Internal illnesses. Arrhythmias due to impaired conduction of impulses (lecture notes)

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Internal illnesses. Arrhythmias due to impaired conduction of impulses (lecture notes)

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LECTURE No. 20. Arrhythmias due to impaired conduction of impulses

Arrhythmias due to impaired conduction of impulses - conduction disturbances between the sinus node, atria and ventricles.

Etiology. The causes are organic lesions of the heart, increased tone of the cholinergic system, intoxication (digitis, β-blockers).

Conduction disturbances are in the form of:

1) sinoatrial or sinoauricular blockades;

2) violations of intra-atrial conduction;

3) atrioventricular blockades:

a) I degree - deceleration of atrioventricular conduction;

b) II A degree (Mobitz type I) - incomplete blockade;

c) II B degree (Mobitz type II) - incomplete blockade;

d) III degree (complete transverse blockade);

4) intraventricular blockades: complete blockade of the left leg of the bundle of His, complete blockade of the right leg of the bundle of His, incomplete transverse ventricular blockade, complete transverse ventricular blockade;

5) premature excitation of the ventricles (WPW, LGL, CLC syndrome);

6) parasystoles;

7) ectopic activity of centers with exit blockade.

Treatment.

With AV block I degree treatment is not required.

With AV block II-III degree proximal type, verapamil (Isoptin), potassium preparations, cardiac glycosides are used.

With complete AV blockcaused by digitalis, the drug is withdrawn. While maintaining the blockade, 0,5-1,0 ml of a 0,1% solution of atropine is injected intravenously, intramuscularly 5 ml of a 5% solution of unithiol 3-4 times a day.

With sudden onset of complete AV blockade shows the introduction of quinidine, novocainamide, aymaline, allapinin.

With moderate sinoauricular blockade while maintaining the correct rhythm of treatment is not required. In severe cases, atropine, sympathomimetics are used.

With sick sinus syndrome and manifestations of Morgagni-Adams-Stokes syndrome implantation of an artificial pacemaker is indicated.

For ventricular arrhythmias lidocaine, trimecaine, difenin are introduced. Cardiac glycosides are completely contraindicated.

With AV blockade and ventricular disorders quinidine, novocainamide, β-blockers, cordarone, allapinin are used.

WPW Syndrome (Wolff-Parkinson-White)

WPW syndrome (Wolff-Parkinson-White) - shortening of atrioventricular conduction, the appearance of a delta wave (serration) on the ascending knee of the R wave and tachyarrhythmia attacks. Described in 1930, noted in apparently healthy young people with tachycardia attacks.

Etiology. Etiological factors are a short atrioventricular node, the possible presence of two atrioventricular nodes, additional pathways for conducting impulses: Kent's bundle, Maheim's bundle, James's bundle.

Clinic. Clinical manifestations may be absent. It is often an incidental ECG finding. There may be attacks of supraventricular paroxysmal tachycardia, less often attacks of flutter or atrial fibrillation. Sudden death and heart failure are extremely rare.

The ECG shows a negative delta wave in leads II, III, aVF (must be differentiated from posterior diaphragmatic myocardial infarction).

Treatment. With frequent attacks of tachycardia, preventive treatment is carried out.

Syndrome LGL (Launa-Ganong-Levin)

Syndrome LGL (Laun-Ganong-Levin) - shortening of PQ with an unchanged QRS complex, paroxysms of supraventricular tachycardia are possible.

CLC Syndrome (Clerk-Levy-Christerko)

Syndrome CLC (Clerk-Levy-Christerko) - shortening of P-Q with an unchanged QRS complex, ventricular arrhythmias are possible.

Parasystole - the presence of two pacemakers (sinus and ectopic), functioning independently; absent on the ECG: a constant distance from the previous normal ventricular complex to the ectopic one, a constant short interectopic interval, ventricular parasystole is more often noted.

Ectopic activity of centers with exit blockade is a rare variant of parasystole, the ectopic pacemaker has a higher rate than the main one.

Author: Myshkina A.A.

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