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Arrhythmias of heart. Department of propede u ti c of internal medicine. Etiology. Violations of rhythm of cardiac activity cause such defeats of myocardium: organic: IHD,defects of heart, AH, m y o c arditi s, c ardiom y opat hy; · toxic: medicines, alcohol;

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arrhythmias of heart

Arrhythmias of heart

Department of propedeutic of internal medicine

etiology
Etiology.
  • Violations of rhythm of cardiac activity cause such defeats of myocardium:
  • organic: IHD,defects of heart, AH, myocarditis, cardiomyopathy;
  • · toxic: medicines, alcohol;
  • · hormonal : thyrotoxicosis, myxedema, pheochromocytoma, climax;
  • · functional : neurogenic, sporting;
  • · anomalies of development of heart - more frequent all WPW.
pathogenesis
Pathogenesis
  • Theories of origin of arrhythmias:
  • Pathological automatism (presence of ectopic focuses)
  • Mechanism of re-entry
  • trigern (starting) activity.
classification of violations of rhythm and conductivity of heart
Classification of violations of rhythm and conductivity of heart
  • I. Violations of formation of impulse
  • Sinus tachycardia (more than 90 complexes are for a minute)
  • Sinus bradycardia (less than 60 complexes are for a minute )
  • Sinus arrhythmia
  • Stop (refuse) of sinus node
  • Migration of supraventricular driver of rhythm
slide5
Extrasystolia (a synonym is premature depolarization):
  • auricle (atrial)
  • auricle-ventrical (atrioventricular)
  • ventrical
slide6
Tachycardia:
  • supraventricular:
  • sino - auricle
  • (sinoatrial)
  • auricle (atrial)
  • auricle - ventrical
  • (atrioventrical)
  • ordinary (to 30 in a hour)
  • frequent (30 and anymore in a hour)
  • allorythmia (bi-, thre-, quadrigeminia)
  • polymorphic
  • twin
  • early (R on T)
  • chronic
  • paroxysmal
  • noudle
slide7
with the additional ways of leadthrough
  • ortodromal
  • antidromal
  • ventrical:
  • unsteady (from 3 ventrical complexes to 30)
  • steady (more than 30 seconds)
  • monomorphic
  • polymorphic
slide8
ІІ. VIOLATION OF LEADTHROUGH OF IMPULSE

- Sinoauricular of blockade

- Atrioventricular blockades:

      • І st.
      • ІІ st.
      • ІІІ st.
slide9
III. COMBINED DYSPOIESISS AND LEADTHROUGHS OF IMPULSE
  • · auricle
  • Parasystole · from AV of connection
  • · ventrical
  • specified at possibility
slide10
IV. DISEASE, SYNDROMES And PHENOMENA
    • Syndromes and ECG phenomena of pre-excitation of ventricles:
  • syndrome of WPW
  • syndrome of the shortened interval of PR (Launa - Ganonga - Livayna)
  • syndrome of early repolarisation of ventricles
  • innate
  • purchased
  • Syndrome of the prolonged interval of QT
slide11
Syndrome of weakness of sinus noudle
  • Syndrome of Morganii-Adams-Stoks
  • Syndrome of Frederic
  • Cardiac sudden death (arrhythmical)
  • asystole
  • fibrilation of ventricles
  • electromechanics dissociation
  • Heart arest
slide12
V. ARRHYTHMIAS ARE AT NORMAL OR BROKEN FUNCTION OF CARDIOSTIMULATORS OF DIFFERENT TYPE
  • Note: In a diagnosis it is needed to specify cardiac surgery interferences and devices, applied for treatment of arrhythmias and asequences heart (with pointing of method and to give interference) - kateterni (radio frequency et al) destruction, implantation of drivers of rhythm and cardioverters - defibrilyatoriv, leadthrough of cardioversion or defibrilyacii (the date of the last is specified) and others like that.
description of normal sinus rhythm
Description of normal sinus rhythm
  • correct rhythm with frequency of heartbeats 60-100 per 1 min.
  • the P wave is positive in II, III, AVF leads, negative - in the AVR leads, permanent form of P wave
  • a complex QRS follows by every P waveR (if there is not а-v-blockade).
  • Interval of P-Q>0.12 (if there are not additional ways of leadthrough).
sinus ta chyc ardia
Sinus tachycardia
  • ECG is criteria:
  • correct rhythm
  • sinus P waves are ordinary configuration.
  • 100-180 beats per 1 min.
  • gradual beginning and completion
  • Reasons: physical and emotional loading, pain, fever, hypovolumia, hypotension, anaemia, thyrotoxicosis, action of certain matters (coffeine, alcohol)
treatment
Treatment
  • liquidation of etiologic factor
  • B-adrenoblockers (propranolol10-40mg, oksprenolol20mg 3 times per days, pindolol 5 mg 3 times on days, nadolol 20 mg 2 times per days, metaprolol 50 mg 2 times per days)
  • sedative facilities
sinus brad yc ardia
Sinus bradycardia
  • ECG is criteria:
  • correct rhythm
  • less than 60 beats per 1 min
  • sinus P waves
  • interval of PQ >0,12 sec.
  • Reasons: increase of parasympatic tonus, myocarditis, myxedema, hypothermia, mechanical icterus, syndrome of weakness of sinus knot.
treatment1
Treatment
  • to the atropine sulfate of 0,5-1 mg or 0,1% solution 1-2 times per day
  • plathyphylinum hydrotartratum 0,5-1 mg or 0,2% solution 1-2 times per day
  • extract of beladonnae -0,02 gr. 3-4 times per days
  • izadrin 5-10 mgsublingval
the first aid is at the attacks of morgani adams stoks
The first aid is at the attacks of Morgani-Adams-Stoks
  • to the atropine sulfate of 0,5-1 mg or 0,1% solution intravenously
  • izadrin 5-10 mgsublingval (at a necessity to repeat)
  • alupent for 1-5-10 mg on 500 ml of izotonic soluble-sodium chloride
  • electro-cardiostimulation (temporal or permanent)
sinus arrhythmia
Sinus arrhythmia
  • ECG is criteria:
  • P wave is sinus origin
  • interval of PQ >0,12 s
  • 45-100 beats per 1 min
  • the rhythm of heart is wrong with the difference of the longest and shortest interval of R-R 0.16 and anymore
  • Treatment: does not require
slide20
a-normal sinus rhythm
  • б- sinus tachycardia
  • в- sinus bradycardia
  • г- sinus arrhythmia
arest of sinus knot
Arest of sinus knot
  • EKG is criteria:
  • complete asystole (absence of P and QRST)
  • the pause of R-R does not make two ordinary intervals, and anymore.
  • Treatment: how to the syndrome of Morgani-Adams-Stoks
syndrome of weakness of sinus knot
Syndrome of weakness of sinus knot
  • EKG is criteria:
  • sinus bradycardia is expressed
  • refuse of sinus knot with periods asystoles
  • a duty of sinus bradycardia is with the attacks of auricle tachycardia, fibrilation (syndrome of «tachy-brady»)
  • a sino-atrial blockade is with extra contractions heart beats
  • slow renewal of function of sine knot.
treatment2
Treatment
  • effective treatment does not exist
  • medical therapy is at the attacks of Morgani-Adams-Stoks
  • implantation of permanent electro-cardyostimulator
extrasystolia
Extrasystolia
  • premature excitation and reduction of heart or his separate parts is as a result of increase of activity of hearths of ectopic automatism.
auricle e x tras y stolia
Auricle extrasystolia
  • EKG of sign:
  • premature reduction after which incomplete scray pause
  • the P wave is changed, negative
  • a complex QRS is not changed or aberrant.
  • Treatment: it is not needed, at presence of clinical symptoms of b-blockers, verapamil, digitalis.
slide26
a- from the overhead departments of auricle
  • б- from the middle departments of auricle
  • в- from the lower departments of auricle
  • г- is blocked auricle extrasystole
v extrasystoles
А-V- extrasystoles
  • with simultaneous excitation of atriums and ventricles.
  • EKG-signs:
  • the P wave is not determined
  • an extraordinary complex QRS is not extended
  • incomplete scray pause
slide28
with previous excitation of ventricles
  • EKG-signs:
  • an extraordinary complex QRS is not extended
  • P wave is after QRS
  • complete scray pause
  • Treatment: like, as at auricle extrasystolia.
ventrical e x tras y stoli a
Ventrical extrasystolia
  • EKG of sign:
  • complex QRS wide without a previous P wave
  • complete scray pause
  • Treatments need frequent monotopic, politopic, group and early as R/T extrasystoles.
slide30
a- sinistroventrical extrasystole
  • b- dextraventrical extrasystole
paroxysmal ta chyc ardi a supraventricular ta chyc ardia
Paroxysmal tachycardia Supraventricular tachycardia
  • EKG is signs:
  • frequency of reductions of atriums - 120-250 per 1 min.
  • auricle complexes are preceded the complexes of QRS
  • the complexes of QRS are not changed
atrioventricular ta chyc ardia
Atrioventricular tachycardia
  • EKG-signs:
  • 150-200 heart beats per 1 min.
  • retrograde P wave (negative) after QRS or accumulates on him
slide33
a- auricle paroxysmaltachycardia
  • б -atrioventriculartachycardia with previous excitation of ventricles
  • в -atrioventriculartachycardia with simultaneous excitation of atriums and ventricles
treatment of paro xys mal supraventri c ular ta chyc ardi a
Treatment of paroxysmalsupraventriculartachycardia
  • atleadthrough to the impulse through an a-v knot:
  • massage of sinus carotic
  • izoptin 0,25%-4ml
  • obzіdan 0,1% - 5ml
  • dіgoxin 0,025% - 1ml v/v
  • cordaron 5% - 6 ml
ventrical ta chyc ardia
Ventrical tachycardia
  • EKG is criteria:

- >140 hearts beats per 1 min.

- the complexes of QRS are extended

trembling and fibril ation of atriums
Trembling and fibrilation of atriums
  • EKG is criteria of trembling:
  • frequency of auricle waves 250-350 per 1 min. ( waves of f)
  • EKG is criteria of fibrilation:
  • waves of f
  • wrong rhythm (different R-R)
  • absence of P wave
trembling and fibril ation of ventricles
Trembling and fibrilation of ventricles
  • EKG is criteria:
  • Sinus wave curve with frequent, rhythmic, wide and high waves, excitation of ventricles with frequency 200-300 per 1 min.
  • it is not possible to distinguish the elements of ventrical complex
  • Treatment:
  • electric cardioversion 200-300 Dzh. At unefficiency the repeated cardioversion
slide39
a- trembling of ventricles
  • b- blinking and fibrilation of ventricles
sinoauricular blockade
Sinoauricular blockade
  • EKG is criteria:
  • periodic fall of cardiac cycles
  • increase of pause between the waves of Р-Р in 2 times
inwardly auricle blockade
Inwardly auricle blockade
  • EKG is criteria:
  • increase of duration and breaking up of wave Р
atrioventricular blockade st
Atrioventricular blockadeІst
  • permanent lengthening of interval of P-Q anymore as on 0,20s
  • a- auricle form
  • б- key form
  • в-distal form blockade
v blockade
А-vblockade ІІ ст
  • the periodic stopping of leadthrough of impulse is from an auricle to the ventricles. There are three types:
  • I type (Mobit I) is the gradual lengthening of interval of P-Q with the subsequent fall of QRST ( periods of Samoylov-Venkenbach)
  • ІІ type (Mobit ІІ) is a fall of complexes of QRST without the gradual lengthening of interval of P-Q
  • ІІІ type (Mobit ІІІ) of fall every second, or 2 and more complexes successively
v blockade1
А-vblockade ІІІ ст
  • complete autonomy of reduction of auricle and ventricles.The intervals of P-P and R-R are permanent, but R-R>P-P.
syndrome of wolf parkinson white
Syndrome of Wolf-Parkinson-White
  • reduction of interval of P-Q (R)
  • a presence in composition a complex QRS of additional wave of excitation is d-wave
  • deformation and increase of duration of complex QRS
  • discordant displacement of RS-T and change of polarity of wave T (inconstant sign)
conclusions
Conclusions
  • It is necessary to know for successful diagnostics and treatment of arrhythmias:
  • basic nosotropic mechanisms of their development
  • · to own the methods of diagnostics of arrhythmias
  • · to distinguish of high quality, potentially malignant and malignant arrhythmias
  • · to understand algorithms diagnostic at the therapeutic going near the different types of arrhythmias
ad