Arrhythmia
Pyelonephritis
Thyrotoxicosis
Rheumatism
12659 09 April
IMPORTANT!
The information in this section cannot be used for self-diagnosis and self-treatment.
In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor. Arrhythmia: causes of occurrence, in what diseases it occurs, diagnosis and treatment methods.
Definition
The heart is a muscular organ, a pump that maintains a constant flow of blood in the vessels, generating impulses at a certain frequency that lead to excitation and contraction of the myocardium. Normally, the contraction of the heart’s parts occurs sequentially: first, the right and left atria contract, then the right and left ventricles.
The main source of heart rhythm is located in the right atrium - the sinus node, which in a healthy adult sets the correct heart rate rhythm (60-80 beats per minute).
In addition to the sinus node, other parts of the myocardium can generate impulses and set the rhythm, but in a healthy person they do not cause arrhythmias due to the adequate functioning of the sinus node.
The heart has the property of conductivity, i.e. the ability to quickly propagate an impulse throughout the myocardial tissue, which is necessary for the coordinated work of all cardiac muscle cells.
Cardiac arrhythmia is a condition characterized by a disturbance in the rhythm of the heart, the process of impulse formation and its conduction. Some arrhythmias at a certain age are considered normal, but most are still a sign of one or another pathology, and therefore require close monitoring and treatment.
Types of cardiac arrhythmias
Depending on the heart rate (HR), arrhythmias are divided into
tachyarrhythmias
(with an increase in heart rate of more than 80–90 beats per minute) and
bradyarrhythmias
(with a decrease in heart rate of less than 60 beats per minute).
Based on the location of the myocardial area, which is an abnormal source of rhythm, supraventricular (supraventricular) arrhythmias
, when the pacemaker is located in the atria or in the atrioventricular node, and
ventricular arrhythmias
, when the pacemaker is located in the ventricles of the heart.
One of the most important classifications of cardiac arrhythmias is based on the immediate cause of its development.
- Arrhythmias due to impaired impulse formation, which are based on impaired functioning of the sinus node, for example, sinus arrhythmia, sick sinus syndrome, etc. According to statistics, the prevalence of sinus arrhythmia (SA) in the general population is 33.9-34.5%, sinus bradycardia (SB) - 7.1-12.8%, sinus tachycardia (ST) - 4.9-9.8%.
- Arrhythmias due to changes in the automaticity of latent pacemakers, for example, replacement cardiac rhythms.
- Arrhythmias caused by abnormal circulation of the impulse in the myocardial tissue, for example, extrasystole, atrial fibrillation (atrial fibrillation), atrial flutter.
- Disturbances in the conduction of impulses through the myocardium:
- blockades, for example, atrioventricular block, right bundle branch block, etc.;
- premature excitation of the ventricles - the passage of an impulse along additional pathways, for example, Wolff-Parkinson-White syndrome.
Separately, there is a respiratory arrhythmia, which is normally observed in young children and consists of an increase in heart rate during inhalation and a slowdown during exhalation.
Possible causes of arrhythmia
Some of the causes of heart rhythm disturbances lie directly in the structure of the heart, while others are caused by external influences on the heart.
To the reasons of the heart
arrhythmias include congenital and acquired heart defects, consequences of myocardial infarction, inflammatory changes in heart tissue (carditis), heart tumors, cardiomyopathy (changes in normal myocardial tissue), etc. Long-term diseases of the endocrine system, arterial hypertension, alcoholism, etc. can lead to changes in the structure of the myocardium.
To extra-cardiac reasons
conditionally include those conditions that cause rhythm disturbances without leading to structural changes in the heart tissue: changes in the innervation of the heart, changes in the balance of electrolytes (potassium, magnesium, calcium) with damage to the kidneys, adrenal glands, parathyroid glands, with prolonged diarrhea or vomiting, with intoxication, other changes in metabolic processes.
What diseases cause arrhythmias?
- Coronary heart disease (a disease based on insufficient blood supply to the heart muscle, resulting in oxygen starvation of the heart) and the consequences of a myocardial infarction.
- Long-term arterial hypertension.
- Hypertrophic, restrictive, dilated (including alcoholic) cardiomyopathy, arrhythmogenic dysplasia of the right ventricle are pathological conditions based on restructuring of the myocardium with disruption of its basic functions.
- Heart defects, for example, mitral stenosis, aortic insufficiency.
- Congenital heart defects, manifested by numerous symptoms, incl. arrhythmia, already from childhood.
- Congenital anomalies of the cardiac conduction system, for example, an accessory bundle in Wolff–Parkinson–White syndrome.
- Inflammatory damage to the myocardium (carditis, myocarditis).
- Acute and chronic kidney diseases, leading to changes in electrolyte balance, restructuring of myocardial tissue: chronic kidney disease due to glomerulonephritis, pyelonephritis, etc., acute kidney injury.
- Diseases of the endocrine glands: hypothyroidism, hyperthyroidism, adrenal dysfunction, etc.
- Tumors of the heart and other organs.
Which doctors should you contact if you have an arrhythmia?
As a rule, arrhythmias are first diagnosed either during a medical examination or when a patient approaches with specific complaints. Deviations in heart rhythm require consultation to clarify the type of arrhythmia and conduct a comprehensive study of the state of the cardiovascular system.
If the cause of the rhythm change is of extracardiac origin, the patient may be referred to other specialists - a nephrologist. If systemic rheumatic diseases are suspected, observation by a rheumatologist is required.
Diagnostics and examinations for arrhythmia
The doctor may suspect arrhythmias when the patient complains of interruptions in the heart, a feeling of “fading” of the heart, fainting, and shortness of breath. The diagnosis algorithm consists of a thorough history taking, assessing the state of the cardiovascular system (listening to the heart with a stethoscope, feeling the pulse, measuring blood pressure, etc.). According to the clinical examination, the doctor assumes damage to one or another system and prescribes additional laboratory and instrumental examinations:
- electrocardiography (ECG) in 12 leads;
