Internal illnesses. Atrial fibrillation, atrial flutter, ventricular fibrillation (the most important)

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Internal illnesses. Atrial fibrillation, atrial flutter, ventricular fibrillation (the most important)

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23. Atrial fibrillation, atrial flutter, ventricular fibrillation

1. Atrial fibrillation (atrial fibrillation)

Complete prolapse of atrial systoles. Up to 350-600 pulses circulate in the myocardium. The rhythm of ventricular contractions is wrong.

Etiology. Organic myocardial damage, thyrotoxicosis.

Pathogenesis. The mechanism of excitation re-entry is micro reentry, stopping the sinus node.

Clinic. General weakness, palpitations, shortness of breath. Auscultation determines the arrhythmia of tones, changes in the volume of tones; pulse deficit. There are no P waves on the ECG, ventricular complexes are irregular, the isoelectric line is wavy.

Treatment. When stopping an attack, sedatives are used, propranolol inside; while maintaining the attack - 4-8 g of potassium chloride diluted in water, intravenous administration of 5,0-10,0 ml of a 10% solution of novocainamide.

In the presence of heart failure in elderly patients, strophanthin is used.

In persistent cases of atrial fibrillation, quinidine and electrical impulse therapy are used. For persistent atrial fibrillation, cardiac glycosides are prescribed. Defibrillation is performed for recently occurring (up to a year) atrial fibrillation.

2. Atrial flutter

Accelerated, superficial, but the correct rhythm of atrial contraction with a frequency of 200-400 per minute.

Etiology. Organic heart disease (valvular disease, ischemic heart disease, thyrotoxicosis, rheumatic heart disease, myocarditis, intoxication).

Clinic. Forms: paroxysmal, constant.

Treatment. It is carried out as in atrial fibrillation.

3. Ventricular fibrillation (ventricular fibrillation)

Uncoordinated, asynchronous contractions of individual muscle fibers of the ventricles.

Etiology. Organic heart diseases (CHD, acute myocardial infarction, etc., heart failure, postoperative period, hypothermia, WPW syndrome, intoxication, electrical injury.

Pathogenesis. Weak, erratic contractions of the muscle fibers of the ventricles are noted, the aortic semilunar valves do not open. The stroke volume of the heart drops to zero, blood flow to the organs stops. Death occurs within 4-8 minutes.

Clinic. Clinical manifestations are characterized by loss of consciousness, pallor, cold sweat. Arterial pressure drops to zero, heart sounds are not heard, there is no breathing, the pupils are dilated.

The onset of death. Stage I - a reversible state for no more than 8 minutes (clinical death), Stage II - biological death.

resuscitation activities. Carrying out artificial ventilation. In case of inefficiency, three-time defibrillation is performed. If there is no effect, 1 ml of a 0,1% solution of adrenaline is injected intravenously or 2 ml endotracheally, after the introduction, defibrillation is repeated.

CPR must be carried out within 40 minutes.

After resuscitation, lidocaine is administered intramuscularly every 2-3 hours for 6-8 days; β-blockers are prescribed over the next 8-18 months.

Author: Myshkina A.K.

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