Paroxysmal atrial fibrillation( atrial fibrillation): treatment, forms, emergency care

Paroxysmal atrial fibrillation or PMA, paroxysmal atrial fibrillation( ICD-10 code: I48) is a common occurrence of atrial contraction. It is a tachycardic attack, in which the rhythm of the heart remains correct, and the frequency of heart contractions( heart rate) varies between 120-240 beats / min. The problem is quite common and often is a manifestation of other types of pathologies.

State of the

The symptoms of PMA usually start suddenly and also abruptly stop, its duration can be prolonged - from a couple of minutes to several days.

  • More often such an ailment is experienced by older people( 60 years and over) - more than 6% of the population.
  • The number of patients with PMA that have not reached the 60th anniversary is less than 1%.

Usually PMA is not easily transferred because of high heart rate, because the "motor" has to work with increased load. If the pathology acquires a permanent form, then there is a possibility of blood clots in the atria, as well as heart failure. People with this type of arrhythmia are 5 percent more likely to have an ischemic stroke.

Electrocardiogram for paroxysmal atrial fibrillation

Electrocardiogram for arrhythmia

Forms

It has been accepted to distinguish three forms of disturbance:

  1. ventricular. In this case, there is a pronounced deformation of QRST, there are often cases of changes in the isoelectric line contour, and heart rhythm disturbances are possible;
  2. atrial. In patients, there is a disturbance in the conduction of the leg of the Hiss beam( right);
  3. mixed. Has manifestations of the previous two forms.

If the cause of the appearance of PMA is not established, then we are dealing with its idiopathic form, which is more common in young people.

The peculiarities of the paroxysmal form of atrial fibrillation will be described by a well-known specialist in the video below:

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Classification of

On the frequency of atrial contractions, it is possible to distinguish such types of PMA:

  • directly flicker, in the case when the heart rate is more than 300 per minute;
  • flutter, when the heart rate does not exceed the mark of "200".

Depending on the frequency of contraction of the ventricles, specialists identify such forms:

  • is tahisystolic. The ventricles contract with a frequency of more than 90 per minute;
  • is bradysystolic. Abbreviations are less than 60;
  • is normosystolic( intermediate).

If the episodes of PMA are repeated, it indicates the presence of a recurring form.

Paroxysmal form of atrial fibrillation has its own causes, we'll talk about them later.

Causes of

One of the main reasons for the appearance of PMA is the presence of a cardiovascular system( CVD) in a patient, namely:

  • of ischemic disease( IHD);
  • heart failure;
  • heart defects, both congenital and acquired( especially often the mitral valve), which are accompanied by an expansion of the chambers;
  • essential hypertension with increasing mass of the heart muscle( myocardium);
  • inflammatory heart diseases such as pericarditis, endocarditis and myocarditis;
  • dilated and / or hypertrophic cardiomyopathy;
  • syndrome of sinus node weakness, as well as Wolff-Parkinson-White syndrome.

Also cause the development of PMA can:

  • lack of potassium and magnesium in the body due to electrolyte disorders;
  • disorders of the endocrine system( pr. Thyrotoxicosis);
  • diabetes mellitus;
  • severe infectious diseases;
  • pathology of the lung with compensatory changes in the structure of the heart;
  • postoperative condition.

In addition to disease, the development of PMA is also affected by:

  • excessive consumption of alcohol-containing beverages;
  • reception of cardiac glycosides, adrenomimetics;
  • nervous exhaustion;
  • frequent stress.

About what symptoms is paroxysmal form of atrial fibrillation of the heart( atrial fibrillation), the following section will tell.

Symptoms of

paroxysmal atrial fibrillation Symptoms of the disease vary from case to case. So, in some patients there are only unpleasant sensations in the region of the heart. But most people manifest the following:

  • sudden palpitations;
  • severe general weakness;
  • lack of air;
  • cooling of the upper and lower extremities;
  • sweating;
  • sometimes shudder.

There may also be a blanching of the skin and cyanosis of the lips( cyanosis).

When it comes to a severe case, you may experience:

  • dizziness;
  • loss of consciousness or fainting;
  • panic attacks or similarly less cardinal conditions, because a person's condition is dramatically and severely deteriorating, which can cause him a strong fear for his life.

At the end of an episode of PMA, the patient usually has an increase in the intestinal peristalsis and a marked urination is noted. When there is a decrease in heart rate below the critical level, the patient may have a severe deterioration of the blood supply to the brain. This can manifest itself in the form of loss of consciousness, and sometimes the stopping of breathing, the pulse can not be determined. In this case, urgent resuscitation is required.

Diagnosis

As already mentioned, the first and main method of diagnosis is electrocardiography. Signs of ciliated paroxysmal arrhythmia on the ECG will be the absence of a P wave in all leads, instead of it chaotic waves f are observed. The R-R intervals will be different in duration.

  • With ventricular PMA, after an attack for several days, the ST shift remains.as well as the negative tooth T. And, since the probability of small-heart attack of myocardial infarction is great, monitoring the patient in dynamics is simply necessary.
  • If the atrial form of the PMA is observed, the electrocardiogram will indicate a marked deformation of the R wave.

Also for the diagnosis of PMA can use:

  • Holter monitoring.
  • A sample with physical activity on the electrocardiogram will help to reveal the true heart rate.
  • The doctor must also listen to the patient's heart with a stethoscope.
  • Patient can be assigned an ultrasound examination of the heart( ECHO-KG), which is used to ascertain the size of the atria and the state of the valve apparatus.
  • Transesophageal ultrasound of the heart, which is rarely performed due to the lack of special equipment, will help doctors to more accurately determine the presence / absence of blood clots in the atrial cavity.

The following section will describe the treatment required by the paroxysmal form of atrial fibrillation( atrial fibrillation).

Treatment of

Treatment of PMA depends, first of all, on the timing of the attack.

  • With his prescription less than 2 days( 48 hours), doctors are doing their best to restore the sinus rhythm.
  • If more than 48 hours have passed, complications of an embolic nature are too likely. Therefore, doctors direct the treatment to heart rate control, for example, by anticoagulants( warfarin), which prevent the formation of thrombi by diluting blood. Three weeks later, the specialist returns to the question of restoring the rhythm.

Therapeutic and medicamentous

paroxysmal atrial fibrillation Most commonly used for the treatment of ailment are such medicinal products as:

  • digoxin, helps to control heart rate;
  • cordaron, is characterized by the presence of a minimal amount of adverse events from its use;
  • Novocainamide, which, with rapid administration, sometimes causes a sharp decrease in pressure.

These medications are administered intravenously in the hospital or by ambulance doctors. Usually, this treatment is effective in 95% of cases.

Patient can prescribe for a patient with paroxysmal atrial fibrillation paranasms, which has a tablet form of release, so it can be used by the patient on his own.

Electroimpulse therapy

In case of ineffectiveness of the previous method, the doctor can appoint electropulse therapy( electric discharge).

The procedure is as follows:

  1. The patient is given anesthesia;
  2. Under the right collarbone and in the apex of the "motor" two electrodes are installed;
  3. The specialist sets the synchronization mode on the device to ensure that the discharge corresponds to the contraction of the ventricles;
  4. Sets the required current value( 100-360 J);
  5. Produces electrical discharge.

This way, there is a kind of resetting of the conduction system of the heart, the efficiency of the method is almost 100 percent.

Operation

Surgical intervention is indicated to people with frequent relapses of PMA and cauterization of lesions of pathological excitation of the heart muscle with a laser. For the treatment in the artery make a puncture with the help of special catheters.

On whether a paroxysmal form of atrial fibrillation( atrial fibrillation) is treated with folk remedies, read on.

The unique way of surgically treating the paroxysmal form of atrial fibrillation will be described by the video below:

Folk remedies

First of all, consult a doctor before taking any folk remedy. These can be:

  • Hawthorn and its alcohol tinctures with motherwort and valerian. Mix 3 bottles of each product in one container, shake well, dispense into the refrigerator for the day. In a day, start taking 30 minutes before eating 1 teaspoon three times a day.
  • Lemon.0.5 kg of fruit cut, pour honey, add 20 kernels from apricot kernels to the mixture. Use 2 times a day( morning and evening) for 1 tablespoon.
  • The grass of Adonis.0,25 l of water boil in enameled dishes. Fire reduce to a minimum, pour 4 gr.herbs, cook the mixture for 3 minutes. Ready to cover the drink and insist no more than 20 minutes in the heat. Take three times a day on a tablespoon.

Emergency care for paroxysmal atrial fibrillation

As such, a physician can:

introduce medications:

  • aymalin( giluritmal);
  • Novokainamide;
  • is rhythmic.

These agents should not be used in severe hemodynamic disorders, in order not to aggravate the condition. Therefore, electropulse therapy can be used, as well as intravenous administration of digoxin.

The attack of PMA can be removed and independently:

  1. Squeeze the abdominal press;
  2. Hold your breath;
  3. Push on the eyeballs.

If this technique does not work, call an ambulance immediately.

Prevention of the disease

paroxysmal atrial fibrillation rhythm First of all, it is necessary to prevent such heart diseases as insufficiency and arterial hypertension. In addition, it is necessary: ​​

  • to reduce( and it is better to exclude altogether) the consumption of alcoholic beverages;
  • to exclude serious physical activity, it is better to replace them with leisurely walks in the park;
  • eliminate from the diet fat and spicy, give preference to products rich in magnesium and potassium.
  • As a preventive measure, prescription drugs can be prescribed:
  • sulfate,
  • asparaginate( Panangin Ave.).

Complications of

As mentioned, the most common form of complication of PMA is the development of heart failure, as well as the appearance of thrombi( pr. Thromboembolism).Such ailments can cause ischemic stroke and lead to stopping the work of the heart, and with it and to death. Especially dangerous is PMA for diabetics, patients with high blood pressure.

About what forecast for the medical history "atrial fibrillation, paroxysmal form of atrial fibrillation" is given, read at the end of the article.

Forecast

In general, the forecast can not be called negative, in particular, if the PMA attack did not provoke more serious diseases. With proper treatment, a person is usually able to live more than 10 years( sometimes 20).

The incidence of ischemic stroke in people with PMA is about 5% per year, that is, every 6th stroke occurs in patients with atrial fibrillation.

Another very unusual method of treating atrial fibrillation will be described by the following video:

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