Internal illnesses. Atrioventricular junction rhythm, idioventricular rhythm, extrasystoles, paroxysmal tachycardia (most important)

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Internal illnesses. Atrioventricular junction rhythm, idioventricular rhythm, extrasystoles, paroxysmal tachycardia (most important)

Lecture notes, cheat sheets

Directory / Lecture notes, cheat sheets

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22. Rhythm of the atrioventricular junction, idioventricular rhythm, extrasystoles, paroxysmal tachycardia

1. Rhythm of the atrioventricular connection

The pacemaker is the area of transition of the atrioventricular node into the bundle of His or the trunk of the bundle of His before it branches into branches.

Etiology. Vagotonia (with a healthy heart), medicinal effects and metabolic disorders (digitis intoxication, quinidine, morphine, hyperkalemia, acidosis, hypoxia), organic heart disease (CHD, hypertension, heart defects, myocarditis, rheumatic heart disease, shock).

Clinic. Bradycardia with the correct rhythm of 40-60 beats per minute, enhanced I tone, increased pulsation of the jugular veins.

On the ECG, there is a negative P wave, an unchanged QRST complex.

Treatment. The underlying disease is being treated. Atropine, isadrin, alupent are used. Antiarrhythmic drugs are contraindicated. For hyperkalemia and acidosis, drip administration of sodium bicarbonate and glucose with insulin is performed. In case of complete atrioventricular block, an artificial pacemaker is implanted.

2. Idioventricular rhythm

The pacemaker of the heart becomes the center of the third order with a rare rate of contraction - 20-30 beats per minute.

Etiology. Severe myocardial damage.

On the ECG - altered QRST complexes (as in ventricular extrasystole), negative P waves.

Treatment. The underlying disease is being treated.

3. Extrasystoles

Contraction of the whole heart or any of its departments under the influence of a premature impulse from the cells of the conduction system of the atria and ventricles.

Etiology. Re-entry of the sinus impulse (local blockade), increased automatism outside the sinus node.

Treatment. Treatment of the underlying disease. A diet and regimen must be followed, and hydrotherapy must be used. Sedatives and antiarrhythmic treatment are prescribed (if necessary). If there is a threat of ventricular fibrillation, intravenous lidocaine or procainamide is indicated.

4. Paroxysmal tachycardia

A sudden increase in heart rate as a result of impulses emanating from a focus located outside the sinus node.

Etiology. Strong emotions, nervous tension, overwork, excessive use of nicotine, etc. thyrotoxicosis, reflex influences, WPW and CLC syndrome, myocardial diseases, hypertension, mitral stenosis, digitalis intoxication, hypokalemia.

Treatment. Relief of supraventricular paroxysmal tachycardia: massage of the sinocarotid zone, use of the Valsalva maneuver (pressure on the eyeballs), 40 mg of propranolol orally, slow intravenous administration of 2-4 ml of 0,25% isoptin solution, in the absence of hypotension 5-10 ml of 10% - of a solution of novocainamide if there is no effect - defibrillation.

Relief of an attack of ventricular paroxysmal tachycardia: electric pulse therapy, intravenous injection of lidocaine. For mild conditions, novocainamide 0,75 g orally and then 0,25 g every 3 hours or intravenously.

Author: Myshkina A.K.

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