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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



  • Tachycardia: heart

  • 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



  • ІІ. heartVIOLATION OF LEADTHROUGH OF IMPULSE

    - Sinoauricular of blockade

    - Atrioventricular blockades:

    • І st.

    • ІІ st.

    • ІІІ st.



  • IV. DISEASE, SYNDROMES And PHENOMENA heart

    • 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


  • Syndrome of weakness of sinus noudle heart

  • Syndrome of Morganii-Adams-Stoks

  • Syndrome of Frederic

  • Cardiac sudden death (arrhythmical)

  • asystole

  • fibrilation of ventricles

  • electromechanics dissociation

  • Heart arest


  • 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 CARDIOSTIMULATORS OF DIFFERENT TYPE

  • 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 CARDIOSTIMULATORS OF DIFFERENT TYPEtachycardia

  • 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 CARDIOSTIMULATORS OF DIFFERENT TYPE

  • 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 CARDIOSTIMULATORS OF DIFFERENT TYPEbradycardia

  • 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 CARDIOSTIMULATORS OF DIFFERENT TYPE

  • 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 CARDIOSTIMULATORS OF DIFFERENT TYPE

  • 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 CARDIOSTIMULATORS OF DIFFERENT TYPE

  • 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


  • a-normal CARDIOSTIMULATORS OF DIFFERENT TYPE sinus rhythm

  • б- sinus tachycardia

  • в- sinus bradycardia

  • г- sinus arrhythmia


Arest of sinus knot
Arest of sinus knot CARDIOSTIMULATORS OF DIFFERENT TYPE

  • 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 CARDIOSTIMULATORS OF DIFFERENT TYPE

  • 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 CARDIOSTIMULATORS OF DIFFERENT TYPE

  • effective treatment does not exist

  • medical therapy is at the attacks of Morgani-Adams-Stoks

  • implantation of permanent electro-cardyostimulator


Extrasystolia
Extrasystolia CARDIOSTIMULATORS OF DIFFERENT TYPE

  • 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 CARDIOSTIMULATORS OF DIFFERENT TYPEextrasystolia

  • 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.


  • a- CARDIOSTIMULATORS OF DIFFERENT TYPE 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- CARDIOSTIMULATORS OF DIFFERENT TYPEV- 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


  • with previous excitation of ventricles CARDIOSTIMULATORS OF DIFFERENT TYPE

  • 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 CARDIOSTIMULATORS OF DIFFERENT TYPEextrasystolia

  • 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.


  • a- CARDIOSTIMULATORS OF DIFFERENT TYPE sinistroventrical extrasystole

  • b- dextraventrical extrasystole


Paroxysmal ta chyc ardi a supraventricular ta chyc ardia
Paroxysmal CARDIOSTIMULATORS OF DIFFERENT TYPEtachycardia 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 CARDIOSTIMULATORS OF DIFFERENT TYPEtachycardia

  • EKG-signs:

  • 150-200 heart beats per 1 min.

  • retrograde P wave (negative) after QRS or accumulates on him


  • a- CARDIOSTIMULATORS OF DIFFERENT TYPE 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 CARDIOSTIMULATORS OF DIFFERENT TYPEparoxysmalsupraventriculartachycardia

  • 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 CARDIOSTIMULATORS OF DIFFERENT TYPEtachycardia

  • EKG is criteria:

    - >140 hearts beats per 1 min.

    - the complexes of QRS are extended


  • EKG is at CARDIOSTIMULATORS OF DIFFERENT TYPEparoxysmal ventrical tachycardia


Trembling and fibril ation of atriums
Trembling and CARDIOSTIMULATORS OF DIFFERENT TYPEfibrilation 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 CARDIOSTIMULATORS OF DIFFERENT TYPEfibrilation 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


  • a- CARDIOSTIMULATORS OF DIFFERENT TYPE trembling of ventricles

  • b- blinking and fibrilation of ventricles


Sinoauricular blockade
Sinoauricular blockade CARDIOSTIMULATORS OF DIFFERENT TYPE

  • 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 CARDIOSTIMULATORS OF DIFFERENT TYPE blockade

  • EKG is criteria:

  • increase of duration and breaking up of wave Р


Atrioventricular blockade st
Atrioventricular blockade CARDIOSTIMULATORS OF DIFFERENT TYPEІst

  • 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- CARDIOSTIMULATORS OF DIFFERENT TYPEvblockade 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- CARDIOSTIMULATORS OF DIFFERENT TYPEvblockade 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 Hiss

  • 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 Hiss

  • 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


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