Arrhythmia caused by violation of the functions of excitability and conductivity of the heart

This type arrhythmias include atrial fibrillation, atrial flutter and fibrillation of ventricles.
Atrial fibrillation is characterized by the absence of a coordinated reduction of myocardial fibrillation and alternating wrong in strength and consistency contractions of the ventricles of the heart. Pathologic process, causing flickering, is localized in the Atria. This coordinated atrial contraction does not, in their infarction occur continuous wave-like movements. The ventricles are in the process a second time and react by changing the sequence and power of heartbeats.
Flicker is observed more often at the heart diseases, mainly to the contraction of the left atrioventricular holes, cardiosclerosis different pathogenesis and thyrotoxicosis.
Certain autopsy picture, typical atrial fibrillation, no.
Shimmer and atrial flutter explain or appearance incremental foci excitation causing simultaneous dissolvine reduction of individual atrial fibers of the muscles, or (Jari you have one source of excitation) a change in the sequence in reducing individual parts of the myocardium fibrillation. For the emergence of flicker and flutter two conditions are necessary: shortening refractory phase fibrillation and slow the passage in them excitation. Both of these processes are closely connected with the activities of the autonomic nervous system, which plays an important role in the pathogenesis of blinking and atrial flutter. The impact of atrial fibrillation in circulation is mainly determined by three factors: stopping contractions of the Atria, incorrect operation of the ventricles and the reduction in the regulatory role of non cardiac nerve function of the heart.
The clinical picture depends on the disease that caused the flickering on the state of the patient's blood circulation and the shape of the flickering. There are the following forms of atrial fibrillation:
1) persistent subdivided into tachysystolic (tahiaritmical) with frequent ventricular and heart rate and predicitions (bradiaritmiu) with ischemia ventricular contractions and
2) paroxysmal.
When tachysystolic, the most frequent form of atrial fibrillation patients complain of discomfort in the heart, sometimes shortness of breath, dizziness and inner turmoil. Pulse Ochsen, pronounced uneven in the sequence and power pulse waves. In this form of flicker is most often observed pulse deficit - the difference between the number of heartbeats and the number of pulse beats.
When predicitions form of atrial fibrillation, as and when the form with a normal number of ventricular contractions, complaints patients often minor or absent. The pulse is not ucase (from 70 to 80 in 1 min). The unevenness in the sequence and power pulse beats slightly expressed. The number ventricular contractions coincides with the number of pulse waves. Poorly expressed and the changing power of the first tone. Between tachysystolic and predicitions forms of atrial fibrillation has a number of transitional forms.
Paroxysmal form of atrial fibrillation in its clinical picture often similar with paroxysmal tachycardia. Seizure flicker largely linked to physical exhaustion, anxiety, or mental injury. Sometimes the attack appears for no apparent reason. The duration of attacks from a few seconds to several days. The clinical picture during a seizure, the same as when tachysystolic form flicker. When listening characterized by a growing and changing sonority first tone.
Spirogramma atrial fibrillation is characterized by an abnormality in the sequence and the pulse wave.


Fig. 33. Atrial fibrillation - tachysystolic form. SFG brachial artery.

Fig. 34. Atrial fibrillation - predicitions form. SFG brachial artery.

ECG (Fig. 33 and 34), and P wave is missing. Throughout the ECG has various size and shape fluctuations due to continued reductions in individual fibers myocardial fibrillation. The oscillation amplitude in different derivations different; the form it can be macowanites and grupowanie. The number of atrial fluctuations from 400 to 600 in 1 min.
Ventricular complexes followed with irregular intervals. The form of complex slightly distorted by layering on him atrial fluctuations. When tachysystolic the form of the QRS complex, sometimes considerably changed due to the functional block of legs or branches wiring system. On FCG lack of atrial oscillations first tone (fourth tone) and changing with each contraction, the amplitude of the first tone.
Flickering can be combined with other types of disturbed rhythm. When a rarely observed combination flicker with a complete atrioventricular block, a phenomenon Frederick - ECG number ventricular contractions reduced form ventricular complexes normal, they follow one after another with the same intervals (Fig. 35).


Picture.35. The combination of atrial fibrillation with full atrioventricular block, a phenomenon Frederick.

Diagnosis of atrial fibrillation usually made on the basis of probing pulse and listening. In some cases, to clarify required electrocardiographic examination.
Evaluation of ability to work is reduced to determining the status of ventricular myocardium and blood circulation. The same phenomenon flicker atrium does not lead to a complete loss of earning capacity.
Treatment of atrial fibrillation are conducted mainly drugs naperstanki and quinidine. Intravenous strofantina can sometimes seek cessation of atrial fibrillation. Terminating atrial fibrillation can be achieved by the use of quinidine and novocaine-amide. Before applying, it is recommended the appointment of drugs naperstanki to improve blood circulation and anticoagulants to prevent the formation of fresh blood clots and avoid embolism during the transition to sinus rhythm. Quinidine assign inwards in gradually increasing doses (0,2-0,3 g every 8-6-4-2 hours) under the supervision of ECG. The daily dose of quinidine in the hospital, you can bring up to 3-3,6, Therapeutic effect occurs when the number of quinidine in 1 l of blood reaches 5 mg At 6-8 mg per 1 l of blood may be the symptoms of intoxication. Treatment with quinidine is recommended to combine with the appointment of kordiamin. Treatment with high doses of quinidine should continue 5-7 days; after restoring sinus rhythm is recommended long-term use (up to 1-2 months), quinidine (0,3-0,6 g / day). Novocaine-amide appoint 0.5-1 g every 6-4 hour. The average dose of 4 grams per day, after restoring sinus rhythm is 1.5-2 g per day. In resistant cases, you can assign a combined treatment with quinidine and novocaine-Amida. Stop flickering manage to make use defibrillator (see the Revival of the body), causing the transition to a normal rhythm by a capacitor discharge certain voltage (N. L. The Gurvich).
Method of terminating atrial fibrillation strong alternating current by Soviet authors is not applied because of its lower efficiency and higher risk compared with capacitor discharge (A. A. Vishnevsky and B. M. Zuckerman).