Atrial fibrillation: causes, symptoms and treatment
Atrial fibrillation is the most common pathology associated with abnormal heart rhythm. Characterized by chaotic contraction (abnormal frequency and rhythm) the Atria. The disease is also called shimmering fibrillation or flutter (fibrillation) fibrillation. The main purpose of the appearance of atrial flutter is a relief of the attack. In the future treatment of diseases caused by pathological arrhythmia.
The main causes of atrial fibrillation — a cardiac and vascular disease. However, the violation of heart rhythm accompanies other pathologies. Factors precipitating atrial fibrillation:
- pathology of the cardiovascular system — hypertension, valvular disease (acquired/congenital), myocarditis, cardiosclerosis, myocardial ischemia (heart attack included), rheumatism of the heart;
- surgery on the heart;
- genetic predisposition (the presence of relatives of arrhythmia);
- pathology of the thyroid gland;
- diabetes mellitus;
- consumption of alcohol in large numbers, drug use;
- a side effect of certain drugs (e.g., diuretics);
- bright emotional turmoil, stress;
- apnea during sleep;
- electric shock;
- age (atrial fibrillation is most common after age 40);
- stroke (disease is diagnosed in about a quarter of stroke patients).
The frequency of attacks of atrial fibrillation differencebut:
- Paroxysmal form — sudden attacks, lasting no more than 7 days. Usually timely assistance helping to stop the arrhythmia a day, often heart rhythm is restored without medical intervention.
- Persistent form — paroxysmal period lasts more than six months. Relief in this case comes only with drug therapy, cardioversion (sometimes fails) or surgical intervention.
- A permanent form — chronic rhythm disturbance recorded more than 1 year. The ineffectiveness of conservative measures forced to resort to radical surgery.
Forms of atrial fibrillation in accordance with the recorded heart rate (HR):
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- tahisistolicescie — heart rate less than 90 minutes (often 350 – 700 V min.);
- normostenichesky — heart rate is around 60 – 90 min.;
- it’s bradycardic — heart rate less than 60 / min.
Depending on the severity of symptoms, since 2010 introduced the following classification of atrial fibrillation:
- Class I — no symptomatic manifestations;
- Class II — low-symptoms, normal activity of the patient;
- Class III — symptoms affects the functioning of the patient;
- Class IV — a disability, daily life is limited.
The clinical picture
Atrial fibrillation the heart (especially the very short seizures – epileptic) may go unnoticed by the patient. Typical symptoms of atrial flutter:
- heart palpitations;
- a feeling of heaviness, chest pain;
- shortness of breath;
- trembling, sweating, pale skin;
- state of weakness until fainting;
- frequent urination;
- pulsation of cervical veins.
The most severe picture in atrial fibrillation — specific attack Morgagni-Adams-Stokes: pallor, unconsciousness, seizures, disturbed breathing, and the heart tones are not detected. As with any cardiac pathology that provokes the a-FIB patient has unexplained panic and fear. Often, the signs of the disease develop quickly. The first call to the cardiologist in a patient diagnosed with chronic heart failure and permanent atrial fibrillation.
How dangerous is atrial fibrillation?
- Acute heart failure — angina, myocardial infarction.
- Thrombus formation and ischemic stroke.
- A small amount is thrown into the vessels of the blood — arrhythmogenic shock.
- Mitral valve stenosis causing sudden cardiac arrest.
- Chronic heart failure — reduced quality of life.
- Auscultation of the heart recording of the heart rate, listening to the chaotic heart tones of different loudness.
- Pulsometrija — arrhythmic heart rate, there is a deficit (fewer in comparison with the heart beat).
- Description ECG (12 leads) — teeth R not fixed, different length of the RR intervals, rasenanlage waves f (a symptom of multiple pathological impulses), QRS complex without any changes.
All ECG changes are recorded only at the time of arrhythmia that are more difficult to diagnose with a rare or small time the paroxysms of the heart. In this case, a Holter monitoring (daily ECG), or the recording of ECG in real time using a portable device. As additional tests that reveal the cause-and the disease is prescribed:
- Ultrasound and MRI of the heart;
- hormonal examination of the thyroid gland;
- an echo (including tee for the detection of blood clots).
- A semi-sitting position.
- Provide fresh air, to unbutton your shirt, untie your tie.
- To call an ambulance.
- To calm the patient.
- At presence to give Validol, Corvalol, or Valerian drops.
An emergency room physician conducts a medical elimination attack:
- When mild a paroxysm of beta — blockers (Inderal, kordan), antiarrhythmic drugs (Disopyramide, Etmozin), Lidocaine.
- I/10% Procainamide (2 – 3 ml) or Ajmaline. The introduction is repeated every 5 min (maximum dose 10 ml) until the disappearance of the paroxysm.
- In the absence of effect — in/slow-Strophanthin (1 ml) or Korglikon (1.5 ml) with 10 ml of saline.
- With the continued seizure and severe hemodynamic — electroimpulse (single-phase currents, charge to 50 j).
Gently apply the following tools:
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- Cordarone regulates heart rate, but does not restore normal rhythm of heart beats.
- Flecainid, Ibutilide restore sinus rhythm, however, provoke ventricular tachycardia.
- Cardiac glycosides often increase heart rate and aggravate the course of the paroxysm.
Effective elimination of atrial fibrillation is only possible with comprehensive treatment from a qualified specialist. Only an experienced cardiologist knows how to treat atrial fibrillation, and assigns the optimum treatment course, accurately adjusted dosage and duration of medication taking into account the disease and the patient.
- Blood thinners — protivodiabeticheskie drugs (Cardiomagnyl, Clopidogrel, Thrombotic), requires monitoring of coagulation.
- Control of cardiac rhythm — antiarrhythmic (Cordarone, Sotalol, Nibentan, Etmozin).
- Regulation of heart rate (support level your resting heart rate to 110 / min.) — beta blockers (Carvedilol), calcium antagonists (Verapamil).
- The implantation of an artificial pacemaker is performed after ablation of the AV node. A new source of normal impulses is implanted by endoscopic access. This method is only a temporary measure.
- Radiofrequency ablation — createterm access is made by burning the places of pathological impulses. The RFA procedure is performed under computer control, does not require General anesthesia. The patient recovers quickly. Catheter ablation of trigger zones gives a complete elimination of atrial fibrillation paroxysms.
- Cryodestruction of pathological impulsation is the newest method that requires a clinic of special equipment and high medical qualifications. Technology is to freeze the nitrogen in the trigger zone, after which the heart muscle remains a small scar. Cryosurgery is especially effective in paroxysmal form of the arrhythmia.
- The causal treatment of the disease.
- Preventive examination of the heart in old age, control of cholesterol and blood clotting.
- The exception is physical/emotional strain, development of resistance to stress.
- Smaller meals (6 times a day in small portions). The diet excludes fatty meat, egg yolk and cholesterindegrading products.
Early detection and appropriate therapy of atrial fibrillation, recommendations for treatment and prevention of disease will not only help to avoid frequent and severe attacks, but also prevent the development of life-threatening complications.