Causes of rhythm disturbance. Heart rhythm disorders: forms and features of pathology

Cardiac arrhythmia (or irregular heartbeat) is a disease of the cardiovascular system, which is characterized by any disturbances in the rhythm of the heart. The phenomenon is associated with a change in the regularity, frequency and sequence of heartbeats, the heartbeat can be either too frequent (development of tachycardia) or too slow (development of bradycardia). Some cases of arrhythmia can lead to cardiac arrest. Arrhythmia occurs at any age, in the upper and lower chambers of the heart, the atria and ventricles, respectively. Some types of illness are subtle, while others are more dramatic and fatal. Cardiac arrhythmia is considered one of the most common causes of death.

Mechanism of normal heart rhythm

To understand what arrhythmia is, the reasons for its appearance, you should understand how myocardial contraction generally occurs. The mechanism of normal heart rhythm is provided by the cardiac conduction system, which is an accumulation of special highly specialized cells. These cells create electrical impulses and conduct them along special fibers that bring the heart muscle to work. Despite the ability of each node of the system to generate impulses to the heart muscle, the sinus node remains the main link here, which sets the necessary rhythm. It is located in the upper part of the right atrium. The impulses generated by the sinus node, like the rays of the sun, propagate from it in all directions. Some impulses are "responsible" for the contraction or excitation of the atria, while others help slow down contractions so that the atria have time to send the next portion of blood to the ventricles. This ensures the normal rhythm of our heart. Its violation can be due to two problems:

Violation of the process of formation of impulses;

Violation of the conduction of generated impulses in the cardiac system.

With such problems, the next node in the chain takes over the “responsibility” for keeping the heart rhythm working, but at the same time the frequency of contractions decreases. This is how arrhythmia develops, the causes of which we will consider a little later.

Types of arrhythmia

Doctors classify arrhythmias depending not only on the place where they occur (atria or ventricles), but also on the rate of heart contractions. A fast heartbeat with more than 100 beats per minute is called tachycardia, and a slow heart rate with a heart rate of less than 60 beats per minute is called bradycardia. The causes of cardiac arrhythmias directly depend on the type of disease.

Not always tachycardia or bradycardia implies heart disease. For example, during physical exertion, a fast heartbeat is considered the norm, since an increase in heart rate allows oxygen to be provided to the body's tissues. During sleep or deep relaxation, the heartbeat tends to be slower.

If tachycardia occurs in the atria, then in this case the violation is classified as follows:

Atrial fibrillation is caused by chaotic electrical impulses in the atria. These signals result in rapid, uncoordinated, or weak contraction of the heart muscle. The causes of atrial fibrillation of the heart are convulsive chaotic activity of the ventricles, which usually occurs against the background of other cardiovascular diseases. A phenomenon such as atrial fibrillation can cause serious complications, such as a stroke.

Flutter - Similar to atrial fibrillation, the electrical impulses are more organized and rhythmic than in fibrillation. Fluttering also leads to stroke.

Supraventricular tachycardia or supraventricular tachycardia, which includes many forms of arrhythmias that originate above the ventricles.

Tachycardias that occur in the ventricles are divided into the following subspecies:

Ventricular tachycardia is rapid, regular heartbeats with abnormal electrical signals to the ventricles. This prevents the ventricles from filling completely and prevents the blood from being pumped efficiently.

Ventricular fibrillation is an arrhythmia caused by inefficient pumping of blood due to ventricular tremor. This is a fairly serious problem and is often fatal if the heart cannot return to normal within a few minutes. Most people who experience ventricular fibrillation either have serious heart conditions or have experienced a major injury, such as being struck by lightning.

Not always a low heart rate means that a person develops bradycardia. If you are in good physical shape, then the heart is able to pump enough blood for 60 beats per minute at rest. Certain medications can also lower heart rate. However, if you have a slow heart rate and your heart is not pumping enough blood, you may have one of several types of bradycardia.

Sinus arrhythmia, the causes of which are due to the weakness of the sinus node.

Blockade of excitation of electrical impulses between the atria and ventricles. In this case, the patient may experience missed beats of the heart muscle.

Premature contraction of the heart - occurs in the ventricles between two normal beats.

Causes of cardiac arrhythmia

A healthy person hardly ever suffers from such problems. When cardiac arrhythmia occurs, its causes are determined by various negative factors for the body. These can be changes in the heart muscle, ischemic disease, electrolyte imbalance in the blood, injuries after a heart attack, healing processes after heart surgery, and others. Heart rate is also associated with anxiety, physical activity, and medication.

It is important to understand that when a person has an arrhythmia, the causes and treatment of the disease for each age category of patients will be different. In children, for example, the disease occurs due to some factors, in adults - others. For a disease such as cardiac arrhythmia, general causes can be listed in the list:

Disorders that damage the heart and valves (endocarditis, myocarditis, rheumatism).

Thyroid disorders.

hereditary factors.

Dehydration or lack of potassium in the body or other electrolytes.

Damage to the heart due to a heart attack.

The risk of getting sick increases with smoking, stress, excessive consumption of caffeine or alcohol, age, high blood pressure, kidney disease, and more.

Cardiac arrhythmia in children

In children, the disease is classified depending on the location of the violation of impulse transmission, i.e. in the ventricles or atria. If an arrhythmia occurs in children, the causes of it should be looked for very carefully in order to increase the child's chances of recovery. Pediatric atrial arrhythmias include the following:

premature atrial contractions;

Supraventricular tachycardia;

Atrial fibrillation;

atrial flutter;

Gastric tachycardia;

Wolff-Parkinson-White syndrome (a condition in which an electrical impulse can arrive at the ventricle too quickly).

Ventricular dysrhythmias in childhood include:

Premature contraction of the ventricles (early or extra heart beats);

Ventricular tachycardia (a life-threatening condition in which electrical signals enter the ventricles at a variable rate);

Ventricular fibrillation (irregular, disorganized heartbeats).

The following disorders are characteristic of pediatric bradycardia:

Sinus node dysfunction (cardiac arrhythmia in children, the causes of which are due to a slow heart rate);

Heart block (delay or complete block of the electrical impulse from the sinus node to the ventricles).

Symptoms of arrhythmia depend on the degree of maturity of the child. Older children can tell themselves about dizziness or a fluttering sensation in the region of the heart. In infants or toddlers, irritability, pallor of the skin, and lack of appetite are noted. Some common arrhythmia symptoms include:

Weakness, fatigue;

Violation of the heart rhythm and pulse;

Dizziness, fainting or;

pale skin;

Pain in the chest;

shortness of breath, sweating;

Lack of appetite;

Irritability.

If cardiac arrhythmia develops in childhood, the causes of the disease are determined by the following factors: infectious diseases, taking certain medications, fever, fever. More serious causes include congenital malformations. In most cases, arrhythmias in children are harmless. However, when there is a change in the heart rate in the child's resting state, outside of play or physical activity, parents should seek professional medical help in a medical institution.

Cardiac arrhythmia in adolescents

If an arrhythmia occurs in adolescents, the causes may vary depending on the sinus rhythm. the body is subject to multiple changes, which often causes various disorders. Such a phenomenon rarely becomes a pathology, changes rather occur at the physiological level and disappear over time. However, this does not mean that arrhythmias in adolescents should not be given importance. At the initial stage of the disease, a teenager needs a regular examination by a doctor who will monitor the dynamics of arrhythmia. If the symptoms of the disease do not disappear within 1-2 years, then the teenager certainly needs treatment.

The most common type of arrhythmia in adolescence is bradycardia. The disease is fraught with the fact that the child's brain does not receive the required amount of oxygen, which leads to a deterioration in intellectual abilities, academic performance, slow reactions, the inability to fully engage in sports and other problems.

The causes of arrhythmia at this age are not always associated with diseases of the cardiovascular system. The disease can be provoked by endocrine disorders, stress, nervous strain, hormonal changes in a teenager, pulmonary or bronchial diseases, colds accompanied by fever, and so on. With vegetative-vascular dystonia, the disease is most often phantom in nature, therefore, in the treatment of such children, it is important to prescribe sedatives and consult psychologists.

Cardiac arrhythmia in women

Women as a group present an interesting set of challenges for a cardiologist who specializes in cardiac arrhythmias. There are monthly changes in certain arrhythmias in which palpitations are a source of discomfort and concern for female patients, and there are certain risks when a woman is diagnosed with a cardiac arrhythmia. The causes, treatment of the disease and its symptoms depend on many different factors that should be considered.

Women have a higher prevalence of sick sinus syndrome, sinus tachycardia, atrioventricular nodal tachycardia and other types of disease. Causes of arrhythmia in women are associated with a violation of the heart rhythm:

Ventricular tachycardia (comes from the lower chambers of the heart);

Supraventricular tachycardia (occurs in the upper chambers of the heart);

Premature atrial contractions (occur in both the upper and lower chambers of the heart).

It is important to remember that an abnormal heartbeat is a symptom of an illness, not a diagnosis. Sometimes, when an arrhythmia appears, the causes of its occurrence can be associated with factors such as stress, nervous overexcitation, emotional distress. However, in these cases, careful diagnosis of the disease is necessary to rule out the possibility of more serious causes.

Arrhythmia during pregnancy usually occurs due to changes in the hormonal background of a woman. An increase in the level of estrogen and human chorionic gonadotropin affects the expression of cardiac ion channels, hemodynamic changes are characterized by an increase in circulating blood volume and a doubling of cardiac output. In addition, pregnancy increases sympathetic tone. All these changes in the female body contribute to the development of arrhythmias.

Cardiac arrhythmia in men

Heart disease is twice as common in men as in women. The most common forms of the disease are atrioventricular block, carotid sinus syndrome, atrial fibrillation, supraventricular tachycardia, Wolff-Parkinson-White syndrome, recurrent ventricular tachycardia, ventricular fibrillation and sudden death, and Brugada syndrome. The causes of arrhythmia in men are often associated with overweight, alcohol abuse, smoking, lack of physical activity, poor diet, stress, and taking certain medications.

Men with heart disease are especially prone to developing arrhythmias, since irregularities in the heart muscle can cause cardiac arrest or delay in the electrical signal from the sinus node to the ventricles. If an arrhythmia appears after eating, the causes of this condition are associated with the pressure of the stomach on the diaphragm. This causes compression of the sternum, pressure on the heart. Causes of arrhythmia in men are also associated with high blood pressure and an overactive thyroid gland, which also increase the risks.

Symptoms of the disease in adults

With a disease such as cardiac arrhythmia, the symptoms and causes of the disease are closely interrelated. So, for example, when the heart beats faster than normal, signs of illness include chest discomfort, palpitations, dizziness, headache, and hypertension. With bradycardia, fatigue, dizziness, fainting or pre-syncope, and a decrease in blood pressure usually occur.

The symptoms of arrhythmia in adults include general weakness, increased feeling of fatigue, heart rhythm and pulse disturbances. With slow heartbeats, the brain does not receive the right amount of oxygen, as a result of which patients report frequent dizziness, fainting or pre-fainting, they develop shortness of breath and sweating increases. The skin turns pale, covered with perspiration. With tachycardia, pain in the chest area is frequent, irritability increases,

If flutters in the chest area are random, then they do not carry any danger. But if the pain in the heart becomes more and more frequent, and the person constantly has a feeling of weakness, the pulse becomes irregular, then it's time to see a doctor.

Arrhythmia treatment

Most forms of heart disease are considered harmless and do not require treatment. If a person has cardiac arrhythmia, the causes and treatment of the disease usually depend on each other, since doctors choose the method of therapy based on the factors that provoked the disease. Treatment of the disease is usually aimed at preventing blood clots in the bloodstream in order to prevent the risk of stroke, restore a normal heart rhythm, control the heart rate in the normal range, reduce risk factors for cardiovascular disease.

If the resulting bradycardia has no clearly defined causes, doctors usually resort to the use of pacemakers. A pacemaker is a small device that is placed near the collarbone. One or more electrodes with tips emanating from the device send electrical impulses through the blood vessels to the heart and thus stimulate regular heartbeats in a person.

For many types of tachycardia, the patient may be prescribed treatment to control the heart rate or restore a normal heart rhythm. Such therapy minimizes all possible complications. For atrial fibrillation, a doctor prescribes blood-thinning medications that prevent blood clots from forming in the bloodstream. With atrial fibrillation, the patient is prescribed drugs using cardioversion, which allows you to restore normal sinus rhythm.

In some cases, the patient may be recommended surgical treatment of arrhythmia. With a serious lesion of the coronary artery, the patient is offered coronary bypass surgery. This procedure improves blood flow to the heart. performed in case of an increased number of heartbeats with an insufficient pulse. During the operation, the doctor makes punctures in the scar tissue, which can no longer conduct electrical impulses.

Prevention

In order to prevent heart disease, and in particular arrhythmia, you should lead a healthy lifestyle, follow the recommendations regarding proper nutrition, give up bad habits, avoid stressful situations, play sports.

- any violation of the regularity or frequency of the normal heart rhythm, as well as the electrical conduction of the heart. Arrhythmia may be asymptomatic or be felt as a heartbeat, fading, or interruptions in the work of the heart. Sometimes arrhythmias are accompanied by dizziness, fainting, pain in the heart, a feeling of lack of air. Arrhythmias are recognized in the process of physical and instrumental diagnostics (heart auscultation, ECG, PECG, Holter monitoring, stress tests). In the treatment of various types of arrhythmias, drug therapy and cardiosurgical methods (RFA, installation of an electrocardiostimulator, cardioverter-defibrillator) are used.

Rhythmic sequential contraction of the heart is provided by special muscle fibers of the myocardium, which form the conduction system of the heart. In this system, the first-order pacemaker is the sinus node: it is in it that excitation arises at a frequency of 60-80 times per minute. Through the myocardium of the right atrium, it spreads to the atrioventricular node, but it turns out to be less excitable and gives a delay, so the atria contract first and only then, as the excitation spreads along the bundle of His and other parts of the conduction system, the ventricles. Thus, the conducting system provides a certain rhythm, frequency and sequence of contractions: first the atria, and then the ventricles. Damage to the conduction system of the myocardium leads to the development of rhythm disturbances (arrhythmias), and its individual links (atrioventricular node, bundle or legs of His) lead to conduction disturbances (blockades). In this case, the coordinated work of the atria and ventricles can be sharply disrupted.

Causes of arrhythmias

The development of organic arrhythmias is based on damage (ischemic, inflammatory, morphological) of the heart muscle. They make it difficult for the normal distribution of an electrical impulse through the conduction system of the heart to its various departments. Sometimes damage also affects the sinus node - the main pacemaker. In the formation of cardiosclerosis, scar tissue prevents the conduction function of the myocardium, which contributes to the emergence of arrhythmogenic foci and the development of conduction and rhythm disturbances.

The group of functional arrhythmias includes neurogenic, dyselectrolyte, iatrogenic, mechanical and idiopathic arrhythmias.

The development of sympathetic arrhythmias of neurogenic origin is facilitated by excessive activation of the tone of the sympathetic nervous system under the influence of stress, strong emotions, intense mental or physical work, smoking, drinking alcohol, strong tea and coffee, spicy food, neurosis, etc. Activation of the sympathetic tone is also caused by diseases thyroid gland (thyrotoxicosis), intoxication, feverish conditions, blood diseases, viral and bacterial toxins, industrial and other intoxications, hypoxia. In women suffering from premenstrual syndrome, sympathetic arrhythmias, pain in the heart, sensations of suffocation may occur.

Vagodependent neurogenic arrhythmias are caused by activation of the parasympathetic system, in particular, the vagus nerve. Vago-dependent rhythm disturbances usually develop at night and can be caused by diseases of the gallbladder, intestines, duodenal ulcer and stomach ulcers, bladder diseases, in which the activity of the vagus nerve increases.

Diselectrolyte arrhythmias develop with electrolyte imbalances, especially magnesium, potassium, sodium and calcium in the blood and myocardium. Iatrogenic rhythm disturbances result from the arrhythmogenic action of certain drugs (cardiac glycosides, β-blockers, sympathomimetics, diuretics, etc.).

The development of mechanical arrhythmias is facilitated by chest injuries, falls, blows, electric shocks, etc. Rhythm disturbances without an established cause are considered idiopathic arrhythmias. In the development of arrhythmias, hereditary predisposition plays a role.

Classification of arrhythmias

Etiological, pathogenetic, symptomatic and prognostic heterogeneity of arrhythmias causes discussions about their unified classification. According to the anatomical principle, arrhythmias are divided into atrial, ventricular, sinus and atrioventricular. Taking into account the frequency and rhythm of heart contractions, it is proposed to distinguish three groups of rhythm disturbances: bradycardia, tachycardia and arrhythmias.

The most complete classification is based on the electrophysiological parameters of rhythm disturbance, according to which arrhythmias are distinguished:

• I. Caused by a violation of the formation of an electrical impulse.

This group of arrhythmias includes nomotopic and heterotopic (ectopic) arrhythmias.

Nomotopic arrhythmias are caused by dysfunction of the automatism of the sinus node and include sinus tachycardia, bradycardia and arrhythmia.

Separately, in this group, sick sinus syndrome (SSS) is distinguished.

Heterotopic arrhythmias are characterized by the formation of passive and active ectopic complexes of myocardial excitation located outside the sinus node.

With passive heterotopic arrhythmias, the occurrence of an ectopic impulse is due to a slowdown or disruption in the conduction of the main impulse. Passive ectopic complexes and rhythms include atrial, ventricular, disorders of the atrioventricular connection, migration of the supraventricular pacemaker, and jumping contractions.

With active heterotopias, the emerging ectopic impulse excites the myocardium before the impulse formed in the main pacemaker, and ectopic contractions “interrupt” the sinus rhythm of the heart. Active complexes and rhythms include: extrasystoles (atrial, ventricular, originating from the atrioventricular junction), paroxysmal and non-paroxysmal tachycardia (originating from the atrioventricular junction, atrial and ventricular forms), flutter and flicker (fibrillation) of the atria and ventricles.

• II. Arrhythmias caused by dysfunction of intracardiac conduction.

This group of arrhythmias occurs as a result of a decrease or cessation of the propagation of an impulse along the conduction system. Conduction disorders include: sinoatrial, intra-atrial, atrioventricular (I, II and III degree) blocks, premature ventricular excitation syndromes, intraventricular blocks of the bundle of His bundle (one-, two- and three-beam).

• III. Combined arrhythmias.

Arrhythmias that combine conduction and rhythm disturbances include ectopic rhythms with exit blockade, parasystole, and atrioventricular dissociations.

Symptoms of arrhythmias

The manifestations of arrhythmias can be very different and are determined by the frequency and rhythm of heart contractions, their effect on intracardiac, cerebral, renal hemodynamics, as well as the function of the myocardium of the left ventricle. There are so-called "silent" arrhythmias that do not manifest themselves clinically. They are usually identified by physical examination or electrocardiography.

The main manifestations of arrhythmias are palpitations or a feeling of interruptions, fading during the work of the heart. The course of arrhythmias may be accompanied by suffocation, angina pectoris, dizziness, weakness, fainting, and the development of cardiogenic shock. Palpitations are usually associated with sinus tachycardia, attacks of dizziness and fainting - with sinus bradycardia or sick sinus syndrome, fading of cardiac activity and discomfort in the region of the heart - with sinus arrhythmia.

With extrasystole, patients complain of sensations of fading, pushing and interruptions in the work of the heart. Paroxysmal tachycardia is characterized by suddenly developing and stopping heart attacks up to 140-220 beats. in min. Sensations of frequent, irregular heartbeat are noted with atrial fibrillation.

Complications of arrhythmias

The course of any arrhythmia can be complicated by ventricular fibrillation and flutter, which is tantamount to circulatory arrest, and lead to the death of the patient. Already in the first seconds, dizziness, weakness develop, then - loss of consciousness, involuntary urination and convulsions. Blood pressure and pulse are not determined, breathing stops, pupils dilate - a state of clinical death occurs. In patients with chronic circulatory failure (angina pectoris, mitral stenosis), during paroxysms of tachyarrhythmia, shortness of breath occurs and pulmonary edema may develop.

With complete atrioventricular block or asystole, syncope may develop (Morgagni-Adems-Stokes attacks, characterized by episodes of loss of consciousness), caused by a sharp decrease in cardiac output and blood pressure and a decrease in blood supply to the brain. Thromboembolic complications in atrial fibrillation in every sixth case lead to a cerebral stroke.

Diagnosis of arrhythmias

The initial stage of diagnosing arrhythmia can be carried out by a therapist or cardiologist. It includes the analysis of the patient's complaints and the determination of the peripheral pulse characteristic of cardiac arrhythmias. At the next stage, instrumental non-invasive (ECG, ECG monitoring), and invasive (ChpEFI, VEI) research methods are carried out:

An electrocardiogram records the heart rhythm and frequency for several minutes, so only constant, stable arrhythmias are detected by an ECG. Rhythm disturbances that are paroxysmal (temporary) in nature are diagnosed by the Holter 24-hour ECG monitoring method, which records the daily heart rhythm.

To identify the organic causes of arrhythmias, Echo-KG and stress Echo-KG are performed. Invasive diagnostic methods make it possible to artificially induce the development of arrhythmia and determine the mechanism of its occurrence. During an intracardiac electrophysiological study, catheter electrodes are brought to the heart, recording an endocardial electrogram in various parts of the heart. The endocardial ECG is compared with the result of an external electrocardiogram recording performed simultaneously.

Prognosis for arrhythmias

In prognostic terms, arrhythmias are extremely ambiguous. Some of them (supraventricular extrasystoles, rare extrasystoles of the ventricles), not associated with organic pathology of the heart, do not pose a threat to health and life. Atrial fibrillation, on the contrary, can cause life-threatening complications: ischemic stroke, severe heart failure.

The most severe arrhythmias are flutter and ventricular fibrillation: they pose an immediate threat to life and require resuscitation.

Prevention of arrhythmias

The main direction of prevention of arrhythmias is the treatment of cardiac pathology, almost always complicated by a violation of the rhythm and conduction of the heart. It is also necessary to exclude extracardiac causes of arrhythmia (thyrotoxicosis, intoxication and febrile conditions, autonomic dysfunction, electrolyte imbalance, stress, etc.). It is recommended to limit the intake of stimulants (caffeine), the exclusion of smoking and alcohol, self-selection of antiarrhythmic and other drugs.

The heart organ in a healthy state contracts evenly and rhythmically. The heart rate of the heart muscle is from 60 pulses per minute to 80 pulses.

The rhythm of contractions in the heart corrects the sinus node, which is also the pacemaker.

There are pacemaker cells in the sinus node that transmit the impulses of the heart from the node, through the driver, to the second node, which corrects the rhythm (atrioventricular) and then transmits it to the walls of the ventricles.

What is the correct rhythm?

At the moment of movement of the rhythm impulse from one node to another, systole passes in the heart. The principle of systole is that the impulse, when moving from the sinus node, through the atria reaches the ventricles and causes contractile movements in the heart.

This is the ideal state of systole in the heart, when the work of all those responsible for the contraction occurs smoothly and rhythmically. But heart rhythm disturbances can occur due to failure to fulfill their functional duties by the main centers of the heart organ.

The reasons may be:

• Overexcitability of the centers of the nerve endings of the brain;
• Deviations in the conduction of impulses - a violation in the pacemaker;
• Deviations in the ability of the heart muscle to contract.

Heart rate variability is always corrected by the centers of the brain, therefore, disturbances in deviations in the brain lead to a failure in the coordinated work of the heart contraction system.

Factors that irritate the centers of the brain:

• Physical overload of the body;
• situation of stress;
• Failure of the pituitary gland;
• Hormonal disorders.

Classification of rhythm disturbance

All violations of the heart rhythm and impulse conduction are classified into two types:

• Violation of the rhythm in the heart;
• Violation in conduction through the heart of the impulse.

Reasons for violation

If the impulse originates in the sinus node and originates frequently, then this provokes sinus tachycardia with a heart rate higher than 90 beats per minute.

If the origin of the impulse occurs slowly, then this is a pronounced sinus bradycardia with a pulsation rate less than 60 gifts in one minute. Sinus arrhythmia also belongs to this type of disorder.

The impulses can diverge both above the focus level and pass below its level.

The source of excitation of the impulse can occur in areas that are located below the route of the impulse.

The impulse originates in the atria, as well as in the atrioventricular node, in the myocardium of the ventricles.

The causes of problems in the sinus node, which transmits the rhythm, depend on the type of arrhythmia:

• Sinus type tachycardia- rapid heart rate, which is associated with a malfunction in the endocrine system, and also have a neurogenic character (nervous strain, psychological trauma, intoxication of the body);
• Bradycardia- slow heart rate, which provokes heart pathologies, as well as a sharp weight loss during fasting, neoplasms in the body;
• Nodal shape rhythm- this is a form of arrhythmia, which is quite rare and is observed mainly in the child's body;
• Reverse heart rate- a pathology in which there is a reverse movement of the rhythm (from the ventricles towards the atria). This form of deviation is called idioventricular rhythm, when the driver occurs in the ventricular muscle and an irregular heartbeat occurs;
• Extrasystole- these are heart contractions that occur prematurely in ectopic foci. The foci are located in the atria or in the walls between the atria and the cardiac ventricles. There are additional cardiac impulses that are not complete. Extrasystole, is a violation of the rhythm of the heart (arrhythmia). This state is expressed by supplemented rhythms of the organ, or its individual sections. Additional contractions can occur in the ventricle (gastric), in the atrium (atrial), as well as in one of the halves of the heart (atriogastric);
• Tachycardia of paroxysmal type- this is an increased heart rate, which is caused by disorders in the nervous and autonomic systems, there is an acute deviation in rhythm;
• Atrial fibrillation- this is not coherence (failure) in the work of the atria and ventricles, contractions occur spontaneously. This arrhythmia is provoked by a deficiency in the potassium myocardium, as well as a pronounced paroxysmal tachycardia, or bradycardia. Atrial fibrillation may be a consequence of the accumulation of glycosides in the body;
• Blocking the heart impulse along its entire path.

Heart rate variability is manifested in the acute degree of development of the pathology and quite often several reasons are involved in this disorder.

Violations in the conduction of the impulse through the heart

Conduction disorders are blockages in the path of the heart impulse. A block for an impulse can occur along its entire path.

Blockade is divided into types:

• Sinoatrial form;
• Development of a block inside the atrium;
• Blockade is atrioverticular;
• Blocking the legs of the bundle of His;
• ERW syndrome (Wolf-Parkinson-White pathology);
• left ventricular asystole (cardiac arrest).

Combinations also appear:

• Parasystole;
• Dissociation of atrioventricular type;
• Ectopic rhythm with blocking the output of the impulse.

These types of pathology provoke the emergence and operation of a double rhythm in the heart. The driver of the ectopic impulse works simultaneously with the driver of the sinus node and therefore the rhythm is demarcated - the atria have their own rhythm, the ventricles have their own.

Two extrasystoles wedged into a normal rhythm

Cardiovascular diseases

Pathologies of the heart and vascular system, which are risk factors for rhythm disturbances:

• Heart defects: congenital and acquired;
• Cardiomyopathy of all kinds;
• heart attack;
• Hypertonic disease;
• Hypertrophy of the left ventricle;
• Endocarditis (inflammation) of the myocardium;
• Myocarditis of the heart muscle;
• Pericarditis of the muscular tissue of the heart;
• rheumatic carditis;
• Rheumatism;
• Cardiosclerosis with the etiology of a heart attack;
• Cardiac insufficiency provokes changes in rhythms.

All these diseases can be a source of disruption in the rhythm and affect both the formation of the impulse and its permeability through the organ.

Pathologies of the heart and arteries provoke life-threatening irregular rhythm disturbances:

• Paroxysmal form of ventricular tachyarrhythmia and tachycardia;
• Fibrillation of the left ventricle and right ventricle;
• Complete blocking of the passage of impulses.

Nervous diseases

Diseases of the nerve fiber system, along with cardiac types of pathologies, can cause failure and rhythm deviations:

• Dystonia vegetative-vascular;
• Neuroses that have a different etiology;
• Neurasthenia;
• Violation of blood flow in the brain - a stroke;
• Encephalopathy of the dyscirculatory form;
• Neoplasms in the brain (malignant, as well as benign);
• head trauma;
• Inflammation of the cerebral cortex;
• Dropsy of the brain.

Diseases of the nervous system provoke pathologies of rhythm:

• Tachycardia of all kinds;
• Bradycardia of all types;
• Extrasystole of the ventricular type;
• Atrioventricular blockade, which has a 1 or 2 degree of development.

Pathologies of the endocrine organs

The organs of the endocrine system are closely related to the heart. The connection between the thyroid gland and the myocardium is especially noticeable. Failure in the production of hormones by the gland immediately causes pathology in the heart organ: with low production - bradycardia develops, with an increased release of hormones - tachycardia.

Endocrine diseases causing arrhythmia:

• Diabetes type;
• Hyperthyroidism of the organ - the thyroid gland;
• Hypothyroidism of thyroid hormones;
• Neoplasms of the adrenal glands - pheochromocytoma disease;
• The period of menopause and menopause (hormonal changes in the female body).

With disturbed rhythm caused by pathologies of the endocrine system, during the treatment of the root cause, the heart rhythm comes to normative indications.

Noncardiac risk factors

Symptoms of cardiac arrhythmias

Symptoms of a violation in the rhythm of the heart organ can be asymptomatic and detected during a preventive instrumental examination.

Symptoms appear when the arrhythmia has a stable form in the heart:

There is a change in the behavior of the patient:

• A person often calms down and listens to the work of the heart organ;
• There is a sharp change in mood;
• Suspiciousness and increased tearfulness;
• Changes in the psyche are accompanied by a feeling of constant anxiety;
• A state of paranoia and fear of death.

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Complicated stage of cardiac arrhythmia

Violations in cardiac impulses and their rhythm are dangerous because improper blood flow leads to pathologies of internal organs important for life and the blood supply system, but also because this condition can turn into a complicated form, which is critical for the body and borderline with life:

• collapse state. Collapse is expressed by a sharp decrease in blood pressure below 90 mm. rt. st (systolic). The collapse can come in the form of an attack, and also be a consequence of the introduced antiarrhythmic drugs. A diagnosis is made of drug-induced hypotension;
• Arrhythmogenic form of shock- occurs when there is a decrease in blood pressure in the bloodstream, in the brain. This complicated form is expressed in the pallor of the skin, in severe form, loss of consciousness, cyanosis of the skin, blood pressure not higher than 60 mm. rt. Art. (systolic). Emergency medical assistance is required, without an ambulance a state of death comes;
• Ischemic form of stroke are the consequences of arterial thrombosis. With the paroxysmal form of tachycardia, the blood becomes foamy and can clog the arteries of the brain. Manifestation of pathology: there is unsteadiness in movements, a problem with speech, paralysis of limbs or parts of the body;
• Thromboembolism of the pulmonary artery (PE)- This disease occurs due to thrombosis of the pulmonary artery. The most difficult situation is a lethal outcome;
• Myocardial infarction in the acute stage of the disease- this is a rather complex condition in which myocardial hypoxia occurs due to insufficient blood flow to the organ. In the myocardial tissue from hypoxia, a focus of necrosis is formed, which manifests itself as severe pain in the sternum;
• Ventricular fibrillation (asystole, clinical death state)- this is a complicated form of paroxysmal tachyarrhythmia of the ventricles, which turns into a flicker of the ventricular chambers. The ability of the ventricles to contract leads to impaired blood flow (blood stops flowing into the bloodstream) and the heart stops.

Sinus node dysfunction

Few patients have a sudden rhythm failure that leads to biological death.

First aid

The provision of assistance in the pathology of cardiac arrhythmias depends on the etiology of the disorder, the stage of neglect of the disease, which is the root cause of the rhythm failure.

There are such problems with the rhythm, when in order to normalize it, it is necessary to take therapeutic drugs, and in some cases, urgent hospitalization is required in the intensive care unit of a cardiology clinic.

If an attack of arrhythmia of the heart impulse has occurred and obvious signs of an unhealthy body are visible, an urgent need to call a cardiological ambulance team.

Signs of arrhythmia:

Before the arrival of the team of doctors, it is necessary to provide assistance in alleviating the attack:

• Put the patient in a horizontal position (with a strong pulse, put a pillow under the head, with a low pulse - a pillow under the knees);
• Unbutton the collar of the shirt;
• Open unhindered access to fresh air (if the attack occurred in the room);
• Measure the index of blood pressure (blood pressure);
• Measure the heart rate (heart rate);
• Drink sedatives - tincture of valerian, corvalol;
• For pain in the heart - take Nitroglycerin;
• If the patient is not the first time in a state of attack - take the drugs that were prescribed to him - to stop the attack;
• With signs of pulmonary edema (suffocation, sputum secreted in the form of foam, bubbling breath) - take a diuretic to remove excess fluid from the body;
• Apply a vagal test - with a deep breath, press on the eyeballs with your palms and hold for 15 seconds;
• In a severe attack with respiratory arrest, perform an indirect heart massage and artificial respiration.

Diagnostics

To recognize the underlying cause of the disorder and to establish a cardiac diagnosis, it is necessary to undergo instrumental study, diagnosis of pathology:

• ECG (electrocardiography)- detection of heart activity, the frequency of contraction of the heart muscle (HR - in this article) is recorded;
• Ultrasound of the cardiac organ- reveals the size of the heart, determines anomalies in the organ, fixes the work of valves and all chambers of the heart organ;
• Holter monitoring method- This is the observation of a sick person for 24 hours. The ECG is recorded both during the day and at the time of the patient's sleep. This technique is carried out only within the walls of the hospital cardiology department of the clinic.
• echocardiography- recognizes the thickness of the walls of the heart chambers, the ability to contract the left ventricle, the detection of heart defects, both congenital and acquired, the condition of the heart valves.

Medical therapy

Treatment of violations of arrhythmic rhythm and abnormal conduction differs depending on the type of disease and on the etiology that caused the arrhythmia. In all cases of pathology, blood thinning drugs are used - Aspirin medication.

Means that are used to relieve pathology and relieve symptoms:

• Drugs of the statin group - to lower cholesterol in the blood (Ravustatin);
• To reduce the blood pressure index (with hypertension) - Enalapril;
• Diuretics to relieve swelling in heart failure - Veroshpiron;
• Cardiac glycosides - drug Digoxin;
• Preparations of the nitrate group - Nitroglycerin.

Regardless of the etiology of cardiac arrhythmia, rhythmically restoring drugs (antiarrhythmics) are used, which are introduced into the body through an artery:

• The drug Panangin;
• Medication Novocainamide;
• Means Strofantin.

And also drugs are used that are able to keep the rhythm.

With ventricular tachycardia, Lidocaine is injected into the artery.

With various types of extrasystoles - Betalok medication is inside the body, through a dropper.

The sinus form of tachycardia is stopped by the drug Anaprilin.

Bradycardia of various underlying causes and blockade are treated with special therapy, which can make the heart beat faster and achieve a regular rhythm.

Preventive actions

Initial preventive measures should take place long before a pathology such as arrhythmia appears in the heart organ.

It is necessary to strengthen the heart muscle with regular loads on the body (but not overload it) and give up addictions (alcoholism and smoking).

Activity will help the blood flow system work better, which will reduce the load on the heart organ.

Maintain a food culture

• Refuse cholesterol-containing foods;
• Reduce salt intake;
• Reduce the intake of sweet foods;
• Refuse caffeinated drinks, fatty and fried foods;
• Do not eat large portions, because this leads to irritation of the nerve vagus node;
• Introduce more fresh vegetables, herbs and fruits into the menu.

The preventive measure is to avoid stress. If it is not possible to calm the nervous system, then it is necessary to take sedative medicinal substances. Good help: yoga classes, aromatherapy, auto-training, as well as a consultation with a psychologist.

Forecast for life

Violation of the heart rhythm of the organ in the absence of serious pathologies of the organ and the transition to a complicated form is favorable. In other cases, the prognosis depends on the neglect of the pathology and how the pathology can be cured.

Extrasystole is a fairly common disorder, especially when it comes to elderly patients. This condition is accompanied by a violation of the normal heart rhythm. And today more and more people are interested in questions about what are the causes of such a problem, how dangerous it can be to health.

Extrasystole - what is it?

Today, many patients of clinics face a similar problem. So what is extrasystole? This is a disorder that is associated with certain disorders. With a similar disease, extraordinary contractions (systoles) are observed either of the whole myocardium or of its individual parts (for example, atria, ventricles).

Extrasystole - the norm or a threat to health?

Of course, today many people are faced with a similar problem. So just how dangerous can these disorders be? In fact, extraordinary contractions can occur and, in fact, occur at any age. For example, often young people complain about the feeling of a strong heart attack, this is extrasystole. Moreover, according to statistics, about 80% of people over fifty suffer from periodic "unscheduled" shocks from time to time.

What causes systole? With some disorders of the vessels, the conducting system changes: the so-called ectopic foci, areas of increased activity, are formed in it. Most often, such a disorder appears in the conduction pathways of the ventricles, atria, and atrioventricular node. It is these ectopic foci that generate impulses that trigger the mechanism of heart contraction in the phase of its relaxation (diastole). This is what an extrasystole looks like. This, by the way, can be extremely dangerous.

Of course, occasionally occurring impulses do not pose a serious threat to human health. Nevertheless, they signal the presence of a particular problem, experts recommend that such patients pay more attention to their lifestyle, monitor nutrition and undergo regular examinations.

On the other hand, too frequent extrasystoles affect the work of the whole organism. After all, as a result of multiple extraordinary contractions, the release of blood decreases, which leads to a decrease in blood flow in the brain and coronary vessels. In such cases, extrasystole of the heart is extremely dangerous, as it can lead to myocardial damage, fainting, or even sudden death of a person.

Heart rhythm disturbance: causes

In fact, there are many factors under the influence of which an extrasystole attack can occur. For example, an abnormal heart rhythm can be associated with exposure to certain chemicals in the body, including certain foods, alcoholic beverages, drugs, even strong tea or coffee. Smoking is also a risk factor. Functional extrasystole of the heart can also occur in women during menstruation.

In addition, the causes include some diseases, including osteochondrosis of the spine (especially the cervical region), as well as vegetative dystonia, neuroses of various origins, and others.

There are other factors, under the influence of which there is a violation of the heart rhythm. The reasons may be associated with organic lesions of the myocardium and the conduction system. For example, seizures often occur in patients with various defects, as well as against the background of cardiosclerosis, cardiomyopathy, coronary disease, inflammatory diseases (myocarditis, pericarditis). Risk factors also include diseases such as hemochromatosis, sarcoidosis, amyloidosis, since in such conditions the risk of heart damage is high.

An attack of extrasystole often occurs against a background of severe fever. In addition, certain drugs can lead to the same effect, including those drugs that contain caffeine, ephedrine, aminophylline, novodrine, as well as tricyclic antidepressants, diuretic drugs and glucocorticoids.

Severe stress, physical overstrain, violation of the content of minerals in myocardial cells - all this can provoke an attack of increased contraction of the heart muscle.

Classification of violations

Of course, today there are many classification systems that make it possible to understand what extrasystole is - for example, depending on the location of the ectopic focus. Most often, rhythm failures are observed in the ventricles, more than 60% of patients go to the doctor with this diagnosis.

In 25%, atrial extrasystole is observed. Much less often, foci of rhythm disturbance occur in the atrioventricular junction, in such cases they are called atrioventricular. In addition, various combinations of the above forms are observed.

In some cases, the main sinus rhythm is preserved simultaneously with the formation of an ectopic focus, such a violation is called parasystole. Violations are also classified according to the number of foci of excitation, they can be both mono- and polytopic.

If extrasystoles go two in a row, then they are called paired. If extraordinary contractions follow the “more than two in a row” pattern, then this is a volley extrasystole. In addition, such disorders are divided into groups depending on the moment of their occurrence during cardiac contraction (these are early, middle and late). If we take into account the frequency of occurrence of extrasystoles, then they can be rare (extraordinary contractions less than 5 per minute), medium (from 6 to 15) or frequent (for example, frequent ventricular extrasystole is accompanied by more than 15 extraordinary contractions of the ventricle per minute).

Naturally, there is a system by which extrasystole is classified depending on its origin. For example, cardiac arrhythmias may be associated with organic or toxic tissue damage, physiological disorders.

How is extrasystole manifested?

In fact, not all patients have signs of heart disease; sometimes rhythm disturbances are detected by chance during a planned electrocardiogram. Moreover, there are many factors that can influence the number and intensity of traits present. For example, patients with organic myocardial lesions can endure extrasystole attacks quite easily, while the clinical picture in people with vegetovascular dystonia looks much more difficult.

Most often, subjectively, an extrasystole is felt as a strong push, even a heartbeat against the chest from the inside. In some cases, patients note that they feel as if the heart is “turning over” or even “somersaulting”. Such sensations are associated with a strong, energetic and sharp contraction of the myocardium.

In some patients, an attack of extrasystole is somewhat reminiscent of the symptoms of coronary disease or angina pectoris. Extrasystole, which is associated with functional changes, is often accompanied by other signs. For example, patients complain of increased sweating, a feeling of lack of air, hot flashes, severe, sudden weakness, and discomfort. Sometimes there is inexplicable even fear.

There are other signs of heart disease. For example dizziness. Frequent atrial or ventricular extrasystole is accompanied by a decrease in blood ejection, which causes this symptom. In patients with cerebral atherosclerosis, such rhythm disturbances can lead to circulatory disorders, which is accompanied by paresis, fainting, aphasia, and other disorders. In any case, with the manifestation of such conditions, you should immediately consult a doctor, since the consequences can be extremely dangerous and severe.

Extrasystole in childhood

In fact, extrasystole in children is diagnosed quite often. A child of any age can suffer from it, sometimes such a disorder is recorded even during fetal development. According to statistics, more than 75% of children in varying degrees suffer from heart rhythm disturbances. Moreover, over the past decade, the number of babies with similar disorders has increased significantly.

What are the main causes of heart rhythm disturbances in children? First of all, it is worth noting congenital malformations and cardiomyopathy. In addition, the most common include infectious myocarditis, rheumatic heart disease, genetically determined diseases.

In some cases, the disease is associated with some disorders of the endocrine and nervous system. For example, hypothyroidism or diabetes mellitus can lead to the appearance of extrasystole. On the other hand, chronic inflammatory and infectious processes, as well as beriberi and deficiency of certain elements, too much physical or emotional stress are important. In any case, such a disorder needs proper treatment. As for the prognosis, the average or rare extrasystole, which is not accompanied by organic lesions of the heart, is considered a relatively safe form of the disease.

Modern diagnostic methods

Naturally, there are many diagnostic methods, including ECG. Extrasystole in such a study, as a rule, is clearly visible. However, the diagnostic process does not begin with this. To begin with, the doctor is required to conduct a complete examination, which begins with the collection of information. The patient should tell the specialist what symptoms he has, how intense his attacks are, how often they occur.

It is extremely important to determine the cause of the heart rhythm disturbances. For this purpose, an anamnesis is collected, the doctor should be aware of the presence of other diseases, taking medications. The fact is that the choice of effective methods of treatment largely depends on the cause and nature of lesions of the conduction system of the heart.

After that, the doctor, as a rule, palpates the pulse on the radial artery. With extrasystole, a specialist can replace a pulse wave that occurs prematurely. Sometimes, on the contrary, extrasystole is accompanied by episodes of "falling out" of the pulse, which is observed when the ventricles are insufficiently filled during diastole.

Then it is carried out. When listening, you can notice the presence of premature І and ІІ tones. By the way, with such a disease, the first tone is increased, which is associated with a small filling of the ventricles. But the second tone, on the contrary, is weakened, since the release of blood into the aorta and pulmonary artery is much less.

After that, the doctor will probably send the patient to do a cardiogram of the heart. This is one of the most accurate research methods. In some cases, a so-called Holter ECG is performed. What is this procedure? A special portable device is attached to the patient's body, which records the heart rate for 1-2 days. Along with this, the patient keeps an activity diary in which he describes his feelings and the actions taken. Such a study is used if it is necessary to find out what provokes an attack of extrasystole.

If heart rhythm disturbances are not observed at rest, additional tests are carried out - this is a bicycle ergometry and a treadmill test. Such studies make it possible to measure indicators (blood pressure) and make an ECG during physical exertion (for example, walking on a treadmill, exercising on an exercise bike). If organic myocardial damage is suspected, patients are advised to do ultrasound and MRI of the heart.

How is extrasystole treated?

As already mentioned, the treatment of extrasystole of the heart directly depends on the causes of its occurrence. For example, if a rhythm disorder is associated with taking some medications, then, of course, they must be canceled. If the causes lie in the disorder of the digestive or cardiovascular systems, then they should be treated first of all, and the attacks of extrasystoles will disappear along with the primary disease.

In some cases, diagnosis helps to understand that rhythm disturbances have arisen against the background of nervous overstrain. Such patients are referred for consultation with a neurologist and are usually given mild sedatives or sedative herbs.

Single and rarely occurring attacks of extrasystole do not require specific drug treatment, patients are only recommended to follow the principles of a healthy lifestyle and undergo repeated examinations from time to time.

If the attacks are observed frequently, accompanied by shortness of breath, strong shocks and weakness, then, most likely, the doctor will select the appropriate medications. As a rule, to eliminate violations, the so-called including lidocaine, sotalol, novocainamide, diltiazem, quinidine, cordarone, mexilene are prescribed. In no case should you use these drugs on your own, since the dosage and mode of administration here are purely individual. Moreover, sometimes drugs are started to be administered during Holter ECG monitoring, this makes it possible to understand whether the drug is really working as it should, and whether it will cause even more harm to the body.

For benign extrasystoles, drugs are taken until the attacks completely disappear, or at least their number is minimized. After that, the number of drugs begins to gradually decrease, and then they are completely canceled. As a rule, such treatment lasts several months. But in malignant forms of the disorder, patients take antiarrhythmic drugs throughout their lives.

In cases where such drugs do not work, or if the patient has an intolerance to them, other methods of treatment are used, in particular, by the way, the indication for this form of therapy is the ventricular form of extrasystole, which is accompanied by 20-30 thousand attacks per day. This is a minimally invasive surgical procedure. It is carried out using a special endovascular catheter that transmits high-frequency currents. Thus, the electrode acts pointwise on areas of the heart where conduction is impaired. With the help of such a procedure, it is possible to block the transmission of pathological, “wrong” impulses and resume normal sinus rhythms.

Consequences of cardiac arrhythmias and prognosis for patients

Forecasts for patients directly depend on the course of the disease and the presence of concomitant disorders. For example, extrasystoles that develop against the background of a heart attack, cardiomyopathy and organic myocardial damage are considered the most dangerous.

In any case, the lack of qualified and timely assistance can lead to a lot of complications. Despite the fact that in most cases, extrasystole is benign, sometimes other dangerous diseases develop against its background, including paroxysmal tachycardia, atrial fibrillation and atrial flutter. Such conditions can lead to sudden death of the patient.

There are some other complications that accompany extrasystole. These are, first of all, problems with blood circulation and tissue nutrition. Indeed, with repeated extrasystoles, the volume of blood ejected by the heart is significantly reduced. This leads to oxygen starvation and disruption of normal blood circulation. Often, extrasystole leads to the development of chronic insufficiency of the renal, coronary and cerebral vessels, which entails even greater complications.

Prevention methods

Of course, a patient with such problems should be registered with a cardiologist and undergo regular examinations. The main method of preventing dangerous complications of extrasystole is the correct treatment of the primary disease. Sick people need to take the drugs prescribed by a specialist, as well as follow the schedule and regimen of treatment. In addition, regular heart rate studies are mandatory, as this gives the doctor the opportunity to monitor the rate of development of the disease and the effect of the prescribed drugs.

Surely patients will need to radically reconsider their lifestyle. Any heart disease requires a special diet. Quitting smoking, drinking alcohol and caffeine is a must. And, of course, moderate but regular physical activity, walks in the fresh air will be useful for the work of the cardiovascular system.

Separately, it is worth talking about first aid. An attack of extrasystole, as a rule, occurs suddenly. The patient should lie down and calm down. It is also recommended to unbutton the top buttons of the shirt, loosen the tie and belt, in a word, remove all possible obstacles that interfere with breathing. If the attack was caused by stress, then it is allowed to take a small amount of a sedative. It is best to call an ambulance, as the consequences of extrasystoles can be dangerous.

Normal heart activity is called contractions in the range of 60-80 beats per minute. The pulses must go at regular intervals. Such work is given to cardiomyocytes by pacemaker cells. Under the influence of certain reasons, their function changes. Violation of the heart rhythm manifests itself in the form of various options. When an arrhythmia occurs, patients are concerned about symptoms, the severity of which is determined by the severity of the condition.

Why does heart rhythm disturbance occur and what is it? The term "arrhythmia" refers to changes accompanied by a disorder in the sequence and regularity of myocardial contractions. The beats per minute will be variable.

The heart rate becomes different from sinus. It is observed normally in a healthy person. Any cause that provokes arrhythmia can lead to a violation of the vital functions for which the heart is responsible.

The classification of rhythm disturbances according to Zhuravleva and Kushavsky from 1981 has received the greatest distribution. It includes the following options for the pathology of the cardiovascular system:

1. Change in automatism in the sinus node (nomotopic arrhythmia):
   1. sinus bradycardia;
   2. sinus tachycardia;
   3. weakness of the conduction of the sinus node;
   4. sinus arrhythmia.
2. Ectopic rhythm (heterotopic arrhythmia):
   1. atrial heart rate;
   2. atrioventricular (nodal) rhythm;
   3. dissociation of function of the atrioventricular type;
   4. idioventricular rhythm (ventricular);
   5. migration of the supraventricular pacemaker;
3. Rhythm disturbance associated with changes in myocardial excitability:
   1. paroxysmal variant of tachycardia;
   2. extrasystole.
4. Rhythm disturbances by type of conduction and excitability changes:
   1. flicker ( ;
   2. atrial fibrillation (atrial fibrillation);
   3. atrial flutter;
5. Rhythm disturbance associated with a change in conduction:
   1. interatrial blockade;
   2. sinoatrial blockade.
6. Atrioventricular blockade:
   1. premature excitation of the ventricles;
   2. blockade of the ventricles (branches of the bundle of His).

Each disease from the listed classification has its own causes, treatment. Symptoms of cardiac arrhythmia are expressed depending on the severity of the condition and the therapy.

Causes of irregular heart rhythm

When failures of the heart rhythm appear, the main importance is given to finding the cause. Many variants of arrhythmia are similar. You can figure out what type of disorder the patient has with the help of a comprehensive examination.

Endogenous factors

Some diseases pose a danger to the cardiovascular system. These include the following causes of heart rhythm disturbances:

1. Chronic diseases of the cardiovascular system. When symptoms of arrhythmia appear, the main importance is attached to ischemic processes in the myocardium, myocarditis, myocardial infarction, congenital and acquired defects. In people over 40, atherosclerosis plays an important role. The deposition of cholesterol in the form of plaques on the walls of blood vessels does not allow them to retain their elasticity properties.
2. Pathology of the nervous system.
3. Violation of metabolic processes in the form of hypokalemia or hyperkalemia.
4. Hormonal changes associated with thyroid diseases (hypothyroidism and thyrotoxicosis).
5. Violation of the heart rhythm as one of the manifestations of cancer pathology.

In some cases, patients with glomerulonephritis or pyelonephritis also complain of interruptions in the work of the heart. For this reason, it is important to remember that pathology from other organ systems can disrupt the normal rhythm.

Exogenous factors

Some environmental factors (or active human activity) negatively affect the body. They cause a heart rhythm disturbance, the symptoms of which may not bother a person for a long time. External factors include:

1. Age over 40 years. Most often, people in this category begin to feel unpleasant symptoms in the region of the heart, which are characteristic of arrhythmias.
2. Tobacco smoking, drinking alcohol. Toxic substances adversely affect blood vessels and myocardium.
3. Traumatic brain injuries lead to damage to the central or autonomic nervous system. Any symptom can have a negative effect on the heart.
4. It is not recommended to drink more than 3 cups of coffee. Due to the content of a large amount of caffeine, acceleration of contractions is noted, blood pressure rises. Changes in the state of the cardiovascular system can lead to arrhythmia.
5. Under the influence of anesthetics, the load on the myocardium increases. This becomes one of the reasons for the disruption of his work.

In some cases, the cause cannot be determined. If the factor is not fully understood, then it is idiopathic. Predisposing phenomena are considered a violation of the regime of work and rest, obesity, a sedentary lifestyle.

Both an adult and a teenager can get sick. The main causes of arrhythmia in a child at an early age are defects, diseases and poor heredity. In pediatrics, they give individual recommendations, depending on age.

Diseases in which rhythm disturbances occur

Not only the pathology of the cardiovascular system leads to a disorder of the functions of the heart. The appearance of signs of the disease is possible if the patient has:

• atherosclerosis;
• myocarditis;
• congenital anomalies of the structure;
• dystrophic processes in the myocardium;
• heart attack;
• heart failure;
• pheochromocytoma;
• arterial hypertension;
• hernia in the esophageal opening of the diaphragm;
• cardiomyopathy.

Among patients, arrhythmia is more common, the main cause of which is a dysfunction of the cardiovascular system.

Myocarditis

Myocarditis is inflammation of the muscle. This occurs after the defeat of cardiomyocytes by infection. Violation of the heart rhythm occurs under the influence of toxic substances released by microorganisms.

The clinical picture depends on the degree of change in the walls of the organ and the severity of the process. The onset may be asymptomatic. Based on pathophysiology data, even slightly affected heart cells cause arrhythmia.

myocardial infarction

Violation of the blood circulation of the coronary vessels leads to myocardial necrosis. In the local area, foci are formed that cease to be active. In some cases, with spasm of the arteries, the same outcome occurs. A properly selected algorithm of emergency care reduces the risk of complications.

One of the consequences of the post-infarction state is a violation of the heart rhythm. Necrotic areas in the myocardium can be large and small.

Pheochromocytoma

Education is a tumor with localization in the adrenal medulla. It is found in early childhood, adolescence and adulthood. Cells begin to produce large amounts of catecholamines. These include epinephrine and norepinephrine. In rare cases, the tumor becomes malignant. This type of cell spreads through the bloodstream to other organs.

Pheochromocytoma always occurs with an increase in blood pressure. During a crisis provoked by catecholamines, it increases sharply. In the interictal period, it remains stable at high numbers, or may decrease. With the formation of even a small tumor, the heart rhythm changes. At the prehospital stage, assistance is provided to normalize pressure. The patient is taken to the hospital and operated on after the examination.

Manifestations of cardiac arrhythmias

Manifestations and signs of arrhythmia depend on the variant of the disease according to the classification. Some patients feel satisfactorily and in rare cases there are unpleasant signs in the heart area. Prolonged asymptomatic course adversely affects the myocardium, and such a condition is difficult to detect at an early stage.

When the normal function of the atrioventricular node is disrupted, an imbalance occurs between the atria and ventricles. Impulse conduction becomes difficult, and the heartbeat slows down. The frequency of myocardial contractions is about 25-45 per minute. The following symptoms are characteristic:

• severe weakness on the background of bradycardia;
• dyspnea;
• dizziness;
• darkening in the eyes;
• fainting;

For atrioventricular blockade, episodes of loss of consciousness are characteristic. The fainting lasts for about a few seconds.

Atrial fibrillation (flicker)

This variant of arrhythmia is more common than others. She was assigned the ICD code - I 48. The heart rate can be up to 600 beats per minute. The process is not accompanied by the coordinated work of the atria and ventricles. Patients describe a sharp deterioration in well-being. Some of them indicate the minutes of such changes.

It all starts with sensations of a strong heartbeat, interruptions and weakness. Gradually joins the lack of air, a feeling of fear and pain in the chest. When atrial fibrillation occurs, the condition worsens dramatically. Everything takes a matter of minutes. During this time, the feeling that "the heart will soon jump out of the chest" does not leave.

Sick sinus syndrome

This variant of arrhythmia is associated with a disorder in the formation of an impulse in the sinus node and further conduction in the atria. Bradycardia appears in the norm and in healthy people who are athletically trained.

People feel pauses during the work of the heart, and the pulse is harvested. With a pronounced syndrome, there is a tendency to fainting, which is preceded by darkening in the eyes or a feeling of heat.

Extrasystole

Under the influence of various factors, the conduction system of the heart generates extraordinary contractions of the myocardium (extrasystoles). Single manifestations are not life-threatening and are rarely felt by people. When there are a lot of them or they become group, patients begin to complain. They experience a strong heartbeat, and between individual beats there is a pause, which is described by people as a fading.

Diagnosis of pathology

Before starting to treat the patient, a complete examination is carried out. It includes the implementation of laboratory and instrumental methods. After receiving the conclusion, the doctor determines the further tactics of managing the patient, depending on the individual characteristics.

Blood analysis

This survey option is one of the most accessible methods. It includes parameters by which the probability of an inflammatory process is determined. This can be done by assessing the level of leukocytes in the blood and the erythrocyte sedimentation rate (ESR). It is important to study and biochemical analysis. The electrolyte composition plays an important role for the normal functioning of the myocardium. An imbalance of potassium and magnesium in the bloodstream leads to arrhythmias.

Lipid profile

This type of examination is necessary for all patients. If the rhythm is disturbed, it is necessary to assess the state of the vascular wall. Based on the results obtained, the doctor begins treatment. If there are very few high-density lipids, and the limits of bad cholesterol exceed the allowable values, therapy is necessary.

ECG (electrocardiography)

The instrumental method is considered one of the main methods for determining cardiac arrhythmias. Any disorders occurring in the myocardium will be reflected on the film. Electrocardiography (ECG) detects the following:

1. The source of rhythm, whose task is to generate impulses.
2. Heart rate.
3. Impaired conduction from the atria to the ventricles.
4. Possible extraordinary contractions of the myocardium.
5. Fibrillation or flutter of the ventricles and atria.

In a number of patients, with the help of this examination, it was possible to detect changes that did not manifest themselves in any way.

Holter ECG

With the help of a modern research method, it is possible to detect changes that an electrocardiogram has detected. The advantage is that it can be done within 24 hours. All this time, a sensor is attached to the patient, which takes all indicators of cardiac activity.

The patient is advised to lead a normal life. So that he does not miss any little thing related to activity, a diary is started. On its pages, the subject fixes his workload, stress and other parameters that the doctor will recommend. The next day, he returns to his cardiologist to evaluate the results.

Event Monitoring

This type of study is carried out using a portable device for recording an electrocardiogram. The convenience of the method lies in its use only when necessary. The indications are:

• pain in the region of the heart;
• strong heartbeat;
• feeling interrupted;
• feeling of fading;
• the appearance of dizziness and a sharp headache;
• pre-fainting state.

After recording the data at the right time, the patient can use the sound sensor to transmit information to his doctor by phone.

During physical activity in the usual mode or with severe tension, patients experience pain. Sometimes it is difficult to evaluate the indicator, and for this reason stress tests are prescribed.
The patient gets on the treadmill, and the doctor sets the required pace.

If there are no changes, then the angle of its inclination is changed, the speed is increased. If pain, interruptions and other unpleasant sensations occur, the procedure is completed and the data obtained is evaluated. When a violation of the heart rhythm is confirmed, treatment is prescribed.

Tilt test

This procedure is a variation of the one described above. Its essence lies in carrying out an orthostatic load. Before the start of the study, the patient is placed on a special table. It is fixed with straps and transferred from a horizontal to a vertical position. In the process of implementation, the following indicators are evaluated:

• blood pressure level;
• ECG changes;
• cerebral hemodynamics.

If fainting occurs, the cause is determined using a tilt test.

EchoCG (echocardiography)

The study makes it possible to assess the state of the structural elements of the heart, the level of blood flow, pressure in the vessels. In the presence of changes associated with age or infectious disease, even minor deviations can be considered.

Electrophysiological research method

To assess the state of the heart, an electrode is inserted through the nasal passage into the esophagus (transesophageal echocardiography). If it is impossible to perform it in the indicated way, the procedure is done intravenously. The sensor enters the cavity, and the doctor gives a slight impulse. It provokes an attack of arrhythmia.

The presented method is assigned to each patient with arrhythmia. The reason for this condition may be due to an altered thyroid function. If the patient has it reduced, then bradycardia and blockade occur, which is easy to detect using an ECG. With hyperthyroidism, tachycardia and extrasystoles are noted.

Treatment of cardiac arrhythmias

The choice of the method of therapy is based on the causes of arrhythmia, clinical manifestations, concomitant diseases. It includes several options:

• medication;
• non-drug.

In the absence of effect, the treatment of cardiac arrhythmias is carried out by cardiac surgeons.

Medical method

To choose the right tool, a comprehensive examination is carried out. Under the control of electrocardiography, the results of treatment with antiarrhythmic drugs are evaluated. The following classes of drugs are prescribed (depending on the indications):

1. Drugs that stabilize cell membranes (class 1) - Lidocaine, Quinidine, Propafenone.
2. Beta-blockers (grade 2) - "Metoprolol", "Atenolol".
3. Potassium channel blockers (grade 3) - Amiodarone, Sotalol.
4. Calcium channel blockers (grade 4) - Verapamil, Diltiazem.

The patient is under the control of the doctor, if necessary, he must take tests. Depending on the psychosomatics and the patient's attitude to his health, a consultation of other specialists is prescribed. Additional funds may be required as indicated. They should go well with arrhythmia pills.

Non-drug treatment

If the therapy is successful and the condition returns to normal, then folk remedies can also be prescribed. For this, medicinal herbs are used, which are mixed in a certain ratio. Valerian root, lemon balm, motherwort and anise are widely used. The ingredients are combined, poured with boiling water and insisted for about half an hour. Then the resulting infusion is taken at a dose of ½ cup three times a day.

One of the healing methods is the right lifestyle and nutrition. It is necessary to give up tobacco, alcoholic beverages and junk food. To maintain a healthy heart, it is recommended to drink water (1.5-2 liters per day). If there is swelling, then this issue is resolved with the attending physician.

The diet should contain a lot of fresh vegetables and fruits. For the myocardium, bananas, dried fruits and baked potatoes are considered especially useful. They are richer than other foods in potassium, which is needed for heart function.

In the absence of dynamics from treatment at home, the patient is referred for surgical intervention. The most common and effective are:

• cardioversion;
• setting an artificial pacemaker;
• ablation;

Cardioversion is indicated for patients with ventricular arrhythmias. The method is based on the application of a discharge of electricity. It is important to make a correct differential diagnosis. If the form of conduction disturbance turns out to be atrial, then the procedure will be contraindicated. This is due to the high likelihood of blood clots.

If the heart cannot cope with the problem on its own, then an artificial pacemaker is installed under the skin. When an arrhythmia focus is detected, a catheter is inserted, the task of which is to destroy it - ablation. This method of treatment will return the patient to a full life.