Fluttering and flickering (fibrillation) of the ventricles. Causes of development and clinical picture of ventricular fibrillation Ventricular fibrillation is necessary

Content

Violation of the heart rhythm is a life-threatening condition. Due to fibrillation, blood flow stops, an increase in metabolic disorders in the body begins. This is the cause of 80% of deaths diagnosed with "sudden death". Pathology is more common in men 45–70 years old with cardiac disorders. Arrhythmia can occur anywhere, so it is important to know the first aid measures to save the life of the victim. Timely resuscitation methods will help the patient hold out until the ambulance arrives and increase the chances of survival.

What is ventricular fibrillation

Normal contraction of the heart muscle is provided by bioelectric impulses. They are generated by the atrioventricular and sinus nodes. Impulses act on the myocardium, cardiomyocytes of the atria and ventricles, provoking the heart to push blood into the vessels. When the conduction of impulses is disturbed, arrhythmia occurs. Ventricular fibrillation is a condition in which there is a chaotic movement of myocardial muscle fibers. They begin to work inefficiently, with a frequency of 300-500 beats per minute. For this reason, urgent resuscitation of the patient is necessary.

The result of fibrillation is a rapid decrease in the number of heart contractions. The volume of ejected blood decreases along with blood pressure, which leads to complete cardiac arrest. If it is not started with the help of special resuscitation measures, the patient will live no more than 3-5 minutes. The arrhythmia cannot stop on its own, therefore, artificial defibrillation is required.

The reasons

Fibrillation often occurs due to causes of cardiovascular pathologies. The main ones include:

• Complete blockade of the atrioventricular node.
• Complication of myocardial infarction.
• Cardiomyopathy - hypertrophic (thickening of the heart wall), dilated (enlargement of the heart chambers), idiopathic (violation of the structure of the heart).
• Arrhythmias - ventricular extrasystole, paroxysmal tachycardia.
• Heart defects, valves (aneurysm, mitral valve stenosis).
• Acute coronary insufficiency (narrowing of large vessels).

There are less common causes of ventricular fibrillation. These include:

• Cardiomegaly (enlargement of the heart).
• Cardiosclerosis (scarring of the heart muscle).
• Brugada syndrome (hereditary ventricular arrhythmia).
• Myocarditis (inflammation of the myocardium).
• A sharp decrease in the volume of blood pumped out by the heart, due to problems of unknown etiology.

The causes of ventricular fibrillation can be caused by processes that are not associated with a violation of the heartbeat. They are shown in the table:

There are factors that rarely provoke the development of fibrillation. These include:

• Hypo- and hyperthermia - hypothermia of the body and its overheating with sudden changes in temperature.
• Dehydration - can cause bleeding and hypovolemic shock (rapid loss of a large number liquids).
• Injuries - mechanical in the sternum, electric shock, blunt and penetrating.
• Hormonal imbalance due to thyroid pathologies.
• Chronic stress, excessive nervous tension.

Classification

Ventricular fibrillation is usually divided into 3 stages - primary, secondary and late. Primary fibrillation occurs 1-2 days after myocardial infarction. Electrical instability of cardiomyocytes is explained by acute ischemia. More than half of the cases of primary fibrillation are observed in the first 4 hours, 40% - within 12 hours after a heart attack, which is the main cause of death in patients with this pathology.

Secondary fibrillation develops due to a lack of blood circulation in the left ventricle and is accompanied by cardiogenic shock. This stage is difficult to eliminate by defibrillation, while the primary passes after a single electrical impulse. Late fibrillation is noted 48 hours after myocardial infarction or at the 5-6th week of heart disease related to ventricular dysfunction. At this stage, the mortality rate is 40–60%.

Symptoms

Arrhythmia is characterized by symptoms identical to complete cardiac arrest (asystole). Signs of ventricular fibrillation:

• violation of the heart rhythm;
• weakness, dizziness;
• sudden loss of consciousness;
• frequent breathing or lack of it, wheezing;
• pallor of the skin and mucous membranes;
• cyanosis (cyanosis of the tips of the ears, nasolabial triangle);
• pain in the heart, its stop;
• lack of pulse on large arteries (carotid, femoral);
• pupil dilation;
• complete relaxation or convulsions;
• involuntary emptying Bladder, intestines.

Arrhythmia begins suddenly, its occurrence is impossible to predict. Signs of fibrillation determine the state of clinical death, when changes in the body are still reversible and the patient can survive. After 7 minutes of arrhythmia, oxygen starvation leads to irreversible disturbances in the cerebral cortex and the process of cell decay begins, i.e. biological death.

Diagnostics

The probability of fibrillation is indirectly determined by signs of cardiac arrest or sudden death. This state can be confirmed using only one diagnostic method - ECG (electrocardiography). The advantages of the study are the speed and the possibility of carrying out the procedure anywhere. For this reason, resuscitation teams are equipped with cardiographs.

Ventricular fibrillation on EKG

An electrocardiogram captures the main stages in the development of fibrillation. These include:

1. Ventricular flutter or short (20 seconds) tachysystole.
2. The convulsive stage - takes 30-60 seconds, is accompanied by an increase in the frequency of contractions, a weakening of cardiac output, and rhythm disturbance.
3. Fibrillation - 2-5 minutes. Large, chaotic frequent flicker waves without pronounced intervals are observed. The R wave is also missing.
4. Atony - up to 10 minutes. Large waves are replaced by small (low amplitude).
5. Complete absence of heart contractions.

Urgent care

Before the arrival of the resuscitation team, the victim with fibrillation must be provided with emergency care. It consists in carrying out resuscitation measures. First stage:

1. It is necessary to hit a person in the face if he has lost consciousness. This will help bring him to his senses.
2. Determine the presence of pulsation in the carotid or femoral arteries, observe if there is movement of the chest.
3. If there is no pulse and breathing, you should proceed to first aid.

The second stage consists in performing a closed heart massage and artificial ventilation of the lungs. The algorithm is the following:

1. Lay the victim down on a flat, hard surface.
2. Tilt your head back, clear your mouth of vomiting, remove your tongue if it is sunk.
3. With one hand, pinch the victim's nose and blow air through the mouth.
4. After blowing, fold the hands crosswise and make rhythmic pressure on lower third sternum. 2 deep breaths, then 15 compressions.
5. After 5-6 cycles of resuscitation, assess the condition of the victim - check for a pulse, breathing.

Closed heart massage is performed rhythmically, but without sudden movements, so as not to break the ribs of a person with fibrillation. You should not try to deliver a precardiac blow to the region of the heart if there are no special skills. Rendering emergency care must be carried out in the first 30 minutes of the onset of arrhythmia and before arrival medical professionals who should be called before the start of resuscitation.

Treatment of ventricular fibrillation

Sudden cardiac arrhythmia is not treatable. It is possible to prevent fibrillation in some heart conditions by inserting a pacemaker or cardioverter defibrillator. Therapy involves the provision of first aid to the victim and the use of special resuscitation equipment:

• Defibrillation is the restoration of the heart rhythm with the help of electrical impulses of different strength and frequency.
• Carrying out artificial ventilation of the lungs - manually using an Ambu bag or through a breathing mask with a ventilator.
• The use of the drug for cardiac resuscitation - Epiniphrine, Amiodoron.

Professional cardioresuscitation methods

Specialized resuscitation of the heart and lungs begins with the removal of data from a portable cardiograph to determine the type of arrhythmia. If this is not an attack of fibrillation, then the use of the apparatus for electrical stimulation will be ineffective. Next, you need to strike in the area of ​​\u200b\u200bthe heart, if the pulse and breathing do not appear, you should use a defibrillator. If physicians tend to diagnose ventricular fibrillation, resuscitation with electric current is carried out immediately.

Using an AC or DC machine to normalize the heart rhythm is dangerous without certainty of the diagnosis. The indications for defibrillation are as follows:

• Arrhythmia, when there is a chaotic contraction of cardiomyocytes.
• Ventricular flutter on the ECG with the preservation of the rhythm. This condition is dangerous because it turns into fibrillation.

Emergency cardiac defibrillation is performed in a specific order. The action algorithm is as follows:

1. Release the chest of the patient in the supine position.
2. Lubricate the defibrillator electrodes with a special gel or soak gauze in a 7% sodium chloride solution.
3. Select the required power and charge the electrodes.
4. Place the right electrode on the subclavian area, and the left electrode just above the heart.
5. Give a discharge by firmly pressing the electrodes to the body.
6. The result is evaluated - waves will appear on the monitor.
7. If fibrillation has not passed, a higher power charge is applied.

The first discharge is given with a power of 200 J. After it, the heart rhythm often normalizes. If this does not happen, a second pulse of 300 J is performed. Then antiarrhythmics are administered intravenously or intracardiac - Lidocaine 1.5 mg / kg of body weight and a third discharge of 360 J is performed. artificial oxygen saturation of the respiratory system. Adrenaline is administered to prevent collapse of the carotid artery and increase blood pressure.

Medical treatment in conjunction with defibrillation and mechanical ventilation increases the chances of survival. The main drugs are shown in the table:

If emergency resuscitation measures have led to the restoration of the heart rhythm and the appearance of vital signs, the patient is taken to the block intensive care for further treatment and follow-up. When 30 minutes have passed since the start of cardioresuscitation, and there is no breathing, pulse and pupillary reaction, the biological death of the victim is ascertained.

Complications of the postresuscitation period

Emergency resuscitation with fibrillation helps to survive 20% of patients. There are complications after emergency resuscitation:

• Chest injuries and rib fractures - too intense heart massage.
• Pneumothorax, hemothorax - accumulation of air, blood in the pleural cavity of the lungs.
• Arrhythmia.
• Myocardial dysfunction - disorders in the work of the heart.
• Aspiration pneumonia - the entry of the contents of the mouth, nose, stomach into Airways.
• Disturbances in the work of the brain caused by impaired blood flow and oxygen starvation.
• Thromboembolism - blockage blood clot pulmonary artery.

Deadly neurological disorders(post-anoxic encephalopathy) occur in 1/3 of patients after resuscitation with fibrillation. Among the survivors, 1/3 have persistent sensory and motor activity disorders. Defibrillator burns, hypotension after myocardial infarction can be a complication. She is treated with medications (Isoprenaline, sodium bicarbonate). The first time after emergency resuscitation, there is a high risk of recurrent fibrillation, which often ends in death.

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* 1 In the first 10-30 seconds, apply a precordial shock, and then, if there is no effect, 3 defibrillator discharges in a row, if they can be quickly delivered. If intervals between shocks increase > 15 s due to: a) the design of the defibrillator or b) the need to confirm that VF is ongoing, then 2 cycles of 5:1 (massage/ventilation) are performed between shocks.

*2 With registered VT, energy doses can be reduced by 2 times.

*3 Adrenaline is administered IV: 1 mg and then every 2-5 minutes, increasing the dose to 5 mg (maximum 0.1 mg/kg every 3-5 minutes). With endotracheal administration, the dose is increased by 2-2.5 times and diluted in 10 ml of 0.9% NaCl solution;

when administered through a peripheral vein, it is diluted in 20 ml of a 0.9% NaCl solution.

*4 Lidocaine 1-1.5mg/kg every 3-5 minutes up to a total dose of 3mg/kg, then novocainamide 30mg/min up to a maximum dose of 17mg/kg can be given (European Committee considers antiarrhythmic drugs to be optional). To prevent recurrence of VF, lidocaine is recommended to be administered at 0.5 mg/kg up to a total dose of 2 mg/kg, then a maintenance infusion of 2-4 mg/min. With low cardiac output, liver failure and age over 70 years, the dose of lidocaine is reduced by 2 times.

*5 Na bicarbonate is recommended to be administered after the 10th minute of resuscitation or if the circulatory arrest lasted more than 3-5 minutes before the start of CPR; 50 mEq is administered and then this dose can be repeated after 10 minutes 1-2 times. Na bicarbonate is also administered if hyperkalemia or metabolic acidosis occurred prior to circulatory arrest; after the restoration of cardiac activity, if the circulatory arrest was prolonged.

*6 Mg sulfate 1-2 g for: a) polymorphic VT, b) suspected hypomagnesemia, c) prolonged refractory/recurrent VF.

*7 Potassium chloride 10 mEq every 30 minutes with initial hypokalemia.

*8 Ornid 5 mg/kg, repeated after 5 minutes, increasing the dose to 10 mg/kg 2 times.

*9 Atropine 1 mg up to 2 times if VF relapse is preceded by bradycardia -> asystole.

*10 beta-blockers (Inderal 1 to 5 mg at 5 min intervals) if VF recurrence is preceded by tachycardia -> arrhythmia.

*11 Calcium preparations are used to a limited extent, only for well-established indications - hyperkalemia, hypocalcemia or intoxication with calcium antagonists.

*12 Intravenous administration a large volume of fluid during circulatory arrest does not make sense without special indications.

Materials used: Intensive care. Paul L. Marino.

Emergency care for ventricular fibrillation

To prevent biological death, urgent measures are needed in the first 4 minutes. In the absence of a pulse on the carotid or femoral arteries, it is necessary to immediately begin a closed heart massage and artificial ventilation of the lungs to maintain blood circulation at a level that ensures the minimum oxygen demand of vital organs (brain, heart) and restore their function under the influence of specific treatment.

In intensive care units, where there is the possibility of constant monitoring of the heart rhythm using ECG, it is possible to immediately clarify the form of cardiac arrest and begin specific treatment.

With ventricular fibrillation, it is most effective to quickly conduct electrical impulse therapy in the first seconds of its occurrence. Often, in primary ventricular fibrillation, timely electrical impulse therapy is the only effective method resuscitation.

In the case of primary ventricular fibrillation, electropulse therapy carried out for 1 minute restores the work of the heart in 60-80% of patients, and at 3-4 minutes (if heart massage and artificial ventilation of the lungs were not performed) - only in isolated cases.

If electropulse therapy is ineffective, to normalize metabolic processes in the myocardium, they continue (or begin) closed heart massage and artificial ventilation of the lungs (preferably with excessive oxygenation).

According to M.Ya. Ruda and A.P. Zysko, if after 2-3 discharges of the defibrillator the rhythm is not restored, the patient should be intubated as soon as possible and transferred to artificial respiration.

Following this, 200 ml of 5% or 50 ml of 7.5% sodium bicarbonate solution should be immediately administered intravenously by bolus every 10 minutes until satisfactory blood circulation is restored or it becomes possible to control blood pH in order to avoid the development of metabolic acidosis in clinical death.

Enter medications intravenously better through a system filled with 5% glucose solution.

To increase the effectiveness of electropulse therapy, 1 ml of a 0.1% solution of adrenaline hydrochloride is administered intracardiac, which, under the influence of heart massage, enters the coronary arteries from the ventricular cavity. It must be remembered that intracardiac administration of the drug can sometimes be complicated by pneumothorax, damage to the coronary vessels, massive hemorrhage into the myocardium. In the future, adrenaline hydrochloride is administered intravenously or intracardiac (1 mg) every 2-5 minutes. For drug stimulation, norepinephrine and mezaton are also used.

If electropulse therapy is ineffective, intracardiac, in addition to adrenaline hydrochloride, novocaine (1 mg / kg), novocainamide (0.001-0.003 g), lidocaine (0.1 g), anaprilin or obzidan (from 0.001 to 0.005 g), ornid (0 .5 g). With ventricular fibrillation, the introduction of these drugs is less effective than electrical impulse therapy. Continue artificial ventilation of the lungs and heart massage. After 2 minutes, defibrillation is performed again. If cardiac arrest occurs after defibrillation, 5 ml of 10% calcium chloride solution, 15-30 ml of 10% sodium lactate solution are administered. Defibrillation is continued either until the restoration of heart contractions, or until signs of brain death appear. Closed heart massage is stopped after the appearance of a distinct independent pulsation in large arteries. It is necessary to intensively monitor the patient and take measures to prevent recurrent ventricular fibrillation.

If the doctor does not have equipment for conducting electropulse therapy, a discharge from a conventional electrical network with an alternating current of 127 V or 220 V can be used. Cases of restoration of cardiac activity after a fist strike on the atrial region are described.

Sometimes ventricular fibrillation occurs so often that it is necessary to resort to defibrillation 10-20 times or more per day. We observed one such patient with myocardial infarction. Defibrillation had an effect only for a short time, despite the use of various antiarrhythmic drugs (potassium preparations, beta-blockers, xicaine, trimecaine, aymaline, quinidine). It was possible to eliminate the relapses of fibrillation only after connecting an artificial pacemaker.

Prof. A.I. Gritsyuk

"Emergency care for ventricular fibrillation" Emergency conditions section

Flutter and Ventricular Fibrillation - Emergency

Flutter and ventricular fibrillation

Flutter and ventricular fibrillation are arrhythmias that cause the cessation of effective hemodynamics, i.e. circulatory arrest. These rhythm disturbances are the most common cause of sudden death in heart disease (so-called arrhythmic death). When these arrhythmias occur, the patient suddenly loses consciousness, there is a sharp pallor or severe cyanosis, agonal type breathing, no pulse on carotid arteries, dilated pupils.

Ventricular flutter is characterized by a very frequent rhythmic, but inefficient activity of the ventricular myocardium. The frequency of the ventricular rhythm in this case, as a rule, exceeds 250 and can be more than 300 per 1 min.

Diagnosis in flutter and ventricular fibrillation

The ECG reveals a sawtooth, undulating curve with rhythmic or slightly arrhythmic waves, almost the same width and amplitude, where elements of the ventricular complex cannot be distinguished and there are no isoelectric intervals. The last sign is given importance when differential diagnosis this arrhythmia with paroxysmal ventricular tachycardia and supraventricular arrhythmias with aberrant QRS complexes, however, even with these arrhythmias, the isoelectric interval in some leads is also sometimes not detected. More importance to distinguish between these arrhythmias, the rhythm frequency has a frequency, but sometimes with ventricular flutter, it can be below 200 per 1 min. These arrhythmias are distinguished not only by ECG, but also by clinical manifestations: with ventricular flutter, circulatory arrest always occurs, and with paroxysmal tachycardia this is very rare.

Ventricular fibrillation. Ventricular fibrillation is called erratic non-coordinated contractions of the fibers of the ventricular myocardium.

Diagnosis. On the ECG ventricular complexes are absent, instead of them there are waves various shapes and amplitudes, the frequency of which can exceed 400 per 1 min. Depending on the amplitude of these waves, large- and small-wave fibrillation is distinguished. With large-wave fibrillation, the amplitude of the waves exceeds 5 mm, with small-wave fibrillation it does not reach this value.

Emergency care for flutter and ventricular fibrillation

In some cases, flutter or ventricular fibrillation can be eliminated by punching the chest to the region of the heart. If cardiac activity has not recovered, immediately begin indirect massage hearts and artificial ventilation lepsikh. At the same time, electrical defibrillation is being prepared, which should be done as quickly as possible, monitoring cardiac activity on the screen of the cardioscope or on the ECG. Further tactics depend on the state of the electrical activity of the heart.

Ventricular flutter is a ventricular tachyarrhythmia that has a regular, fast rhythm (about 200-300 beats per minute). Most often, the condition may be accompanied by a decrease in blood pressure. Possible loss of consciousness, pallor, diffuse cyanosis skin, agonal breathing, convulsions, dilated pupils.

In addition, it can provoke sudden coronary death. Diagnosis of such a pathology is carried out on the basis of electrocardiographic studies and clinical data. if ventricular flutter occurs, includes immediate defibrillation and cardiopulmonary resuscitation.

What is ventricular flutter?

A similar phenomenon is disorganized electrical activity of the myocardium, which is characterized by frequent and rhythmic contraction of the ventricles. The frequency of such contractions exceeds 200 beats per minute. It can also progress to fibrillation (flickering), which will be frequent, up to 500 beats, but irregular and erratic ventricular activity.

In the cardiology department, experts consider fibrillation and flutter to be a dangerous type of arrhythmias that can lead to inefficient hemodynamics. In addition, they are the most common causes arrhythmic death. According to epidemiological data, fibrillation and flutter most often occur in individuals whose age ranges from 47 to 75 years. A characteristic feature is that in men they appear three times more often than in women. In 70-80% of cases, the cause of sudden death is ventricular fibrillation.

What causes pathology?

Ventricular flutter can occur against the background of various heart diseases, in the presence of a variety of extracardiac pathologies. Often organic lesion myocardium, which develops against the background of coronary artery disease, may be complicated by ventricular fibrillation and flutter. In addition, this pathology accompanies the following diseases:

Other reasons

Less commonly, the development of this disorder may occur as a result of intoxication with cardiac glycosides, electrolyte imbalances, high blood levels of catecholamines, electrical trauma, cardiac concussion, hypoxia, acidosis, hypothermia. Also, ventricular tachycardia can be caused by some of the medicines, for example, sympathomimetics, barbiturates, narcotic analgesics, antiarrhythmics.

Another reason for the occurrence of flutter is the conduct of cardiac surgical procedures. These include coronary angiography, electrical cardioversion, defibrillation in the cardiology department.

The pathogenesis of ventricular flutter

The development of such a disease is directly related to the re-entry mechanism, which has a circular nature of the circulation of the excitation wave passing through the ventricular myocardium. It causes the ventricles to contract frequently and rhythmically, and there is no diastolic interval. The re-entry loop can be located along the perimeter of the entire infarction zone, or the site of a ventricular aneurysm. The normal heart rate table by age will be presented below.

The main role in the pathogenesis of ventricular fibrillation is played by multiple random re-entry waves, which provoke the contraction of individual myocardial fibers while there are no ventricular contractions. This phenomenon is due to the electrophysiological heterogeneity of the myocardium: at the same time, different parts of the ventricles can be in the period of repolarization and in the period of depolarization.

What does it launch?

Fibrillation and ventricular flutter, as a rule, triggers ventricular and supraventricular extrasystoles. The re-entry mechanism can also initiate ventricular and Wolff-Parkinson-White syndrome, atrial fibrillation, and then support them.

In the process of development of flutters and flickering, the stroke volume of the heart rapidly decreases, and then becomes zero. As a result, blood circulation stops instantly. flutter paroxysmal and ventricular fibrillation are always accompanied by syncope, and sustainable form tachyarrhythmia entails first clinical and then biological death.

Classification of ventricular flutter

In the development process, heart diseases such as ventricular fibrillation and flutter go through four stages:

The first is the tachysystolic stage of ventricular flutter. The duration of this stage is a maximum of two seconds. It is characterized by frequent, coordinated heartbeats. On the ECG, this stage corresponds to 3-6 ventricular complexes with a sharp high-amplitude fluctuation.

The second stage is convulsive ventricular tachyarrhythmia. Its duration is from 15 to 50 seconds. It is characterized by frequent, local contractions of the myocardium of an irregular nature. The ECG reflects this stage in the form of high-voltage waves of different magnitude and amplitude.

The third stage is the stage of ventricular fibrillation. The duration of this stage is 2-3 minutes. It is accompanied by multiple irregular contractions of individual areas of the myocardium, which have different frequencies.

The fourth is the stage of atony. This stage develops approximately 2-5 minutes after the onset of ventricular fibrillation. The fourth stage is characterized by small, irregular waves of contractions, an increasing number of areas that have ceased to contract. They are reflected on the ECG in the form of irregular waves, the amplitude of which gradually decreases.

Cardiologists distinguish between ventricular fibrillation and flutter according to the variant of their clinical development. So, there are permanent and paroxysmal forms. At the same time, flutters of the second form can be recurrent in nature, that is, they can be repeated several times during the day.

Symptoms

Heart disease - ventricular fibrillation and flutter, in fact, correspond to clinical death. If flutter occurs, then for a short time, it is possible to maintain low cardiac output, consciousness and arterial hypotension. Rarely, ventricular flutter may result in spontaneous sinus-type rhythm recovery. Most often, such an unstable rhythm passes into ventricular fibrillation.

Flutter and ventricular fibrillation are accompanied by the following symptoms:

If similar symptoms are observed and it is established that fibrillation and ventricular flutter have occurred, then the patient needs urgent medical care. The central nervous system and other organs will be irreversibly damaged if normal functioning is not restored within 4-5 minutes. heartbeat.

Complications

Death is the most unpleasant outcome of such deviations. As a result, the following complications may occur:

Diagnosis of ventricular flutter

Ventricular fibrillation and flutter can be recognized and diagnosed using clinical and electrocardiographic data. If there is such a deviation, then on an electrocardiographic study it will be displayed in the form of regular, rhythmic waves that have almost the same shape and amplitude. They resemble a sinusoidal type curve with an oscillation frequency of 200-300 per minute. Also on the ECG there is no isoelectric line between the waves, P and T waves.

If ventricular fibrillation is observed, then waves with a heart rate (heart rate) of 300-400 oscillations per minute will be recorded, which continuously change their duration, shape, direction and height. There is no isoelectric line between the waves.

Ventricular fibrillation and flutter must be differentiated from cardiac tamponade, massive PE, supraventricular arrhythmia, paroxysmal ventricular tachycardia.

The table of heart rate in the norm by age is given below.

Treatment of ventricular flutter

In the event of the development of ventricular flutter or fibrillation, immediate resuscitation should be provided, which is aimed at restoring sinus heart rhythm. Primary resuscitation should include precordial shock or artificial respiration in tandem with chest compressions. Specialized cardiopulmonary resuscitation includes mechanical ventilation and electrical defibrillation of the heart.

Simultaneously with resuscitation measures, solutions of atropine, adrenaline, sodium bicarbonate, procainamide, lidocaine, amiodarone, magnesium sulfate should be administered intravenously. In parallel with this, repeated electrodefibrillation is required. In this case, with each series, the energy should be increased from 200 to 400 J. If there is a recurrence of ventricular fibrillation and flutter, which occurs as a result of complete atrioventricular heart block, then it is necessary to resort to temporary stimulation of the heart ventricles with a rhythm that exceeds the frequency of their own oscillations.

special instructions

If the patient does not recover spontaneous breathing, cardiac activity, consciousness within 20 minutes, there is no reaction to the light of the pupils, then resuscitation measures must be stopped. If the resuscitation was successful, then the patient is transferred to the ICU for further observation. Subsequently, the attending cardiologist decides whether it is necessary to implant a cardioverter-defibrillator or a dual-chamber pacemaker.

- ventricular fibrillation of the heart, in which the cellular structures of the heart muscle work chaotically and arrhythmically, without performing a pumping function. A deadly condition occurs much more often in the first 4 hours after acute cardiac ischemia, and the only types effective therapy are primary resuscitation and the use of a defibrillator. But even timely and professionally performed therapeutic measures are far from always able to bring a sick person back to life: atrial and ventricular fibrillation in the vast majority of cases (90%) leads to an irreversible condition - biological death.

Causes of ventricular arrhythmias

Under normal conditions, the muscular system of the heart contracts simultaneously, rhythmically and synchronously, obeying the sinus node, which is the pacemaker. Ventricular fibrillation and flutter is always an asynchronous and unproductive work of muscle fibers and cardiomyocytes, requiring a large amount of oxygen and energy. The absence of a coordinated contraction of the myocardium stops the vital blood flow in the human body. Ventricular fibrillation, the causes of which must be sought in the ischemic pathology of the heart muscle, leads to death human body. The main causative factors of pathology include:

• heart failure;
• postinfarction cardiosclerosis;
• ( and );
• myocarditis;
• severe forms of rhythm disturbance and impulse conduction;
• acute oxygen deficiency;
• severe hypothermia of the human body;
• metabolic disorders associated with a sharp deficiency or excess of potassium and calcium minerals;
• toxic effect of poisons and large doses of alcohol;
• drug overdose.

Separately, an idiopathic variant of ventricular fibrillation is distinguished, when the cause of unexpected clinical death is outwardly healthy person impossible to find out. Possible causative factor there may be genetic changes in cardiomyocytes that contribute to the occurrence of ventricular disorders.

The risk of sudden death associated with the occurrence of ischemia of the heart muscle and ventricular fibrillation increases against the background of predisposing and contributing factors:

• lack of regular physical activity;
• smoking;
• overeating with the development of obesity;
• prolonged and excessive use of strong alcoholic beverages;
• high arterial pressure without adequate correction;
• diabetes;
• atherosclerosis.

Sudden death is a tragedy that can be prevented by following the principles healthy lifestyle life and regularly visiting a doctor to identify the first signs of cardiac pathology.

Stages of a deadly condition

The mechanism of development of ventricular fibrillation is due to multiple impulses from different parts of the heart, which trigger a series of uncoordinated contractions passing through 4 successive and short stages:

1. Atrial flutter - rhythmic contractions lasting no more than 2 seconds;
2. Large-wave ventricular fibrillation (convulsive stage) - chaotic contractions of different parts of the heart, lasting about 60 seconds;
3. Myocardial flicker (stage of small-wave contractions) - up to 3 minutes;
4. Atony of the heart.

Ventricular fibrillation, the treatment of which depends entirely on the timeliness of emergency care, leaves a person with little chance of survival. After 30 seconds from the moment of atrial flutter, the patient loses consciousness, after 50 seconds a typical convulsive state occurs. At the end of 2 minutes, breathing stops and clinical death. The only option to start the heart and restore the rhythm is effective resuscitation with the use of a defibrillator in the stage of large-wave contractions, which is possible only in a hospital setting.

Typical symptoms

Regardless of the causes, all the symptoms of cardiac muscle fibrillation are manifested by signs of rapidly developing clinical death:

• loss of consciousness;
• tonic contractions of the muscles of the body (convulsions) with involuntary urination and defecation;
• cyanosis of the skin;
• dilated pupils in the absence of reaction to light;
• cessation of the pulsation of the arteries;
• frequent and noisy breathing, which stops after 2 minutes from the onset of the attack.

The classification of deadly ventricular arrhythmias divides the pathology into 2 types:

• primary (idiopathic);
• secondary (occurring against the background of cardiac pathology).

In the first case, clinical death occurs unexpectedly, in the second case, the symptoms of heart disease indicate the risk of sudden death, which allows effective prevention and helps prevent an attack. However, timely cardiac resuscitation of idiopathic atrial and ventricular fibrillation is more effective (sometimes a single defibrillator pulse is enough to restore cardiac rhythm) than emergency help when the patient's heart stops.

Diagnostic criteria

In addition to typical symptoms, stationary conditions the state of clinical death is determined by ECG signs of ventricular fibrillation:

• with atrial flutter on the monitor, the doctor will see frequent and rhythmic waves with a contraction rate of up to 300 per minute;
• against the background of convulsions in stage 2, large non-rhythmic waves occur with a frequency of about 600 contractions;
• flickering appears on the ECG in small waves, the frequency of which can reach 1000;
• in the final stage, there is a rapid attenuation of the waves and the cessation of cardiac activity.

Electrocardiographic signs help to quickly assess the situation and make a decision on rendering effective assistance but only in a hospital setting. AT ordinary life should be guided by external symptoms to immediately begin urgent measures. Early cardiopulmonary resuscitation and the use of a defibrillator are the most important and mandatory methods for the treatment of clinical death.

emergency events

The algorithm of actions in a hospital setting consists of sequentially performed resuscitation measures:

1. Primary

• assess the state of a person (pulse in the carotid arteries, the presence of breathing, pupil reaction);
• call for help from personnel who will prepare resuscitation equipment;
• prepare the airways;
• blow air into the lungs (artificial respiration);
• ensure blood circulation (indirect heart massage);
• perform defibrillation (3 shocks).

The lack of effect indicates persistent changes in the heart muscle, requiring intensive therapy.

1. Secondary

• lung intubation with artificial ventilation;
• introduction of drugs into the vascular system;
• repeated discharges.

The electrical shocks of the defibrillator are optimally carried out in the first 5 minutes of resuscitation. Delay sharply reduces the effectiveness of the method: each minute of delay reduces the chances of removing from reversible death by 10-15%. After 10 minutes from the start of fibrillation, any urgent measures are useless.

Video

Atrial and ventricular fibrillation, which occurs in the first hours of large-focal myocardial infarction, is the main cause of human death, because outside medical institution providing effective assistance is almost impossible. If a clinical death is detected in a hospital, the chance to save the life of a sick person is minimal (no more than 10%): professional resuscitation with the use of a defibrillator does not always help restore a normal heart rhythm.

Ventricular fibrillation is an irregular contraction of the myocardium, which is manifested by uncoordinated contraction of individual sections of the heart muscle. The frequency of compression reaches 300 or more. This is an extremely dangerous condition leading to the death of a person if urgent medical care is not provided. Ventricular fibrillation on the ECG is reflected by characteristic uneven waves of different amplitudes and oscillation frequencies up to 500-600 per minute. ICD disease code 149.0.

Fibrillation (flicker) of the ventricles of the heart often causes the death of the patient. Irregular heart rhythm disrupts blood circulation, up to its complete cessation. The ventricles at the same time are reduced to no avail and do not pump blood. There is oppression respiratory function, arterial pressure is drastically reduced. This leads to brain hypoxia and death. Therefore, when myocardial flutter appears, it is necessary to proceed with urgent therapeutic measures in order to prevent the suppression of vital functions.

To understand why pathology appears, you need to remember the anatomy of the heart. It consists of 4 chambers - 2 atria and 2 ventricles. Thanks to the impulses coming from the brain, the heart mechanism works rhythmically, ensuring normal blood circulation. Violation of the supply of impulses or the way they are perceived by the heart muscle leads to asynchronous contraction of the myocardium, a malfunction of the heart.

The change in rhythm develops by the mechanism of re-entry or re-entry. Impulse performs circular motions, causing erratic contractions of the myocardium without a diastolic phase (the heart does not relax). With fibrillation, many re-entry loops occur, which leads to a complete disorder in the work of the heart.

The main cause of dysfunction is a violation of the passage of the impulse through the atrioventricular node. Fibrillation and flutter of the ventricles occurs due to non-conduction of the impulse or the appearance of scarring on the heart muscle after a heart attack. Changes are observed in the first hour of the appearance of pathology.

Almost half of the patients who died due to advanced ventricular fibrillation had blood clots in the coronary vessels, which led to death.

Ventricular flutter maintains the appearance of rhythmic ventricular contractility, and with fibrillation, the rhythm is not regular. But with both dysfunctions, the work of the heart is not effective. Pathology often develops in patients who have had an acute infarction, on the electrocardiogram of which a Q wave was noted. This is a sign that the heart vascular system there were morphological changes leading to fatal ventricular arrhythmias.

Also, the cause of fibrillation is the primary changes in the electrophysiological functions of the heart muscle. At the same time, structural heart disease is not observed. The cardiogram shows an elongated Q-T interval and supraventricular tachycardia.

Fibrillation is preceded by ventricular tachycardia, which occurs due to the rapid contraction of the ventricles due to the unstable supply of impulses. This state lasts up to half a minute, accompanied by a heartbeat. If the process is delayed, then fibrillation develops, the person faints, blood circulation stops, vital organs and systems suffer. It is necessary to immediately carry out resuscitation procedures to save the life of the patient.

Persons at risk of developing pathology are:

• who have had a heart attack;
• having a history of fibrillation;
• with congenital heart defects;
• with ischemia of the heart;
• with cardiomyopathy;
• with myocardial damage (a consequence of trauma);
• drug users;
• with changes in water and electrolyte metabolism.

The most common cause of ciliary syndrome is hypertrophic cardiomyopathy. It leads to sudden cardiac death in young people during heavy physical work. Specific cardiomyopathy caused by oncology (sarcoidosis) is also the cause of ventricular flutter. In addition, pathology appears for unknown reasons (idiopathic form), but doctors tend to argue that its appearance is associated with a disruption in the work of the autonomic nervous system.

Clinical picture and diagnosis

The first sign of the development of fibrillation is short-term fainting of unclear etiology. They are caused by extrasystole or ventricular tachycardia. This is the primary phase of the disease, which is not accompanied by circulatory disorders.

Paroxysm of ventricular fibrillation leads to loss of consciousness, convulsions. This happens because the pumping mechanism of the heart is not functioning. There is a circulatory arrest and clinical death. This is the secondary phase, which is considered extremely difficult. The clinic of changes is expressed in the following symptoms:

• clouding of consciousness;
• lack of pulse and breathing;
• spontaneous urination and defecation;
• lack of pupillary response to light;
• pupil dilation;
• cyanosis of the skin.

The main criterion emergency the patient is the lack of respiratory function and pulsation on large blood vessels (cervical and femoral arteries). If resuscitation is not carried out within 5 minutes, then irreversible pathological disorders occur in the tissues of the brain, nervous system, and others. internal organs. The clinical diagnosis is established on the basis of the cardiogram of the heart. After removing the patient from a critical condition, in order to establish the true cause of the development of the pathology, an examination is prescribed, consisting of various diagnostics.

1. The use of cardiac monitoring helps to determine the electrical function of the heart.
2. ECG makes it possible to trace the rhythm of myocardial contractions, anomalies in the work of the internal organ.
3. AT laboratory research blood check magnesium, sodium, hormones that affect the functioning of the myocardium.
4. A chest x-ray is done to find out the boundaries of the heart and the size of large vessels.
5. An echocardiogram helps to detect foci of myocardial damage, areas with reduced contractility, and pathology of the valvular system.
6. Angiography coronary vessels performed using a contrast agent, which makes it possible to identify narrowed or impassable areas.

In rare cases, CT or MRI is performed.

Ventricular fibrillation ECG

The process of development of fibrillation goes through four phases, which are characterized by certain changes in the ECG.

1 phase - tachysystole. Duration 2 seconds, accompanied by rhythmic contractions of the myocardium, consisting of 4-6 ventricular complexes. On the ecg, this is expressed as high-amplitude fluctuations.

Phase 2 - convulsive (20-50 sec.), In which there is a frequent convulsive non-rhythmic contraction of the fibers of the heart muscle. The cardiogram shows high-voltage waves with different amplitudes.

Phase 3 - flickering (up to 3 min) - multiple chaotic contractions of individual zones of the heart muscle of different frequencies.

Phase 4 - agony. It is observed 3-5 minutes after phase 3. It is determined by the inhibition of cardiac activity, which is displayed on the cardiogram in the form of irregular waves, an increase in the area of ​​\u200b\u200bareas that do not contract. ECG registers a gradual decrease in the amplitude of oscillations.

On the ECG, the outlines of the ventricular complexes do not have clear boundaries, they differ in different amplitudes, the teeth differ in height and width, they can be sharp and rounded. Often it is impossible to determine them. Intervals between waves are erased and pathological curves are formed.

First aid

If a person has symptoms of tachycardia (dizziness, shortness of breath, pain in the heart, nausea), then you should urgently call ambulance. In the absence of consciousness in a person, you need to check his pulse. If the heartbeat is not audible, urgently proceed to chest compressions. To do this, you need to rhythmically press on the chest (up to 100 clicks per minute). During the manipulation between compressions, it is necessary to allow the chest to straighten up. If the patient's airways are clean (there is no aspiration of the contents of the stomach into the lungs), then normal oxygen saturation of the blood is maintained for at least 5 minutes. This helps to buy time to provide more qualified assistance.

Patients with a history of severe cardiac pathologies accompanied by arrhythmias are advised by doctors to purchase a portable defibrillator. Following the recommendations of the instructions and having undergone appropriate training, relatives will be able to provide the necessary urgent help to the patient during an attack of ventricular fibrillation, thus prolonging his life until the arrival of the cardio team.

Medical measures

Emergency care for ventricular fibrillation is carried out according to the protocol, which indicates the algorithm of the activities performed. First
they do a pulsation check on the large arteries, and if it is not there, then proceed to CPR (cardiopulmonary resuscitation). First you need to make sure that the airways are clean, and if they are blocked, eliminate foreign body. For this, the person is turned on his side and 3-4 sharp blows are made with the edge of the palm between the shoulder blades. After that, they try to remove a foreign object from the throat with a finger.

Then they practice a precordial blow, which is applied to the lower third of the sternum. In some cases, such manipulation leads to the resumption of the work of the cardiac mechanism. If this does not happen, then an indirect heart massage and artificial ventilation of the lungs are performed. If in this way it is not possible to resume the heart rhythm, then specific measures are taken.

The resumption of the functional activity of the cardiac system is carried out in intensive care units with the help of a defibrillator, which inflicts electrical impulse discharges into the region of the heart. Electric discharges of increasing energy are produced (from 200 to 400 J). If fibrillation reappears or persists, then practice the introduction of "Adrenaline" every 3 minutes, alternately with defibrillator blows. Manipulation is carried out under the control of the ECG, where the heart rate is displayed. During registration ventricular tachycardia the discharge force is halved. At the same time carry out IVL.

Treatment of ventricular fibrillation after stopping the attack and to prevent their recurrence in the future can be carried out conservatively, as well as with the use of surgical intervention. Often, patients are fitted with a pacemaker that maintains a normal heart rhythm when the patient is prone to serious arrhythmias that cause fibrillation. His work is based on applying a series of impulses to restore sinus rhythm. Besides surgical method treatment is indicated to eliminate dysfunctions of the valvular mechanism.

Medications

Along with the behavior of electronic defibrillation, medications are administered to the patient intravenously. The introduction is carried out slowly and in case of inefficiency, the dosage is increased.

If the resuscitation measures carried out do not lead to the appearance of a heartbeat and breathing for half an hour, then they are stopped. At a positive result The patient is transferred to the IT ward.

Alternative treatment

Ventricular fibrillation is a deadly pathology that is not treated by any folk method. Only emergency resuscitation carried out by qualified specialists can save the patient's life. After stopping the attack, patients undergo long-term inpatient treatment, which is aimed at eliminating the causes that caused ventricular fibrillation.

After drug therapy or surgery, doctors may recommend that patients drink infusions. medicinal herbs, improving cardiac activity, as well as soothing teas. In addition, they are advised to strictly adhere to a diet that limits the intake of salt, fatty and high-calorie foods. The diet mostly consists of dishes containing vegetables and fruits rich in mineral components (potassium, magnesium), vitamins. Such a diet reduces the load on the myocardium, supplies it with useful substances.

About principles proper nutrition says nutritionist. He also develops a diet, according to a specific clinical case.

Prevention and prognosis

After the patient is discharged, the main recommendation is given by the doctor to the patient's relatives - you should not hesitate to provide emergency care when symptoms of fibrillation appear. It is urgent to call an ambulance, because with an incorrect assessment of the patient's condition, you can lose him. In addition, the cardiologist strongly recommends that the patient get rid of bad habits, as well as:

• timely treatment of heart disease;
• stick to a diet;
• give up alcohol;
• reduce physical activity;
• avoid stress.

Such patients need to limit physical labor, but this does not mean that they should lead a sedentary lifestyle. Regular classes in the health group lead to a good result, especially if they are held outdoors. Hiking before going to bed has a positive effect on the body. They soothe and saturate the body with oxygen. If possible, you should sign up for the pool. Classes under the supervision of an instructor also help to strengthen the cardiovascular system.

A positive outcome of the disease depends on the start of resuscitation. If they began to be carried out in the first minutes of circulatory arrest, then 70% of patients survive. With a later provision of medical care, when the blood flow stopped for more than 5 minutes, the prognosis is not comforting. Even if the patient remained alive, the changes in the nervous system and brain are irreversible. Such violations do not allow a person to live a full life and often they die from hypoxic encephalopathy.