Fibrillation is what? Paroxysmal fibrillation

Have you ever had moments when your heart began to beat chaotically? Or, conversely, slowed down? This causes a feeling of fear and anxiety, makes you think about going to the hospital. Doctors have a definition for any condition, including for this. Fibrillation is one of the forms of heart rhythm disturbance. In cardiological practice, such cases are not uncommon, that's why today they will talk about them.

Definition and prevalence

There is also a scientific definition of this behavior of the heart. Fibrillation is a tachyarrhythmia that is combined with the chaotic activity of the electrical impulses of the atria. Their frequency can reach seven hundred beats per minute, and at such a speed the coordinated reduction becomes impossible.

Fibrillation is one of the most common forms of rhythm disturbance. It can be reliably determined only by the results of electrocardiography. There are characteristic signs: the absence of a sinus rhythm, the appearance of f-waves (trembling of the atria). The frequency of contractions depends on the properties of the atrioventricular node, as well as the activity of the autonomic nervous system in combination with drugs.

Specialists associate this disease with an organic lesion of the heart muscle. Chaotic contractions of the heart lead to impaired circulation and the risk of emboli. This phenomenon is associated with high mortality of this disease.

Classification

There are following forms of atrial fibrillation:

1. First discovered. Such a diagnosis is made if the patient has not previously sought medical help for atrial fibrillation.
2. Paroxysmal. The attack of trembling lasts no more than a week (usually two days) and passes by itself.
3. Persistent. Attacks last more than seven days.
4. Long persistent. The attack lasts ten to twelve months, but the doctors decided to restore the rhythm.
5. Constant. Atrial fibrillation is observed continuously, but the restoration of rhythm at the initial stages was not carried out, and then it turned out to be ineffective.

In terms of symptoms, atrial fibrillation is divided into four classes:

1. Asymptomatic.
2. Light discomfort without disruption of life.
3. Expressed symptoms that affect the comfort of life.
4. Invalidization. In this case, the patient can not take care of himself.

Depending on the pulse rate, doctors allocate tachy-, normo- and bradysystolic forms of the disease.

Risk factors

Fibrillation of the heart appears in patients who are predisposed to this. She may be preceded by a variety of cardiological problems:

- hypertonic disease;
- heart failure;
- Acquired defects of the mitral valve;
- congenital malformations of various etiologies.

An important role is played by dilated cardiomyopathy, coronary heart disease, chronic inflammatory diseases of the heart membranes, as well as tumors. The paroxysmal form of atrial fibrillation in people under the age of forty can be isolated from other diseases.

In addition, there is a list of pathologies that equally affect the appearance of fibrillation, but they are not related to the work of the cardiovascular system:

- obesity;
- diabetes;
- chronic obstructive pulmonary diseases;
- increased activity of the thyroid gland.

If the patient has a family history, that is, close relatives have people with atrial fibrillation, the chances that the disease will appear in the proband, increase by thirty percent.

Pathogenesis

Fibrillation is a chaotic twitching of the muscle, in this case cardiac. Organic diseases contribute to structural changes in the anatomy of the heart and cause impaired conductivity of electrical impulses. This is due to an increase in the number of connective tissue and subsequent fibrosis. This process progresses, aggravating the dissociation of nerve fibers, and consequently, fibrillation persists.

Doctors consider several hypotheses about how the paroxysmal form of this ailment appears. Theories of foci and multiple waves are the most common. Some scientists prefer to combine both versions, since it is impossible to single out the only cause of the disease.

According to the first theory (focal), in the myocardium there are many foci of electrical activity, which are located near the large vessels and the posterior wall of the atria. Over time, they spread to the entire area of the auricles. The second theory postulates that fibrillation occurs as a result of spontaneous and chaotic carrying out of a large number of fine excitation waves.

Symptoms and complications

Paroxysmal fibrillation can occur asymptomatically if hemodynamic disturbances are compensated to a sufficient extent. As a rule, patients complain of a feeling of frequent heartbeat, chest pain or discomfort in this area.

Against this background, heart failure is progressing, which is clinically manifested by dizziness, fainting and shortness of breath. Sometimes at the time of an attack, the urination is more frequent in patients. Specialists attribute this to an increase in the amount of sodium diuretic protein.

Objectively, there may be a pulse deficit when the number of heartbeats exceeds the number of pulse waves propagating to the periphery. With an asymptomatic form of fibrillation, the first "bell" can be a stroke.

Long-term atrial fibrillation is complicated by heart failure, thrombosis of large and small vessels of the heart or brain.

Diagnostics

Fibrillation is a disorderly frequent reduction of cardiomyocytes. Initially, the doctor collects an anamnesis of illness and life, finds out the date of the first attack, the presence of risk factors, and also learns about the medications the patient is taking at the moment. Patients do not complain, so they discover this pathology with the help of instrumental research methods. These include ultrasound, Holter daily monitoring and ECG. Fibrillation manifests itself by the following specific features:

- Absence of a tooth P (no sinus rhythm);
- appearance of f-waves of fibrillation;
- Unequal intervals between teeth R.

In the same way, it is possible to identify concomitant pathologies of the heart: myocardial infarction, arrhythmia, etc. Ultrasound is performed to identify and confirm the organic pathology of the heart, as well as measure the thickness of the walls of the myocardium, the volume of the atria and ventricles. In addition, on the screen, clear wall clots and vegetation on the valves are clearly visible.

In addition, after the first episode of fibrillation, the doctor assigns an analysis to the thyroid hormone level to exclude her hyperfunction.

Anticoagulant therapy

At this point, the reader already has an idea of why and how the fibrillation appears. The treatment is aimed at eliminating either the etiological factor or leveling the symptoms of the disease.

Anticoagulants, that is, drugs that dilute blood, are prescribed for the prevention of blood clots and, as a consequence, strokes and heart attacks. The most common among tableted forms are "Warfarin" and "Aspirin". When appointing this group of drugs, the doctor takes into account the patient's propensity for thrombosis, the risk of developing ischemia in the near future, and the patient's contraindications to this type of therapy.

It is important to remember that with the use of anticoagulants it is necessary to constantly monitor the INR (international standardized ratio). This will allow to cancel the drug on time and reduce the risk of bleeding.

Control of rhythm

Fibrillation of the heart in most cases is a reversible condition. If the time has not passed since the onset of the attack, the doctor can restore the normal sinus rhythm. This can be done by directional discharge of electric current or antiarrhythmic drugs.

Initially, the heart rate is reduced or raised to one hundred beats per minute. Then you need to consider the risk of thromboembolism, so for three weeks before the procedure and a month after it, the patient receives anticoagulant therapy. But all this is necessary only if the attack of fibrillation lasts more than two days or the duration of it can not be established. If it is known that forty-eight hours have not passed since the beginning of chaotic contractions of the heart or the patient has severe hemodynamic disturbances, then the recovery of the rhythm is carried out urgently, low-molecular-weight heparin is injected .

1. Electrical cardioversion. This is a rather painful procedure, requiring patient immersion in medication sleep. In modern defibrillators, the discharge is synchronous with the R wave on the cardiogram. This avoids accidental ventricular fibrillation. Begin, as a rule, with a hundred Joules and, if necessary, each subsequent discharge is increased by fifty Joules. This is a two-phase model. A single-phase discharge is immediately done at two hundred Joules, with a maximum level of four hundred.
2. Drug cardioversion. For drugs that can affect the rhythm of the heart, include "Prokainamid", "Amiodarone", "Nibentan" and "Propafenon."

To prevent repeated attacks of atrial fibrillation after cardioversion, antiarrhythmic drugs are prescribed, which the patient must take months, and even years.

Heart Rate Control

All known forms of atrial fibrillation imply a violation of heart rate. Therefore, the doctors thought out a therapy to eliminate this symptom. For this, drugs that can reduce heart rate can be used. These include:

Beta-blockers;
- calcium channel blockers.

With ineffectiveness of drugs from these groups, they designate "Amiodarone" or "Dronedaron". This therapy can reduce the occurrence of arrhythmia, but it is not able to remove it completely.

If treatment is not effective, doctors sometimes resort to catheter ablation. In order to maintain the sinus rhythm, you must eliminate all the excited areas. Using a radio-frequency probe, the cardiac surgeon isolates the trigger regions from each other, preventing the propagation of electric waves.

There is another method in which the nerve node between the atrium and the ventricle is destroyed. This creates temporary transverse cardiac blockade. Then this patient is implanted with an artificial rhythm injector, which controls the number of heartbeats. The quality of life of such a patient is noticeably improving, but this does not affect the duration of his life.

Fibrillation after cardiac surgery

Paroxysm of fibrillation is also possible after surgical interventions on the heart. This is one of the most frequent complications encountered after such operations. The pathophysiology of this condition differs from that which occurs in ordinary patients with atrial fibrillation.

In addition to the usual risk factors, the patient is observed ion dissociation, namely a decrease in the level of potassium, a decrease in the volume of circulating blood, a mechanical trauma to the heart tissue and edema of the atria. All this provokes the activation of immunity in the form of a cascade of complement system reactions. There is a release of mediators of inflammation, stimulation of the sympathetic nervous system, as well as a violent oxidative reaction. All this is a trigger factor for triggering atrial fibrillation.

Therefore, the treatment of postoperative complications begins with the correction of all the above problems. To do this, use beta-blockers, "Amiodarone", steroid hormones and non-steroidal anti-inflammatory drugs.

Forecast and recommendations

A person can avoid such a dangerous diagnosis as "atrial fibrillation." The doctors' recommendations are fairly simple and transparent. It is necessary to lead a healthy lifestyle, maintain a diet, do not allow an increase in blood pressure above one hundred and forty. These simple actions will not only prevent the onset of fibrillation, but also help to avoid other heart diseases.

Of course, it is recommended that smoking cessation and reduction of alcohol consumption be recommended. In order to strengthen the blood vessels, cardiologists are asked to get enough essential fatty acids with their food or take capsules with fish oil.

Treatment of bacterial and viral infections is better to finish, even if subjectively you already feel good.

The risk of developing a stroke in people with atrial fibrillation increases by fifty years to five percent, and by eighty to twenty. Every sixth registered stroke on the planet is observed in patients diagnosed with "atrial fibrillation."