Arrhythmias of heart Department of propedeutic of internal medicine

Etiology. Violations of rhythm of cardiac activity cause such defeats of myocardium: organic: IHD,defects of heart, AH, myocarditis, cardiomyopathy; · toxic: medicines, alcohol; · hormonal : thyrotoxicosis, myxedema, pheochromocytoma, climax; · functional : neurogenic, sporting; · anomalies of development of heart - more frequent all WPW.

Pathogenesis Theories of origin of arrhythmias: Pathological automatism (presence of ectopic focuses) Mechanism of re-entry trigern (starting) activity.

Classification of violations of rhythm and conductivity of heart I. Violations of formation of impulse Sinus tachycardia (more than 90 complexes are for a minute) Sinus bradycardia (less than 60 complexes are for a minute ) Sinus arrhythmia Stop (refuse) of sinus node Migration of supraventricular driver of rhythm

Extrasystolia (a synonym is premature depolarization): auricle (atrial) auricle-ventrical (atrioventricular) ventrical

Tachycardia: supraventricular: sino - auricle (sinoatrial) auricle (atrial) auricle - ventrical (atrioventrical) ordinary(to 30 in a hour) frequent (30 and anymore in a hour) allorythmia(bi-, thre-, quadrigeminia) polymorphic twin early(R on T) chronic paroxysmal noudle

with the additional ways of leadthrough ortodromal antidromal ventrical: unsteady (from 3 ventrical complexes to 30) steady (more than 30 seconds) monomorphic polymorphic

ІІ. VIOLATION OF LEADTHROUGH OF IMPULSE - Sinoauricular of blockade - Atrioventricular blockades: І st. ІІ st. ІІІ st.

III. COMBINED DYSPOIESISS AND LEADTHROUGHS OF IMPULSE · auricle Parasystole · from AV of connection · ventrical specified at possibility

IV. DISEASE, SYNDROMES And PHENOMENA –Syndromes and ECG phenomena of pre-excitation of ventricles: syndrome of WPW syndrome of the shortened interval of PR (Launa - Ganonga - Livayna) syndrome of early repolarisation of ventricles innate purchased Syndrome of the prolonged interval of QT

Syndrome of weakness of sinus noudle Syndrome of Morganii-Adams-Stoks Syndrome of Frederic Cardiac sudden death (arrhythmical) asystole fibrilation of ventricles electromechanics dissociation Heart arest

V. ARRHYTHMIAS ARE AT NORMAL OR BROKEN FUNCTION OF CARDIOSTIMULATORS OF DIFFERENT TYPE Note: In a diagnosis it is needed to specify cardiac surgery interferences and devices, applied for treatment of arrhythmias and asequences heart (with pointing of method and to give interference) - kateterni (radio frequency et al) destruction, implantation of drivers of rhythm and cardioverters - defibrilyatoriv, leadthrough of cardioversion or defibrilyacii (the date of the last is specified) and others like that.

Description of normal sinus rhythm correct rhythm with frequency of heartbeats per 1 min. the P wave is positive in II, III, AVF leads, negative - in the AVR leads, permanent form of P wave a complex QRS follows by every P waveR (if there is not а-v-blockade). Interval of P-Q>0.12 (if there are not additional ways of leadthrough).

Sinus tachycardia ECG is criteria: correct rhythm sinus P waves are ordinary configuration beats per 1 min. gradual beginning and completion Reasons: physical and emotional loading, pain, fever, hypovolumia, hypotension, anaemia, thyrotoxicosis, action of certain matters (coffeine, alcohol)

Treatment liquidation of etiologic factor B-adrenoblockers (propranolol 10-40mg, oksprenolol 20mg 3 times per days, pindolol 5 mg 3 times on days, nadolol 20 mg 2 times per days, metaprolol 50 mg 2 times per days) sedative facilities

Sinus bradycardia ECG is criteria: correct rhythm less than 60 beats per 1 min sinus P waves interval of PQ >0,12 sec. Reasons: increase of parasympatic tonus, myocarditis, myxedema, hypothermia, mechanical icterus, syndrome of weakness of sinus knot.

Treatment to the atropine sulfate of 0,5-1 mg or 0,1% solution 1-2 times per day plathyphylinum hydrotartratum 0,5-1 mg or 0,2% solution 1-2 times per day extract of beladonnae -0,02 gr. 3-4 times per days izadrin 5-10 mg sublingval

The first aid is at the attacks of Morgani-Adams-Stoks to the atropine sulfate of 0,5-1 mg or 0,1% solution intravenously izadrin 5-10 mg sublingval (at a necessity to repeat) alupent for mg on 500 ml of izotonic soluble-sodium chloride electro-cardiostimulation (temporal or permanent)

Sinus arrhythmia ECG is criteria: P wave is sinus origin interval of PQ >0,12 s beats per 1 min the rhythm of heart is wrong with the difference of the longest and shortest interval of R-R 0.16 and anymore Treatment: does not require

a-normal sinus rhythm б- sinus tachycardia в- sinus bradycardia г- sinus arrhythmia

Arest of sinus knot EKG is criteria: complete asystole (absence of P and QRST) the pause of R-R does not make two ordinary intervals, and anymore. Treatment: how to the syndrome of Morgani-Adams-Stoks

Syndrome of weakness of sinus knot EKG is criteria: sinus bradycardia is expressed refuse of sinus knot with periods asystoles a duty of sinus bradycardia is with the attacks of auricle tachycardia, fibrilation (syndrome of «tachy-brady») a sino-atrial blockade is with extra contractions heart beats slow renewal of function of sine knot.

Treatment effective treatment does not exist medical therapy is at the attacks of Morgani-Adams-Stoks implantation of permanent electro- cardyostimulator

Extrasystolia  premature excitation and reduction of heart or his separate parts is as a result of increase of activity of hearths of ectopic automatism.

Auricle extrasystolia EKG of sign: premature reduction after which incomplete scray pause the P wave is changed, negative a complex QRS is not changed or aberrant. Treatment: it is not needed, at presence of clinical symptoms of b-blockers, verapamil, digitalis.

a- from the overhead departments of auricle б- from the middle departments of auricle в- from the lower departments of auricle г- is blocked auricle extrasystole

А-V- extrasystoles with simultaneous excitation of atriums and ventricles. EKG-signs: the P wave is not determined an extraordinary complex QRS is not extended incomplete scray pause

with previous excitation of ventricles EKG-signs: an extraordinary complex QRS is not extended P wave is after QRS complete scray pause Treatment: like, as at auricle extrasystolia.

Ventrical extrasystolia EKG of sign: complex QRS wide without a previous P wave complete scray pause Treatments need frequent monotopic, politopic, group and early as R/T extrasystoles.

a- sinistroventrical extrasystole b- dextraventrical extrasystole

Paroxysmal tachycardia Supraventricular tachycardia EKG is signs: frequency of reductions of atriums per 1 min. auricle complexes are preceded the complexes of QRS the complexes of QRS are not changed

Atrioventricular tachycardia EKG-signs: heart beats per 1 min. retrograde P wave (negative) after QRS or accumulates on him

a- auricle paroxysmal tachycardia б - atrioventricular tachycardia with previous excitation of ventricles в - atrioventricular tachycardia with simultaneous excitation of atriums and ventricles

Treatment of paroxysmal supraventricular tachycardia at leadthrough to the impulse through an a-v knot: massage of sinus carotic izoptin 0,25%-4ml obzіdan 0,1% - 5ml dіgoxin 0,025% - 1ml v/v cordaron 5% - 6 ml

Ventrical tachycardia EKG is criteria: - >140 hearts beats per 1 min. - the complexes of QRS are extended

 EKG is at paroxysmal ventrical tachycardia

Trembling and fibrilation of atriums EKG is criteria of trembling: frequency of auricle waves per 1 min. ( waves of f) EKG is criteria of fibrilation: waves of f wrong rhythm (different R-R) absence of P wave

Trembling and fibrilation of ventricles EKG is criteria: Sinus wave curve with frequent, rhythmic, wide and high waves, excitation of ventricles with frequency per 1 min. it is not possible to distinguish the elements of ventrical complex Treatment: electric cardioversion Dzh. At unefficiency the repeated cardioversion

a- trembling of ventricles b- blinking and fibrilation of ventricles

Sinoauricular blockade EKG is criteria: periodic fall of cardiac cycles increase of pause between the waves of Р-Р in 2 times

Inwardly auricle blockade EKG is criteria: increase of duration and breaking up of wave Р

Atrioventricular blockade І st permanent lengthening of interval of P-Q anymore as on 0,20s a- auricle form б- key form в- distal form blockade

А-v blockade ІІ ст the periodic stopping of leadthrough of impulse is from an auricle to the ventricles. There are three types: I type (Mobit I) is the gradual lengthening of interval of P-Q with the subsequent fall of QRST ( periods of Samoylov-Venkenbach) ІІ type (Mobit ІІ) is a fall of complexes of QRST without the gradual lengthening of interval of P-Q ІІІ type (Mobit ІІІ) of fall every second, or 2 and more complexes successively

А-v blockade ІІІ ст  complete autonomy of reduction of auricle and ventricles.The intervals of P-P and R-R are permanent, but R-R>P-P.

EKG is at the complete blockade of right bundle of bunch of Hiss

EKG is at the complete blockade of left bundle of bunch of Hiss

Syndrome of Wolf-Parkinson- White reduction of interval of P-Q (R) a presence in composition a complex QRS of additional wave of excitation is d-wave deformation and increase of duration of complex QRS discordant displacement of RS-T and change of polarity of wave T (inconstant sign)

EKG is at the syndrome of WPW

Conclusions It is necessary to know for successful diagnostics and treatment of arrhythmias: basic nosotropic mechanisms of their development · to own the methods of diagnostics of arrhythmias · to distinguish of high quality, potentially malignant and malignant arrhythmias · to understand algorithms diagnostic at the therapeutic going near the different types of arrhythmias