Tachysystolic form of atrial fibrillation, otherwise known as "atrial fibrillation", is a failure of the heart rhythm, as a result of which the heart rate becomes more than 90 beats per minute. Fibrillation occurs when each individual muscle fiber of the heart chamber begins to contract actively and randomly. As a result, this leads to a violation of blood flow. Signs of the disease do not appear in all individuals; in practice, an asymptomatic form of the disease is common.
Classification of atrial fibrillation
Systematize atrial fibrillation:
- by ventricular rate;
- chaotic rhythm duration;
- waves on the cardiogram.
Fibrillation is distinguished by duration:
- Primary - a single rhythm disturbance was recorded for the first time. It may vary in clinical manifestations, duration and complications.
- Persistent - lasts more than seven days. Does not stop without medical intervention and can last up to a year.
- Constant - like the previous one, a long period of time continues, but restoring the normal rhythm of the sinus node is impractical. The main goal of therapy is to maintain the existing rhythm and control the frequency of contractions.
- Paroxysmal - Atrial fibrillation starts and ends unexpectedly. Up to seven days, an attack of atrial fibrillation continues, which stops on its own.
Wave subtypes:
- large - 300-500 contractions per minute. Large and rare ECG teeth;
- small - up to 800 contractions (teeth small and frequent).
Depending on the damage to the heart valves, fibrillation occurs:
- Non-valvular - with prosthetic valves.
- Valvular - with heart defects (congenital or acquired). The latter can form against the background of infective endocarditis, rheumatism. With this type of atrial fibrillation, therapy begins with the elimination of the provocateur.
Different forms of fibrillation are distinguished by frequency:
- Tachysystolic. The ventricles contract more than 90 times per minute, and at the same time there may be no pulse for some time. The reason for this phenomenon lies in the fact that the heart does not work at full strength. Insufficient strengthcontractions do not produce a pulse wave, cardiac output is irregular, and the ventricles are poorly supplied with blood.
- Normosystolic. Ventricular contractions are within the acceptable range of 60 to 90.
- Bradysystolic - contractions about 60 times, the work of the ventricles is inhibited. However, the pulse wave proceeds normally.
The second and third forms are the most favorable.
Paroxysmal form of atrial fibrillation. Tachysystolic variant
One of the most commonly diagnosed heart diseases is paroxysmal atrial fibrillation. In a normal state, the heart beats about seventy times a minute. Violation of its contractile activity leads to a change in the frequency of contractions, which can reach 800. Paroxysmal arrhythmia is accompanied by a circulatory failure. Its danger lies in the fact that myocytes contract randomly, the sinus node does not function, only two ventricles work. Paroxysm refers to recurring seizures or seizures. A characteristic symptom of paroxysmal atrial fibrillation is an increased heart rate and sudden tachycardia with a regular heart rhythm. If in 60 seconds the frequency of contractions exceeds 90, then this is a tachysystolic variant of the paroxysmal form of atrial fibrillation. Less than 60 is bradysystolic, and the intermediate option is normosystolic. The attack lasts from several minutes to seven days, it occurs suddenly and also stops. The following types of abbreviations are distinguished:
- flicker - the number of heartbeats perminute - more than 300;
- flutter - max 200.
This form of fibrillation can be recognized by the following symptoms:
- trembling;
- strong heartbeat;
- suffocation;
- excessive sweating;
- limbs getting cold;
- weakness;
- panic attacks;
- dizziness;
- fainting.
However, some individuals do not notice an attack, and the bradysystolic or tachysystolic form of paroxysmal atrial fibrillation is detected during the examination period, i.e. at a doctor's appointment in a medical institution. When sinus rhythm returns to normal, all signs of arrhythmia disappear. After an attack, a person develops polyuria and increased intestinal motility. It is necessary to stop the disease as early as possible, and preferably within two days after the onset of an attack. With constant fibrillations, drug therapy is recommended, which will help prevent cerebrovascular accident. Due to the random contraction of the atrial walls, the blood moves at a high speed. As a result, a clot can easily stick to the wall of the atrium and cause thrombosis, which leads to a stroke. If the tachysystolic form of paroxysmal atrial fibrillation degenerates into a permanent one, then there is a huge risk of heart failure.
Diagnosis of atrial fibrillation
When examining a patient, they reveal:
- blueness near the nasolabial fold;
- paleskin;
- excitement.
ECG for this disease was first recorded in 1906, and described in detail in 1930. On the ECG, atrial fibrillation of the tachysystolic form looks like this:
- missing P wave means no sinus rhythm;
- there are waves f of different heights and shapes;
- R-P intervals vary in duration;
- S-T segment and T wave can be modified.
Additional diagnostic methods are:
- biochemical and complete blood count;
- x-ray;
- transesophageal examination;
- echocardioscopy.
In practice, the diagnosis of "atrial fibrillation, tachysystolic form" is made on the basis of the patient's complaints, his questioning, external examination and ECG.
Causes of atrial fibrillation
Isolate cardiological and other factors that caused atrial fibrillation. The first are:
- neoplasms in the heart;
- hypertension;
- myocardial infarction;
- heart defects;
- cardiosclerosis;
- cardiomyopathy;
- myocarditis;
- cardiac ischemia;
- heart failure;
- consequences of heart surgery. Arrhythmia is formed as a result of a violation in the muscle tissues of the organ of the balance of trace elements (magnesium, calcium, sodium and potassium), as well as the occurrence of an inflammatory process in the area of \u200b\u200bthe sutures. It completely disappears after the coursetreatment.
The presence of several pathologies in an individual, such as hypertension and angina pectoris, increases the risk of developing rhythm disturbances. In mature and elderly individuals, the cause of the tachysystolic form of atrial fibrillation is coronary artery disease in combination with hypertension or without it.
Other factors:
- thyrotoxicosis:
- diabetes mellitus;
- gene mutations;
- obesity;
- hypokalemia;
- kidney disease;
- chronic obstructive pulmonary pathologies;
- vegetovascular dystonia;
- alcohol poisoning;
- tobacco smoking;
- electrical injury;
- side effects of some medications.
Extracardiac factors cause atrial fibrillation at a young age, and heart disease in older people.
Atrial fibrillation occurs in medical practice for unknown reasons - idiopathic arrhythmias.
Clinical manifestations of atrial fibrillation
Symptoms in the tachysystolic form of AF may be absent, and the pathology can be diagnosed only on ultrasound of the heart or ECG. However, the development of acute symptoms is also possible; in such cases, the unstable psycho-emotional state of the individual acts as a provocateur. Basically, the first manifestation of rhythm disturbance is in the form of an unexpected attack (paroxysm). Subsequent attacks become more frequent and lead to a permanent or persistent form of fibrillation. Some people have short attacks throughout their lives, notpassing into the chronic stage. At the beginning of the attack, an internal, rather sharp push in the chest is felt. Then the following symptoms appear:
- fear of death;
- feeling short of breath;
- chest pain;
- chill;
- tremor of limbs and body;
- shortness of breath;
- pulse is unstable, its speed changes;
- cold sweat breaks out;
- pressure drops;
- pallor of the skin;
- polyuria;
- disruption of the digestive tract.
Possible manifestation of neurological signs:
- loss of sensation;
- paralysis;
- coma;
- paresis.
This clinical picture is present if rhythm disturbance provokes thrombosis.
A person develops edema by the end of the day with a constant form of arrhythmia.
Some features of the tachysystolic form of atrial fibrillation
Irregular rhythm, accompanied by frequent and chaotic work of the heart chambers, is called tachysystolic atrial fibrillation. The source of such excitation is the myofibrils located in the atria (ectopic foci of electrical impulses), which make up to 700 contractions per minute. In this case, the ventricles during the same period make more than 90 shocks. Symptoms are similar to typical atrial fibrillation:
- heavy sweating;
- shake;
- discomfort in the chest area;
- panic attacks;
- shortness of breath;
- dizziness;
- weakness;
- pulsing neck veins.
A hallmark of the tachysystolic form of atrial fibrillation is pulse failure with an accelerated heartbeat, which leads to:
- flickering, if this cause caused such a heartbeat, then the number of contractions is 350-700;
- atrial flutter. Contractions occur 200-400 per minute. In this case, the correct atrial rhythm is stored and transmitted to the ventricles.
Atrial fibrillation of the tachysystolic form is more dangerous than others and is more difficult to tolerate, since in this case a huge load is placed on the heart. A fairly common complication is acute heart failure due to circulatory failure in peripheral vessels as a result of a decrease in minute and systolic blood volume.
Tachysystolic variant of atrial fibrillation in a permanent form is a rather dangerous disease that is difficult to treat. Nevertheless, it is possible to live with it qualitatively. The main thing is to follow all the doctor's prescriptions. The provocateur of atrial fibrillation in adulthood and old age is coronary artery disease, accompanied by hypertension or without it. In young individuals, provocative factors are:
- hyperthyroidism;
- heart defects;
- rheumatism.
Conditions in which tachysystolic atrial fibrillation may occur:
- IHD;
- acute cor pulmonale;
- cardiomyopathy;
- myocarditis;
- pericarditis;
- myocardial infarction and some other pathologies.
With the normo- and bradysystolic form of cardiac arrhythmias, there may be no subjective sensations or there may be a frequent heartbeat. Objectively, an arrhythmic pulse with its deficiency is determined. With the tachysystolic form, symptoms of heart failure and swelling occur.
Therapy
Treatment of the tachysystolic form of atrial fibrillation is to relieve unpleasant symptoms and prevent negative consequences. All therapeutic actions are directed to:
- to maintain a certain frequency of contractions;
- return to normal rhythm.
To achieve these goals apply:
- drug therapy with anticoagulants, antiarrhythmics, calcium channel blockers and beta-adrenergic receptors;
- electrocardioversion, i.e. exposure to electric current;
- installing a pacemaker;
- catheter RF ablation.
The use of anticoagulants helps prevent thromboembolism. Medicines of this group can be used for a long time. Patients of the older age group with concomitant pathologies (IHD, diabetes mellitus, thyrotoxicosis, hypertension, congestive heart failure, rheumatic heart disease) are recommended "Warfarin". Low molecular weight drugs of the heparin group are used in difficult situations when emergency measures are needed. All categories of patients are prescribed "Acetylsalicylic acid", "Dipyridamole". It is important to know that taking these drugs provokes bleeding, so it is necessary to controlblood clotting.
In order to normalize the heart rate in the treatment of tachysystolic atrial fibrillation, Amiodarone, Diltiazem, Metoprolol, Verapamil, Carvedilol are recommended. The use of these remedies makes it possible to alleviate the condition and remove unpleasant symptoms, and in addition, to prevent the development of conditions that provoke a threat to the existence of the individual. Unfortunately, such therapy is not able to stop the progression of rhythm disorders.
Electrocardioversion. Catheter radiofrequency ablation
With persistent tachysystolic form of atrial fibrillation, it is possible to achieve stabilization of the heart rhythm with electric current discharges. It is mainly used in a life-threatening situation. Manipulation is carried out under ECG control and anesthesia. A device called a cardioverter defibrillator delivers a synchronous electrical signal to the heart without causing ventricular fibrillation. In cases of problems with blood circulation with a short attack of arrhythmia, urgent cardioversion is indicated. At the same time, heparin preparations are administered. The impact on the heart can be carried out both from the outside and from the inside. In the first case, through the chest, and in the second, the electrode is brought through the catheter to the organ. Planned electrocardioversion is used in patients with prolonged arrhythmia without manifestations of circulatory disorders. Before this procedure, a three-week course of taking "Warfarin" is prescribed, which continues after the manipulation for a month.
In the medical form of cardioversion, means are used to restore sinus rhythm, which are administered intravenously:
- Nibentan has a strong effect. Due to possible side effects, including those affecting the rhythm of ventricular contractions, the patient should be monitored for a day.
- "Amiodarone" well stops seizures. It is indicated for persons with identified organic myocardial disorders. Taking it regularly can reduce the risk of sudden cardiac arrest by 50 percent.
- "Procainamide" has a membrane-stabilizing effect. Often provokes unwanted reactions in the form of headaches, hallucinations, lowering pressure.
This type of cardioversion is commonly used for paroxysmal arrhythmia and primary fibrillation. Therapy carried out in the first hours of the attack gives a positive result.
Radiofrequency catheter ablation is a surgical intervention that is used when other methods do not give the desired effect. A catheter inserted into a vein delivers an electrode to the heart tissue. It destroys the anomalous area that generates impulses with electrical discharges. A pacemaker is implanted at the same time.
Treatment and prevention of atrial fibrillation
In the absence of contraindications, antiarrhythmic drugs are used in a hospital setting:
- "Aimalin";
- "Novocainamide";
- "Disopyramide".
If usingof the above means, the rhythm has not recovered, then they switch to other drugs:
- Flecainide;
- "Amiodarone";
- Propafenone.
Medicines for the prevention of thromboembolism are recommended for persistent atrial fibrillation:
- Warfarin;
- "Fenilin";
- Sinkumar.
In the absence of the effect of drugs, try electrocardioversion. After the rhythm is restored, it is required to maintain it. In practice, it has been proven that the effectiveness of taking medications with a constant form of arrhythmia is about 50 percent, and from cardioversion - 90, provided that a doctor is contacted in a timely manner. Another way to treat the tachysystolic variant of a permanent form of atrial fibrillation is to use a special device that acts on the ventricles with electrical impulses. The pacemaker works even if medication has failed.
A large number of patients have relapses within the first year. Provocative factors are:
- physical activity;
- stress;
- drinking alcohol;
- taking diuretics;
- physiotherapy treatments.
If attacks are less than once a month, then constant therapy with antiarrhythmic drugs is not needed. With frequent attacks, the regimen and dosage of medications are selected for each patient. Treatment is monitored using:
- ECG;
- echocardiography;
- daily monitoring.
In the presence of a permanent form of atrial fibrillation (tachysystolic or otherwise), it is inappropriate to restore sinus rhythm. The goal of treatment is to prevent thromboembolism and reduce the frequency of contractions. In addition, continuous medication is indicated:
- calcium antagonists;
- cardiac glycosides;
- beta-blockers.
Aspirin or indirect anticoagulants are recommended to prevent thromboembolism.
Contraindications for the relief of attacks of atrial fibrillation
Treatment is not recommended for the following conditions:
- Tachy-bradysystolic syndrome.
- Frequent attacks of atrial fibrillation, in which electrocardioversion or the introduction of antiarrhythmic drugs into a vein is indicated. In view of the fact that in such patients it is impossible to maintain sinus rhythm for a long period, it is not advisable to stop an arrhythmia attack.
- Severe chronic heart failure and an observed enlargement of the left ventricle.
- An unconditional contraindication is a history of thromboembolism and the presence of a thrombus in the atria.
Complications
Prolonged course of atrial fibrillation provokes consequences:
- Severe cardiomyopathy with symptoms of heart failure, developing against a background of chronic atrial fibrillation.
- Thromboembolism caused by ineffective atrial contractions. Blood clots can be in the kidneys, lungs,spleen, brain vessels, peripheral vessels of the extremities.
- Hemodynamic disorder resulting in the formation or progression of heart failure, reducing the quality of life and performance of the individual.
Quite a high percentage of mortality among individuals with atrial fibrillation due to the occurrence of ventricular fibrillation. Of particular danger is the tachysystolic form of atrial flutter, so it is advisable to follow the advice of specialists on taking medications and other preventive measures. Comprehensive measures will help prevent new attacks, slow down the transition of the disease into a chronic form, in which there is a high risk of severe consequences.
Documentation of medical documents for patients receiving treatment in a hospital
For a patient who is being treated in a hospital, medical documents are filled out, in which all information about his state of he alth, such as a medical history, is entered. "Atrial fibrillation, tachysystolic form" is the main diagnosis, followed by concomitant and complications. In addition, the following data is entered into the medical history:
- Full name;
- place of work;
- age;
- date of admission to the he alth facility;
- complaints;
- case history;
- life history;
- the condition of the patient (described by organs);
- research results;
- differential and clinical diagnosis;
- etiology and pathogenesis of the underlying disease;
- treatment;
- prevention;
- forecast;
- epicrisis;
- recommendations.
This is how the medical history looks like.
How to deal with the problem of atrial fibrillation? Advice from practicing cardiologists
Regardless of the causes and clinical picture of atrial fibrillation, you should:
- prevent relapses;
- maintain normal sinus rhythm;
- control the frequency of contractions;
- prevent complications.
For this, a constant intake of medications is shown under the supervision of the attending doctor. Secondary prevention implies a complete rejection of alcohol, smoking, overexertion - both mental and physical. The prognosis of the disease depends on the cause that caused the tachysystolic form of atrial fibrillation and its consequences. Improving the quality of life requires the timely help of an experienced specialist. With constant fibrillation, it is recommended not only to take the necessary medications, but also to change your usual activities. Only an integrated approach will improve the quality of life and delay or eliminate the occurrence of complications. For this you need:
- Refuse fatty foods. Include foods rich in potassium and magnesium in your daily diet. Eat more vegetables, grains, fruits.
- Physical activity should be gentle.
- Carry out regular monitoring of the pulse. At the first unpleasant or dangerous symptoms, consult a doctor.
- Completely give up alcohol and cigarettes.
Also, permanent atrial fibrillation(tachysystolic form) involves frequent visits to the cardiologist and regular instrumental examinations. Patients need to know that during atrial fibrillation, both the minute and systolic blood volumes decrease, which further leads to a failure of the peripheral circulation. This situation acts as a provocative factor and leads to the fact that the main organ does not cope with its work and the organs begin to experience a lack of nutrients and oxygen, in other words, heart failure occurs.
