Internal illnesses. Arrhythmias due to impaired conduction of impulses (most important)

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Internal illnesses. Arrhythmias due to impaired conduction of impulses (most important)

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24. ARRYTHMIAS DUE TO IMPULSE CONDUCTION DISORDERS

Conduction disturbances between the sinus node, atria and ventricles.

Etiology. Organic heart disease, increased tone of the cholinergic system, intoxication (digitis, b-blockers).

Treatment. With AV blockade of the XNUMXst degree, no treatment is required.

With AV blockade of the degree of the proximal type, verapamil (Isoptin), potassium preparations, and cardiac glycosides are used.

With complete AV blockade caused by digitalis, the drug is withdrawn.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 unitiol 3-4 times a day.

In case of sudden complete AV blockade, administration of quinidine, procainamide, ajmaline, and allapinine is indicated.

With moderate sinoauricular blockade while maintaining the correct rhythm, treatment is not required. In severe cases, the use of atropine and sympathomimetes.

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

For ventricular arrhythmias, lidocaine, trimecaine, and diphenine are administered. Cardiac glycosides are completely contraindicated.

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

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. Attacks of supraventricular paroxysmal tachycardia are possible, and less commonly attacks of atrial 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 (Laun-Ganong-Levin) - shortening of PQ with an unchanged QRS complex, paroxysms of supraventricular tachycardia are possible.

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

Parasystole - the presence of two pacemakers (sinus and ectopic), functioning independently; 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.K.

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