Arrhythmia caused by dysfunction of the contractility of the heart

These arrhythmias are alternating and paradoxical pulse.
Alternating pulse is in the correct alternation of large and small pulse waves. Autopsy picture is sharp degenerative or inflammatory changes infarction. The mechanism of occurrence of alternating pulse are not completely understood. In clinical cases of alternating pulse, apparently caused the partial asistoliei fibers of ventricular myocardium.
The clinical picture. Alternating pulse monitored in patients with severe myocardial damage, especially when it is associated with high blood pressure and tachycardia; sometimes with paroxysmal tachycardia. With the feeling of the heart rate can be set to the correct alternation of large and small pulse beats. Auscultation of the power tones are usually the same for large and small pulse beats. Described, however, cases of fluctuations of the intensity of colors. On spirogramma observed alternation of large and small waves (Fig. 39). ECG ventricular complexes, corresponding to large and small shock pulse, usually the same.


Fig. 39. Alternating pulse. SFG brachial artery.

The diagnosis can be made on the basis of the feelings of the pulse data and be noticed. To distinguish alternating pulse from pretending it sometimes arrythmia (bigeminii) - pseudoalteromonas pulse (Fig. 14) - using data electrocardiographic studies. Evaluation of ability to work due to severe myocardial damage adverse; patients to professional work are usually not suitable.
Treatment is determined by the primary disease and condition of myocardium.
Paradoxical pulse, the rhythm, consisting in a sharp decrease, and sometimes disappearance of pulse waves when inhaling and increase of pulse waves during exhalation. This pulse was called paradoxical, since it is not observed respiratory arrhythmia. Paradoxical pulse can occur when the anomalies of the chest or if it tumors and scars, impeding the passage of the pulse wave, with breath - extracurricula form. It may occur with heavy losses attack, when expressed negative pressure in the chest cavity with a deep breath, can impede blood flow and cause a reduction of pulse wave - dynamic form. Sometimes paradoxical pulse due to the strong binding between the heart and surrounding tissues that make it difficult when you inhale the systole and cause a reduction in pulse wave - mechanical form.
The diagnosis is usually does not cause trouble.
Treatment and estimation of capacity for work depends on the underlying disease. Cm. also Antiarrhythmic agent.