The tachysystolic form of atrial fibrillation, otherwise referred to as "atrial fibrillation", is a heart rhythm failure, 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 disruption 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
Atrial fibrillation is systematized:
- by the frequency of ventricular contractions;
- duration of chaotic rhythm;
- waves on the cardiogram.
The duration of fibrillation is distinguished:
- Primary - a single rhythm disturbance was recorded for the first time. It can be different in clinical manifestations, in duration and complications.
- Persistent - lasts more than seven days. It does not stop without medical intervention and can last up to a year.
- A constant one, like the previous one, lasts a long period of time, but restoring the normal rhythm of the sinus node is inappropriate. The main goal of therapy is to maintain the existing rhythm and control the frequency of contractions.
- Paroxysmal - atrial fibrillation unexpectedly begins and also ends. Up to seven days the onset of atrial fibrillation continues, which stops on its own.
Wave subspecies:
- large - 300-500 cuts per minute. On the ECG, large and rare teeth;
- small - up to 800 contractions (small and frequent teeth).
Depending on the damage to the heart valves, fibrillation can be:
- Non-valve - with prosthetic valves.
- Valvular - with heart defects (congenital or acquired). The second can form against the background of infectious endocarditis, rheumatism. With this type of atrial fibrillation, therapy begins with the elimination of the provocateur.
According to the frequency sign, different forms of fibrillation are distinguished:
- Tachysystolic. The ventricles per minute contract more than 90 times, and there may be no pulse for a while. The reason for this phenomenon lies in the fact that the heart works with incomplete force. Insufficient contractions do not produce a pulse wave, cardiac output is irregular, and the ventricles are poorly supplied with blood.
- Normosystolic. Ventricular contractions are in the acceptable range from 60 to 90.
- Bradisystolic - reduction of about 60 times, ventricular function is inhibited. However, the pulse wave passes normally.
The second and third forms are most favorable.
Paroxysmal form of atrial fibrillation. Tachysystolic variant
One of the most commonly diagnosed heart ailments is considered a paroxysmal form of atrial fibrillation. In normal condition, the heart contracts about seventy times per minute. Violation of its contractile activity leads to a change in the frequency of contractions, which can reach 800. Paroxysmal arrhythmia is accompanied by circulatory failure. Its danger lies in the fact that myocytes contract chaotically, the sinus node does not function, only two ventricles work. Paroxysm refers to frequently recurring seizures or seizures. A characteristic symptom of paroxysmal atrial fibrillation is an increased heart rate and sudden tachycardia with the correct 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 bradisystolic, 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:
- flickering - the number of heart contractions per minute is more than 300;
- flutter - a maximum of 200.
This form of fibrillation can be recognized by the following symptoms:
- the appearance of trembling;
- palpitations
- suffocation;
- increased sweating;
- limbs get colder;
- weakness;
- panic attacks;
- dizziness;
- fainting state.
However, some individuals do not notice an attack, and a brady-systolic or tachysystolic form of paroxysmal atrial fibrillation is detected during the examination, that is, at a doctor’s appointment in a medical facility. When the 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 soon as possible, and preferably within two days after the onset of the attack. With constant fibrillations, drug therapy is recommended, which will help prevent a violation of cerebral circulation. Due to the irregular contraction of the atrial walls, the blood moves at high speed. As a result, a blood clot can easily adhere to the wall of the atrium and cause thrombosis, which leads to a stroke. If the tachysystolic form of paroxysm of atrial fibrillation degenerates into a constant, then there is a huge risk of heart failure.
Diagnosis of atrial fibrillation
Upon examination, the patient reveals:
- cyanosis near the nasolabial fold;
- pale skin;
- emotion.
An ECG for this ailment was first recorded in 1906, and described in detail in 1930. On the ECG, atrial fibrillation of the tachysystolic form is as follows:
- P wave is missing - this means that there is no sinus rhythm;
- there are waves f of different heights and shapes;
- RP intervals are different in duration;
- ST segment and T wave are subject to change.
Additional diagnostic methods are:
- biochemical and general blood test;
- 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
There are cardiological and other factors that caused atrial fibrillation. The first include:
- neoplasms in the heart;
- hypertension;
- myocardial infarction;
- heart defects;
- cardiosclerosis;
- cardiomyopathy;
- myocarditis;
- heart ischemia;
- heart failure;
- consequences of heart surgery. Arrhythmia is formed due to 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 sutures. It completely disappears after a course of treatment.
The presence of several pathologies in an individual, for example, hypertension and angina pectoris, increases the risk of rhythm disturbances. In individuals of mature and old age, the cause of the tachysystolic form of atrial fibrillation is IHD in combination with or without hypertension.
Other factors:
- thyrotoxicosis:
- diabetes;
- gene mutations;
- obesity;
- hypokalemia;
- kidney disease
- chronic obstructive pulmonary pathology;
- vegetovascular dystonia;
- poisoning with alcohol-containing drinks;
- smoking;
- electrical injury;
- side effects of certain medications.
Extracardiac factors provoke atrial fibrillation at a young age, and heart disease in older people.
Atrial fibrillation occurs in medical practice for unknown reasons - ideopathic rhythm disturbance.
Clinical manifestations of atrial fibrillation
Symptoms with a tachysystolic form of AF may be absent, and pathology can be diagnosed only by ultrasound of the heart or ECG. However, the development of acute signs 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). Subsequently, seizures become more frequent and lead to a constant or persistent form of fibrillation. Some people have short attacks throughout their lives that do not progress to the chronic stage. At the beginning of the attack, an internal, rather sharp push to the chest is felt. Then the following symptoms appear:
- fear of death;
- feeling of lack of air;
- chest pains;
- chills;
- tremor of limbs and body;
- dyspnea;
- the pulse is unstable, its speed changes;
- cold sweat is released;
- pressure drops;
- pallor of the skin;
- polyuria;
- disruption of the digestive tract.
Possible manifestation of neurological signs:
- loss of sensation;
- paralysis;
- coma;
- paresis.
Such a clinical picture is present if rhythm disturbance provokes thrombosis.
In humans, edema appears at the end of the day with a constant form of arrhythmia.
Some features of the tachysystolic form of atrial fibrillation
Violation of the rhythm, accompanied by frequent and chaotic work of the heart chambers, is called tachysystolic atrial fibrillation. The source of such excitation is myofibrils located in the atria (ectopic foci of electrical impulses), which make up to 700 contractions per minute. Moreover, the ventricles during the same period make more than 90 shocks. Symptoms are similar to the typical pattern of atrial fibrillation:
- heavy sweating;
- trembling
- discomfort in the chest area;
- panic attacks;
- dyspnea;
- dizziness;
- weakness;
- throbbing veins on the neck.
A hallmark of the tachysystolic form of atrial fibrillation is considered to be heart failure with accelerated heartbeat, which leads to:
- flicker, if this cause caused such a heartbeat, then the number of contractions is 350-700;
- atrial flutter. Reductions occur 200-400 per minute. In this case, the correct atrial rhythm is preserved and transmitted to the ventricles.
Atrial tachysystolic atrial fibrillation is more dangerous compared to others and is more difficult to tolerate, since in this case a huge load is on the heart. A rather frequent complication is acute heart failure due to circulatory failure in peripheral vessels as a result of a decrease in minute and systolic blood volume.
The tachysystolic variant of atrial fibrillation in constant form is a rather dangerous ailment that is difficult to treat. Nevertheless, it is possible to live with quality life. The main thing is to carry out all the appointments of a doctor. The provocateur of atrial fibrillation in adulthood and old age is coronary heart disease, accompanied by hypertension or without it. In young individuals, the provocative factors are:
- hyperthyroidism;
- heart defects;
- rheumatism.
Conditions in which atrial fibrillation of the tachysystolic form may occur:
- Ischemic heart disease;
- acute pulmonary heart;
- cardiomyopathy;
- myocarditis;
- pericarditis;
- myocardial infarction and some other pathologies.
With the normo-and bradysystolic form of heart rhythm disturbances, subjective sensations may be absent or frequent heartbeat is noted. An arrhythmic pulse with its deficiency is objectively determined. With a tachysystolic form, symptoms of heart failure and swelling occur.
Therapy
Treatment of a tachysystolic form of atrial fibrillation is to relieve unpleasant symptoms and prevent the occurrence of negative consequences. All therapeutic actions are directed:
- to maintain a certain frequency of contractions;
- return to the rhythm rate.
To achieve these goals apply:
- drug therapy with anticoagulants, antiarrhythmic drugs, calcium channel blockers and beta-adrenergic receptors;
- electrocardioversion, i.e., exposure to electric shock;
- installation of a pacemaker;
- catheter radiofrequency ablation.
The use of anticoagulant agents helps prevent thromboembolism. Medicines in this group can be used for a long time. Patients of the older age category with concomitant pathologies (coronary heart disease, diabetes mellitus, thyrotoxicosis, hypertension, congestive heart failure, rheumatic heart disease) recommend "Warfarin". Low molecular weight heparin drugs 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 medications provokes bleeding, so you need to control blood coagulation.
In order to normalize heart rate in the treatment of a tachysystolic form of atrial fibrillation, Amiodarone, Diltiazem, Metoprolol, Verapamil, Carvedilol are recommended. The use of these funds can alleviate the condition and remove unpleasant symptoms, and in addition, 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 disturbances.
Electrocardioversion. Catheter radiofrequency ablation
With a persistent tachysystolic form of atrial fibrillation, it is possible to achieve stabilization of the heart rhythm by discharges of electric current. It is mainly used in life-threatening situations. Manipulation is carried out under the supervision of an ECG and under general anesthesia. A device called a cardioverter-defibrillator delivers simultaneously an electrical signal to the heart without causing ventricular fibrillation. In cases of problems with blood circulation with a short-term attack of arrhythmia, urgent cardioversion is indicated. At the same time, heparin preparations are administered. The effect on the heart can be carried out both externally and internally. In the first case, through the chest, and in the second, the electrode is inserted 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 manipulation for a month.
With the medical form of cardioversion, they use means to restore sinus rhythm, which are administered intravenously:
- Nibentan has a strong effect. Due to possible side effects, including those that affect the rhythm of contractions of the ventricles, the patient should be monitored for a day.
- Amiodarone relieves seizures well. It is indicated for people with identified organic myocardial disorders. Its constant intake reduces the risk of sudden cardiac arrest by 50 percent.
- "Procainamide" has a membrane stabilizing effect. Often provokes undesirable reactions in the form of a headache, hallucinations, pressure reduction.
This type of cardioversion is usually used with a paroxysmal form of arrhythmia and primary fibrillation. Therapy carried out in the first hours of the attack gives a positive result.
Catheter radiofrequency ablation is a surgical procedure that is used when other methods do not give the desired effect. A catheter inserted into a vein delivers an electrode into the heart tissue. It destroys the anomalous region generating the pulses by electric discharges. At the same time, a pacemaker is implanted.
Treatment and prevention of atrial fibrillation
In the absence of contraindications in a hospital, antiarrhythmic drugs are used:
- Aimalin;
- Novocainamide;
- "Disopyramides."
If, using the above funds, the rhythm has not recovered, then they switch to other drugs:
- Flecainide
- Amiodarone
- "Propafenone."
With a constant form of atrial fibrillation, medications are recommended for the prevention of thromboembolism:
- Warfarin
- “Phenylin”;
- Sincumar.
In the absence of the effect of drugs, try electrocardioversion. After the restoration of the rhythm, 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 of cardioversion - 90, provided that you consult a doctor in a timely manner. Another way to treat a tachysystolic variant of the constant form of atrial fibrillation is to use a special device that acts on the ventricles with electrical pulses. A pacemaker has an effect, even if drug therapy was unsuccessful.
A large number of patients already have relapses during the first year. Provocative factors are:
- physical exercise;
- stress
- the use of alcohol-containing drinks;
- taking diuretics;
- physiotherapeutic procedures.
If seizures are less than once a month, then continuous therapy with antiarrhythmic drugs is not needed. With frequent attacks, the dosage regimen and dose of medication are selected for each patient. Treatment monitoring is carried out using:
- ECG;
- echocardiography;
- daily monitoring.
In the presence of a constant form of atrial fibrillation (tachysystolic form or another), it is inappropriate to restore the sinus rhythm. . , :
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:
- - .
- Frequent bouts of atrial fibrillation, in which electrocardioversion or the introduction of antiarrhythmic drugs into a vein is indicated. Due to the fact that in such patients it is impossible to maintain a 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 absolute contraindication is a history of thromboembolism and the presence of a thrombus in the atria.
Complications
A prolonged course of atrial fibrillation provokes the consequences:
- Severe cardiomyopathy with symptoms of heart failure, developing against the background of a chronic form of atrial fibrillation.
- Thromboembolism, the cause of which lies in ineffective atrial contractions. Blood clots can be in the kidneys, lungs, spleen, brain vessels, peripheral vessels of the limbs.
- Violation of hemodynamics, as a result of which heart failure is formed or progresses, the quality of life and the working capacity of the individual are reduced.
A rather high mortality rate among individuals with atrial fibrillation due to ventricular fibrillation. Of particular danger is the tachysystolic form of atrial flutter, therefore 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 to a chronic form, in which there is a high risk of severe consequences.
Filling out medical documents for patients receiving treatment in a hospital
For a patient being treated in a hospital, medical documents are filled in, which contains all the information about his state of health, for example, a medical history. "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 a healthcare institution;
- complaints
- medical history;
- anamnesis of life;
- patient's condition (described by organs);
- research results;
- differential and clinical diagnosis;
- etiology and pathogenesis of the underlying disease;
- treatment;
- prophylaxis;
- forecast;
- epicrisis;
- recommendations.
This is how the medical history looks like a schematic.
How to deal with the problem of atrial fibrillation? Cardiologist Tips
Regardless of the causes and clinical picture of atrial fibrillation, it is necessary:
- prevent relapse;
- maintain normal sinus rhythm;
- control the frequency of contractions;
- prevent the development of complications.
For this, the constant intake of medications under the supervision of the attending doctor is indicated. Secondary prevention involves a complete rejection of alcohol, smoking, overstrain - both mental and physical. The prognosis of the disease depends on the cause of the tachysystolic form of atrial fibrillation, and its consequences. Improving the quality of life requires the timely help of an experienced professional. With constant fibrillation, it is recommended not only to take the necessary medicines, but also to change the usual activity. Only an integrated approach will improve the quality of life and delay or eliminate complications. To do this, you must:
- Refuse fatty foods. Include potassium, magnesium rich foods in your daily diet. More vegetables, cereals, fruits.
- Exercise should be gentle.
- Regularly monitor your heart rate. At the first unpleasant or dangerous symptoms, consult a doctor.
- Stop alcohol and cigarettes completely.
In addition, the constant form of atrial fibrillation (tachysystolic form) involves frequent visits to the cardiologist and regular instrumental examinations. Patients need to know that with atrial fibrillation, both minute and systolic blood volumes decrease, which subsequently leads to a failure of 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.