A pathology in which the heart rate is increased, while the indicators of the latter remain stable, is called atrial flutter. This violation refers to forms of atrial fibrillation. Atrial fibrillation and flutter among such pathologies are most common, and they can alternate. The main difference of the first is that with it, atrial activity is chaotic.
The concept
The pathology under consideration causes a violation of the course of the impulse in the heart through the atrial conducting 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.
In this case, the rhythm of the ventricles can remain normal or be elevated, but not as much as the rhythm of the atria. This is due to the fact that the atrioventricular node cannot conduct an impulse so often. An exception to this are patients with WPW syndrome, in the heart of which there is a Kent bundle that conducts an impulse from the atrium to the ventricle at an increased speed compared with the atrioventricular node. In this regard, such patients may also have ventricular flutter.
Pathology is most characteristic of men over 60 years of age.
The passage time of an attack is called flutter paroxysm.
Etiology of the disease
Atrial flutter is influenced by both factors related to the cardiovascular system, and those that are caused by a malfunction of internal organs and other systems.
The first reasons include:
- abnormal structure of the heart;
- hypertrophy of his chambers;
- cardiomyopathy of various severity and forms;
- high blood pressure;
- the presence of a tendency to form blood clots;
- coronary artery 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;
- cardiovascular disease in relatives;
- constant shocks and stresses;
- excess physical activity;
- uncontrolled intake of funds containing caffeine;
- bad habits.
For cardiological reasons, the clinical picture may be unexpressed and inherent in many cardiovascular diseases. They can be taken for signs of concomitant pathology:
- oxygen deficiency during physical exertion;
- decreased motor activity;
- depressed state;
- apathy;
- fast fatiguability;
- dyspnea.
People at risk should undergo periodic medical examinations by a cardiologist, since if this pathology occurs and the treatment is not started promptly, a fatal outcome may occur.
Classification of atrial flutter
It is carried out according to the nature of development and the clinical course of the pathology.
According to the first sign, the following forms of atrial flutter are distinguished:
Typical (classical) - the frequency of flutter per minute is 240-340 beats. A wave of excitations circulates in a typical circle in the right atrium.
Atypical - the frequency is 340-440 beats, the correct rhythm is not observed. A wave of excitations circulates there, but not in a typical circle.
By the nature of the course, 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 only possible by performing special diagnostic measures.
Paroxysmal atrial flutter lasts up to one week, stops on its own, persistent - more than this period, the sinus rhythm is not restored on its own. Permanent occurs when the applied therapy did not bring the expected result or when it was not carried out.
Tachysystology leads first to diastolic and then to systolic left ventricular myocardial dysfunction, 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:
- pain having a pressing character located in the chest area;
- fainting and loss of consciousness;
- headache and dizziness;
- feeling of weakness;
- hyperhidrosis;
- pallor of epithelial integument;
- heavy breathing, shallow;
- heart palpitations;
- dyspnea.
The following factors can contribute to the appearance of symptoms:
- disruption of the digestive tract;
- drinking plenty of fluids, including alcohol;
- transferred emotional overstrain;
- prolonged stay in the heat or stuffy room;
- excessive physical activity.
Attacks can occur from a few per week to 1-2 per year and are determined by the individual characteristics of the body.
Diagnostics
To determine the ailment, the following activities are carried out:
- electrophysiological examination of the heart ;
- determination of electrolytes;
- rheumatological tests;
- determination of thyroid hormones;
- biochemical and general blood test;
- MRI and CT;
- transesophageal echocardiography to detect blood clots in the atria;
- ECG;
- medical history and physical examination of the patient.
Atrial flutter on an ECG demonstrates:
- dynamics of the frequency and duration of paroxysms;
- the appearance of F-atrial waves;
- wrong rhythm.
As a result of the diagnosis, it becomes clear what caused the ailment and how to treat it.
With atrial flutter, a rapid and rhythmic pulse is detected. With a coefficient of 4: 1, the pulse can be 75-85 beats per minute, with a constant dynamics of the coefficient, the rhythm becomes incorrect. With this pathology, frequent and rhythmic pulsation of the cervical veins is noted, which exceeds the arterial pulse by 2 times or more and corresponds to the rhythm of the atria.
With atrial flutter on an ECG , atrial F waves are sawtooth in 12 leads, a regular gastric rhythm, P waves are absent. Ventricular complexes remain unchanged, they are preceded by atrial waves. During massage of the carotid sinus, the latter become more pronounced due to increased AV block.
When conducting an ECG during the day, the heart rate is estimated at different periods and pathological paroxysms are determined.
ICD atrial flutter
After switching to ICD-10, in accordance with the recommendations of the European Association of Cardiology, the term “atrial fibrillation” was derived from 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.
Drug treatment
Emergency medical care is provided by the use of low power current. Antirrhythmics are administered at the same time.
In normal cases, the treatment of atrial flutter involves taking the following drugs:
- anticoagulants;
- potassium products;
- cardiac glycosides;
- beta adenoblockers
- antiarrhythmic drugs;
- calcium channel blockers.
With an attack lasting no more than 2 days, use electrical pacemaker 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:
- installation of a pacemaker;
- radiofrequency ablation.
With irregular flutter, drugs are used to thin the blood.
A course of drug therapy is prescribed after the operation.
Treatment of atrial flutter should be performed when the first clinical signs appear. However, to completely eliminate the pathology today is impossible. Only the probability of their occurrence is minimized if the patient takes all the drugs prescribed by the doctor.
International recommendations
World experts suggest the use of the following drugs for the implementation of antithrombotic therapy, depending on the level of risk of thromboembolic complications:
- in the presence of a thrombus, a history of thromboembolism, artificial heart valves, mitral stenosis, arterial hypertension, thyrotoxicosis, heart failure, 75 years of age and older, with ischemic heart disease and diabetes mellitus - from the age of 60 - oral anticoagulants;
- in case of failure to reach 60 years of age and the presence of cardiac 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 ailments - the same medicine in the same dosage or the absence of treatment.
Recommendations for atrial flutter include control of indirect coagulants at the beginning of treatment - from once a week and more often if necessary, in the future - once a month.
Surgical and instrumental treatment
Possible treatment with electric current when using a defibrillator. In many cases, stabilization of heart rhythms and improvement in the well-being of patients are observed. Sometimes such a method of treatment does not bring the expected results, the rhythm is broken again after a while.
In addition, carrying out this procedure can lead to the development of strokes, so before it is possible, intravenous and subcutaneous injections are prescribed to dilute blood.
If conservative treatment does not help and relapses of arrhythmia are observed, then the doctor prescribes:
- radiofrequency ablation;
- cryoablation.
They are carried out in relation to the conductive paths along which the pulse is circulated during the attack.
With the onset of various complications and a severe course of the pathology, an operation is performed. It is necessary in order to:
- Stabilize your heart rate and heart rate
- improve the general condition of the patient;
- suppress the focus of pathology.
Typical paroxysms are controlled by transesophageal pacing.
Forecast
The disease is characterized by resistance to therapeutic treatment against arrhythmia, a tendency to relapse, and persistence of paroxysms.
The long-term outlook is unfavorable. Hemodynamics are disturbed, the work of the cameras becomes inconsistent, cardiac output is reduced by 20% or more. There is a mismatch between the capabilities and needs of the body for the implementation of metabolic processes, which leads to chronic circulatory failure. Atrial flutter, the prognosis of which is disappointing, can lead to expansion of the cavities of the heart muscle, which can provoke a fatal outcome.
In the chronic form of the disease, parietal thrombi form in the atria. In the event of their separation, catastrophic conditions in the vessels can be observed. The consequences of the disease can occur in the small and large circle of blood circulation, causing heart attacks of the intestine, spleen, kidneys, gangrene of the extremities, strokes.
Complications
Various forms of atrial flutter can lead to the following complications:
- heart failure;
- thromboembolism;
- myocardial infarction;
- a stroke;
- ventricular tachyarrhythmia;
- ventricular fibrillation.
All these pathologies can lead to death.
Prevention
With the congenital form of the disease, special preventive measures do not exist. The expectant mother should eliminate bad habits and rationally build her diet.
General preventative recommendations include the following:
- timely treatment of various ailments to exclude their transition into a chronic form;
- moderate physical activity;
- balanced diet;
- rejection of bad habits.
Lifestyle
From the diet exclude:
- alcohol-containing drinks;
- coffee;
- tea;
- sweet soda.
The intake of fluid is limited, the number of meals should be large, while it is taken in small portions. Do not eat foods that can cause flatulence and bloating. The diet is almost salt-free.
The patient should be disciplined, take prescribed medications and avoid the influence of factors that can cause an exacerbation of pathology.
Finally
Atrial flutter is a tachycardia with a violation of the heart rhythm. It is mainly disturbed in the atria, sometimes its increase is also observed in the ventricles. The disease is not completely cured. You can only minimize the negative effects with the help of drug therapy, the use of various instrumental methods, as well as, in case of their inefficiency, the operation.