Ventricular flutter is ventricular tachyarrhythmia, which has the correct frequent rhythm (about 200-300 beats in one minute). Most often, the condition may be accompanied by a decrease in blood pressure. Loss of consciousness, pallor, diffuse cyanosis of the skin, agonal breathing, convulsions, dilated pupils are not ruled out.
In addition, it can trigger sudden coronary death. Diagnosis of such a pathology is based on electrocardiographic studies and clinical data. Emergency care for ventricular flutter includes immediate defibrillation and cardiopulmonary resuscitation.
What is ventricular flutter?
A similar phenomenon is the disorganized electrical activity of the myocardium, which is characterized by frequent and rhythmic contraction of the ventricles. The frequency of such contractions exceeds 200 beats per minute. It can also turn into fibrillation (flicker), which will be a frequent, up to 500 strokes, but irregular and erratic ventricular activity.
In the cardiology department, experts attribute fibrillation and flutter to dangerous arrhythmias, which can lead to ineffective hemodynamics. In addition, they are the most common causes of arrhythmic death. According to epidemiological data, fibrillation and flutter most often occur in people whose age ranges from 47 to 75 years. A characteristic feature is that in men they appear three times more often than in women. In 70-80% of cases, the cause of sudden death is precisely ventricular fibrillation.
Reasons for pathology?
Ventricular flutter can occur against a background of various heart diseases, in the presence of a variety of extracardial pathologies. Quite often, organic myocardial damage, which develops against the background of IHD, can be complicated by ventricular fibrillation and flutter. In addition, this pathology accompanies the following diseases:
- postinfarction cardiosclerosis ;
- heart aneurysm;
- acute myocardial infarction;
- myocarditis;
- hypertrophic cardiomyopathy;
- dilated cardiomyopathy;
- Wolf-Parkinson-White syndrome;
- valvular heart defects (stenosis of the aortic orifice, mitral valve prolapse).
Other reasons
Less commonly, the development of this disorder may occur due to intoxication with cardiac glycosides, electrolyte imbalances, high levels of catecholamines in the blood, electrical injuries, chest injuries, heart concussions, hypoxia, acidosis, hypothermia. Also, ventricular tachycardia can be caused by some of the drugs, for example, sympathomimetics, barbiturates, narcotic analgesics, antiarrhythmic drugs.
Another cause of flutter is cardiac surgery. These include coronary angiography, electrical cardioversion, defibrillation in the cardiology department.
The pathogenesis of ventricular flutter
The development of such a disease is directly related to the re-entry mechanism, which has a circular nature of the circulation of the excitation wave passing through the myocardium of the ventricles. It leads to the fact that the ventricles contract often and rhythmically, and there is no diastolic interval. The re-entry loop can be located around the perimeter of the entire infarct zone, or a portion of the ventricular aneurysm. The heart rate table is normal by age will be presented below.
The main role in the pathogenesis of ventricular fibrillation is played by multiple random re-entry waves, which provoke the contraction of individual myocardial fibers while the contractions of the ventricles are completely absent. This phenomenon is due to the electrophysiological heterogeneity of the myocardium: at the same time, different parts of the ventricles can be in the period of repolarization and in the period of depolarization.
What does it launch?
Ventricular fibrillation and flutter, as a rule, are triggered by ventricular and supraventricular extrasystoles. Initiate ventricular and atrial tachycardia, Wolf-Parkinson-White syndrome, atrial fibrillation, and then the re-entry mechanism can support them.
In the process of development of flutter and flicker, it rapidly decreases, and then the stroke volume of the heart becomes zero. As a result, blood circulation stops instantly. Flutters of a paroxysmal nature and ventricular fibrillation are always accompanied by fainting conditions, and a stable form of tachyarrhythmia entails first clinical and then biological death.
Classification of ventricular flutter
In the process of development, such heart diseases as ventricular flicker and flutter go through four stages:
The first is the tachysystolic stage of ventricular flutter. The duration of this stage is a maximum of two seconds. It is characterized by frequent, coordinated heart contractions. On the ECG of this stage, 3-6 ventricular complexes with a sharp high-amplitude fluctuation correspond.
The second stage is convulsive ventricular tachyarrhythmia. Its duration is from 15 to 50 seconds. It is characterized by frequent, local myocardial contractions of an irregular nature. The ECG reflects this stage in the form of high-voltage waves having different sizes and amplitudes.
The third stage is the ventricular fibrillation stage. The duration of this stage is 2-3 minutes. It is accompanied by multiple irregular contractions of individual zones of the myocardium, having a different frequency.
The fourth is the stage of atony. This stage develops approximately 2-5 minutes after ventricular fibrillation has occurred. The fourth stage is characterized by small, irregular waves of contractions, an increasing number of sites that have ceased to contract. On the ECG are reflected in the form of irregular waves, the amplitude of which gradually decreases.
Cardiologists distinguish ventricular flicker and flutter according to their clinical development. So, a permanent and paroxysmal form is distinguished. In this case, the flutter of the second form can be of a recurring nature, that is, they can be repeated several times during the day.
Symptoms
Heart disease - ventricular fibrillation and flutter, in fact, correspond to clinical death. If a flutter occurs, then for a short time, it is possible to maintain a low cardiac output, consciousness and arterial hypotension. Occasionally, ventricular flutter can result in spontaneous restoration of the sinus rhythm. Most often, such an unstable rhythm transitions to ventricular fibrillation.
The following symptoms accompany flutter and ventricular fibrillation:
- circulatory arrest;
- loss of consciousness;
- the disappearance of the pulse on the femoral and carotid arteries;
- agonal breathing;
- sharp pallor;
- dilated pupils;
- diffuse cyanosis of the skin;
- lack of reaction to light;
- involuntary bowel movements and urination;
- tonic cramps.
If such symptoms are observed and it is established that fibrillation and ventricular flutter have arisen, then the patient needs urgent medical attention. The central nervous system and other organs will be irreversibly affected if normal heart rhythm is not restored within 4-5 minutes.
Complications
Death is the most unpleasant outcome of such deviations. As a result of cardiopulmonary resuscitation , the following complications may occur:
- aspiration pneumonia;
- fracture of the ribs followed by a wound to the lung;
- hemothorax;
- pneumothorax;
- burns of the skin;
- various arrhythmias;
- encephalopathy of a hypoxic, anoxic, ischemic nature;
- myocardial dysfunction, which is caused by reperfusion syndrome.
Diagnosis of ventricular flutter
Ventricular flickering and flutter can be recognized and diagnosed using clinical and electrocardiographic data. If there is such a deviation, then on an electrocardiographic study it will be displayed in the form of regular, rhythmic waves having almost the same shape and amplitude. They resemble a sinusoidal type curve with an oscillation frequency of 200-300 per minute. Also on the ECG there is no isoelectric line between the waves, P waves and T.
If ventricular fibrillation is observed, then waves with a heart rate (heart rate) of 300-400 vibrations per minute, which continuously change their duration, shape, direction and height, will be recorded. There is no isoelectric line between the waves.
Ventricular fibrillation and flutter must be differentiated from cardiac tamponade, massive pulmonary embolism, supraventricular arrhythmia, paroxysmal ventricular tachycardia.
The heart rate table is normal by age below.
Ventricular flutter treatment
In case of ventricular flutter or fibrillation, immediate resuscitation care should be provided, which is aimed at restoring sinus heart rhythm. Primary resuscitation should include applying a precardial beat or performing artificial respiration in tandem with indirect heart massage. Specialized cardiopulmonary resuscitation includes mechanical ventilation and electrical defibrillation of the heart.
At the same time as resuscitation measures, atropine, adrenaline, sodium bicarbonate, procainamide, lidocaine, amiodarone, magnesium sulfate should be administered intravenously. In parallel with this, repeated electrodefibrillation is required. In this case, in each series, energy should be increased from 200 to 400 J. If a relapse of ventricular fibrillation and flutter occurs, which occurs as a result of complete atrioventricular heart block, then it is necessary to resort to temporary stimulation of the heart ventricles with a rhythm that exceeds the frequency of their own vibrations.
special instructions
If the patient does not recover spontaneous breathing, cardiac activity, consciousness within 20 minutes, there is no reaction to the pupils' light, then resuscitation measures must be stopped. If resuscitation was successful, then the patient is transferred to ICU for further observation. Subsequently, the attending cardiologist decides whether to implant a cardioverter defibrillator or a dual-chamber pacemaker.