Hospital pediatrics. Heart rhythm disturbances in children (most important)

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Hospital pediatrics. Heart rhythm disturbances in children (most important)

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14. Violation of the heart rhythm in children. Paroxysmal tachycardia. Atrial fibrillation

Arrhythmias - these are disorders of the heart rhythm and conduction, occur with congenital heart defects, acquired heart diseases, dysfunction of the central and autonomic nervous system.

Classification of cardiac arrhythmias.

1. Violation of the function of automatism - violation of the formation of an excitation impulse:

1) nomotopic arrhythmias (disturbances in the formation of an impulse in the sinus node) (sinus arrhythmia, sinus tachycardia, sinus bradycardia);

2) heterotopic rhythm disturbances (the impulse originates outside the sinus node).

2. Passive ectopic rhythms:

1) nodal rhythm;

2) migration of the pacemaker (from the sinus node to the atrioventricular junction).

3. Active ectopic rhythms:

1) extrasystole;

2) paroxysmal tachycardia;

3) atrial and ventricular fibrillation;

4) flutter of the atria and ventricles.

4. Disorders of the conduction function (blockade), slowdown, complete delay in the conduction of excitation through the conduction system:

a) sinoauricular blockade;

b) atrioventricular blockade;

c) intra-atrial blockade;

d) intraventricular blockade;

e) blockade of the legs of the bundle of His.

Paroxysmal tachycardia - this is an attack of a sharp increase in heart rate, 2-3 times the normal rhythm.

Complaints in older children about discomfort in the heart, a feeling of tension in the neck, dizziness, fainting, pain in the epigastric region, abdomen. In young children, paroxysmal tachycardia is accompanied by convulsive and dyspeptic symptoms. On physical examination, shortness of breath, cyanosis, pulsation of the veins, congestion in the lungs, enlargement of the liver, the pulse cannot be counted, low filling, and a decrease in blood pressure.

Allocate atrial, atrioventricular, ventricular forms of paroxysmal tachycardia.

On the ECG with atrial paroxysmal tachycardia, a long series of atrial extrasystoles with a sharp shortening of the T-P interval is detected, the layering of the P wave on the T wave with its deformation, the QRS complex is not changed or moderately deformed, atrioventricular paroxysmal tachycardia is characterized by repeated repetition of atrioventricular extrasystoles with negative P waves , or by shifting them to the QRS complex, or by merging them with the T wave.

Atrial fibrillation - this is a violation of the correct activity of the atria due to the appearance in the atria of one or more foci of excitation. Complaints about the deterioration of well-being, a sense of fear, anxiety.

On the ECG, the P wave is absent and is slowed down by waves of various sizes and shapes. The QRS complex is not changed, the S-T interval is below the isoelectric line, the T wave and the isoelectric line are deformed by flicker waves.

Author: Pavlova N.V.

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