Atrial fibrillation is one of the most common forms of heart rhythm disorder. Another name for pathology is atrial fibrillation.
In the presence of this disease, a person complains of sudden attacks of tachycardia. At these moments it seems to him that the heart is about to "jump out of the chest." Sometimes other sensations are possible, as if the heart stops for a few seconds, after which it begins to beat with a vengeance. During the period of "fading" of the heart, a person's hands begin to shake, he feels a strong weakness and trembling all over his body.
The disease is characterized by strong interruptions in the work of the heart muscle. The atria stop contracting normally, instead they “tremble”, resulting in a decrease in the amount of blood entering the ventricles. Sometimes they begin to produce an arrhythmic vibration, which causes a person to have groundless bouts of fear, panic attacks, and a strong deterioration in the general condition.
Atrial fibrillation is accompanied by frequent bouts of tachycardia, which leads to an acute lack of air, shortness of breath, and vertigo. Sometimes nausea and subsequent urge to vomit. In some patients, such ailments cause syncope - short-term loss of consciousness. Like many other heart diseases, atrial fibrillation has a close relationship with the patient's age. The risk of developing pathology increases significantly after the patient reaches 40 years of age, but the episodes of the disease become especially strong at 70-80 years.
What it is?
By atrial fibrillation imply a violation of the contractile function of the heart muscle caused by the disorganization of atrial activity. This pathology is characterized by a sudden increase in heart rate, up to 600 beats per minute.
At the same time, the number of ventricular and atrial contractions also becomes arrhythmic, that is, these processes do not coincide with each other in time.
Why does atrial fibrillation develop?
The causes of atrial fibrillation are divided into 2 groups:
- cardiac, directly related to the work of the heart;
- extracardiac - other factors, due to the impact of which there was a violation of the contractile function of the heart muscle.
Let's take a closer look at each of these groups.
Cardiac causes of ma
This group of causes of atrial fibrillation include:
- postoperative conditions;
- diseases of the coronary arteries of the heart;
- persistent arterial hypertension;
- heart defects (congenital and acquired);
There are much more extracardiac causes of atrial fibrillation.
Extracardiac causes of MA
This group includes:
- previous surgical interventions in the heart area;
- endocrine diseases (diabetes mellitus, thyrotoxicosis, etc.);
- obstructive processes occurring in the organs of the respiratory system, and having a chronic nature;
- viral pathologies;
- gastrointestinal tract diseases;
- diseases caused by impaired function of the central nervous system.
Factors predisposing to the development of atrial fibrillation may also be:
- uncontrolled medication;
- antibiotic therapy;
- chronic fatigue syndrome;
- frequent stress;
- emotional outbursts;
- excessive exercise;
- alcohol abuse;
- excessive smoking;
- Abuse of coffee and other beverages that contain caffeine in large quantities (for example, the so-called "energy").
Atrial fibrillation can occur not only in older patients, but also in young people. In this case, we can talk about the development of such pathologies as mitral valve prolapse. Such a disease is latent in most cases, so it can only be detected during prophylactic examinations.
Atrial fibrillation has its own varieties, according to which its symptoms also differ. The disease is classified according to the following criteria:
- clinical course;
- the rate of contraction of the heart ventricles.
Consider these forms of arrhythmia separately.
Types of arrhythmias in the clinical course
Atrial fibrillation according to the classification of the clinical course is:
- Paroxysmal. This form of atrial fibrillation is characterized by the sudden onset of an attack, the duration of which can reach 6-7 days. But, as a rule, it does not last longer than a day. The pathological condition passes independently, and does not require medical intervention.
- Persistent. This form of atrial fibrillation can last up to 7 days. It is stopped only by taking medication.
- Chronic, which may disturb the patient over a long period of time, without succumbing to medical treatment.
Even if the disease is mild, it cannot be considered safe for human health. Any failures in the work of the heart entail a threat, so it is unacceptable to ignore them!
Classification of MA for the frequency of ventricular contraction
If we consider the classification of atrial fibrillation according to the frequency of ventricular contractions, then it can be:
- bradysystolic, in which the ventricular rate is reduced to 60 beats per minute;
- normosystolic with a frequency of contractions from 60 to 90 strokes / min .;
- tachysystolic when the frequency of contractions of the heart ventricles exceeds 90 beats per minute.
Quite often, atrial fibrillation can occur without noticeable symptoms, so it is almost impossible to identify it without undergoing special instrumental diagnostic measures. As a rule, the detection of pathology occurs completely by chance, during examination for the presence of other deviations in the patient's state of health.
If the arrhythmia still manifests itself, then the signs of its occurrence may be as follows:
- sudden increase in heartbeat, accompanied by pulsation of the neck veins;
- weakness, general weakness;
- fast fatiguability;
- heart pain, resembling angina pain (feeling of pressure in the heart);
- systematic dizziness;
- lack of coordination of movements at the time of the attack;
- shortness of breath even with mild exertion and in a state of absolute rest;
- excessive sweating;
When the pathology becomes chronic, the patient is no longer tormented by discomfort and other unpleasant sensations in the region of the heart. Gradually, the person begins to get used to life with the disease.
To make an accurate diagnosis, the patient must undergo a special medical examination. Diagnostic scheme consists of the following activities.
- Visual examination of the patient, during which the presence of the underlying disease that caused the development of atrial fibrillation can be established.
- Medical history based on patient complaints.
- Clinical studies of urine and blood. Such procedures will also help identify pathologies that can cause AI.
- Biochemical analysis of blood.
- An electrocardiogram that helps to detect malfunctions of the heart.
- Hormone test.
- KhMEKG - monitoring of the cardiogram, carried out over several days by the method of Holter. The procedure helps to establish with accuracy the periods when arrhythmia flashes occur, even if the patient’s condition has not changed.
- Echocardiography, which helps to identify structural changes in the heart muscle.
- Transesophageal echocardiography, which helps to detect blood clots in the atria or their ears. Performed by inserting the probe into the patient's esophagus.
- Chest X-ray.
- Load test conducted using a special simulator. During a physical exercise, the doctor evaluates the work of the heart muscle.
How to treat atrial fibrillation?
Treatment of arrhythmia depends on its form. Thus, the methods of therapy used in paroxysmal MA, are not suitable for stopping the pathological condition in the chronic form of the disease.
Features of treatment of paroxysmal atrial fibrillation
In this case, all efforts are directed at restoring sinus heart rate. If more than 48 hours have passed since the development of paroxysm, then the question of a further treatment strategy is decided on an individual basis for each person. In this case, it should take at least 3 weeks after taking warfarin or similar drugs. However, all measures aimed at getting rid of the pathology require obligatory hospitalization of the patient.
The following methods are used to restore the heart rhythm:
- drug therapy with procainamide, Korglikon, strophanthin (intravenously) and cordarone (oral);
- treatment with drugs that reduce the heart rate - beta-blockers (Carvedilol, Nebilet, etc.), antiarrhythmics (Propanorm, Allapinin), antiplatelet agents (Aspirin Cardio, TromboAss, etc.);
- cardioversion, which is used with the ineffectiveness of drug therapy. Such manipulation is carried out in a special intensive care unit of cardiology, and requires the introduction of intravenous anesthesia. The technique of the procedure is based on the use of a small discharge of electric current, with which the doctor “makes” the heart beat in the correct rhythm.
If the attacks of arrhythmia often recur, 2 decisions can be made by a doctor:
- Translate paroxysmal form of MA into a permanent, and only then treat the pathology.
- Conduct emergency surgery.
In addition to the above, there are also other techniques, the use of which helps to get rid of the disease. There are other approaches with which you can forget about the unpleasant symptoms for a long time.
Therapy with warfarin and new anticoagulants
If atrial fibrillation takes place, all patients, except for people who have reached the age of 65, as well as patients with a low risk of developing complications, are prescribed oral anticoagulants. As a rule, tablets are used.
Warfarin intake starts with a minimum dose of 2.5 mg, but gradually it will increase to 5 mg. In this case, the patient should regularly undergo control studies to assess the positive dynamics of treatment, as well as to understand how the drug affects the general health of the patient. If the ability to control the INR is absent, the patient may be prescribed other drugs - Aspirin or Klopidorgel.
Such well-known anticoagulants as Dabigatran, Apixaban, and others, have not been considered novelties for a long time, so they are referred to as ordinary oral anticoagulants. This cannot be said about Edoksaban. This drug has already passed 3 phases of clinical tests. But, while it is not registered, its application at MA is not carried out.
When is surgery indicated?
Surgical treatment of atrial fibrillation has its own goals. For example, if there is a heart disease that caused an arrhythmia, heart surgery prevents the emergence of new outbreaks of the disease. Although, of course, we can not exclude the possibility of recurrence of pathology.
So, with other cardiac pathologies, it is more expedient to use laser ablation. It is held at:
- Permanent atrial fibrillation, which is accompanied by rapidly progressive heart failure;
- The ineffectiveness of drug antiarrhythmic therapy;
- Intolerance to drugs used to treat AI.
Radiofrequency ablation involves exposing the diseased areas of the atria to a special electrode with a radio sensor at the end. The electrode is inserted into the femoral artery, but before this the patient is injected with general anesthesia. The process is controlled by x-ray television. The procedure is absolutely safe, and the risk of injury is reduced to a minimum.
In some cases, the doctor may decide to introduce to the patient a special device - a pacemaker. This device is also called an artificial heart rate driver. With it, you can normalize the heart rate.
A pacemaker can be single-chamber (it stimulates only the atrial contraction) and two-chamber (stimulation of the atrium and ventricles is stimulated). Modern devices can be easily adapted to the rhythm of a person’s life, which makes it possible for him not to think about the intensity of physical activity performed. In addition, the device remembers all the data about what loads have occurred recently, on the basis of which the doctor will be able to make calculations and evaluate the work of the patient's heart.
Technique of operation
The operation for the introduction of an electric pacemaker is carried out in 7 stages:
- The doctor makes a skin incision in the lower part of the clavicle;
- Under careful X-ray control, a special electrode is inserted into the heart;
- The doctor tests the work of the electrodes;
- The ends of the inserted electrodes are fixed in the right place; do it with the help of special hooked tips or corkscrews;
- A groove is made in the subcutaneous fatty tissue, where the pacemaker housing will subsequently be placed;
- The implanted pacemaker is connected to the electrodes;
- The incision site is sutured.
Do not think that installing a pacemaker will adversely affect the patient's quality of life. On the contrary, in case of atrial fibrillation, the device makes the heart stronger and more durable. However, from the moment of surgery, the patient must always remember that he is wearing a rather complicated device. In order not to harm himself, he will need to observe precautions.
Since arrhythmia is often accompanied by other pathologies of the cardiovascular system, it is very important to follow a diet to prevent new attacks. It will help to avoid unnecessary stress on the heart, while enriching the body with essential vitamins and minerals.
To do this, from the diet should be excluded:
- all products that contain sugar (including fruit);
- salts and salt products;
- smoked meat;
- fatty meats and fish;
- fatty butter, margarine;
- bakery products;
Instead of "harmful" food, the patient is recommended to eat more fruits and vegetables - raw, stewed, or steamed. In this form, they retain all their beneficial properties, and enrich the body with fiber, which is very useful for normal metabolism.
Life prognosis, complications and consequences
In most cases, the complications of the disease occur due to untimely access to a doctor, as well as due to non-compliance with all recommendations of the doctor. Many patients, having noticed the first progress, stop treatment, or start taking medications at their discretion. Dyspnea, dizziness, pain in the heart and sharp attacks of lack of air - these are the main reasons for going to a cardiologist.
Is atrial fibrillation treated completely? There is no single answer, because it depends on many factors.Doctors give the most favorable prognosis for treatment if it was started at an early stage of development. Complications are possible only if the disturbing symptoms of the pathology were ignored for a long time. And it does not matter, consciously the person neglected the visit to the doctor, or wrote off the indisposition for the manifestation of fatigue or physical exhaustion. In this case, the delay in visiting the cardiologist's office can be fraught with thrombosis of the heart vessels.
With no treatment for atrial fibrillation, the prognosis is extremely unfavorable. A malfunction of the atria can lead to progression of the underlying pathology that caused the onset of atrial fibrillation. The consequences of this can be unpredictable.