Paroxysm of atrial fibrillation (ICD 10: I49) refers to a special form of atrial fibrillation, in which the attack of pathological heart rhythm lasts for no more than 7 days. It is characterized by a chaotic twitching of the muscle fibers of the atria and a violation of the conductivity of electrical impulses in the myocardium. Due to heart rhythm disturbances in this pathology, they can fluctuate within 200-300 beats for several hours or even days.
Paroxysm of atrial fibrillation often occurs in the elderly and adulthood and is much less common in children and adolescents with congenital malformations of the heart muscle.
Disease feature
Paroxysm of atrial fibrillation (ICD code 10 - I49) is a pathological condition that is accompanied by an acute violation of the heart rhythm. Often the cause of its occurrence is ischemia, which was not cured in a timely manner.
Paroxysm of atrial fibrillation is characterized by the fact that it begins suddenly and causes discomfort. The duration of one such attack is approximately 5-7 minutes. Such a pathology is an acute attack of tachycardia, during which a person can experience more than 140 heart contractions per minute, which is very dangerous for his state of health.
Main classification
Depending on the number of heart contractions per minute, such types of pathology are distinguished as flutter with a frequency of up to 200 beats and flicker of 200 beats. Since against the background of arrhythmias, the ventricles begin to contract in an enhanced mode, according to the classification, these forms of the disease are distinguished:
- tachysystolic;
- bradisystolic;
- normosystolic.
Another classification of arrhythmia divides the disease into such forms as:
- ventricular, with severe cardiac arrhythmias;
- atrial, with a change in the conductivity of the bundle of His;
- mixed, with a combination of these two forms.
The first attack should be distinguished from paroxysm of atrial fibrillation, in which outbreaks of the disease periodically recur and last up to 7 days. With frequent exacerbations of arrhythmia, we can talk about a relapsing type of disease.
According to available signs, pathology is divided into several classes. At the first, the clinical picture is almost completely absent. In the second, the quality of life does not suffer, but slight signs of the course of the disease are observed. The third degree is characterized by the fact that there are numerous complaints and a person has to significantly limit himself. At the fourth - the clinical picture is pronounced, and complications, up to disability, can also be observed.
Causes of occurrence
Paroxysm of atrial fibrillation (ICD 10: I49) refers to rather complex pathologies, the main causes of which are as follows:
- chronic heart failure;
- cardiomyopathy;
- hypertension with an increase in heart mass;
- ischemia;
- inflammatory processes in the myocardium;
- congenital heart defects.
In addition, there are certain predisposing factors, which include:
- smoking and alcohol consumption;
- acute deficiency of magnesium and potassium;
- severe infectious processes;
- endocrine disorders;
- nervous strain and stress;
- postoperative condition;
- taking medications.
If a specific cause of the disease has not been established, then this form is called idiopathic. A similar condition is observed mainly in young patients.
Before starting treatment, it is very important to establish the provocative factor precisely. This will help the doctor choose the right method of therapy and reduce the risk of dangerous complications, including preventing repeated attacks.
The main symptoms
Paroxysm of atrial fibrillation (ICD code 10: I49) is complicated by the course. The nature of the course of the pathology largely depends on the frequency of ventricular contractions. It is worth noting that minor deviations from the norm may not manifest themselves at all. Moreover, a reduction of 120 strokes or more is mainly accompanied by such signs as:
- lack of air;
- excessive sweating;
- panic attacks;
- heartache;
- dyspnea;
- uneven heart rate;
- weakness;
- trembling
- dizziness.
With a critical violation of heart contractions, a person worsens cerebral circulation. The patient may periodically faint. In addition, a complete respiratory arrest is sometimes observed. This condition requires urgent medical attention.
Urgent Care
With paroxysm of atrial fibrillation, emergency care is very important. The algorithm of actions in this case should be clear and coherent. If an arrhythmia occurs, the main task is to seek medical help within 48 hours. After 2 days, there is a high probability of blood clots inside the heart and the development of a heart attack and stroke. Urgent measures for paroxysm of atrial fibrillation should go in the following sequence:
- lay the patient on a bed, sofa or floor;
- open the window and provide fresh air;
- the victim must take a deep breath.
After this, it is recommended to give the person "Warfarin" or other anticoagulants that were previously prescribed by the doctor. This will significantly reduce the risk of blood clots. When carrying out emergency measures for paroxysm of atrial fibrillation, in parallel with this, you need to call a team of emergency ambulance. Subsequent treatment should be carried out only by a doctor who selects medications depending on the complexity of the attack.
To stop the paroxysm of atrial fibrillation, the doctor introduces a cardiac glycoside, in particular Strofantin, Korglikon, or Novocainamide solution. In severe cases, cardiac defibrillation is performed.
Diagnostics
After rendering at first aid paroxysm atrial fibrillation, an emergency diagnosis is required. To confirm the presence of a problem, the heart rhythm is listened. An accurate diagnosis is possible with a flutter during the second or fourth contraction.
Additionally, the doctor prescribes electrocardiography. This procedure helps determine the presence of pathological changes in the heart. The diagnosis is made taking into account the degree of atrial size and valve wear. The results obtained largely affect the tactics of therapy.
Treatment features
Treatment of paroxysm of atrial fibrillation is selected separately for each patient. In addition to prescribing medications, it is important to adhere to a diet, eliminate heavy physical exertion, and lead a healthy lifestyle. It is very important to establish the main cause of the pathology and to influence it.
When a mild form of the disease occurs, treatment can be done on an outpatient basis. The main indications for hospitalization are such as:
- first-time attack;
- heart rate more than 200 per minute;
- a sharp drop in pressure;
- signs of heart failure;
- blood clots.
The main goal of conservative therapy is to restore heart rate. It is important to eliminate the existing symptoms as soon as possible, reduce the risk of thrombosis and prevent complications.
Initially, the doctor prescribes antiplatelet agents and anticoagulants. If a person is younger than 60 years old and there is no organic myocardial damage, drug therapy should include the continuous use of acetylsalicylic acid. In the presence of ischemia and other diseases, the use of "Warfarin" is indicated with regular testing. In particularly acute cases, low molecular weight heparins are prescribed , but it is worth remembering that they can be taken only in a short course.
To restore the normal rhythm of the heart, cardioversion is prescribed, which can be medication or instrumental. There are a number of antiarrhythmic drugs that prevent the occurrence of paroxysmal fibrillation attacks. These include such as "Propafenone", "Sotaleks", "Cordaron", "Amiodaron".
If heart rate is monitored without eliminating arrhythmias, then beta-blockers and calcium channel blockers are prescribed.
Additionally, an electric cardioversion can be prescribed, which implies bringing the heart rhythm back to normal by exposure to electric current. Due to the high degree of pain, the procedure is performed under general anesthesia. A defibrillator with electrodes is installed in the right collarbone, which sends impulses to the heart and "reboots" the organ.
Cardioversion is performed on an emergency or scheduled basis. If the procedure is planned, then within a month before and after it, a person must take "Warfarin". Before an emergency cardioversion, the patient is immediately given “Heparin”.
With a recurring form of the disease and the failure of other methods, the operation is indicated, namely, radiofrequency catheter ablation. It is a minimally invasive intervention. The electrode is inserted through the femoral vein into the heart, and then pathological foci of excitation are destroyed by a shock.
If you need to destroy the bundle of His, then during the operation requires the installation of a pacemaker. With a particularly severe form of leakage, the installation of a defibrillator is indicated to eliminate the occurring attack.
Paroxysm of atrial fibrillation is very dangerous for the patient’s life, therefore treatment must be carried out only under the supervision of a doctor. Folk remedies are used only as preventive measures to strengthen the heart muscle. For this, it is recommended to take the extracts of wild rose, hawthorn, the consumption of lemon with honey, as well as the addition of vegetable oils to food.
Possible complications
Paroxysm of atrial fibrillation (ICD code 10: I49) refers to serious and dangerous diseases, which, if improperly and untimely, can lead to dangerous complications. If assistance has not been provided, then a change in the intensity of blood flow is possible. This increases the likelihood of embolism in the atria. As complications can be such as:
- pulmonary edema as a result of acute failure;
- hypoxic shock, accompanied by a decrease in pressure;
- fainting
- heart failure;
- pathological change in blood flow.
The most serious complication is thromboembolism. The likelihood of its occurrence increases significantly if more than two days have passed since the attack without appropriate treatment. This period is sufficient for the formation of large blood clots in the atria.
Complications are mainly caused by circulatory disorders or due to the formation of blood clots. One of the most dangerous consequences of paroxysm is shock, in which pressure decreases sharply and the process of supplying tissues and organs with oxygen is disrupted. Such a violation can occur due to a high or low frequency of ventricular contraction.
With heart failure, pulmonary edema often occurs. During an attack, loss of consciousness may occur, which is provoked by disturbances in the blood supply to the brain. Possible negative consequences may be a heart attack, stroke or gangrene.
Forecast
The prognosis for paroxysm of atrial fibrillation is individual for each patient. It largely depends on the history of the disease, the cause of its occurrence, the form of the course and timely treatment. In addition, the weight of the patient, his age, as well as the presence of concomitant pathologies play a very important role.
In general, the prognosis for such a disease is quite favorable. Timely treatment allows you to maintain normal health, avoiding the frequent occurrence of seizures. It is worth noting that with full compliance with all medical prescriptions, a person can lead a completely normal lifestyle, with the exception of only a few restrictions in nutrition and physical activity.
The most important thing is to consult a doctor in a timely manner and not to self-medicate. In addition, normalization of the heart rhythm is important, which must be restored within the first day, until dangerous complications have arisen.
Prophylaxis
Paroxysm of atrial fibrillation (ICD 10: I49) refers to dangerous conditions, which is why it is best to prevent the onset of an attack than to treat it for a long time. To reduce the risk of atrial fibrillation, it is important to adhere to the following recommendations:
- rejection of bad habits;
- obesity prevention;
- healthy eating
- timely treatment of all myocardial diseases.
In addition, you need to enrich your menu with products with a high content of calcium, to undergo a scheduled examination every 6 months with a cardiologist. It is important to avoid all sorts of stresses, depressive states and nervous strain. Be sure to allocate time for proper sleep and relaxation.
You constantly need to monitor your pulse and pressure with a home blood pressure monitor. An electrocardiogram is recommended at least once a year. With proper treatment and compliance with all the rules of prevention, you can achieve very good results.
With this diagnosis, quite a lot of people live to a very old age, but all medical prescriptions must be followed.