Types of cardiac arrhythmias and their treatment. Abnormal heart rhythm and conduction (cardiac arrhythmias) Abnormal heart rhythm

The rate of contraction of the heart muscle is considered to be 60-80 beats per minute. The passage of impulses occurs at the same time intervals. Conduction and automatism are controlled by the pacemaker cells of the sinus node. Syndrome of cardiac arrhythmia (arrhythmia) is characterized by an increased pulse - tachycardia - or a decrease in the contractile function of the myocardium - bradycardia.

The pathological condition suggests the presence clinical course one or more diseases. Violation of the heartbeat is noted at any age without sexual predisposition. Depending on the mechanism, arrhythmia can be harmless or life-threatening.

Classification and main symptoms of cardiac arrhythmias

An anomaly associated with a violation of the rhythm of contractions of the heart muscle is determined by several types:

Tachycardia - the pulse rate reaches 140 or more beats per minute. If there is no pathology of the sinus node or myocardium at the heart of the disease, it occurs against the background of stressful situations, physical activity, and blood loss.
Bradycardia is characterized by a decrease in heart rate to 60 beats or less. A prerequisite for the development of the disease is the inability to generate and distribute electrical impulses by the sinus node. Violation is noted during sleep or at rest. If bradycardia is persistent, treatment is needed.
Paroxysmal tachycardia is an abnormal phenomenon, which is sometimes based on heart disease. More often it is detected in completely healthy people. An abrupt pulse is observed, the onset of an attack is felt as a syndrome of sudden cardiac arrest, then the rhythm accelerates, can reach up to 200 beats per minute. The tachycardia ends suddenly, as it began, without visible reasons.
Extrasystole occurs when untimely contraction of the heart. The anomaly is based on long-term use or overdose of drugs, intoxication with drugs or ethanol. In children, extrasystole can lead to cardiac arrest.
Atrial fibrillation, in which impulses come from an ectopic (displaced from the normal) center. As a result, the atria contract unstably, in waves. The rhythm is irregular, disorderly.
Flutter, in which 200 or more impulses come from the sinus region, causing a temporary vibration of the muscles of the atria. Reaching the atrioventricular node, abnormal excitation is partially removed. These disorders cannot be established by probing the pulse, they are determined using an electrocardiogram.
Atrioventricular heart block (AV) affects the internal system of excitation transmission, is divided into 1, 2, 3 degrees. All three types arise in phases or continuously, capable of moving into the next stage. An anomaly can lead to severe complications, for example, Morgagni-Adams-Stokes syndrome, in which the attack is epileptic in nature with loss of consciousness.
Chronic heart failure is formed against the background of the second and third degree of AV blockade, in which the rhythm is sharply slowed down.
Ventricular fibrillation refers to serious violations. If measures are not taken immediately, cardiac arrest and sudden death occur.

Sometimes arrhythmia does not manifest itself in any way - pathological change detected during routine examination.

Symptoms

Signs of violation heart rate accompanied by:

rapid pulse in the form of seizures with tachycardia;
decrease in the frequency of myocardial contractions (bradycardia);
weakness increased sweating, rapid fatigue;
nausea, dizziness;
a feeling of lack of air (the patient cannot take a full breath);
shortness of breath;
visual impairment (blackout in the eyes);
the child becomes lethargic inactive;
pain syndrome in the region of the heart, manifested by a pressing or stabbing sensation;
pre-fainting state.

With prolonged seizure normal rate blood pressure changes upwards or downwards. Polyuria appears, while the urine has light color and low density. The patient feels fear, becomes restless.

Causes of pathologies

The etiology of arrhythmia can be versatile, both pathological and physiological factors of influence. Anomalies of the cardiovascular system:

congenital and acquired defects;
heart attack;
myocarditis, cardiomyopathy;
elevated arterial pressure;
cardiosclerosis, rheumatic heart disease;
ischemia;
an increase in the volume of the mass of the ventricles due to adipose tissue.

From the side of the central nervous system:

vegetovascular dystonia;
violation of intracranial circulation;
neuroses of a different nature;
neoplasms in the brain (cyst, tumor);
head injury.

Arrhythmia can cause chronic diseases:

dysfunction thyroid gland;
insufficient production of hormones by the adrenal glands;
diabetes;
stomach ulcer, diaphragmatic lesion;
respiratory diseases.

To physiological reasons relate:

premenstrual period;
pregnancy;
menopause;
stress, prolonged nervous tension;
improperly organized diet and daily routine;
overheating or hypothermia;
uncontrolled use of antidepressants, hormonal drugs, antibiotics.

Violation of the frequency of contraction of the heart muscle in children and adolescents is due to:

clinical syndrome congenital heart disease;
heredity;
food intoxication;
diseases of an infectious nature;
side effect of some medications.

The main risk group is overweight people over 45 years of age.

Diseases that cause rhythm disturbances

The main anomalies that affect the normal function of the sinus node include:

Holiday heart syndrome occurs when you drink too much alcohol. Ethanol and acetaldehyde, which is its metabolite, cause alcoholic cardiomyopathy, contributing to rhythm disturbance. There is an increased risk of atrial fibrillation, heart attack, and death. The anomaly is also caused by energy drinks, caffeine, nicotine and narcotic drugs.
Syndrome open heart- the space between the right and left atrium. This is a normal state in embryonic development. On the left side there is a small valve that closes the gap at the moment of the first cry of the child. Usually, the pathology disappears when it reaches the age of five. In adults, the presence of a channel between the atria is caused by genetic predisposition, physical activity, heavy sports. Pathology causes drops in blood pressure, arrhythmia.
Soldier's heart syndrome (phrenocardia) is a type of cardioneurosis, manifested by shortness of breath, rapid pulse, and anxiety. Patients experience lack of sleep, fatigue after waking up, pain behind the sternum on the left side. Muscular fatigue of the heart is characteristic of sensitive people who experience other people's suffering as their own.
Beer heart syndrome is caused by frequent and long-term use intoxicating drink. Addiction blocks sufficient intake of vitamin B (thiamine), which leads to an increase in the volume of the muscle mass of the heart. The disease affects the functionality of the nervous system, contributes to hormonal disorders. Patients have varicose veins, a failure in the rhythm of myocardial contraction.
Dilated heart syndrome is characterized by dilated cavities. With pathology, the size of the organ increases, the muscle layer remains unchanged. Anatomical disturbance leads to inhibition of pumping ability, contractile activity. At the time of systole, a reduced volume of blood enters, a negative process covers all parts of the heart that suffer from oxygen deficiency.

One of the reasons for the manifestation of arrhythmia is a psychological factor, the so-called alien heart syndrome. Occurs against the background of a heart attack, transplantation of a donor or artificial organ. In rare cases, the underlying cause is schizophrenia.

Diagnosis of pathology

With symptoms such as palpitations or fading, instability of blood pressure, fatigue, you should consult a doctor for an examination. Diagnosis of arrhythmia includes active and passive methods. The inertial method is based on the use of:

Blood sampling to determine the electrolyte composition, cholesterol level, the amount of enzymes.
An electrocardiogram (ECG) records the duration of the heartbeat interval.
Phonocardiography (PCG) listens for murmurs in the valves.
Echocardiography helps determine the size of the heart chambers and wall thickness using ultrasound probes.
Chest x-ray.
Monitoring according to the Holter method, daily ECG with a portable recorder during the patient's usual rhythm of life.
If a pathology in the gastrointestinal tract is suspected, fibrogastroscopy or cholecystography is additionally performed.

Active diagnostics involves induction (amplification of symptoms) pathological condition, referring to specially designed tests:

electrophysiological monitoring;

tilt table test.

The main task of diagnostics is to identify the cause that caused the anomaly, and build a scheme for its adequate elimination.

Treatment of rhythm disturbance

The choice of therapy depends on the clinical picture of the arrhythmia, so the prescription of drugs will vary. If the patient has tachycardia, drugs that inhibit the frequency of contractions are used. With bradycardia, on the contrary, medications increase the heart rate. The main direction in the treatment of the disease is based on the use of channel blockers:

potassium - "Sotahexal", "Kordaron";
calcium - "Diltiazem", "Verapamil";
sodium - "Lidocaine", "Novocainamide";
beta-blockers: "Atenolol", "Metoprolol", "Bisoprolol";
glycosides - "Adenosine", salts of magnesium or potassium.

If an emergency is needed health care, use:

loss of consciousness during bradycardia: "Dopamine", "Atropine", "Adrenaline";
supraventricular tachycardia - "ATF", "Verapamil";
rapid contraction of the ventricular type - "Lidocaine", "Kordaron".

It is possible to stabilize the patient's condition during an attack of paroxysmal arrhythmia by reflex action. It is carried out as follows:

massage of the neck area with circular movements;
breathing exercises provide a deep breath and a slight exhalation;
pressure on eyeballs within two or three minutes, the same manipulations are carried out in the abdominal area;
induce vomiting if necessary.

The reflex technique helps to switch the central nervous system from the heart to the points of influence and in most cases gives a positive result.

Possible complications and prognosis

Syndrome of cardiac arrhythmia may occur long time without affecting the quality of life, remaining unnoticed. Therein lies its danger. Reduced blood circulation due to insufficient output can provoke a series of serious complications. Against the background of arrhythmias develop:

Myocardial infarction. Pathology occurs during an attack of tachycardia, when the coronary arteries cannot cope with frequent ejections of blood, which does not enter the right amount in the tissue of the heart muscle. The lack of oxygen forms necrosis, the death of myocardial fibers. A heart attack is accompanied by a sharp pain on the left side of the chest.
A stroke (ischemic) causes blood clots to form in the heart muscle. Such a complication is observed with paroxysmal tachycardia. Clots form in the cavity of the organ and spread throughout the body, reaching the brain, blocking the lumen. The patient has pallor of the skin, fainting, impaired speech and coordination of movement, paralysis of the limbs is possible.
Asystole (cardiac arrest). Fibrillation can occur with ventricular fibrillation. The contractile function is lost, the blood stops flowing into the vessels. Chaotic contraction of the myocardium leads to biological or clinical death.
Arrhythmogenic shock occurs after a sharp decrease in blood pressure and heart rate to 35 beats per minute. Insufficient blood supply internal organs and the brain is manifested by loss of consciousness, cyanosis. If help is not provided in time, the attack ends in death.
Thromboembolism of the pulmonary artery occurs after blockage of the lumen blood clot. Clinical picture determined by suffocation, cyanosis of the skin of the face, neck, upper chest. The patient may die from asphyxia.
Collapse occurs after the introduction of antiarrhythmic drugs with atrial fibrillation or Morgagni-Adams-Stokes attack. In this case, blood pressure drops sharply, there is no consciousness, the skin turns pale.

The prognosis for a heart rhythm disorder depends on the underlying cause of the pathology. If it is not of an organic nature, the expected outcome is quite favorable. In the case of a chronic anomaly, the situation is determined by the severity.

Arrhythmia is one of the most common cardiac diseases, in which the heart rate increases or decreases under the influence of external adverse factors. These factors include colds, overwork, alcohol intake, and so on. In this case, even healthy people occasionally show symptoms of the disease.
Among cardiovascular diseases a special place is occupied by rhythm disturbance, which in medical terminology is referred to as “cardiac arrhythmia”. Most often, this disease is not dangerous, but sometimes there may be undesirable consequences in the form of surgery, which improves the patient's quality of life.

In a normal state, the heart contracts rhythmically, with approximately the same frequency, which at rest should be determined in the range from 60 to 90 beats / min. A similar indicator is typical for adults, since children normally have a higher heart rate, approximately 70-140 depending on age (than less baby, the higher the heart rate, which is in newborns in the range of 110-140 beats / min.).

Wikipedia notes that "arrhythmia is any heart rhythm that differs from normal sinus rhythm (WHO, 1978)".

Sometimes such a violation can be considered as a variant of the norm, and then they talk about physiological arrhythmia. With its presence, even the army is not contraindicated. In other situations, a rhythm disorder is a pathology that, if not adequately treated, can lead to serious complications.

Video: How the heart works. Cardiac arrhythmia: symptoms, causes and treatment

Normal heart activity

The human heart is divided into four chambers, two of which are filled with arterial blood, and two - venous. The upper sections are called the atria, and the lower sections are called the ventricles. The blood flow moves from the veins through the atria to the ventricles and then to the arteries. Promotion of blood in this way occurs due to heart contractions.

The conduction system is responsible for ensuring timely contractions of the heart. Its main driver is the sinus node, located in the upper right corner of the right atrium (more precisely, near the atrial appendage). The electrical impulse generated in this area by a small group of cardiomyocytes is transmitted along the fibers of the left atrium and further along the lower atrioventricular node, passes through the bundle of His and Purkinje fibers to the ventricles. Thus, the atria contract first, and then the ventricles.

A trained heart, for example, in people who love sports, may contract less frequently than in an ordinary person. This is due to the increased mass of the myocardium due to constant sports exercises. This allows the heart to make stronger emissions into the bloodstream. Therefore, in such cases, the heart rate can be 50 beats / min or less, while it will be considered a variant of the norm since it does not cause negative consequences.

In the case of a rhythm disorder, Wikipedia indicates that “the term “arrhythmia” combines various mechanisms, clinical manifestations and prognostic disorders in the formation and conduction of an electrical impulse.”

The reasons

The disease is often associated with cardiac pathologies, which are characterized by a change in the structure of the organ (destruction, ischemia, malnutrition, etc.). Rhythm disorder most often acts as a complication in case of insufficient activity of the heart, coronary disease, cardiac myopathies, congenital and acquired malformations, inflammation of the myocardium.

When exposed to certain drugs, arrhythmia also occurs. In particular, misuse cardiac glycosides, diuretics, sympathomimetics, antiarrhythmic drugs with proarrhythmic action can lead to rhythm disturbance varying degrees expressiveness.

In some cases, the consequences of a simple lack of certain microelements are expressed by the development of arrhythmia. This is most common with hypokalemia, hypomagnesemia, hyperkalemia and hypercalcemia.

It is worth remembering the obvious harm of bad habits such as smoking, drinking alcohol and drugs. Such substances can have a toxic effect on the heart and blood vessels. As a result, undesirable consequences in the form of not only arrhythmias, but also more serious diseases.

Risk factors

Every year, the diagnosis of “arrhythmia” is increasingly being made to patients of various age categories, which is primarily associated with risk factors. Arrhythmia affects adults and children. Identification of a particular cause of the disease is the basis various methods diagnostics and screening tests. Also, their competent use allows for effective prevention.

genetic predisposition. Some arrhythmias, like the Wolff-Parkinson-White syndrome, are hereditary diseases. Others are associated with birth defects.
Pathology of the thyroid gland. This endocrine organ seriously affects the functioning of the heart. Thyroid produces hormones that speed up or slow down metabolic processes in the body. Accordingly, with thyrotoxicosis, tachycardia occurs, and with insufficient work of the organ, bradycardia occurs.
Arterial hypertension. Increased blood pressure threatens ischemic disease heart, which in turn is often complicated by rhythm disturbance.
episodes of hypoglycemia. A temporary decrease in the concentration of glucose in the blood can contribute to the development of arrhythmias. With decompensated diabetes mellitus, hypertension and coronary artery disease occur, and this also leads to a disorder of cardiac activity.
Excess body weight. Such a condition often causes the development of hypertension, coronary artery disease and other pathological disorders. In addition, increased body weight in itself puts an additional burden on the heart, thereby contributing to a rapid heartbeat.
Elevated blood cholesterol. This indicator should be especially carefully checked in people 55 years of age and older, when the risk of developing cardiovascular diseases, including arrhythmias, increases.
Anemia - iron deficiency provokes the development of hypoxia of various tissues, including the heart. This, in turn, leads to rhythm disturbance.
Hormonal imbalance - with menopause in women, extraordinary contractions and other manifestations of arrhythmia are most often observed.
Osteochondrosis - a violation of the structure of the spinal column leads to compression of the nerve roots, which in turn contributes to the development of autonomic regulation disorders (includes nervus vagus and the sympathetic nervous system). From this, first of all, cardiac activity suffers.

Symptoms

Arrhythmias appear in various forms Therefore, the clinic depends on the specifics of the course of the disease. Nevertheless, there are common manifestations characteristic of all types of rhythm disturbance:

Sensation of interruption of cardiac activity.
Change in heart rate.
Vegetative disorders (weakness, sensation of heat, cold extremities).
The appearance of fear and anxiety.

In severe cases, heart pain, pre-syncope and fainting conditions are added to the listed symptoms. It can also be determined by blanching of the skin, high or low blood pressure.

Characteristic features of individual forms of arrhythmia:

At various times, when even the army is contraindicated, an increase in heart rate is determined. In particular, an increase in heart rate from 150 beats / min is typical for, and when a heart rate is combined from 400 beats / min with loss of consciousness, it is often diagnosed.
Bradycardia is characterized by a slowing of the rhythm, that is, in adults, a heart rate below 50 beats / min is diagnosed.
manifested by fading of the heart and extraordinary heart contractions.
Heart blockades are expressed by severe violations of the general condition of the patient. In particular, convulsions, fainting, lack of pulse are determined.

Video: The first symptoms of heart problems that should not be ignored

Types of arrhythmia

Disorder of automatism - there are several subgroups: nomotopic, when the pacemaker is the sinus node (respiratory and non-respiratory sinus arrhythmia, sinus bradycardia, sinus node weakness syndrome) and heterotopic, when a different pacemaker is determined than the sinus node (idioventricular, lower atrial and atrioventricular rhythm ).
An excitability disorder - most often associated with it (it can be ventricular, atrioventricular and supraventricular) and extrasystole (a separate classification is considered by source, number of sources, time of occurrence, frequency and ordering).
Conduction disorder - options for increasing conductivity (occurs with WPW syndrome), as well as its decrease (typical for blockades of various localizations) are considered.

Depending on the severity of the course of a particular arrhythmia, the army is either contraindicated, or a young man is allowed to line service.

In some cases, mixed arrhythmias occur, when, in addition to extrasystole, a condition such as atrial fibrillation is diagnosed. Or, atrial flutter is combined with ventricular flutter.

Screening and diagnosis

A heart rhythm disorder is dealt with by a cardiologist, who at the reception first of all conducts a patient interview and an external examination. Next is assigned instrumental examination, laboratory tests, consultations of related specialists.

Almost without exception, all cardiological patients are prescribed electrocardiography, which in most cases allows you to determine many forms of arrhythmia. Each case has its own ECG signs:

Sinus tachycardia - other than an increase in heart rate, other rhythm changes are not determined.
- there is a decrease in heart rate relative to the age norm.
- the heart rate increases, decreases or remains normal, while the rhythm becomes irregular.
Sick sinus syndrome - there is a constant decrease in heart rate of the sinus type, sometimes the sinus rhythm disappears, while sinoauricular blockades are periodically recorded. Also on the ECG, tachycardia-bradycardia syndrome can be diagnosed.
Heterotopic arrhythmias - are manifested by a change in heart rate and rhythm regularity, which are most often non-sinus. With an idioventricular rhythm, the heart rate is 20-40 beats / min, and with an atrioventricular rhythm, 40-60 beats / min.
Extrasystole - is determined when extraordinary contractions occur on the ECG, which can be single, paired, multiple. Also, this form of arrhythmia is characterized by an incomplete compensatory pause. Depending on the source of excitation, changes can be noted in the atria, the atrioventricular node, and the ventricles.
Paroxysmal tachycardia - appears suddenly, while the heart rate can reach 150 beats / min and above.
Heart blockades - are determined by the loss of complexes of the corresponding localization, with a weak severity of the pathology, only a slowdown in the rhythm can be observed.
- The heart rate is 150-160 beats per minute, while the ventricular complexes do not change, and the rhythm becomes non-sinus.

In addition to electrocardiography, other passive research methods are used. This may be Holter monitoring, ultrasound of the heart (echocardiography). If attacks of arrhythmia occur rarely and they are not recorded on the ECG, then induction tests are used:

Tests with physical activity - for this, an exercise bike or a treadmill is used, while an ECG is recorded in parallel.
Tilt table test - often used for frequent and unreasonable pre-syncope and syncope. For this, the patient is fixed on a table, which, after taking indicators in a horizontal position, is transferred to a vertical one and again records the heart rate and blood pressure.
An electrophysiological study is carried out in order to determine the arrhythmogenic focus, and, if possible, its elimination is also carried out. Often used for atrial fibrillation.

Conservative treatment

In the presence of a severe course of arrhythmia, antiarrhythmic therapy is used. Their reception is possible only with the consent of the attending physician, otherwise undesirable consequences may occur.

Groups of antiarrhythmic drugs used in arrhythmias:

Drugs that affect the conduction system of the heart. This group includes cardiac glycosides, beta-blockers. Due to this action, the heart rate slows down, so they are more often used for tachycardia and atrial fibrillation.
Direct antiarrhythmic drugs - affect the permeability of ion channels, which in turn reduces the heart rate. The list of drugs from this group includes amiodarone, allapenin, ritmonorm and others.

People with a tendency to form blood clots are treated with thrombolytic drugs, including cardiac aspirin, clopidogrel, and other similar drugs prescribed by a doctor. Also, the inclusion of flax seed, garlic, celery, parsley in the diet helps to thin the blood.
The heart muscle can be strengthened by mildronate, riboxin, ATP. The doctor may prescribe other drugs that are widely used in cardiology practice. Including it is useful to use seeds, nuts, dried fruits, fish.
If the arrhythmia is a complication of another disease, it is treated first, thereby allowing the elimination of arrhythmia attacks without the use of cardiac drugs.

Long-term treatment of arrhythmia involves careful implementation of medical recommendations, thereby reducing the likelihood of recurrent attacks. In difficult cases, when conservative means cannot achieve the desired effect, they resort to the implantation of a pacemaker or radiofrequency catheter ablation.

Alternative methods of treatment of arrhythmia

An unconventional type of therapy can be used in combination with a conservative therapy regimen. In some cases, when attacks of rhythm disturbance are not very pronounced and there are no other cardiac disorders, they try to treat only herbal preparations. In any case, the treatment folk remedies previously agreed with the doctor, otherwise there may be disastrous consequences.

Spring Adonis - among a wide variety of green pharmacy preparations, it has shown its high efficiency, the only thing is that it is used with caution and no more than two weeks, then a break is taken for the same period. For treatment, take a tincture, which is taken 15 drops three times a day. Adonis is a cardiac glycoside, so it is taken in conjunction with diuretics.
Violet tricolor - also known as "pansies". Dried grass is suitable for use, which in the amount of 2 tsp. brewed with a glass of boiled water. After insisting for several hours, the infusion is ready to receive 2 tbsp. l. up to three times a day. It is important not to overdose the medicine, as nausea and vomiting may develop.
Oxalis inflorescences - used to treat rhythm disturbances in the form of an infusion, which is prepared from a glass of boiling water and a tablespoon of the plant. The medicine must be infused, it is considered ready for use after cooling.
Asparagus - few people know, although with the help of its shoots and rhizomes, you can calm the heart and normalize the rhythm. These components should be finely chopped, a tablespoon of the mixture is taken from the total amount and poured with a glass of boiling water. Further, for about three hours, the medicine is infused in heat and then taken in in large numbers several times a day. Thus, it can be treated for several months, but with interruptions for 10 days every three weeks of admission.
Hawthorn is a plant widely recommended in the treatment of cardiovascular diseases. Mostly flowers are taken, but the fruits of the plant can also be used. A glass of boiling water takes a few tablespoons of flowers or fruits. It usually takes 20 minutes to brew, then you can drink it like a tea.

In some cases, it is recommended to take garlic for arrhythmias, but this product is far from suitable for everyone, especially for those who have a stomach ache. Pregnancy is not contraindicated for taking fresh garlic, but everything should be in moderation. Honey can also have a beneficial effect on the heart, but only if there is no allergy.

Folk remedies can be considered mixtures of herbs that have a calming, restorative, vitaminizing effect. Whatever medicine is chosen, it is important to take it with the consent of the attending physician, otherwise side effects may occur.

Complications

In most cases, arrhythmia is not felt or causes minor discomfort, but in the absence of adequate drug exposure, the disease is dangerous not only for health, but also for human life. The risk increases when the arrhythmia is combined with other cardiac diseases. In particular, the following pathologies can develop:

Decompensated heart failure. The prolonged course of tachycardia or bradycardia in severe cases leads to stagnation of blood in the cavities of the heart. With timely control of heart rate, you can significantly improve your health.
Stroke. A similar complication is more typical for atrial flutter, which are not able to transfer the necessary portion of blood to the ventricles. If normal blood flow is disturbed in the atria, then the risk of blood clots formation increases, which can enter the general circulation. Often, blood clots enter the cerebral vessels, subsequently causing ischemia of the brain structures.
Cardiac arrest is the most formidable complication, which often becomes the cause. If medical assistance is not provided in time for this condition, the person dies.

Prevention

There are a number preventive measures, which allow you to prevent the development of arrhythmia or reduce the likelihood of repeated attacks.

In the presence of infectious diseases it is necessary to qualitatively and urgently carry out their treatment.
Concomitant diseases in the form of cardiac pathologies, thyroid diseases and arterial hypertension should be treated in a timely manner.
Nutrition should be complete and balanced.
In the presence of enhanced physical training, you need to reduce it, but do not go to the other extreme - physical inactivity.
Not allowed to have bad habit by the type of smoking, you also need to give up alcohol.
Stressful situations should be minimized, or even better, completely eliminated.
Some indicators such as blood glucose, body weight and cholesterol should be constantly monitored.

Which doctor to contact

The arrhythmologist is engaged in the study of the nature of arrhythmia, its diagnosis, treatment and prevention. At the same time, in most clinics there is no separate specialization in arrhythmology, therefore, patients with arrhythmias are seen by a cardiologist.

The functional diagnosis of heart rhythm disorders is carried out by a doctor of the appropriate specialization. With its help, ultrasound, electrocardiography, and, if necessary, Holter monitoring are performed.

The presence of concomitant pathology may require additional consultation of doctors of related specialties. This may be an endocrinologist who treats the thyroid gland, or a gynecologist who helps with the pathological course of menopause. Successful treatment of the underlying disease often allows you to cope with attacks of arrhythmia.

The ineffectiveness of conservative therapy is an indication for referring the patient to a consultation with a cardiac surgeon, who decides on the need for radiofrequency ablation of the pathological focus. An operation to implant a pacemaker may also be performed.

Heart rhythm disturbances (arrhythmias) are one of the most difficult sections of clinical cardiology. This is partly due to the fact that a very good knowledge of electrocardiography is necessary for the diagnosis and treatment of arrhythmias, and partly because of the huge variety of arrhythmias and a large selection of treatments. In addition, with sudden arrhythmias, urgent therapeutic measures are often required.

One of the main factors that increase the risk of arrhythmias is age. So, for example, atrial fibrillation is detected in 0.4% of people, while most of the patients are people over 60 years of age. The increase in the frequency of development of cardiac arrhythmias with age is explained by changes that occur in the myocardium and the conduction system of the heart during aging. Myocytes are replaced by fibrous tissue, so-called "sclerodegenerative" changes develop. In addition, with age, the frequency of cardiovascular and extracardiac diseases increases, which also increases the likelihood of arrhythmias.

The main clinical forms of cardiac arrhythmias

Extrasystole.
Tachyarrhythmias (tachycardia).
- Supraventricular.
- Ventricular.
Sick sinus syndrome.
Violations of atrioventricular and intraventricular conduction.

According to the nature of the clinical course, cardiac arrhythmias can be acute and chronic, transient and permanent. To characterize the clinical course of tachyarrhythmias, such definitions as "paroxysmal", "recurrent", "continuously recurrent" are used.

Treatment of cardiac arrhythmias

Indications for the treatment of rhythm disturbances are severe hemodynamic disturbances or subjective arrhythmia intolerance. Safe, asymptomatic or oligosymptomatic easily tolerated arrhythmias do not require special treatment. In these cases, the main therapeutic measure is rational psychotherapy. In all cases, the underlying disease is treated first.

Antiarrhythmic drugs

The main method of therapy for arrhythmias is the use of antiarrhythmic drugs. Although antiarrhythmic drugs cannot "cure" an arrhythmia, they help reduce or suppress arrhythmic activity and prevent recurrence of arrhythmias.

Any exposure to antiarrhythmic drugs can cause both antiarrhythmic and arrhythmogenic effects (that is, on the contrary, contribute to the onset or development of arrhythmia). The probability of an antiarrhythmic effect for most drugs is on average 40-60% (and very rarely for some drugs with certain types of arrhythmia reaches 90%). The probability of developing an arrhythmogenic effect is on average approximately 10%, and life-threatening arrhythmias may occur. During several major clinical research a marked increase in overall mortality and the incidence of sudden death (2-3 times or more) was found among patients with organic heart disease (post-infarction cardiosclerosis, hypertrophy or dilatation of the heart) while taking class I antiarrhythmic drugs, despite the fact that these drugs are effective eliminated arrhythmias.

According to the most common classification of antiarrhythmic drugs by Vaughan Williams today, all antiarrhythmic drugs are divided into 4 classes:

Class I - sodium channel blockers.
Class II - blockers of beta-adrenergic receptors.
Class III - drugs that increase the duration of the action potential and myocardial refractoriness.
Class IV - calcium channel blockers.

The use of combinations of antiarrhythmic drugs in some cases can achieve a significant increase in the effectiveness of antiarrhythmic therapy. At the same time, there is a decrease in the frequency and severity side effects due to the fact that drugs in combination therapy are prescribed in smaller doses.

It should be noted that there are no indications for prescribing so-called metabolic drugs to patients with rhythm disturbances. The effectiveness of course treatment with drugs such as cocarboxylase, ATP, inosie-F, riboxin, neoton, etc., and placebo are the same. The exception is mildronate, a cytoprotective drug, there is evidence of the antiarrhythmic effect of mildronate in ventricular extrasystoles.

Features of the treatment of the main clinical forms of arrhythmias

Extrasystole

The clinical significance of extrasystole is almost entirely determined by the nature of the underlying disease, the degree of organic damage to the heart and the functional state of the myocardium. In persons without signs of myocardial damage with normal contractile function of the left ventricle (ejection fraction greater than 50%), the presence of extrasystole does not affect the prognosis and does not pose a danger to life. In patients with organic myocardial damage, for example, with postinfarction cardiosclerosis, extrasystole can be considered as an additional prognostically unfavorable sign. However, the independent prognostic value of extrasystoles has not been determined. Extrasystole (including extrasystole of "high gradations") is even called "cosmetic" arrhythmia, thus emphasizing its safety.

As already noted, the treatment of extrasystole with class I C antiarrhythmic drugs significantly increases the risk of death. Therefore, if indicated, treatment begins with the appointment of β-blockers. In the future, evaluate the effectiveness of therapy with amiodarone and sotalol. It is also possible to use sedatives. Class I C antiarrhythmic drugs are used only for very frequent extrasystole, in the absence of the effect of therapy with β-blockers, as well as amidoron and sotalol (Table 3)

Tachyarrhythmias

Depending on the localization of the source of arrhythmia, supraventricular and ventricular tachyarrhythmias are distinguished. According to the nature of the clinical course, 2 extreme variants of tachyarrhythmias are distinguished (permanent and paroxysmal. An intermediate position is occupied by transient or recurrent tachyarrhythmias. Atrial fibrillation is most often observed. The frequency of detection of atrial fibrillation increases sharply with the age of patients.

Atrial fibrillation

Paroxysmal atrial fibrillation. During the first day, 50% of patients with paroxysmal atrial fibrillation show spontaneous restoration of sinus rhythm. However, whether the restoration of sinus rhythm will occur in the first hours remains unknown. Therefore, with early treatment of the patient, as a rule, attempts are made to restore sinus rhythm with the help of antiarrhythmic drugs. AT last years the algorithm for the treatment of atrial fibrillation has become somewhat more complicated. If more than 2 days have passed since the onset of the attack, the restoration of a normal rhythm can be dangerous - the risk of thromboembolism is increased (most often in the vessels of the brain with the development of a stroke). In non-rheumatic atrial fibrillation, the risk of thromboembolism ranges from 1 to 5% (on average, about 2%). Therefore, if atrial fibrillation lasts more than 2 days, it is necessary to stop attempts to restore the rhythm and prescribe the patient indirect anticoagulants (warfarin or phenylin) for 3 weeks at doses that maintain the international normalized ratio (INR) in the range from 2 to 3 (prothrombin index is about 60 %). After 3 weeks, an attempt can be made to restore sinus rhythm with medical or electrical cardioversion. After cardioversion, the patient should continue taking anticoagulants for another month.

Thus, attempts to restore sinus rhythm are made within the first 2 days after the development of atrial fibrillation or 3 weeks after the start of anticoagulants. In the tachysystolic form, the heart rate should first be reduced (transferred to the normosystolic form) with the help of drugs that block conduction in the atrioventricular node: verapamil, β-blockers or digoxin.

To restore sinus rhythm, the following drugs are most effective:

amiodarone - 300-450 mg IV or a single oral dose of 30 mg / kg;
propafenone - 70 mg IV or 600 mg orally;
novocainamide - 1 g IV or 2 g orally;
quinidine - 0.4 g orally, then 0.2 g every 1 hour until relief (max. dose - 1.4 g).

Today, a single oral dose of amiodarone or propafenone is increasingly being prescribed to restore sinus rhythm in atrial fibrillation. These drugs are highly effective, well tolerated and easy to take. The average time to restore sinus rhythm after taking amiodarone (30 mg / kg) is 6 hours, after propafenone (600 mg) - 2 hours.

With atrial flutter, in addition to drug treatment, transesophageal stimulation of the left atrium with a frequency exceeding the flutter frequency can be used - usually about 350 pulses per minute, lasting 15-30 seconds. In addition, with atrial flutter, electrical cardioversion with a 25-75 J discharge after intravenous administration of Relanium can be very effective.

Permanent form of atrial fibrillation. Atrial fibrillation is the most common form of sustained arrhythmia. In 60% of patients with a permanent form of atrial fibrillation, the main disease is arterial hypertension or coronary artery disease. In the course of special studies, it was found that coronary artery disease causes the development of atrial fibrillation in approximately 5% of patients. In Russia, there is an overdiagnosis of coronary artery disease in patients with atrial fibrillation, especially among the elderly. To make a diagnosis of coronary artery disease, it is always necessary to demonstrate the presence of clinical manifestations of myocardial ischemia: angina pectoris, painless myocardial ischemia, postinfarction cardiosclerosis.

Atrial fibrillation is usually accompanied by discomfort in chest, hemodynamic disturbances may be noted and, most importantly, the risk of thromboembolism, primarily in the vessels of the brain, increases. To reduce the risk, indirect anticoagulants (warfarin, phenylin) are prescribed. Less effective is the use of aspirin.

The main indication for the restoration of sinus rhythm with a constant form of atrial fibrillation is "the desire of the patient and the consent of the doctor."

To restore sinus rhythm, antiarrhythmic drugs or electrical impulse therapy are used.

Anticoagulants are prescribed if atrial fibrillation is observed for more than 2 days. The risk of developing thromboembolism is especially high in mitral defect heart, hypertrophic cardiomyopathy, circulatory failure and thromboembolism in history. Anticoagulants are prescribed for 3 weeks before cardioversion and for 3 to 4 weeks after restoration of sinus rhythm. Without prescribing antiarrhythmic drugs after cardioversion, sinus rhythm persists for 1 year in 15–50% of patients. The use of antiarrhythmic drugs increases the likelihood of maintaining sinus rhythm. The most effective is the appointment of amiodarone (cordarone) - even with refractory to other antiarrhythmic drugs, sinus rhythm is maintained in 30 - 85% of patients. Kordaron is quite often effective also at the expressed increase in the left auricle.

In addition to amiodarone, sotalol, propafenone, etatsizin and allapinin are successfully used to prevent the recurrence of atrial fibrillation, quinidine and disopyramide are somewhat less effective. When saving permanent form atrial fibrillation patients with tachysystole to reduce heart rate are prescribed digoxin, verapamil or β-blockers. With a rare bradysystolic variant of atrial fibrillation, the appointment of aminophylline (teopec, teotard) can be effective.

Studies have shown that the two main strategies for managing patients with atrial fibrillation - attempts to maintain sinus rhythm or normalization of heart rate against the background of atrial fibrillation in combination with the use of indirect anticoagulants - provide approximately the same quality and life expectancy of patients.

Paroxysmal supraventricular tachycardia

Paroxysmal supraventricular tachycardias, which are much less common than atrial fibrillation, are not associated with the presence of an organic heart lesion. The frequency of their detection does not increase with age.

Relief of paroxysmal supraventricular tachycardia begins with the use of vagal techniques. The most commonly used are the Valsalva test (straining on inspiration for about 10 s) and massage carotid artery. A very effective vagal technique is the “diving reflex” (immersion of the face in cold water) - restoration of sinus rhythm is observed in 90% of patients. In the absence of the effect of vagal influences, antiarrhythmic drugs are prescribed. The most effective in this case are verapamil, ATP or adenosine.

In patients with easily tolerated and relatively rare attacks of tachycardia, independent oral relief of attacks is practiced. If intravenous administration of verapamil is effective, it can be administered orally at a dose of 160-240 mg once, at the time of the onset of seizures. If intravenous administration of novocainamide is recognized as more effective, 2 g of novocainamide is indicated. Quinidine 0.5 g, propafenone 600 mg, or amiodarone 30 mg/kg orally can be used.

Ventricular tachycardia

Ventricular tachycardia in most cases occurs in patients with organic heart disease, most often with postinfarction cardiosclerosis.

Treatment of ventricular tachycardia. To stop ventricular tachycardia, you can use amiodarone, lidocaine, sotalol or novocainamide.

In severe, refractory to drug and electrical impulse therapy, life threatening ventricular tachyarrhythmias, large doses of amiodarone are used: orally up to 4-6 g per day orally for 3 days (that is, 20-30 tablets), then 2.4 g per day for 2 days (12 tablets each) followed by dose reduction.

Prevention of recurrence of tachyarrhythmias

With frequent attacks of tachyarrhythmias (for example, 1 to 2 times a week), antiarrhythmic drugs and their combinations are sequentially prescribed until the attacks stop. The most effective is the appointment of amiodarone as monotherapy or in combination with other antiarrhythmic drugs, primarily with β-blockers.

In rare but severe attacks of tachyarrhythmias, it is convenient to select an effective antiarrhythmic therapy using transesophageal electrical stimulation of the heart - with supraventricular tachyarrhythmias - and programmed endocardial ventricular stimulation (intracardiac electrophysiological study) - with ventricular tachyarrhythmias. With the help of electrical stimulation, in most cases it is possible to induce an attack of tachycardia, identical to those that spontaneously occur in this patient. The inability to induce an attack with repeated pacing while taking drugs usually coincides with their effectiveness with long-term use. Of note, some prospective studies have demonstrated the benefit of blind amiodarone and sotalol for ventricular tachyarrhythmias over testing of class I antiarrhythmic drugs with programmed ventricular pacing or ECG monitoring.

In severe paroxysmal tachyarrhythmias and refractoriness to drug therapy use surgical methods for the treatment of arrhythmias, implantation of a pacemaker and a cardioverter-defibrillator.

Selection of antiarrhythmic therapy in patients with recurrent arrhythmias

Given the safety of antiarrhythmic drugs, it is advisable to start evaluating efficacy with β-blockers or amiodarone. If monotherapy is ineffective, the efficacy of prescribing amiodarone in combination with β-blockers is evaluated. If there is no bradycardia or prolongation of the PR interval, any β-blocker can be combined with amiodarone. In patients with bradycardia, pindolol (Whisken) is added to amiodarone. Shown, that joint reception amiodarone and β-blockers contribute to a significantly greater reduction in mortality in patients with cardiovascular diseases than taking each of the drugs separately. Some experts even recommend the implantation of a dual chamber stimulator (in DDDR mode) for safe amiodarone therapy in combination with β-blockers. Class I antiarrhythmics are used only when β-blockers and/or amiodarone fail. Class IC drugs are usually prescribed while taking a beta-blocker or amiodarone. The efficacy and safety of sotalol, a β-blocker with class III drug properties, is currently being studied.

P. Kh. Janashia, Doctor of Medical Sciences, Professor
N. M. Shevchenko, Doctor of Medical Sciences, Professor
S. M. Sorokoletov, Doctor of Medical Sciences, Professor
RSMU, Medical Center Bank of Russia, Moscow

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The appearance of interruptions in cardiac activity against the background of those present neurological diseases. It is more pronounced in females. It is characterized by a functional disorder in the rhythmic work of the heart. With a pronounced clinic, appropriate treatment is prescribed. Preparations are selected by a neurologist.

Pulmonary arrhythmia

This definition often denotes a heart rhythm disorder that has developed against the background of a hypertrophied right ventricle. The disease is mainly associated with high blood pressure pulmonary artery. Also, arrhythmia contributes to the stretching of the walls of the right ventricle. It is difficult to treat due to the chronic process.

Atrial fibrillation

Very rapid and erratic contraction of the atria, in which there is a contraction of more than 300 times per minute. Pathology is extremely dangerous for human life and requires immediate intervention of medical personnel. The risk of developing pathology increases with age, which is facilitated by organic lesions myocardium.

Ventricular extrasystole

An important type of arrhythmia for diagnosis, in which there is an untimely contraction of the ventricles. The signal for extraordinary depolarization comes from an additional (ectopic) focus of excitation. To prevent the development of serious complications, it is necessary to carry out timely treatment ventricular extrasystoles.

Atrial fibrillation

This type of arrhythmia is characterized by the appearance of chaotic contractions of the atrial muscles with an increase in heart rate up to 500-600 beats per minute. Pathology can cause a serious lack of blood circulation, because of which a person is threatened with death. It is often a complication of cardiac diseases that have been started or improperly treated.

sinus arrhythmia

Violation of the normal activity of the heart, in which sinus rhythm is maintained. May present with increased, slow, or irregular heartbeats. This type arrhythmia is divided into pathological sinus arrhythmia and functional, which does not require treatment. The concept is considered general and refers to a number of diseases, each of which is manifested by specific clinical signs.

Sinus bradycardia

Violation of the normal functioning of the sinus node, in which a slow heartbeat develops. In this case, the heart rate is up to 50 beats per minute. In trained people, it is considered as a variant of the norm. If the pathology brings inconvenience to a person, then drug treatment is prescribed.

Paroxysmal tachycardia

An attack of arrhythmia, characterized by the occurrence and termination for no apparent reason. During a heartbeat, the heart rate can reach 300 beats per minute. There are ventricular, atrial and nodal (atrioventricular) forms of the disease. Almost all manifestations of pathology require medical correction.

A form of arrhythmia with supraventricular location resulting from accelerated work sinus node. Manifested in adults with a heart rate of 100 beats per minute, in children from 120 beats per minute. Depending on the severity of clinical manifestations, it can be considered physiological and pathological. Treatment of sinus tachycardia is required in violation of the normal lifestyle of a person.

Valvular arrhythmias

It is a clinical definition of cardiac disorders that occur with insufficiency or stenosis of the valvular apparatus. Especially often appear with prolapse mitral valve. Due to the presence of organic pathology, surgical intervention is often required.

Pancreatic arrhythmias

They may appear to patients as one disease, although in fact arrhythmia is a violation of the heart rhythm. Since the pancreas is anatomically located close to the heart, some of its diseases cause interruptions in cardiac activity, clinically defined as “pancreatic arrhythmias”. They cannot be ignored, therefore, consultations are held with a cardiologist, followed by the appointment of antiarrhythmic treatment.

Intestinal arrhythmia

In some situations intestinal diseases combined with arrhythmias (interruptions in the work of the heart), which significantly complicates general state sick. In particular, palpitations occur during infectious processes occurring in the intestines, acute poisoning and after injury. In each case, specific treatment in the form of antiarrhythmic drugs is required.

Intercostal neuralgia

Violation of the heart rhythm, which in neurology can be combined with intercostal neuralgia. In addition to muscle pain, the main clinic is supplemented by heart failures. Therefore, to general treatment more antiarrhythmic drugs are added.

Heterotopic arrhythmias

A group of automatism disorders not associated with the main pacemaker - the sinus node. This includes ventricular, atrial, and junctional rhythms. Excitation of the heart muscle occurs with acceleration or deceleration, which is manifested by the corresponding clinic. Often they take the form of paroxysmal tachycardia, which develops in one or another part of the heart.

Vagal arrhythmia

It is an irregular heart rhythm, directly related to the influence of the parasympathetic nerve (vagus). It develops in 90% of cases in men after taking alcoholic beverages or fatty foods in large quantities. It may not cause significant discomfort and quickly pass after the elimination of the irritating factor. In other cases, therapeutic intervention is required.

Systolic arrhythmia

It is manifested by a disturbed heart rhythm as a result of improper contraction of the ventricles. Belongs to the group of extrasystoles. Depending on the cause, organic and functional types of disorders are distinguished. In the second case, most often the patients are women. In the presence of damage to the heart muscle, they can contribute to the occurrence of more complex conditions (fibrillation, flicker).

Medical arrhythmia

Appears to be an abnormal heart rhythm or heart rate caused by drugs. Most often develops after exceeding the dose of cardiac glycosides and diuretics. With timely assistance, it does not lead to the development of complications.

Ischemic arrhythmia

Interruptions in the work of the heart associated with a lack of oxygen supply to the heart muscle (myocardium). With the disease, an irregular, frequent, or slow heartbeat may be observed. For diagnosis, ECG, coronary angiography are used to identify ischemic areas. In difficult cases, surgery may be required.

supraventricular arrhythmia

Also known as supraventricular extrasystole. Premature impulses originate in the atria. Irregular heartbeats appear, disrupting the normal functioning of the muscular organ. Medical correction is relevant in case of presentation of complaints to patients, reduced ability to work. Without a pronounced clinic, the treatment of pathology is not carried out.

Vascular arrhythmia

It is an additional symptom complex of vegetative-vascular dystonia, characterized by abnormal heart rhythm, its acceleration or deceleration. It is not easy to treat due to the main cause of development - disorders of the nervous system. Therefore, it is often necessary to consult a psychotherapist along with the use of antiarrhythmic drugs.

Hypertensive arrhythmia

Irregular heartbeats, with fast or slow heart rate. Manifested against the background of hypertension. May develop as a result of a hypertensive crisis. This type of arrhythmia is considered a complication of the underlying disease, so timely treatment is necessary.

Respiratory arrhythmia

Mostly diagnosed in teenagers. It is manifested by an increase in the number of heartbeats on a deep breath, while on exhalation, the heart rate decreases. Often missing clinical manifestations Therefore, pathology is detected during a general examination of the patient. With age, the likelihood of its occurrence may decrease.

cardiac arrhythmia

This type of arrhythmia is a group of heart diseases, including various rhythm disturbances with an increase or decrease in heart rate. A heart impulse against the background of arrhythmia can be formed or conducted in a pathological manner. The form of the disease is diagnosed using an ECG, after which the most appropriate antiarrhythmic agent is prescribed.

ventricular fibrillation

With this pathology, the ventricles contract chaotically with a heart rate of 250 to 500 beats per minute. Cardiac arrest is possible due to the lack of its coordinated work. It develops against the background of various heart diseases, the main of which is myocardial infarction, hypertensive crises, angina pectoris, cardiomyopathy.

Ventricular tachycardia

Frequent contraction of the ventricles of the heart, in which there is a heart rate of 120 times per minute or more. Also known as paroxysmal tachycardia. It can be considered as a physiological state (after physical exertion, against the background of emotional and mental stress) and pathological (it develops at rest). It can be complicated by fibrillation, therefore, in any form, it is necessary to undergo treatment with antiarrhythmic drugs.

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

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

Classification of cardiac arrhythmias

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

I. Violation of the formation of an impulse.

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

sinus tachycardia,

sinus bradycardia,

sinus arrhythmia,

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

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

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

migration of the supraventricular pacemaker.

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

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

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

atrial flutter;

flicker (fibrillation) of the atria;

flutter and flicker (fibrillation) of the ventricles.

II. Conduction disorders:

sinoatrial blockade;

intra-atrial (inter-atrial) blockade;

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

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

ventricular asystole;

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

III. Combined arrhythmias:

parasystole;

ectopic rhythms with exit block;

atrioventricular dissociations.

Diagnosis examples:

1. IHD, ventricular extrasystole.

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

3. IHD, chronic form atrial fibrillation, tachyform.

Etiology

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

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

prolapse of the heart valves;

heart tumors (myxomas, etc.);

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

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

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

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

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

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

idiopathic cardiac arrhythmias.