parasystole, paroxysmal
tachycardia - and passive, in which, against the background of suppression of the automatism of the sinus node, ectopic pacemakers of the second and third order appear - atrial, from the atrioventricular connection, during migration of the supraventricular pacemaker, from the ventricles. Separately, fibrillation and flutter of the atria and ventricles are distinguished. Conduction dysfunctions include sinoauricular block, intraatrial block, atrioventricular block, bundle branch block, Wolff-Parkinson-White syndrome, CLC syndrome - shortened P-Q interval and cardiac asystole.
Etiology, pathogenesis
Arrhythmias differ in their polyetiology. Among the factors of their development are functional disorders and organic lesions of the central nervous system (stress, neuroses, tumors, skull injuries, cerebrovascular accidents, vagotonia, etc.), as well as neuro-reflex factors (visceral-visceral reflexes in gastrointestinal diseases, spinal pathology and etc.); damage to the myocardium and cardiovascular system (coronary artery disease and myocardial infarction, myocarditis, cardiomyopathies, heart defects, pathology of large vessels, hypertension, pericarditis, heart tumors).
inside myocardial cells and in the extracellular environment, which leads to changes in the excitability, refractoriness and conductivity of the sinus node, conduction system and myocardial contractility. Violations of the following functions dominate: increased or suppressed activity of the sinus node; increasing the activity of lower-order automatism foci; shortening or lengthening the refractory period; reduction or cessation of conduction through the conduction system and contractile myocardium, sometimes conduction of an impulse along pathways that do not function normally.
The mechanism of the circular wave of excitation also plays a role in the appearance of ectopic rhythms and complexes. Ectopic myocardial activity occurs in cases where the threshold intracellular potential occurs prematurely. Ectopic activity and re-entry lead to the exit of certain areas from the control of the sinus node. Individual cycles of ectopic excitation or circular circulation lead to the development of extrasystole.
A long period of activity of an ectopic focus of automatism or circulation of a circular wave through the myocardium causes the development of paroxysmal tachycardia.
Clinical picture
Automatic dysfunction.
Sinus tachycardia. .
nbsp; Sinus tachycardia - increased heart rate to 90-160 beats/min at rest while maintaining correct sinus rhythm.
Subjectively, it manifests itself as palpitations, a feeling of heaviness, and sometimes pain in the heart area. On auscultation, the first sound at the apex is intensified, a pendulum rhythm can be observed (the strength of the first and second sounds is almost the same with equal systole and diastole) and embryocardia (the first sound is stronger than the second, the duration of systole is equal to the duration of diastole). Pre-existing murmurs may weaken or disappear.
Sinus bradycardia
Sinus bradycardia is a decrease in heart rate to 60 beats/min or less while maintaining correct sinus rhythm. It often does not appear clinically. Sometimes patients complain of a rare heart rhythm, weakness, a feeling of heart palpitations, and dizziness. However, in response to physical activity, an increase in heart rate appears, which distinguishes bradycardia from complete atrioventricular block with bradycardia. A combination with sinus arrhythmia is often noted.
Sinus arrhythmia
Sinus arrhythmia is an abnormal sinus rhythm, characterized by periods of gradual acceleration and slowdown of impulses in the sinus node with periodically changing frequency.
A distinction is made between respiratory arrhythmia and arrhythmia that does not depend on breathing. The complaints of patients are usually minor and are subjectively manifested by palpitations or cardiac arrest. Pulse and heart rate either accelerate or slow down.
With respiratory arrhythmia, there is a clear connection with the phases of breathing; after holding the breath, it disappears. The strength and sonority of heart sounds are not changed.
Sick sinus syndrome
Sick sinus syndrome is a weakening or loss of automaticity in the sinus node. The latent form does not manifest itself clinically. The manifest form - hypodynamic - is manifested by severe bradycardia, pain in the heart area, disturbances of cerebral blood flow in the form of dizziness, fainting, memory loss, headache, transient paresis, speech disorders, Morgagni attacks. With Short's syndrome - bradytachycardia - the risk of intracardiac blood clots and thromboembolic complications, including ischemic strokes, increases.
Syncope conditions caused by Morgagni attacks are characterized by suddenness, absence of pre-fainting reactions, pronounced pallor at the time of loss of consciousness and reactive hyperemia of the skin after the attack, rapid restoration of initial well-being. Loss of consciousness occurs with a sudden decrease in heart rate of less than 20 beats/min or during asystole lasting more than 5-10 seconds.
Extrasystole
Extrasystole is a heart rhythm disturbance characterized by premature contraction of the entire heart or its individual parts due to increased activity of foci of ectopic automatism. Parasystole is an ectopic rhythm with an active heterotropic focus, which functions regardless of the main pacemaker, characterized by a myocardial response in the form of excitation of the atria of the ventricles or the entire heart to each of the impulses and the main and ectopic pacemaker.
Patients complain of a feeling of interruptions in the work of the heart, tremors and fading behind the sternum. In the case of long-term allorhythmia (bigeminy, trigeminy), such complaints are often absent. In some patients, increased fatigue, shortness of breath, dizziness, and general weakness are more pronounced. On physical examination, extrasystole is defined as a premature beat followed by a compensatory pause.
Paroxysmal tachycardia
Paroxysmal tachycardia is a disturbance of the heart rhythm in the form of attacks of palpitations with a contraction frequency of 140-220 beats/min under the influence of impulses from heterogeneous foci that completely displace the sinus rhythm. During paroxysm, patients feel a rapid heartbeat, often starting with a sharp jolt behind the sternum. In many cases, palpitations are accompanied by shortness of breath, pain in the heart or behind the sternum, dizziness, and weakness. An attack of atrial paroxysmal tachycardia may be accompanied by nausea, vomiting, flatulence, and sweating. At the end of the attack, frequent heavy urination with the release of large amounts of light urine of low specific gravity (1001-1003) is disturbing. The pulse is rhythmic, sharply increased, systolic blood pressure decreases. Auscultation reveals an equalization of the intensity of the 1st and 2nd heart sounds, the pauses between the sounds become the same (pendulum-like rhythm).
Atrial ectopic rhythms are characterized by the generation of a rhythm for the entire heart by an ectopic focus located in the left or right atrium. There are no specific gutters or symptoms. The clinical picture is dominated by the symptoms of the underlying disease. Diagnosed by ECG.
The rhythm of the atrioventricular (AV) connection - the source of the rhythm is located in the AV connection, the frequency of the impulses generated by it is 30-60 beats/min. Clinical manifestations depend on the severity of the underlying disease. With severe bradycardia, fainting, dizziness, and pain in the heart are possible. Bradycardia is objectively determined to be 40-60 beats/min, the first sound above the apex may be intensified, and swelling of the neck veins is possible.
Migration of the supraventricular pacemaker is a gradual movement of the rhythm source within the atrial conduction system or from the sinus node to the area of the AV junction and back. There are no characteristic clinical signs. Objectively, a slight arrhythmia similar to sinus arrhythmia is detected.
Ventricular (idioventricular) rhythm is a rhythm disorder in which, against the background of suppression of the pacemakers of the first and second order, the third order centers (bundle branches, less often Purkinje fibers) become the pacemaker. Clinically, bradycardia is noted at 30-40 beats/min, the rhythm is correct, it becomes more frequent during physical activity, under the influence of atropine. Dizziness and frequent occurrence of Morgagni-Adams-Stokes attacks with loss of consciousness and convulsions are typical. There is a tendency to ventricular tachycardia, flutter and ventricular fibrillation, asystole and sudden death.
Flickering and fluttering
Atrial fibrillation
Atrial fibrillation (atrial fibrillation) is a heart rhythm disorder in which frequent contractions (350-600 beats/min) of individual atrial muscle fibers are observed throughout the entire cardiac cycle, but there is no coordinated contraction. Based on the frequency of ventricular contractions, atrial fibrillation is divided into tachysystolic (heart rate 90 or more), normosystolic (heart rate 60-90) and bradysystolic (heart rate less than 60).
With the tachysystolic form of atrial fibrillation, patients complain of strong heartbeat, weakness, and increasing cardiovascular failure. During auscultation, arrhythmia, erratic appearance of tones and varying volumes of the first tone are noted. The pulse is rhythmic, pulse waves of different amplitudes, a pulse deficit is determined.
Atrial flutter
Atrial flutter is an increase in atrial contractions to 200-400 beats/min while maintaining the correct atrial rhythm. Atrial flutter can be paroxysmal or observed for a long time (up to 2 weeks or more). Patients complain of rapid heartbeat, sometimes shortness of breath and pain in the heart area. On examination, undulation of the neck veins is noted, and auscultation reveals tachycardia. The rest of the symptoms depend on the underlying disease.
Ventricular flutter and fibrillation are frequent (200-300/min) rhythmic contractions of the ventricles, caused by a stable circular movement of the impulse generated in the ventricles. Clinically, ventricular flutter and fibrillation are terminal conditions and are equivalent to circulatory arrest. In the first seconds, weakness and dizziness appear; after 18-20 seconds, loss of consciousness occurs; after 40-50 seconds, convulsions and involuntary urination occur. Pulse and blood pressure are not determined, heart sounds are not heard. Breathing slows down and stops. The pupils dilate. Clinical death occurs.
Sinoauricular block
Sinoauricular block is a violation of the conduction of impulses from the sinus node to the atria. During a cardiac pause, patients experience dizziness, noise in the head, and possible loss of consciousness. At this time, heart sounds are not heard and there is no pulse on palpation of the radial arteries.
Atrioventricular block
Atrioventricular (AV) block is a violation of the conduction of impulses from the atria to the ventricles.
First degree AV block manifests itself as slowing of AV conduction. Clinically not recognized. Sometimes, upon auscultation, a presystolic three-part rhythm is noted due to the tone of atrial contraction (due to the lengthening of the P-Q interval).
Second degree AV block is incomplete AV block. Patients complain of interruptions in the functioning of the heart, sometimes slight dizziness. Auscultation, the correct rhythm is interrupted by long pauses (loss of ventricular contractions). There are three types of AV block of the second degree according to Mobitz - ECG.
III degree AV block - complete AV block. Patients complain of weakness, dizziness, darkening of the eyes, short-term fainting, pain in the heart, which is especially characteristic when the heart rate decreases to less than 40 beats/min. The pulse is rare, with auscultation - bradycardia, regular heart rhythm, sonority of the first tone, may vary. Usually it is dull, but from time to time (when the contractions of the atria and ventricles coincide), Strazhesko’s “cannon” tone appears. In some cases, it is possible to listen during pauses to the dull tones of atrial contractions coming as if from afar (symptom of “echo”). Systolic blood pressure may be elevated.
Bundle branch block
Bundle branch block is a violation of the conduction of supraventricular impulses along one of the bundle branches. Conduction disturbances occur in the bundle branches and their branches. If the conduction impulse along one of the legs is interrupted, then the excitation wave passes to both ventricles through the intact leg, resulting in non-simultaneous excitation of the ventricles. Clinically, this is manifested by splitting or bifurcation of heart sounds.
Wolff-Parkinson-White (WPW) syndrome is caused by the presence of an additional conduction pathway between the atria and ventricles (bundle of Kent). It occurs in 0.15-0.20% of people, and 40-80% of them have various heart rhythm disturbances, most often supraventricular tachycardia. Paroxysms of atrial fibrillation or flutter may occur (in approximately 10% of patients). In 1/4 of people with WPW syndrome, predominantly supraventricular extrasystole is observed. This pathology is more often observed in men and can appear at any age.
Diagnostics
Automatic function disorders
Sinus tachycardia
ECG signs: heart rate 90-160 beats/min; atrial waves and ventricular complexes are characterized by normal shape and sequence; the R-R interval is shortened; The ST segment may shift below the isoline.
Sinus bradycardia
ECG signs: decrease in heart rate to 59 beats/min or less, increase in the duration of the R-R interval; correct sinus rhythm; it is possible to extend the P-Q interval to 0.21 seconds.
With vagal bradycardia, positive Chermak tests are noted - pressure on the common carotid artery sharply slows down the pulse, Aschner-Dagini tests - pressure on the eyeballs leads to the same thing. An orthostatic test in the absence of a difference in pulse rate in a horizontal and vertical position indicates the organic nature of bradycardia.
Sinus arrhythmia
ECG signs: fluctuations in the duration of the R-R interval more than 0.16 seconds, with respiratory arrhythmia they are associated with breathing; preservation of all ECG signs of sinus rhythm.
ECG signs: persistent sinus bradycardia 45-50 beats/min; intermittent sinoauricular block; periodically - complete stop of the sinus node (a pause during which the P, T waves and QRS complex are not recorded, lasting more than two R-R intervals); during the period of complete stop of the sinus node, escape contractions from the AV junction may be observed (QRST complex without a preceding P wave). With Short's syndrome (bradytachycardia), there is a change from severe bradycardia to paroxysms of supraventricular tachycardia, atrial fibrillation and flutter. Characteristic is the slow restoration of sinus function after electrical or pharmacological cardioversion, as well as during spontaneous cessation of an attack of supraventricular tachyarrhythmia (pause before restoration of sinus rhythm is more than 1.6 seconds).
Ectopic complexes and rhythms
Extrasystole
Extrasystoles can be atrial, from the AV junction, or ventricular.
ECG signs: premature appearance of the extrasystolic complex. Supraventricular extrasystoles are characterized by an unchanged shape of the ventricular complex and an incomplete compensatory pause. In atrial extrasystoles, the P wave may be normal or slightly altered when the ectopic focus and the sinus node are close. If extrasystoles come from the middle parts of the atria, the P wave decreases or becomes biphasic, and extrasystoles from the lower parts of the atria are characterized by a negative P wave.
Extrasystoles from the atrioventricular junction, due to the retrograde propagation of the impulse to the atria, have a negative P wave located after the QRS complex (with previous excitation of the ventricles); with simultaneous excitation of the atria and ventricles, the P wave is absent. Ventricular extrasystoles are characterized by deformity, high amplitude of the ventricular complex, a width exceeding 0.12 seconds, and a complete compensatory pause. The largest wave of the extrasystole is directed discordantly in relation to the ST segment, as well as to the T wave.
With right ventricular extrasystole in lead I, the main wave of the QRS complex is directed upward, in lead III - downward. In leads V1-2 it is directed downwards, in V5-6 - upwards. With left ventricular extrasystole, the main wave of the QRS complex in lead I is directed downward, in lead III - upward. In VI-2 it is directed upward, in V5-6 - downward.
The appearance on the ECG of extrasystoles with different forms of the ventricular complex (polytopic) indicates several ectopic foci. Polytopic and multiple extrasystoles are inherent in organic damage to the myocardium and are prognostically unfavorable.
Parasystole
ECG signs: two rhythms independent from each other are recorded, the ectopic rhythm resembles an extrasystole, but in-
The coupling interval (the distance from the previous normal complex to the extrasystole) changes all the time. The distances between individual parasystolic contractions are multiples of the smallest distance between parasystoles.
To diagnose parasystole, a long-term ECG recording is required to measure the distance between individual ectopic complexes.
Paroxysmal tachycardia
ECG signs: sudden onset and end of an attack of tachycardia
106G cardia over 160 beats/min (160-250 beats/min) while maintaining the correct rhythm. The atrial form is characterized by the presence of a P wave before the QRS complex (it can be positive or negative, of a changed shape), the initial part of the ventricular complex is not changed, the P-Q interval can be lengthened, and P can approach T.
The atria are excited by normal sinus impulses, and the ECG may show normal P waves superimposed on different parts of the QRST complex. It is rare to detect P waves.
Paroxysmal tachycardia from the AV junction is characterized by the position of a negative P wave behind the QRS complex or its absence on the ECG, and the unchanged ventricular complexes. In the ventricular form, deformation and expansion of the QRS complex of more than 0.12 seconds, discordant location of the ST segment and T wave are noted. The shape resembles an extrasystole.
Atrial ectopic rhythms
ECG signs of right atrial ectopic rhythm: negative P wave in leads II, III, aVF or V1-V6 or simultaneously in leads II, III, V1-V6.
Coronary sinus rhythm: negative P wave in leads II, III, aVF; in precordial leads V1-V6 the P wave is negative or diffuse, in I, aVR the P wave is positive; The P-Q interval is shortened, the QRST complex is not changed.
ECG signs of left atrial ectopic rhythm: negative P wave in leads II, III, aVF, V3-V6, positive in lead aVR; the duration of the P-Q interval is normal; in lead V1, the P wave has a “shield and sword” shape when there is a pointed oscillation on the positive P wave.
Rhythm of the atrioventricular (AV) junction
ECG signs of the rhythm of the AV junction with previous excitation of the ventricles: a negative P wave is located between the QRS complex and the T wave; R-P interval (retrograde conduction) - more than 0.20 seconds; the rhythm of the atria and ventricles is the same. ECG signs of the rhythm of the AV junction with simultaneous excitation of the atria and ventricles: the P wave is not detected, the ventricular rhythm is correct. The ECG for ectopic rhythm from the AV junction and paroxysmal tachycardia emanating from the AV junction are the same. Diagnosis is carried out by rhythm frequency: if the rhythm is 30-60 beats/min, it is an ectopic AV rhythm; if the frequency is more than 140 beats/min, it is paroxysmal tachycardia.
Migration of the supraventricular pacemaker
ECG signs: the P wave changes shape and size from cycle to cycle (decreases, becomes deformed, becomes negative, returns to its original form). The P-Q interval gradually shortens, then becomes normal. Fluctuations in R-R intervals are often pronounced.
Ventricular (idioventricular) rhythm
ECG: bradycardia 30-40 beats/min (sometimes less) with regular heart rhythm; widening and deformation of the QRS complex as with bundle branch block; the P wave is absent.
Flickering and fluttering
Atrial fibrillation
ECG signs: absence of P waves, instead of which there are flickering waves of different amplitudes and durations, better visible in leads II, III, aVF, V1-V2; ventricular arrhythmia - different R-R distances. There are coarse-wavy (waves with an amplitude greater than 1 mm) and small-wavy (wave amplitude less than 1 mm) forms of atrial fibrillation.
Atrial flutter
ECG signs: instead of P waves, flutter waves are determined, identical in length, shape and height (“saw teeth”) with a frequency of 200 to 400 per minute. Every second, third or fourth impulse is delivered to the ventricles (due to functional AV block): the number of ventricular complexes usually does not exceed 120-150 per minute; the ventricles contract in the correct rhythm. Sometimes there is an alternation of atrial flutter and fibrillation.
ECG for ventricular flutter: a sinusoidal curve is recorded with frequent, rhythmic, wide and high, similar waves of ventricular excitation with a frequency of 200-300 per minute. The elements of the ventricular complex cannot be distinguished. ECG with ventricular fibrillation: instead of ventricular complexes, frequent (200-500 per minute) irregular waves of varying amplitude and duration are observed.
Sinoauricular block
ECG signs: loss of the PQRST complex; after a normal complex, a pause is recorded, equal in duration to the double R-R interval. If more complexes occur, then the pause will be equal to their total duration. At the end of the pause there may be a jumping contraction from the AV junction. Blocking of the sinus impulse and the appearance of a pause can occur regularly - every second, every third, etc.
Intraatrial block
ECG signs: increase in the duration of the P wave by more than 0.11 seconds, splitting of the P wave.
Atrioventricular block.
ECG signs: 1st degree AV block - prolongation of the P-Q interval by more than 0.20 seconds; AV block of the second degree Mobitz I - gradual lengthening of the P-Q interval, after the appearance of the next P wave the ventricular complex falls out - the Samoilov-Winkenbach period, the ventricular complex is not changed; AV block of the second degree Mobitz II - the P-Q interval is normal or extended, but the same in all cycles, loss of the ventricular complex, QRS complexes are normal or widened and deformed; AV block of the second degree Mobitz III - the P-Q interval is the same in all cycles, every second or third, etc. atrial impulse is naturally blocked, Samoilov-Winkenbach periods appear regularly; III degree AV block - the number of ventricular complexes is 2-3 times less than atrial complexes (20-50 per minute), the R-R intervals are the same, the number of P waves is normal, the R-R intervals are the same, the P wave is located randomly in relation to the QRS complex , then precedes it, then layers on it, then appears behind it, if the pacemaker is located in the AV junction or the common trunk of the His bundle, the shape of the QRS complex is not changed; if the QRS is similar to that of the left bundle branch block, the pacemaker is in the right, and vice versa.
Bundle branch block
ECG signs: widening of the ventricular complex; if the QRS complex is 0.12 seconds or wider, the block is complete; incomplete blockade - QRS wider than 0.09 seconds, but not exceeding 0.12 seconds. Complete blockade of the left leg: in leads I, V5-V6, the QRS complex is represented by a wide R wave with a notch at the apex or knee (ascending or descending), the Q wave is absent; in leads V1-V2, the ventricular complexes have a QS appearance with a wide and deep S wave; the ST segment and T wave are discordant with respect to the main wave of the QRS complex.
The electrical axis of the heart is deviated to the left. Complete blockade of the right bundle branch: in the right precordial leads there is a split and jagged QRS complex of the form rSR’, RSR’, the ST segment is located downward from the isoline, the T wave is negative or biphasic; wide deep S wave in leads V5-V6. The axis of the heart is usually located vertically (R1 = S1). Blockade of the terminal branches of Purkinje fibers is diagnosed by a significant widening of the QRS complex, combined with a diffuse decrease in the amplitude of the ventricular complex.
ECG signs: shortening of the P-Q interval by less than 0.12 seconds; the presence in the QRS complex of an additional delta excitation wave, attached in the form of a ladder to the QRS complex; an increase in duration (0.11-0.15 seconds) and a slight deformation of the QRS complex, a discordant shift of the ST segment and a change in the polarity of the T wave (non-constant signs).
CLC syndrome
ECG signs: shortening of the P-Q interval by less than 0.12 seconds; The QRS complex is not widened, its shape is normal, there is no delta wave.
Treatment
Automatic function disorders
Sinus tachycardia
Treatment of sinus tachycardia is aimed at treating the underlying disease.
For neuroses, sedative therapy (valerian, tranquilizers) is indicated. In the treatment of sinus tachycardia without symptoms of heart failure, beta-blockers (anaprilin, obzidan, cardanum). With symptoms of heart failure during tachycardia, the prescription of cardiac glycosides (digoxin, isolanide) is justified.
Sinus bradycardia
Sinus bradycardia in practically healthy people does not require treatment. In other cases, treatment is aimed at eliminating the cause of bradycardia and treating the underlying disease. For vagal sinus bradycardia, accompanied by respiratory arrhythmia, small doses of atropine have a good effect. For bradycardia associated with NDC, accompanied by signs of impaired blood supply, aminophylline, alupent, and belloid provide a symptomatic effect. In severe cases, pacing may be required.
Sinus arrhythmia
Respiratory arrhythmia does not require treatment. In other cases, treatment of the underlying disease is carried out.
Sick sinus syndrome (SSNS)
In the early stages of the development of SSSS, it is possible to achieve a short-term unstable increase in heart rate by discontinuing drugs that slow down the heart rate and prescribing anticholinergic (atropine in drops) or sympatholytic drugs (isadrin 5 mg, starting with 1/4 - 1/2 tablet, doses gradually increase to prevent the occurrence of ectopic arrhythmias). In some cases, a temporary effect can be obtained by prescribing belladonna preparations. Some patients showed an effect when using nifedipine, nicotinic acid, and in heart failure - ACE inhibitors. The main method of treatment for SSSS is constant electrical stimulation of the heart. Ectopic complexes and rhythms
Extrasystole
Treatment of extrasystoles depends on the underlying disease. For vegetative-vascular disorders, treatment is usually not carried out, sometimes sedatives (tranquilizers) are prescribed, and for poor sleep - sleeping pills. When the vagus is strengthened, atropine and belladonna preparations are indicated. If you have a tendency to tachycardia, beta-blockers (anaprilin, obzidan, propranolol) are effective. Isoptin has a good effect,
cordarone. For extrasystoles of organic origin, potassium chloride and panangin are prescribed. In exceptional cases, they resort to antiarrhythmic drugs - such as novocainamide, ajmaline. In case of myocardial infarction with extrasystole, the use of lidocaine (1% solution) with panangin intravenously is effective. Polytopic extrasystoles occurring due to digitalis intoxication can lead to ventricular fibrillation and require urgent discontinuation of the drug. Lidocaine, Inderal, and potassium preparations are used for treatment.
To relieve intoxication associated with the accumulation of cardiac glycosides, unithiol is used and potassium-sparing diuretics (veroshliron) are prescribed.
Paroxysmal tachycardia
In some patients, attacks of paroxysmal tachycardia stop spontaneously. For the supraventricular form, massage of the carotid sinus on the right and left for 15-20 seconds, pressure on the eyeballs and abdominal press are indicated. If there is no effect from medications, beta-blockers are prescribed: propranolol (obzidan, anaprilin) - 40-60 mg, veropamil - 2-4 ml of a 0.25% solution or procainamide - 5-10 ml of a 10% solution. The drugs are administered slowly, under the control of blood pressure and pulse. It is dangerous (due to excessive bradycardia or asystole) to alternately administer veropamil and propranolol intravenously. Treatment with digitalis (digoxin) is possible if the patient did not receive it in the days immediately before the attack. If the attack does not stop and the patient’s condition worsens, use Electropulse therapy (which is contraindicated in case of intoxication with cardiac glycosides). For frequent and poorly controlled attacks, temporary or permanent cardiac pacing is advisable. If the attack is associated with digitalis intoxication or weakness of the sinus node, the patient should be hospitalized immediately.
In case of ventricular tachycardia, the patient is hospitalized, antiarrhythmic drugs are prescribed (lidocaine 80 mg) under the control of ECG and blood pressure, repeating the administration of 50 mg every 10 minutes to a total dose of 200-300 mg. If an attack occurs during a myocardial infarction and the patient’s condition worsens, then electropulse therapy is used. After an attack, anti-relapse treatment is carried out (procainamide, lidocaine and other drugs are used for several days or longer).
Passive ectopic rhythms
Treatment of the underlying disease.
Flickering and fluttering
Atrial fibrillation
Treatment depends on the underlying disease and its exacerbation (fight against myocarditis, compensation for thyrotoxicosis, surgical elimination of defects). In case of persistent atrial fibrillation, sinus rhythm is restored with antiarrhythmic drugs or electrical impulse therapy. Cardiac glycosides, beta blockers, novocainamide, verapamil (finoptin, isoptin), etmozin, etatsizin, ajmaline, quinidine are used.
In the case of normo- and bradysystolic forms of atrial fibrillation and the absence of cardiac decompensation, antiarrhythmic drugs are not used. Treatment is aimed at the underlying disease.
Atrial flutter
Treatment of atrial flutter follows the same principles as atrial fibrillation. To relieve paroxysm of flutter, frequent intra-atrial or transesophageal electrical stimulation of the atria can be used. With frequent paroxysms, constant use of antiarrhythmic drugs is necessary for prophylactic purposes (for example, digoxin, which in some cases can transform the paroxysmal form into a permanent one, which is better tolerated by patients)
Ventricular flutter and fibrillation
Treatment boils down to the immediate start of chest compressions and artificial respiration for the time required to prepare for electrical pulse therapy, as well as other resuscitation measures.
Conduction dysfunction
Sinoauricular block
Treatment of the underlying disease. For severe hemodynamic disturbances, atropine, belladonna, ephedrine, and alupent are used. The appearance of frequent fainting states is an indication for cardiac pacing.
Atrioventricular block
For AV block I degree and II degree Mobitz type I without clinical manifestations, treatment is not required. In case of hemodynamic disturbances, atropine is prescribed, 0.5-2.0 mg intravenously, then electrical cardiac pacing. If AV block is caused by myocardial ischemia (the level of adenosine in the tissues increases), then an adenosine antagonist, aminophylline, is prescribed. In case of 2nd degree AV block of Mobitz type II, III and complete AV block, regardless of clinical manifestations, temporary, then permanent pacing is indicated.
Bundle branch block
Bundle branch blocks in themselves do not require treatment, but they should be taken into account when prescribing medications that slow down the conduction of impulses in the tract system.
Wolff-Parkinson-White syndrome
WPW syndrome, which is not accompanied by attacks of tachycardia, does not require treatment. If cardiac arrhythmias occur, and these are most often paroxysms of supraventricular tachycardia, the principles of treatment are the same as for similar tachyarrhythmias of other origins (cardiac glycosides, beta blockers, isoptin, novocainamide, etc.). If there is no effect of pharmacotherapy, electrical defibrillation is performed.
For frequent paroxysms of tachyarrhythmia, refractory to drug therapy, surgical treatment is performed: intersection of additional conduction pathways.
Clinical examination
Observation is carried out by a cardiologist (therapist). In case of the secondary nature of rhythm disturbances, correction of the treatment of the underlying disease is necessary; in these cases, examinations are carried out according to indications.
Reasons for rhythm changes
Non-sinus rhythms can occur due to changes occurring in the area of the sinus node, as well as in other conducting sections. These modifications can be:
- sclerotic;
- ischemic;
- inflammatory.
Ectopic disorders are classified in different ways. There are several forms:
- Supraventricular rhythm of ectopic nature. Its causes are an overdose of cardiac glycosides, as well as vegetative dystonia. It rarely happens that this form is caused by increased automatism of the ectopic focus. In this case, the heart rate will be higher than with an accelerated or replacement rhythm of an ectopic nature.
- Ventricular rhythm. Typically, this form indicates that significant changes have occurred in the myocardium. If the ventricular rate is very low, ischemia may occur, affecting important organs.
- Atrial rhythm. It often occurs in the presence of rheumatism, heart disease, hypertension, diabetes mellitus, ischemia, neurocirculatory dystonia, also even in healthy people. As a rule, it is present temporarily, but sometimes it lasts for a long period. It happens that atrial rhythm is congenital.
Changes occurring in the myocardium due to neuroendocrine influences can also occur in children. This means that in the child’s heart there are additional foci of excitation that function independently of each other. Such violations are divided into several forms:
- active: paroxysmal tachycardia and extrasystole;
- accelerated: atrial fibrillation.
Ventricular extrasystoles in childhood begin to develop in cases of cardiac organic pathology. It is very rare, but there are cases when this type can be diagnosed in a healthy child, even a newborn.
Against the background of a viral infection, attacks of paroxysmal tachycardia occur at an early age, which can occur in a very severe form, called supraventricular. This is possible with congenital heart defects, atropine overdose and carditis. Attacks of this form often occur when the patient awakens and changes body position.
Symptoms of the disease
We have learned that non-sinus rhythms depend on the underlying disease and its causes. This means that there are no specific symptoms. Let's look at some signs that indicate that it is time to see a doctor yourself or together with your child if his condition worsens.
Let's take paroxysmal tachycardia as an example. Most often it begins as unexpectedly as it ends. At the same time, its precursors, such as dizziness, chest pain, and so on, are not observed. At the very beginning of the crisis there is usually no shortness of breath or heart pain, but these symptoms can appear during a prolonged attack. Initially, there arises: a feeling of anxiety and fear that something serious is happening to the heart, motor restlessness, in which a person wants to find a position in which the disturbing state will stop. Next, hand trembling, darkening of the eyes and dizziness may begin. Then it is observed:
- increased sweating;
- nausea;
- bloating;
- the urge to urinate, even if the person has not consumed much liquid, occurs every fifteen or ten minutes, and about 250 ml of light, transparent urine is released each time; this feature persists even after the attack, then gradually disappears;
- urge to defecate; This symptom is not observed often and occurs after the onset of a seizure.
Attacks of short duration may occur during sleep, and the patient may experience a sharply increased heart rate due to some kind of dream. After it ends, heart activity returns to normal, shortness of breath disappears; a person feels a “fading” of the heart, followed by a heartbeat, which indicates the beginning of a normal sinus rhythm. It happens that this impulse is accompanied by a painful sensation. However, this does not mean that the attack always ends so abruptly; sometimes heart contractions slow down gradually.
Separately, it is worth considering the symptoms that occur in children with the development of ectopic rhythm. Each mentioned form of disorder of this nature has its own symptoms.
Extrasystoles are characterized by:
- interruptions in cardiac function;
- a feeling of “fading” of the heart;
- feeling of heat in the throat and heart.
However, there may be no symptoms at all. Vagotopic extrasystoles in children are accompanied by excess body weight and a hypersthenic constitution. Paroxysmal tachycardia at an early age has the following symptoms:
- fainting;
- feeling of tension and anxiety;
- dizziness;
- pallor;
- cyanosis;
- dyspnea;
- stomach ache.
Diagnosis of the disease
Diagnosis of the disease, in addition to the symptoms indicated by the patient, is based on ECG data. Some forms of ectopic rhythm disturbances have their own characteristics that are visible in this study.
The atrial rhythm is different in that the configuration of the R wave changes; its diagnostic signs are not clear. With a left atrial rhythm, there is no change in the PQ interval; it is also equal to 0.12 s or exceeds this level. The QRST complex does not differ, since excitation through the ventricles occurs in the usual way. If the pacemaker is located in the lower parts of the left or right atrium, then the ECG will show the same picture as with coronary sinus rhythm, that is, positive PaVR and negative P in the third and second leads aVF. In this case, we are talking about the lower atrial rhythm, and it is very difficult to find out the exact localization of the ectopic focus. The right atrial rhythm is characterized by the fact that the source of automatism is P-cells, which are located in the right atrium.
In childhood, a thorough diagnosis is also carried out. Atrial extrasystoles are characterized by an altered P wave, as well as a shortened P-Q interval with an incomplete compensatory pause and a narrow ventricular complex. Extrasystoles of an atrioventricular connection differ from the atrial form in that there is no P wave in front of the ventricular complex. The right ventricular extrasystole is characterized by the fact that the main R wave has a standard upward lead, and the left ventricular one is distinguished by the downward lead of the same tooth.
With paroxysmal tachycardia, embryocardia is detected during the examination. In this case, the pulse has a small filling and is difficult to count. Reduced blood pressure is also observed. The ECG shows a rigid rhythm and ventricular aberrant complexes. In the period between attacks and with the supraventricular form, extrasystole is sometimes recorded, and during the crisis itself the picture is the same as with group extrasystole with a narrow QRS complex.
Treatment methods
When diagnosing non-sinus rhythms, treatment is aimed at the underlying disease. Accordingly, it is very important to identify the cause of cardiac dysfunction. For vegetative-vascular disorders, sedatives are usually prescribed; for vagal strengthening, belladonna and atropine are prescribed. If there is a tendency to tachycardia, beta-blockers, for example, obzidan, anaprilin and propranolol, are considered effective. Known drugs are cordarone and isoptin.
Extrasystoles of organic origin are usually treated with panangin and potassium chloride. Sometimes antiarrhythmic drugs such as ajmaline and procainamide may be used. If extrasystole is accompanied by myocardial infarction, it is possible to use panangin together with lidocaine, which are administered by intravenous drip infusion.
Digitalis intoxication can lead to polytopic extrasystoles, which causes ventricular fibrillation. In this case, you need to urgently stop the drug, and use potassium preparations, Inderal, and lidocaine as treatment. To relieve intoxication associated with cardiac glycosides, the doctor may prescribe diuretics and unithiol.
With the supraventricular form, you can massage the carotid sinus on the left and right for about twenty seconds. Pressure is also applied to the abdominals and eyeballs. If these methods do not provide relief, your doctor may prescribe beta blockers, such as verapamil or procainamide. Drugs should be administered slowly while monitoring pulse and blood pressure. It is not recommended to alternate propanol and verapamil intravenously. Digitalis can be used only if it has not entered the patient’s body for the next few days before the attack.
If the patient's condition worsens, electropulse therapy is used. However, it cannot be used in case of intoxication with cardiac glycosides. Cardiac pacing can be used continuously if attacks are severe and frequent.
Complications may include heart problems, or rather their exacerbation. To avoid this, you should seek medical help in a timely manner and not neglect treatment of underlying diseases that provoke the development of ectopic rhythm. For clear and coordinated functioning of the heart, it is simply necessary to lead a healthy lifestyle and avoid stress.
Ectopic rhythms. When the activity of the sinus node weakens or ceases, replacement ectopic rhythms may occur (from time to time or constantly), that is, heart contractions caused by the manifestation of automatism in other parts of the conduction system or myocardium. Their frequency is usually less than the frequency of sinus rhythm. As a rule, the more distal the source of the ectopic rhythm, the lower the frequency of its impulses. Ectopic rhythms can occur with inflammatory, ischemic, sclerotic changes in the area of the sinus node and in other parts of the conduction system; they can be one of the manifestations of sick sinus syndrome (see below). Supraventricular ectopic rhythm may be associated with autonomic dysfunction and overdose of cardiac glycosides.
Occasionally, the ectopic rhythm is caused by an increase in the automaticity of the ectopic center; in this case, the heart rate is higher than with a replacement ectopic rhythm (accelerated ectopic rhythm). The presence of an ectopic rhythm and its source are determined only by ECG.
The atrial rhythm is characterized by changes in the configuration of wave I. Its diagnostic signs are unclear. Sometimes the shape of the P wave and the duration of P-Q changes from cycle to cycle, which is associated with migration of the pacemaker through the atria. Atrioventricular rhythm (rhythm from the atrioventricular junction) is characterized by inversion of the P wave, which can be recorded near the ventricular complex or superimposed on it. The frequency of the replacement atrium-ventricular rhythm is 40-50 per 1 min, for the accelerated one - 60-100 per 1 min. If the ectopic center is slightly more active than the sinus node, and the reverse conduction of the impulse is blocked, then conditions arise for incomplete atrioventricular dissociation; in this case, periods of sinus rhythm alternate with periods of replacement atrium-ventricular (rarely ventricular) rhythm, the feature of which is a rarer atrial rhythm (P) and an independent, but more frequent ventricular rhythm (QRST). Ectopic ventricular rhythm (no regular P wave, ventricular complexes are deformed, frequency 20-50 per minute) usually indicates significant changes in the myocardium; at a very low frequency of ventricular contractions, it can contribute to the occurrence of ischemia of vital organs.
Treatment. With the above ectopic rhythms, the underlying disease should be treated. Atrioventricular rhythm and incomplete atrioventricular dissociation associated with autonomic dysfunction can be temporarily reversed by atropine or an atropine-like drug. If the ventricular rate is infrequent, temporary or permanent pacing may be necessary.
Extrasystoles- premature contractions of the heart caused by the occurrence of an impulse outside the sinus node. Extrasystole can accompany any heart disease. In no less than half of the cases, extrasystole is not associated with heart disease, but is caused by vegetative and psycho-emotional disorders, drug treatment (especially cardiac glycosides), electrolyte imbalances of various nature, consumption of alcohol and stimulants, smoking, and reflex effects from internal organs. Occasionally, extrasystopia is detected in apparently healthy individuals with high functional capabilities, for example, in athletes. Physical activity generally provokes extrasystole associated with heart disease and metabolic disorders, and suppresses extrasystole caused by autonomic dysregulation.
Extrasystoles may occur in a row, two or more - paired and group extrasystoles. The rhythm in which each normal systole is followed by an extrasystole is called bigeminy. Especially unfavorable are hemodynamically ineffective early extrasystoles that occur simultaneously with the T wave of the previous cycle or no later than 0.05 s after its end. If ectopic impulses are formed in different foci or at different levels, then polytopic extrasystoles arise, which differ from each other in the shape of the extrasystolic complex on the ECG (within one lead) and in the size of the pre-extrasystolic interval. Such extrasystoles are often caused by significant changes in the myocardium. Sometimes long-term rhythmic functioning of the ectopic focus is possible along with the functioning of the sinus pacemaker - parasystole. Parasystolic impulses follow a regular (usually rarer) rhythm, independent of sinus rhythm, but some of them coincide with the refractory period of the surrounding tissue and are not realized.
On the ECG, atrial extrasystoles are characterized by a change in the shape and direction of the P wave and a normal ventricular complex. The post-extrasystolic interval may not be increased. With early atrial extrasystoles, there is often a violation of atrioventricular and intraventricular conduction (usually in the form of right leg block) in the extrasystolic cycle. Atrioventricular (from the area of the atrioventricular junction) extrasystoles are characterized by the fact that the inverted P wave is located near the unchanged ventricular complex or superimposed on it. Possible disruption of intraventricular conduction in the extrasystolic cycle. The post-extrasystolic pause is usually increased. Ventricular extrasystoles are distinguished by a more or less pronounced deformation of the QRST complex, which is not preceded by a P wave (with the exception of very late ventricular extrasystoles, in which a normal P wave is recorded, but the P-Q interval is shortened). The sum of the pre- and post-extrasystolic intervals is equal to or slightly exceeds the duration of the two intervals between sinus contractions. With early extrasystoles against the background of bradycardia, there may be no post-extrasystolic pause (intercalated extrasystoles). With left ventricular extrasystoles in the QRS complex in lead V1, the largest is the R wave directed upward, with right ventricular extrasystoles the largest is the S wave directed downward.
Symptoms. Patients either do not feel extrasystoles, or feel them as an increased push in the heart or cardiac arrest. When examining the pulse, extrasystole corresponds to a premature weakened pulse wave or loss of the next pulse wave, and during auscultation - premature heart sounds.
The clinical significance of extrasystoles may vary. Rare extrasystoles in the absence of heart disease usually do not have significant clinical significance. An increase in extrasystoles sometimes indicates an exacerbation of an existing disease (coronary heart disease, myocarditis, etc.) or glycoside intoxication. Frequent atrial extrasystoles often foreshadow atrial fibrillation. Particularly unfavorable are frequent early, as well as polytopic and group ventricular extrasystoles, which in the acute period of myocardial infarction and during intoxication with cardiac glycosides can be a harbinger of ventricular fibrillation. Frequent extrasystoles (6 or more per minute) can themselves contribute to the worsening of coronary insufficiency.
Treatment. The factors that led to extrasystole should be identified and, if possible, eliminated. If extrasystole is associated with a specific disease (myocarditis, thyrotoxicosis, alcoholism, etc.), then treatment of this disease is of decisive importance for eliminating arrhythmia. If extrasystoles are combined with severe psycho-emotional disorders (regardless of the presence or absence of heart disease), sedative treatment is important. Extrasystoles due to sinus bradycardia, as a rule, do not require antiarrhythmic treatment; sometimes they can be eliminated with belloid (1 tablet 1-3 times a day). Rare extrasystoles in the absence of heart disease also usually do not require treatment. If treatment is considered indicated, then an antiarrhythmic drug is selected taking into account contraindications, starting with lower doses, keeping in mind that propranolol (10-40 mg 3-4 times a day), verapamil (40-80 mg 3-4 times per day), quinidine (200 mg 3-4 times a day) is more active with supraventricular extrasystoles; lidocaine (100 mg intravenously), novocainamide (orally 250-500 mg 4-6 times a day), diphenin (100 mg 2-4 times a day), etmozin (100 mg 4-6 times a day) - for ventricular extrasystoles, cordarone (200 mg 3 times a day for 2 weeks, then 100 mg 3 times a day) and disopyramide (200 mg 2-4 times a day) - for both.
If extrasystoles occur or become more frequent during treatment with cardiac glycosides, they should be temporarily canceled and a potassium supplement prescribed. If early polytopic ventricular extrasystoles occur, the patient must be hospitalized; the best remedy (along with intensive treatment of the underlying disease) is intravenous administration of lidocaine.
Heart contractions that occur automatically due to other contractions in the myocardium or conduction system are called ectopic atrial rhythm. We'll figure out what it is in this article.
Description of the pathology
When the sinus node is weakened or stops working, and this happens either on an ongoing basis or from time to time, ectopic rhythms arise (or they are also called replacement rhythms).
Their frequency is less than that of sinus rhythm. Ectopic atrial rhythm can be considered non-sinus. The further away its source is, the less frequent its pulses will be. What is the reason for changes in heart function?
The main reasons why the rhythm changes
Changes occurring in the area of the sinus node and other conducting parts lead to the appearance of non-sinus rhythm. These deviations from the normal rhythm may be:
Sclerotic;
Ischemic;
Inflammatory.
Classification of non-sinus rhythms
The classification of non-sinus rhythms may vary. Below are the most common forms.
A non-sinus rhythm may be a supraventricular rhythm of an ectopic nature. This happens due to an overdose of cardiac glycosides, as well as vegetative-vascular dystonia. The automaticity of the ectopic focus increases, resulting in this form of non-sinus rhythm. Here, a high heart rate is observed, in contrast to the accelerated and replacement ectopic rhythms.
Non-sinus rhythm can also be ventricular. This indicates significant changes in the myocardium. If the ventricular rate is too low, there is a high risk of developing coronary heart disease, which can have serious consequences.
In addition, the rhythm may be atrial. Often develops with rheumatism, disease defects, diabetes mellitus. Neurocirculatory dystonia can lead to such a rhythm. However, ectopic atrial rhythm also occurs in completely healthy people. It is transient in nature, but can last for a long time. May develop congenitally.
It is interesting that ectopic rhythm occurs not only in adults, but also in young children. This is possible with existing additional foci of excitation that function independently of each other. This is influenced by neuroendocrine factors and changes occurring in the myocardium.
Types of violations
Such episodes of ectopic atrial rhythm in a child may be:
Active, which are characterized by paroxysmal tachycardia and extrasystole.
Accelerated (differing in atrial fibrillation).
Cardiac organic pathology leads to ventricular extrasystoles in childhood. This pathology can be diagnosed in a healthy newborn child.
A viral infection can lead to attacks of paroxysmal tachycardia in young children. This type of tachycardia has a severe form, which is called supraventicular.
Congenital heart defects, aspirin overdose, and carditis provoke this severe form of rhythm.
An attack can occur when the child has just woken up or has suddenly changed the position of his body. The supraventicular form is very dangerous.
What are the signs of ectopic atrial rhythm?
As already mentioned, the underlying disease leads to non-sinus rhythms. It is not characterized by any specific symptoms. The main ailments and causes of the rhythm determine the symptoms.
Below are symptoms that you should pay close attention to and then consult a doctor immediately:
An attack of paroxysmal tachycardia begins suddenly and ends just as suddenly;
There are no warning signs of an attack;
There is no shortness of breath or heart pain at the onset of the attack;
The emergence of feelings of severe anxiety and fear;
The appearance of motor restlessness, such that a person seeks a body position that will help stop the attack;
The person’s hands begin to tremble, his vision darkens, his head begins to spin;
The appearance of increased sweating;
Presence of nausea and bloating;
The urge to urinate and have bowel movements may appear: a person can urinate every 10-15 minutes from the onset of tachycardia, while the urine is released in a light color, almost transparent, the urge to defecate occurs less frequently.
Paroxysmal tachycardia can begin while a person is sleeping. Then his heart begins to beat intensely because he had, for example, some kind of dream. After the attack ends, the heart begins to work calmly, and the person no longer feels shortness of breath.
Afterwards a shock is observed, then the rhythm becomes normal sinus. Sometimes there is pain during the push. In some cases, the slowing of the heart rate occurs gradually.
Other symptoms
There are certain signs of non-sinus rhythm. Depending on what the possible ectopic atrial rhythm is accompanied by, they can be different:
So, for example, with extrasystoles the heart may work intermittently, a person feels as if his heart is stopping, feels heat in the throat and heart. But these symptoms may not exist. Excess body weight and hypersthenic constitution often lead to vagotopic extrasystoles.
In a child it leads to fainting, darkening of the eyes, dizziness, feelings of tension and anxiety, pallor, cyanosis, shortness of breath, and abdominal pain. This is what distinguishes ectopic atrial rhythm in children.
Methods for diagnosing ectopic rhythm
If a person exhibits the above symptoms, he needs to urgently consult a physician or cardiologist. The specialist will prescribe an ECG, which will show certain changes in the heart or ectopic atrial rhythm.
The R wave changes its configuration during atrial rhythm. It does not have clear diagnostic signs. The PQ interval does not change with left atrial rhythm. Due to normal excitation along the ventricles, the QRST complex does not change. There will be a positive PaVR and a negative P in the third and second leads aVF when the pacemaker is located in the left and right atria, namely in their lower sections. The exact location of the ectopic rhythm is not determined in cases of inferior atrial rhythm.
In a right heart rhythm, the source of automaticity (P-cells) will be located in the right atrium. This is how ectopic atrial rhythm manifests itself in adolescents.
Children also require a thorough diagnosis. With atrial extrasystoles, the P wave changes. The PQ interval is shortened, an incomplete compensatory pause and a narrow ventricular complex are observed.
Or there may be an accelerated ectopic atrial rhythm.
Extrasystoles may have an atrioventricular character; this is reflected on the ECG by the absence of a P wave in front of the ventricular complex. With a right ventricular extrasystole, the P wave is usually retracted upward (and downward with a left ventricular extrasystole).
The presence of embryocardia is characteristic of paroxysmal tachycardia. In this case, it is impossible to calculate the pulse. There is a decrease in blood pressure. Presence of rigid rhythm and ventricular aberrant complexes. If an ECG is performed outside an attack or during supraventricular tachycardia, then a separate extrasystole can be observed, and at the time of the attack itself a group extrasystole with a shortened QRS complex is recorded.
In addition to the usual ECG study, 24-hour Holter and transesophageal ECG monitoring is used. All this can detect ectopic atrial rhythm.
Treatment
If a person has a non-sinus rhythm, then treatment is selected depending on the underlying disease. In order for therapy to be effective, it is necessary to carefully understand the cause of the malfunction of the heart. If it is caused by vegetative-vascular disorders, then the prescription of sedatives will be required. If the vagus is strengthened, then belladonna and Atropine will help! Tachycardia requires the use of beta-blockers (Cordarone, Anaprilin, Isoptin, Obzidan).
With extrasystoles
For extrasystoles of organic origin, a course of “Panangin” or potassium chloride is prescribed. Medicines against arrhythmia in some cases can also have a positive effect (Novocainamide, Aymalin). For myocardial infarction and simultaneous extrasystole, Panangin and Lidocaine are used. A person receives these medications through a dropper.
In case of intoxication with cardiac glycosides
When intoxicated with digitalis, polytopic extrasystoles occur, which lead to ventricular fibrillation. Immediate discontinuation of the drug and treatment with Inderal, Potassium, and Lidocaine are required. Unithiol and diuretics will help remove intoxication. What else should be done when diagnosed with ectopic atrial heart rhythm?
Sometimes the carotid sinus is massaged for 20 seconds on the left and right sides if there is a supraventricular form. Pressing on the stomach and eye area helps. Lack of relief requires the use of beta blockers. They are administered at a slow speed, and monitoring of pulse and blood pressure is necessary. Mixing Propanol and Verapamil intravenously is not recommended.
What to do if the attack does not stop?
If the attack does not stop and continues for some time, the patient’s condition worsens, electropulse therapy is used. Intoxication with cardiac glycosides is a contraindication to such therapy. For frequent and severe attacks, cardiac pacing is used continuously.
Complications may include exacerbation of heart problems. Timely consultation with a doctor will ensure the absence of ectopic rhythm, since the underlying diseases will be cured or at least controlled. Therefore, it is important not to panic if an atrial ectopic rhythm is detected on the ECG. We've looked at what it is.
special instructions
In order for the heart to work clearly and harmoniously, you need to be less nervous and adhere to a healthy lifestyle. The more often a person spends time in the fresh air and engages in moderate physical labor, the healthier his heart will be. In your diet, you need to limit fatty foods, which contribute to the formation of cholesterol plaques. You need to eat more fiber, fresh vegetables, fruits, which contain vitamins. The most important for the heart are calcium, magnesium, and potassium.
Dairy products are rich in calcium, bananas and tomatoes contain a huge amount of potassium, magnesium is present in spinach, buckwheat, and carrots.
Conclusion
Sometimes the reason for heart rate deviations from the norm lies in the human psyche. In this case, after visiting a therapist or cardiologist, it makes sense to consult a psychotherapist. A full course of psychotherapy may be required.
Heart problems should not be taken lightly, but at the same time, the development of cardiophobia or fear of heart attack and other serious pathologies should not be allowed to develop.
For neurocircular dystonia, it makes sense to take sedatives for a long time, preferably herbal ones, since they are safe and have virtually no contraindications or side effects. These include valerian tincture, motherwort tincture, Novopassit, Persen.
This is how dangerous ectopic atrial rhythm is. What this is, we hope, has now become clear to everyone.
Atrial rhythm is a condition accompanied by weakening of the functioning of sinus contractions. In this case, the sources of impulses are the lower atrial rhythms. Normally, the normal driver of the heart is the sinus node. Its cells are capable of generating up to 90 impulses in 60 seconds. When the functioning of the sinus node is impaired, various types of heart rhythm and conduction disturbances occur.
Atrial rhythm develops when extraneous impulses that excite the heart are formed outside the sinus node. There is an advance of secondary atrial contractions, there is no parallel excitation, and nerve impulses are locally blocked.
Extra, extraordinary contractions are formed, knocking down the main cardiac impulses. The endocrine and vegetative nature of the formation of precardiac impulses is distinguished. This condition is often observed in adolescents during puberty or adults with hormonal disorders.
The transmission of an electrical impulse, which sequentially excites all parts of the heart, begins from the right atrium. The conduction system distributes impulses to distant ventricular tissues. The heart begins to contract, and satisfactory blood flow into the arteries is observed. When rhythm and conduction disturbances occur, various diseases of the cardiovascular system develop. A variety of factors can cause the sinus node to lose its ability to produce the energy that is necessary to propagate the impulse to the most distant parts of the heart.
The norm is the formation of periodic excitation in the area of the sinoatrial node with subsequent spread to the atria and ventricles. When processes that affect the transmission of cardiac contraction change, replacement contractions are formed. In this case, impulses develop beyond the natural, physiological boundaries intended for their formation.
Classification
Atrial rhythm is classified depending on how irregular the intervals are.
| Atrial fibrillation |
|
| Atrial flutter |
Patients tolerate this condition more easily than atrial fibrillation
|
| Extrasystole |
With extrasystole, the clinical picture may not be clearly expressed
|
| Migration of pacemakers |
|
Causes
Heart rhythm develops when the rhythmic functioning weakens or the activity of the sinus node completely ceases.
The development of complete or partial work depression may be influenced by exposure to:
- inflammatory process
- persistent increase in blood pressure
- ischemia
- cardiosclerosis
- hormonal disorders
- carbon monoxide intoxication
- use of certain groups of drugs
Heart rhythm can develop in professional athletes, people who smoke and drink alcohol, and are subject to frequent stress and significant physical activity.
With timely diagnosis and treatment, the prognosis for patients with myocarditis and atrial rhythm is predominantly favorable.
Cardiomyopathy is a collective term for myocardial diseases of unknown origin. The pathological process can develop under the influence of sclerotic and dystrophic disorders in the cells of the heart. Cardiomyopathy is accompanied by impaired functioning of the heart ventricles. The development of the disease can be influenced by dysfunction of the cardiovascular system and immunity, hormonal imbalances, viral infections, and hereditary predisposition.
Depending on the type of pathology, cardiomyopathy is accompanied by heart rhythm, cardialgia, dizziness, weakness, fainting, rapid heartbeat, pallor of the skin, shortness of breath, and heart failure. The liver may increase in size, ascites and edema occur, and heart pain cannot be relieved with nitroglycerin-based drugs.
The prognosis for patients with cardiomyopathy is not always favorable. The rapid development of heart failure is fraught with arrhythmic and thromboembolic complications and death. Planned therapy can stabilize the patient's condition for an indefinite period of time.
Rheumatism
With rheumatism, inflammatory damage to connective tissues and the heart is observed. With rheumatic fever, body temperature rises, arthralgia and polyarthritis develop, and the heart valves are affected. The disease is characterized by a chronic course with periodic exacerbations in the autumn and spring seasons. Children and adolescents and female representatives are at risk.
Rheumatic carditis develops 7-20 days after the development of rheumatism and is accompanied by atrial rhythm, heart pain, interruptions, shortness of breath, asthenic syndrome, cough, palpitations, circulatory failure, pulmonary edema, cardiac asthma. Damage to the cardiovascular system in rheumatism is observed in more than 80% of cases. The disease is accompanied by inflammation of the cardiac membranes, damage to the endocardium, myocardium, pericardium, and myocardium.
Congenital and acquired heart defects can lead to the development of atrial rhythm. With such a pathology, disturbances in the functioning or structure of organs are observed, which leads to a failure of blood circulation and electrical conductivity. The causes of the congenital type of disorders are chromosomal abnormalities, environmental factors, gene mutation, and multifactorial predisposition. Acquired defects can be infectious, atherosclerotic, local or isolated.
Sick sinus syndrome
In sick sinus syndrome, rhythm disturbances are observed due to dysfunction of the sinoatrial nodes. The disease is accompanied by a violation of the formation and conduction of impulses from the sinus nodes to the atria. There is a risk that the heart will suddenly stop functioning. The causes of the disorder may be diseases of the cardiovascular system, idiopathic degenerative and infiltrative diseases, hypothyroidism, and dystrophy of the musculoskeletal system.
Sick sinus syndrome is accompanied not only by atrial rhythm, but also by severe rhythm disturbances, headache, dizziness, pulmonary edema, cardiac asthma, coronary insufficiency, pale skin, and a sharp decrease in blood pressure. The clinical picture is diverse and depends on the presence of concomitant disorders and the individual characteristics of the patient’s body.
In coronary heart disease, severe dysfunction of the sinus nodes is observed. The normal supply of oxygen is disrupted, cells cannot work in their natural physiological mode. The causes of IHD can be bad habits, hereditary predisposition, hypertension, obesity, diabetes. According to the results of cardiography, atrial rhythm is observed in the majority of patients with coronary heart disease. There are also complaints of headache, shortness of breath, pain in the sternum, and chronic fatigue.
Vegetovascular dystonia
Vegetative-vascular dystonia is a broad complex of disorders in which vascular tone is impaired. The patient complains of atrial rhythm, constant heartbeat, increased sweating, discoloration of the skin, and lightheadedness. The formation of an ectopic rhythm is observed, and the heart rate is disturbed. This condition can cause systematic fluctuations in blood pressure and significantly worsens the quality of life of patients.
Symptoms
In some cases, the atrial rhythm may not appear for a long time, in others, pronounced signs of disturbance are observed.
The main symptoms that should not be ignored:
- shortness of breath even after minor physical exertion
- burning pain in the area behind the sternum
- swelling of the legs
- dizziness
- lightheadedness
- discoloration of the skin in a bluish tint
- muscle weakness
- severe fatigue
- interruptions in heart function
- feeling of tightness in the chest
- heart palpitations, accompanied by a feeling of fear, panic
- faintness
- heart rate fluctuations
- cardiac arrest for a few seconds followed by chest shocks
With paroxysmal tachycardia, clear signs are observed in the form of a sudden acceleration of the heartbeat; heart rate can exceed 145 beats/min. Due to insufficient oxygen supply to the heart, the patient complains of lack of air and chest pain. In this case, the pulse may remain within normal limits.
How to distinguish from sinus
Atrial rhythms occur when the functioning of the sinus nodes is inhibited. They are distinguished by their slow, substitutive nature. There is a decrease in heart contraction, acceleration of heart activity, and the development of pathological activity in the atria. Often the heart rate exceeds the heart rate, and a left atrial or right atrial contraction is formed.
To distinguish atrial rhythm from sinus rhythm, electrocardiography is required. The doctor examines the nature of changes in contractions, pays attention to the heart rate, the duration of the intervals, how correctly the ventricles contract, and whether deformed, negative teeth are formed.
With an atrial rhythm, atrial flutter can accelerate to 400 beats per minute, while with a sinus rhythm, it remains uniform. In the ECG picture, in the first case, saw-like teeth will be observed, in the second, an almost flat, uneven line will be visible.
Features in children
Children have congenital and acquired forms of heart rhythms. The main reasons: vegetative-vascular dystonia, hormonal changes, thyroid dysfunction. Right atrial and lower atrial rhythms occur as a result of prematurity, pathological birth, and hypoxic phenomena.
In young children, immaturity of neurohumoral cardiac activity is observed. As the child develops and matures, heart rate indicators normalize on their own. If during the examination no cardiovascular disorders or central nervous system dysfunction are detected in the child, then a transient type of atrial rhythm is diagnosed. The child should be under constant medical supervision until adolescence.
If paroxysmal tachycardia or atrial fibrillation is detected, then a comprehensive examination is prescribed. Such serious abnormalities can occur as a result of congenital cardiomyopathies, heart defects, and viral myocarditis.
Possible complications
The likelihood of developing complications depends on the underlying factor causing the pre-death rhythm. The prolonged course of the disease and the lack of high-quality, timely care is fraught with serious complications: cardiosclerosis, sclerotic lesions of the heart muscles, heart failure, arrhythmia. In severe cases, death is possible.
Which doctor should I contact?
If your heart rhythm is abnormal and you suspect atrial rhythm, it is recommended to consult a cardiologist.
Diagnostics
The gold standard for diagnosing atrial rhythm is the electrocardiogram. The development of the disorder is indicated by deformations of the P waves. The amplitude is impaired, the teeth are shortened. With paroxysmal tachycardia, a regular rhythm and high frequency of contractions are observed; it is not always possible to determine the P waves.
- ultrasound examination of the heart
- 24-hour electrocardiogram monitoring
- for myocardial ischemia, coronary angiography is prescribed
- patients with other types of arrhythmia are advised to undergo transesophageal electrophysiological study
There are a large number of disorders that can interfere with the functioning and automaticity of the sinus node. The doctor must adequately assess the degree of the disorder, conduct a differential diagnosis with sinus arrhythmia, atrial node, migration of the pacemaker through the atria, polytopic atrial extrasystole.
Treatment
If the atrial rhythm is not accompanied by unpleasant symptoms, vegetative-vascular dystonia, dysfunction of the cardiovascular system and hormonal disorders, specific therapy is not carried out.
In other cases, the treatment regimen is selected taking into account the symptoms that appear:
- bradycardia requires the use of drugs that include atropine, as well as herbal adaptogens: ginseng, Rhodiola rosea, Schisandra chinensis, Eleutherococcus. If the heart rate often decreases to 45-55 beats per minute, surgical intervention with implantation of artificial pacemakers is indicated;
- moderate extrasystole is eliminated with sedatives and adaptogens;
- for vegetative-vascular dystonia, it is recommended to take sedatives, which include motherwort, valerian, and Novopassita. Phytoseda;
- Atrial fibrillation and flutter require emergency medical attention. The patient is administered Panangin, Nicotinamide, and is prescribed medications from the group of beta blockers and antiarrhythmic drugs;
- in order to prevent stroke, heart attack and other complications, the use of Panangin and Cardiomagnyl is recommended.
The basis of therapy is the impact on the underlying diseases that cause atrial rhythm. If it is not possible to stop the attack with medications, electropulse therapy is recommended. A contraindication to this procedure is poisoning with drugs from the group of cardiac glycosides. If the patient's condition is severe, regular cardiac pacing is recommended. If conservative treatment methods are ineffective, surgical intervention with the installation of artificial pacemakers is indicated.
Forecast
The prognosis depends on the course and severity of the disease provoking the atrial rhythm. If no concomitant dysfunction of the cardiovascular system was detected, the prognosis is favorable. The sooner the patient seeks qualified assistance, the more favorable the outcome.
Prevention
To prevent atrial rhythm, it is important to qualitatively and timely treat dysfunctions of the cardiovascular and hormonal systems. At the first signs of violations, seek help from experienced, qualified specialists. A high-quality, balanced diet, adherence to work and rest, moderate physical activity, and abandonment of bad habits are recommended.
To prevent the formation of arteriosclerotic plaques, excessively fatty and fried foods are removed from the diet, and a sufficient amount of fiber, greens, berries, fresh fruits and vegetables, whole grains, cereals, seeds, and nuts are introduced.
Timely diagnosis and adequate therapy are the best prevention of serious complications, including sudden death. In some cases, lifelong medication and regular monitoring by a cardiologist are required. This allows you to increase life expectancy and improve its quality. If the cause of the atrial rhythm does not depend on the influence of the physiological characteristics of the body, consultation with a psychotherapist may be required.
Video: Decoding the cardiogram - norm and pathology
Despite the variety of functional diagnostic methods used, in the practice of a cardiologist, electrocardiography occupies a strong position as the “gold standard” for diagnosing heart rhythm and conduction disorders.
Electrocardiography allows you to diagnose and identify heart blocks and arrhythmias, hypertrophy of various parts of the heart, determine signs of ischemic myocardial damage, and also indirectly judge electrolyte disturbances, the effects of various medications, and extracardiac diseases. Some electrocardiographic signs, together with characteristic clinical manifestations, are combined into clinical electrocardiographic syndromes, of which there are currently more than 40 types.
This review is devoted to the most difficult section of ECG diagnostics – cardiac arrhythmias. The variety of heart rhythm disturbances, including those caused by sinus node dysfunction, greatly complicates their diagnosis. Nevertheless, the relevance of an adequate assessment of dysfunction of the sinus node automatism is beyond doubt.
The review presents modern views on ECG diagnosis of disorders of sinus node automatism. A description of the main causes of heart rhythm disturbances is given, and criteria for diagnosing dysfunctions of sinus node automatism, illustrated with electrocardiograms, are presented. The article provides a modern classification of cardiac rhythm and conduction disorders, as well as algorithms for differential diagnosis between various cardiac arrhythmias.
Keywords: cardiac automaticity, sinus node, sinus rhythm, jump contractions, wandering rhythm, replacement rhythms, slow atrial rhythm, junctional rhythm, idioventricular rhythm, sick sinus syndrome, heart block, sinus node arrest, atrial asystole.
For quotation: Zadionchenko V.S., Yalymov A.A., Shekhyan G.G., Shchikota A.M. ECG diagnosis of dysfunctions of sinus node automatism, replacement complexes and rhythms // RMZh. Cardiology. 2016. No. 9. P. –539.
For quotation: Zadionchenko V.S., Yalymov A.A., Shekhyan G.G., Shchikota A.M. ECG diagnosis of dysfunctions of sinus node automatism, replacement complexes and rhythms // RMZh. 2016. No. 9. pp. 530-539
ECG diagnosis of sinus node automaticity dysfunctions, substituting complexes and rhythms
V.S. Zadionchenko, A.A. Yalymov, G. G. Shekhyan, A.M. Shchikota
A.I. Evdokimov Moscow State Medical and Dental University, Moscow, Russia
Despite a variety of functional tests used by cardiologists, electrocardiography (ECG) remains the gold standard for the diagnosis of heart rhythm and conduction disorders. Currently, electrocardiography can be done almost everywhere, however, ECG interpretation by an expert is performed rarely. ECG helps to diagnose cardiac hypertrophy, heart block and arrhythmias, myocardial ischemic injury as well as to identify extracardiac pathologies, electrolyte imbalances, and the effects of various drugs. Electrocardiographic signs and typical clinical symptoms can be grouped into more than 40 clinical electrocardiographic syndromes. Long QT syndrome, post-tachycardia syndrome, Frederick syndrome, and Wolff-Parkinson-White syndrome are the best known conditions. The paper discusses the most difficult part of ECG diagnostics, i.e., heart arrhythmias. A variety of heart rhythm problems (including arrhythmias caused by sinus dysfunction) make their diagnosis difficult. Nevertheless, adequate interpretation of sinus node automaticity dysfunction is an important issue. The paper summarizes recent opinion on electrocardiographic diagnostics of this pathology. Major causes of heart rhythm problems are described. Diagnostic criteria sinus node automaticity dysfunction are illustrated by ECGs. Finally, current grading system of heart rhythm and conduction disorders as well as algorithms for the differential diagnosis of arrhythmias are reviewed.
Key words: heart automaticity, sinus node, sinus rhythm, escape beat, wandering pacemaker, substituting rhythms, slow atrial rhythm, junctional rhythm, idioventricular rhythm, sick sinus syndrome, heart block, sinus arrest, atrial asystole.
For citation: Zadionchenko V.S., Yalymov A.A., Shekhyan G.G., Shchikota A.M. ECG diagnosis of sinus node automaticity dysfunctions, substituting complexes and rhythms // RMJ. Cardiology. 2016. No. 9. P. –539.
The article is devoted to the ECG diagnosis of dysfunctions of the automatism of the sinus node, replacement complexes and rhythms
The sinus node (sinoauricular node, Keys–Flac node) (SU) is the normal pacemaker of the heart. Pacemaker cells of the SG (first order pacemaker) have the greatest automaticity; they generate 60–90 impulses per minute.
Disorders of the automatism function of the SG can be divided into types that have and do not have hemodynamic significance, which, in turn, makes their timely and correct diagnosis extremely important, which makes it possible to prescribe adequate therapy and avoid (including iatrogenic) errors in the process treatment, to prevent the development of sudden death and other complications. Table 1 presents the classification of rhythm and conduction disorders.
According to the etiology, cardiac arrhythmias can be divided into the following main types:
1. Dysregulatory or functional: associated with disorders of neuroendocrine regulation, autonomic dysfunction, psychogenic influences, fatigue, reflex effects (gastritis, peptic ulcer, aerophagia, Roemheld syndrome, cholelithiasis, nephroptosis, urolithiasis, colitis, constipation, flatulence, pancreatitis, intervertebral hernia, embolism in the pulmonary system arteries, mediastinal tumors, bronchopulmonary processes, pleural adhesions, thoracic operations, diseases of the genital organs, skull injuries, brain tumors, multiple sclerosis).
2. Myogenic or organic: associated with myocardial diseases (cardiomyopathy, myocarditis, post-myocardial cardiosclerosis, myocardial dystrophy), with damage to cardiomyocytes that occurs against the background of coronary heart disease (myocardial infarction, ischemic cardiomyopathy), hypertension, heart defects.
3. Toxic: arising under the influence of drugs (cardiac glycosides, anesthetics, tranquilizers, antidepressants, neuroleptics, aminophylline and its analogs, adrenomimetics (adrenaline, nor-adrenaline, mezaton, dobutamine, dopamine, salbutamol), acetylcholine, vagolytics (atropine), glucocorticosteroids, ACTH , antiarrhythmic drugs, cytostatics, antiviral drugs, antifungal drugs, antibiotics, diuretics, ether, alcohol, caffeine, nicotine, heavy metal salts, benzenes, carbon monoxide, mushroom poisoning, infections, endogenous intoxication in oncopathology, uremia, jaundice, etc. .
4. Electrolyte: hypokalemia, hyperkalemia, hypocalcemia, hypercalcemia, hypomagnesemia.
5. Dishormonal: thyrotoxicosis, hypothyroidism, pheochromocytoma, puberty, menopause, pregnancy, hypopituitarism, ovarian dysfunction, premenstrual syndrome, tetany.
6. Congenital: congenital disorders of atrioventricular (AV) conduction, long QT syndrome, ventricular preexcitation syndromes (WPW, CLC, etc.).
7. Mechanical: cardiac catheterization, angiography, cardiac surgery, cardiac trauma.
8. Idiopathic.
ECG diagnosis of arrhythmias caused by dysfunction of the automatism of the sinus node is carried out using an electrocardiographic study, which allows us to distinguish the following main types.
1. Sinus tachycardia– this is a regular rhythm with unchanged ECG waves (P wave, PQ interval, QRS complex and T wave do not differ from the norm) from the sinus node with a frequency of > 90 per minute. Sinus tachycardia at rest rarely exceeds 150–160 beats per minute (Fig. 1).
Differential diagnosis:
– supraventricular non-paroxysmal tachycardia;
– supraventricular paroxysmal tachycardia;
– atrial flutter 2:1;
– atrial fibrillation with ventricular tachysystole;
– ventricular paroxysmal tachycardia.
Etiology:
– physiological tachycardia: physical activity, emotions, fear, orthostatic, congenital features;
– neurogenic tachycardia: neurosis, neurocirculatory asthenia;
– CVD: inflammatory and degenerative myocardial diseases, valve defects, collapse, heart failure, cor pulmonale, myocardial infarction, arterial hypertension;
– drug and toxic tachycardia: vagolytics (atropine), sympathicotonics (adrenaline, norepinephrine, mesaton, dobutamine, dopamine), aminophylline, corticosteroids, ACTH, caffeine, coffee, tea, alcohol, nicotine;
– infectious diseases: ARVI, sepsis, pneumonia, tuberculosis, etc.;
– other: blood loss, anemia.
2. Sinus bradycardia– slowing of sinus rhythm with heart rate< 60 в 1 мин вследствие пониженного автоматизма синусового узла. Синусовая брадикардия с ЧСС < 40 сокращений в 1 мин встречается редко (рис. 2) .
Differential diagnosis:
– AV block II stage. 2:1 or 3:1;
– AV block, stage III;
– atrial rhythms;
– nodal rhythm;
– atrial flutter with conduction 4:1, 5:1;
– SA blockade, SU failure;
Etiology:
– physiological bradycardia: constitutional, in athletes and people engaged in physical work, during sleep, during vagal tests (pressure on the eyeballs, solar plexus and carotid sinus, Valsalva test), when holding the breath, sometimes with fear, emotions, during second half of pregnancy, with vomiting and hypothermia;
– extracardial vagal bradycardia: neurosis with vagotonia, depression, peptic ulcer, increased intracranial pressure with cerebral edema, meningitis, brain tumor, cerebral hemorrhage, labyrinth diseases, Meniere’s syndrome, hypersensitive carotid sinus, shock, increased blood pressure, vago-vagal reflexes for renal, biliary, gastric and intestinal colic, intestinal obstruction, myxedema, hypopituitarism;
– drug and toxic bradycardia: cardiac glycosides (digoxin, strophanthin), opiates, acetylcholine, quinidine, beta blockers, cordarone, sotalol, calcium antagonists, anesthetics, tranquilizers, antipsychotics, pilocarpine. Uremia, jaundice, mushroom poisoning, hyperkalemia;
– infectious diseases: viral infections (viral hepatitis, influenza), typhoid fever, diphtheria, cholera;
– CVD: ischemic heart disease, diphtheria myocarditis, rheumatism, cardiomyopathies.
3. Sinus arrhythmia– irregular activity of the control system, leading to alternating periods of increased and decreased rhythm. There are respiratory and non-respiratory sinus arrhythmia.
With respiratory sinus arrhythmia, the heart rate gradually increases when inhaling, and slows down when exhaling.
Non-respiratory sinus arrhythmia persists during breath-holding and is not associated with the phases of breathing. Non-respiratory sinus arrhythmia, in turn, is divided into 2 forms: periodic (periodic, gradual alternation of acceleration and deceleration of cardiac activity) and aperiodic (lack of gradual alternation of phases of acceleration and deceleration of cardiac activity) (Fig. 3).
Etiology:
– physiological arrhythmia: adolescents, elderly people;
– extracardiac diseases: infectious diseases, temperature reactions, obesity, pleuro-pericardial adhesions, increased intracranial pressure;
– CVD: rheumatism, ischemic heart disease, heart defects, heart failure;
– drug and toxic arrhythmia: opiates, cardiac glycosides, vagotonics.
Differential diagnosis:
– AV block II stage;
– SA blockade, SU failure;
– atrial fibrillation;
– atrial flutter (irregular shape);
- atrial extrasystole.
4. SU stop(CS failure, sinus arrest, sinus pause, sinus-inertio) – periodic loss of the control system’s ability to generate impulses. This leads to loss of excitation and contraction of the atria and ventricles. There is a long pause on the ECG, during which the PQRST waves are not recorded and the isoline is recorded. The pause when stopping the ultrasound is not a multiple of 1 R-R (P-P) interval (Fig. 4).
Etiology:
– reflex: sensitive carotid sinus, vagal tests;
– medicinal and toxic arrest of sinusitis: cardiac glycosides (digoxin, strophanthin), opiates, acetylcholine, quinidine, beta blockers, calcium antagonists. Hypokalemia, intoxication;
– CVD: coronary artery disease, myocarditis, cardiomyopathies, surgical damage to the sinus, weakness of the sinus.
Differential diagnosis:
– AV block II-III stage;
– SA blockade, stage II;
– atrial fibrillation with ventricular bradysystole, Frederick’s syndrome;
– nodal rhythm;
– sinus arrhythmia;
– sinus bradycardia;
– atrial asystole.
5. Atrial asystole(partial asystole) - absence of atrial excitation, which is observed during 1 or (more often) more cardiac cycles. Atrial asystole can be combined with ventricular asystole, in such cases complete cardiac asystole occurs. However, during atrial asystole, pacemakers of the II, III, IV order usually begin to function, which cause excitation of the ventricles (Fig. 5).
Etiology:
– reflex: sensitive carotid sinus, vagal tests, intubation, deep breathing, due to irritation of the pharynx;
Differential diagnosis:
– AV block II-III stage;
– SA blockade, stage II;
– blocked atrial extrasystoles;
– atrial fibrillation with ventricular bradysystole;
– Frederick's syndrome;
– nodal rhythm;
– sinus arrhythmia, sinus bradycardia;
– SU stop.
6. Sick sinus syndrome(SSSS) (sinus dysfunction, bradycardia and tachycardia syndrome, patient sinus syndrome, Short syndrome, sick sinus syndrome, lazy sinus syndrome, sluggish sinus syndrome) is the presence of one or more of the following signs:
– persistent severe sinus bradycardia (Fig. 2);
– minimum heart rate determined during daily ECG monitoring for 1 day<40 в 1 мин, а ее рост во время физической нагрузки не превышает 90 в 1 мин;
– bradysystolic form of atrial fibrillation;
– migration of the atrial pacemaker (Fig. 12);
– stopping the SU and replacing it with other ectopic rhythms (Fig. 6–10, 13);
– sinoauricular block;
– pauses >2.5 s that occur as a result of the arrest of the sinus system, SA blockade, or rare replacement rhythms (Fig. 6);
– tachy-brady syndrome, alternating periods of tachycardia and bradycardia (Fig. 6);
– rarely attacks of ventricular tachycardia and/or ventricular fibrillation;
– slow and unstable restoration of the function of the suture system after extrasystoles, paroxysms of tachycardia and fibrillation, as well as at the moment of termination of stimulation during electrophysiological examination of the heart (post-tachycardial pause, which normally does not exceed 1.5 s, in case of suction systolic systolic activity can reach 4–5 s);
– inadequate reduction in rhythm when using even small doses of beta blockers. Presence of bradycardia during the administration of atropine and exercise testing.
Classification
There is no unified classification of SSSU. Depending on the nature of the lesion, true (organic), regulatory (vagal), medicinal (toxic) and idiopathic SSS are distinguished (Fig. 6).
According to clinical manifestations there are:
– latent SSSU: there are no changes on the ECG, and the pathology of the SS is detected by additional functional research methods (EFI);
– compensated SSSU: no clinical changes, there are changes on the ECG;
– decompensated SSSU: there are clinical and ECG manifestations of the disease.
According to ECG signs there are:
– bradyarrhythmic variant of SSSU.
– tachycardia-bradycardia syndrome.
Etiology:
– CVD: ischemic heart disease, myocarditis, cardiomyopathies, surgical damage to the joint, rheumatism, congenital defects;
– reflex: sensitive carotid sinus, vagal tests, reflex effects in peptic ulcers, cholelithiasis, hiatal hernia;
– medicinal and toxic: cardiac glycosides (digoxin, strophanthin), opiates, acetylcholine, quinidine, beta blockers, calcium antagonists. Hyperkalemia, intoxication, hypoxemia;
– idiopathic forms.
Passive ectopic complexes and rhythms
Reduced activity of the sinus sinus or complete blockade of sinus impulses due to functional or organic damage to the sinus system causes the activation of automatic centers of the second order (cells of atrial pacemakers, AV connection), third order (His system) and fourth order (Purkinje fibers, ventricular musculature).
Automatic centers of the second order produce unchanged ventricular complexes (supraventricular type), while centers of the third and fourth order generate dilated and deformed ventricular complexes (ventricular, idioventricular type). The following rhythm disturbances have a substitutive nature: atrial, nodal, migration of the pacemaker through the atria, ventricular (idioventricular rhythm), jumping contractions.
7. Atrial rhythm(slow atrial rhythm) - a very slow ectopic rhythm with foci of impulse generation in the atria (Table 2).
Right atrial ectopic rhythm is the rhythm of an ectopic focus located in the right atrium. The ECG shows a negative P wave in leads V1-V6, II, III, aVF. The PQ interval is of normal duration, the QRST complex is not changed.
Coronary sinus rhythm (coronary sinus rhythm) - impulses to excite the heart come from cells located in the lower part of the right atrium and the coronary sinus vein. The impulse propagates through the atria retrogradely from bottom to top. This leads to the registration of negative P waves in leads II, III, aVF. The PaVR wave is positive. In leads V1-V6 the P wave is positive or 2-phase. The PQ interval is shortened and usually< 0,12 с. Комплекс QRST не изменен. Ритм коронарного синуса может отличаться от правопредсердного эктопического ритма только укорочением интервала PQ.
Left atrial ectopic rhythm - impulses to excite the heart come from the left atrium. In this case, a negative P wave is recorded on the ECG in leads II, III, aVF, V3-V6. The appearance of negative P waves in I, aVL is also possible; the P wave in aVR is positive. A characteristic sign of left atrial rhythm is the P wave in lead V1 with an initial rounded dome-shaped part, followed by a pointed peak - “shield and sword” (“dome and spire”, “bow and arrow”). The P wave precedes the QRS complex with a normal P-R interval = 0.12–0.2 s. Atrial rhythm frequency – 60–100 per minute, rarely< 60 (45–59) в 1 мин или >100 (101–120) per 1 min. The rhythm is correct, the QRS complex is not changed (Fig. 7).
Regular rhythm with negative P waves I, II, III, aVF, V3-V6 before the QRS complex. The P wave in lead V1 has an initial rounded dome-shaped portion followed by a pointed peak—a “shield and sword.” Normal P-R interval = 0.12-0.2 s.
Inferior atrial ectopic rhythm is the rhythm of an ectopic focus located in the lower parts of the right or left atria. This leads to the registration of negative P waves in leads II, III, aVF and a positive P wave in aVR. The PQ interval is shortened (Fig. 8).
Differential diagnosis:
– sinus arrhythmia;
– nodal rhythm;
– migration of the pacemaker through the atria;
– atrial flutter;
– atrial rhythms (right atrial, left atrial, lower atrial, coronary sinus rhythm).
8. Nodal rhythm(AV rhythm replacing AV nodal rhythm) - heart rhythm under the influence of impulses from the AV junction with a frequency of 40–60 per minute. There are 2 main types of AV rhythm:
– nodal rhythm with simultaneous excitation of the atria and ventricles (nodal rhythm without P wave, nodal rhythm with AV dissociation without P wave): the ECG shows an unchanged or slightly deformed QRST complex, no P wave (Fig. 9);
– junctional rhythm with different-time excitation of the ventricles and then the atria (junctional rhythm with a retrograde P wave, isolated form of the AV rhythm): an unchanged QRST complex is recorded on the ECG, followed by a negative P wave (Fig. 10).
Differential diagnosis:
– sinus bradycardia;
– atrial rhythm;
– migration of the pacemaker through the atria;
– polytopic atrial extrasystole;
– idioventricular rhythm.
9. Migration of the pacemaker through the atria(wandering rhythm, sliding rhythm, migrating rhythm, migration of the heart rate driver, wandering pacemaker). There are several variants of wandering (wandering) rhythm:
Wandering rhythm in the SU. The P wave is of sinus origin (positive in II, III, aVF), but its shape changes with different heart contractions. The P-R interval remains relatively constant. Severe sinus arrhythmia is always present.
Wandering rhythm in the atria. The P wave is positive in II, III, aVF, its shape and size change with different heart contractions. Along with this, the duration of the P-R interval changes.
Wandering rhythm between the sinus and atrioventricular nodes. This is the most common variant of the wandering rhythm. With it, the heart contracts under the influence of impulses that periodically change their location: they gradually move from the suture block, atrial muscles to the AV junction and return to the suture block again. ECG criteria for pacemaker migration in the atria are ≥ 3 different P waves in a series of cardiac cycles, a change in the duration of the P-R interval. The QRS complex does not change (Fig. 11, 12).
Etiology:
– reflex: healthy people with vagotonia, sensitive carotid sinus, vagal tests, intubation, deep breathing;
– CVD: ischemic heart disease, rheumatism, heart defects, heart surgery.
Differential diagnosis:
– AV block II stage;
– atrial fibrillation;
– sinus arrhythmia;
– polytopic atrial extrasystole.
10. Idioventricular (ventricular) rhythm(intrinsic ventricular rhythm, ventricular automatism, intraventricular rhythm) - ventricular contraction impulses arise in the ventricles themselves. ECG criteria: widened and deformed QRS complex (>0.12 s), rhythm with heart rate< 40 в 1 мин (20–30 в 1 мин). Терминальный идиовентрикулярный ритм – очень медленный и неустойчивый. Ритм чаще правильный, но может быть неправильным при наличии нескольких эктопических очагов в желудочках или наличии 1 очага с различной степенью образования импульсов или блокады на выходе (exit block). Если присутствует предсердный ритм (синусовый ритм, мерцание / трепетание предсердий, эктопический предсердный ритм), то он не зависит от желудочкового ритма (АВ-диссоциация) (рис. 13, 14) .
Differential diagnosis:
– AV block, stage III;
– SA blockade II-III stage;
– atrial fibrillation with ventricular bradysystole, Frederick’s syndrome;
– nodal rhythm;
– sinus bradycardia;
– jumping contractions.
Etiology:
– medicinal and toxic effects: cardiac glycosides (digoxin, strophanthin), quinidine. Infectious diseases, intoxication;
– CVD: ischemic heart disease, myocarditis, cardiomyopathies, surgical damage to the sinus, weakness of the sinus, terminal cardiac condition.
11. Popping cuts(replacement systoles, escape systoles, ersatzsystolen, echappements ventriculaires, individual automatic contractions of the ventricles) - single impulses from the AV junction or ventricles. The difference between jumping contractions and nodal or idioventricular rhythm is the absence of a long period of contractions.
Nodal jump-out contractions (the QRS complex is not changed and is the same in shape as the rest of the ventricular complexes. A jump-out contraction can be recognized by the position of the negative P wave or its absence) (Fig. 15).
Ventricular jump contractions (the QRS complex is deformed and widened) (Fig. 16).
ECG criteria: the R-R interval before the jumping contraction is always longer than 1 whole interval, and not shortened, as with extrasystole. The R-R interval after the pop-up contraction is of normal length, and not lengthened, as with extrasystole, and in all cases is shorter than the interval preceding the pop-up contraction.
Etiology:
– medicinal and toxic effects: cardiac glycosides (digoxin, strophanthin), quinidine. Infectious diseases, intoxication;
– CVD: ischemic heart disease, myocarditis, cardiomyopathies, surgical damage to the sinus, weakness of the sinus, terminal cardiac condition.
Differential diagnosis:
– sinus arrhythmia;
– atrial extrasystole;
– ventricular extrasystole;
– migration of the atrial pacemaker;
– SA blockade, stage II, failure of the SU;
– AV block II stage;
– nodal rhythm;
– idioventricular rhythm.
Conclusion
The variety of dysfunctions of the automatism function of the control system significantly complicates their diagnosis. Nevertheless, the relevance of adequate assessment of SU dysfunction is beyond doubt.
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