Pathology, in which the heart rate becomes more frequent, despite the fact that the indicators of the latter remain stable, is called atrial flutter. This violation refers to the forms of atrial fibrillation. Fibrillation and atrial flutter among this kind of pathologies are the most common, and they can alternate. The main difference between the first is that with it the activity of the atria is chaotic.
Concept
The pathology under consideration causes a violation of the course of the impulse in the heart along the atrial conduction system. It begins to circulate in a circle in the right atrium. This leads to repeated repeated excitations of the myocardium, which dramatically increases the frequency of contractions.
At the same time, the ventricular rate may remain normal or be elevated, but not as much as the atrial rate. This is due to the fact that the atrioventricular node cannot conduct an impulse so often. An exception to this are patients withWPW-syndrome, in the heart of which there is a bundle of Kent, which conducts an impulse from the atrium to the ventricle at an increased speed compared to the atrioventricular node. In this regard, such patients may also experience ventricular flutter.
Pathology is most common in men over 60.
The time it takes for an attack to pass is called a flutter paroxysm.
Etiology of disease
The occurrence of atrial flutter is influenced by both factors related to the cardiovascular system, and those that are caused by disruption of the internal organs and other systems.
First reasons include:
- abnormal structure of the heart;
- hypertrophy of his chambers;
- cardiomyopathy of varying severity and forms;
- high blood pressure;
- presence of a tendency to form blood clots;
- ischemic disease;
- atherosclerosis;
- complications after surgery.
Indirect causes include the following:
- endocrine disorders;
- pulmonary embolism;
- emphysema of this organ.
Factors contributing to the development of this pathology are as follows:
- drug intoxication;
- sign of sleep apnea;
- diabetes mellitus;
- cardiovascular disease in relatives;
- constant turmoil and stress;
- excessive physical activity;
- uncontrolled acceptance of funds containingcaffeine;
- bad habits.
With cardiac causes, the clinical picture may be unexpressed and inherent in many cardiovascular diseases. They can be mistaken for signs of comorbidity:
- oxygen deficiency during exercise;
- decrease in motor activity;
- depressed state;
- apathy;
- fatigue;
- shortness of breath.
People at risk should undergo periodic medical examinations by a cardiologist, since if this pathology occurs and treatment is not started in time, death is possible.
Classification of atrial flutter
It is carried out according to the nature of the development and the clinical course of the pathology.
According to the first sign, the following forms of atrial flutter are distinguished:
Typical (classic) - flutter frequency per minute is 240-340 beats. The wave of excitations circulates in a typical circle in the right atrium.
Atypical - the frequency is 340-440 beats, the correct form of the rhythm is not noted. A wave of excitement circulates in the same place, but not in a typical circle.
According to the nature of the course, the pathology is divided into the following forms:
- first developed;
- persistent;
- paroxysmal;
- constant.
The clinical picture in the form of the pathology is almost identical, therefore, it is possible to establish what kind of violation is possible only by carrying out special diagnostic measures.
Paroxysmal atrial flutter lasts up to one week, stops on its own, persistent - more than this period, sinus rhythm does not recover on its own. Permanent occurs when the applied therapy did not bring the expected result or when it was not carried out.
Tahisistology leads first to diastolic and then to systolic dysfunction of the left ventricular myocardium, as well as the appearance of heart failure. With this pathology, coronary blood flow decreases up to 60%.
Symptoms of the disease
In some cases, it is asymptomatic, which does not exclude the onset of death. There are the following signs of atrial flutter:
- pressive pain located in the chest area;
- fainting and loss of consciousness;
- headache and dizziness;
- feeling weak;
- hyperhidrosis;
- pallor of epithelial integuments;
- breathing heavy, shallow;
- heartbeat palpitations;
- shortness of breath.
The following factors may contribute to the onset of symptoms:
- disruption of the digestive tract;
- drinking lots of fluids, including alcohol;
- transferred emotional overstrain;
- extended exposure to heat or stuffy room;
- excessive exercise.
Seizures can occur from several per week to 1-2 per year and are determined by individual characteristicsorganism.
Diagnosis
To determine the disease, the following activities are carried out:
- cardiac electrophysiological study;
- determination of electrolytes;
- rheumatological tests;
- definition of thyroid hormones;
- biochemical and complete blood count;
- MRI and CT;
- transesophageal echocardiography to detect blood clots in the atria;
- ECG;
- History taking and physical examination of the patient.
Atrial flutter on ECG shows:
- dynamic frequency and duration of paroxysms;
- appearance of F-atrial waves;
- wrong rhythm.
As a result of the diagnosis, it becomes clear what caused the disease and how it should be treated.
With atrial flutter, a rapid and rhythmic pulse is detected. With a conduction ratio of 4:1, the pulse can be 75-85 beats per minute, with a constant dynamics of the coefficient, the rhythm becomes irregular. With this pathology, there is a frequent and rhythmic pulsation of the cervical veins, which exceeds the arterial pulse by 2 times or more and corresponds to the atrial rhythm.
With atrial flutter, the 12-lead ECG shows atrial sawtooth F waves, regular gastric rhythm, no P waves. Ventricular complexes remain unchanged, preceded by atrial waves. When massaging the carotid sinus, the latter become more pronounced due to increased AV-blockade.
When conducting an ECG during the day, the pulse rate is evaluated at different periods and paroxysms of the pathology are determined.
ICD atrial flutter
After the transition to the ICD-10, in accordance with the recommendations of the European Association of Cardiology, the term "atrial fibrillation" was derived from the official terminology. Instead, the concepts of "fibrillation" and "atrial flutter" began to be used. It is in this combination that they are recorded in the international classifier of diseases of the 10th revision. Their code is I48.
Medicated treatment
Emergency medical care is provided by the use of low power current. At the same time, antirhythmics are administered.
General treatment for atrial flutter includes the following medications:
- anticoagulants;
- potash;
- cardiac glycosides;
- beta-blockers
- antiarrhythmic drugs;
- calcium channel blockers.
When an attack lasts no more than 2 days, use electrical pacing with the following drugs:
- "Amiodarone";
- "Quinidine" and "Verapomil";
- "Propafenone";
- Procainamide.
Anticoagulants are administered to prevent thromboembolism.
At the same time, the following activities are also carried out:
- Pacemaker installation;
- radiofrequency ablation.
Irregular flutter is treated with blood thinners.
Coursedrug therapy is also prescribed after the operation.
Atrial flutter should be treated as soon as the first clinical signs appear. However, it is currently impossible to completely eliminate the pathology. Only the probability of their occurrence is minimized if the patient takes all the drugs prescribed by the doctor.
International recommendations
World experts suggest using the following drugs for antithrombotic therapy, depending on the level of risk of thromboembolic complications:
- if there is a thrombus in the atrium, a history of thromboembolism, artificial heart valves, mitral stenosis, arterial hypertension, thyrotoxicosis, heart failure, 75 years of age and older, with coronary artery disease and diabetes mellitus - from 60 years old - oral anticoagulants;
- if you are under 60 years of age and have heart pathologies that do not imply the presence of congestive heart failure, arterial hypertension - "Aspirin" (325 mg / day);
- for the same age in the absence of heart disease - the same medicine in the same dosage or no treatment.
Recommendations for atrial flutter include monitoring with indirect coagulants at the beginning of treatment - from once a week and more often if necessary, thereafter - once a month.
Surgical and instrumental treatment
Possible electric current treatment when useddefibrillator. In many cases, there is a stabilization of heart rhythms and an improvement in the well-being of patients. Sometimes such a method of treatment does not bring the expected results, the rhythm is broken again after a while.
In addition, this procedure can lead to the development of strokes, therefore, before it is carried out, if possible, intravenous and subcutaneous injections are prescribed to thin the blood.
If conservative treatment does not help and arrhythmia recurs, the doctor prescribes:
- radiofrequency ablation;
- cryoablation.
They are held in relation to the conducting paths along which the impulse is circulated during an attack.
In the event of various complications and severe pathology, an operation is performed. It is necessary in order to:
- stabilize heart rate and heart rate;
- improve the general condition of the patient;
- suppress the focus of pathology.
Typical paroxysms are treated with transesophageal pacing.
Forecast
The disease is characterized by resistance to therapeutic treatment against arrhythmia, a tendency to relapse, persistence of paroxysms.
The long-term outlook is unfavorable. Hemodynamics is disturbed, the work of the chambers becomes inconsistent, cardiac output decreases by 20% or more. There is a discrepancy between the capabilities and needs of the body for the implementation of metabolic processes, which leads tochronic circulatory failure. Atrial flutter, which has a poor prognosis, can lead to expansion of the cavities of the heart muscle, which can lead to death.
In the chronic form of the disease, parietal blood clots form in the atria. In the event of their separation, catastrophic conditions in the vessels can be observed. The consequences of the disease can manifest themselves in the pulmonary and systemic circulation, causing heart attacks of the intestines, spleen, kidneys, gangrene of the extremities, and strokes.
Complications
Different forms of atrial flutter can lead to the following complications:
- heart failure;
- thromboembolism;
- myocardial infarction;
- stroke;
- ventricular tachyarrhythmias;
- ventricular fibrillation.
All these pathologies can lead to death.
Prevention
There are no special preventive measures for the congenital form of the disease. The expectant mother should exclude bad habits and rationally build her diet.
General preventive recommendations include:
- timely treatment of various ailments to prevent their transition into a chronic form;
- moderate exercise;
- rational nutrition;
- giving up bad habits.
Lifestyle
Excluded from the diet:
- alcoholic beverages;
- coffee;
- tea;
- sweet soda.
Liquid intake is limited, the number of meals should be large, while it is taken in small portions. You can not eat foods that can cause flatulence and bloating. The diet is almost s alt-free.
The patient must be disciplined, take prescribed medications and avoid the influence of factors that can exacerbate the pathology.
In closing
Atrial flutter is a tachycardia with abnormal heart rhythm. Basically, it is disturbed in the atria, sometimes its strengthening is observed in the ventricles. The disease is not completely cured. It is only possible to minimize negative phenomena with the help of drug therapy, the use of various instrumental methods, and, if they are ineffective, an operation.
