Arrhythmia
Introduction
Introduction to arrhythmia Cardiacarrhythmia (cardiacarrhythmia) is caused by sinus dysfunction or activation in the sinus node. The conduction of conduction is slow, blocked or transmitted through abnormal channels, that is, the origin of cardiac activity and/or the frequency of conduction disturbance leading to heart beat. And/or rhythm is abnormal. Arrhythmia is an important group of diseases in cardiovascular disease. It can be associated with cardiovascular disease alone or in combination with cardiovascular disease. Sudden onset and sudden death, can also continue to affect the heart and fail. basic knowledge The proportion of the disease: the probability of the population is 0.6% Susceptible people: occur in a variety of patients with structural heart disease Mode of infection: non-infectious Complications: heart failure, shock, syncope, cerebral embolism
Cause
Cause of arrhythmia
Cause:
Arrhythmia can be seen in a variety of organic heart disease, including coronary atherosclerotic heart disease (referred to as coronary heart disease), cardiomyopathy, myocarditis and rheumatic heart disease (referred to as rheumatic heart disease) is more common, especially in the occurrence of heart Arrhythmias in patients with basic health or autonomic dysfunction are also common in patients with debilitating or acute myocardial infarction. Other causes are electrolyte or endocrine disorders, anesthesia, hypothermia, thoracic or cardiac surgery, drug effects, and central nervous system. Some diseases are unknown, such as diseases.
Prevention
Arrhythmia prevention
The prevention of arrhythmia is very important. It is sometimes very difficult to completely prevent arrhythmia, but appropriate measures can be taken to reduce the incidence and the following points should be done:
1. Prevention of induced factors:
Once diagnosed, patients are often highly nervous, anxious, depressed, seriously concerned, frequently seek medical treatment, and urgently require medication to control arrhythmia, and completely ignore the cause, the prevention and treatment of incentives, often cause the Lord to take the lead, put the cart before the horse, common causes: smoking, alcoholism, overwork , nervous, excited, overeating, indigestion, cold and fever, excessive intake of salt, blood potassium, low blood magnesium, etc., patients can combine the actual situation of the previous disease, sum up experience, avoid possible incentives, more than simply medication Simple, safe and effective.
2. Stable emotions:
Maintain a calm and stable mood, relax your spirits, not be overly nervous, and especially nervous emotions in mental factors can easily induce arrhythmia, so patients should treat them with a peaceful attitude, avoid overjoyed, sad, angry, and ignore minor events. I can comfort myself, not watching the thrilling TV, the ball game, etc.
3. Self-monitoring:
When the arrhythmia is not easy to be caught, the patient can find the problem most. Some heart rhythms often have aura symptoms. If you can find timely measures to reduce or even avoid arrhythmia, if you find clinical symptoms of arrhythmia, Active treatment should be under the guidance of medical staff to prevent prolonged illness, causing serious consequences and irreversible complications. Patients with atrial fibrillation often have signs of aura or prodromal symptoms, such as palpitations, and the pulse is reduced. At this time, rest and oral stability tablets can prevent problems before they occur.
Some patients have developed a self-control method for their own arrhythmia treatment. When they occur, they can control arrhythmia with previous experience, such as "paroxysmal supraventricular tachycardia" patients, and immediately stimulate the throat after the attack. Nausea and vomiting, or deep breathing, or oppression of the eye can achieve the purpose of stimulating the vagus nerve, slowing down the heart rate, and can also be immediately transferred.
4. Rational use of drugs:
In the treatment of arrhythmia, the individualization of medication is emphasized. Some patients are often willing to accept the advice of the patient and change the medicine by themselves. It is dangerous to do so. The patient must take the medicine according to the doctor's request, and pay attention to the reaction after the medication. Some anti-heart rhythms Anomalous drugs can sometimes cause arrhythmia, so you should use as little medicine as you can to achieve reasonable compatibility.
5. Check your body regularly:
Regularly review ECG, electrolytes, liver function, thyroid function, etc., because anti-arrhythmia drugs can affect electrolyte and organ function, after medication should be reviewed regularly and observe the effect of medication and adjust the dosage.
6, life should be regular:
Develop a habit of working on time, ensure sleep, because insomnia can induce arrhythmia, exercise should be appropriate, exercise, do not reluctantly exercise or exercise excessive, do not do vigorous and competitive activities, can do qigong, tai chi, keep standards Weight, bath water should not be too hot, bath time should not be too long, develop a habit of bowel movements on time, keep the stool smooth, diet regularly quantitative, modest life, do not drink strong tea, do not smoke, avoid cold, prevent colds, do not engage in intense work Do not work as a driver.
7. Active prevention and treatment:
The underlying diseases that cause arrhythmia, control various risk factors such as high blood pressure, high blood fat, diabetes, etc., control and prevent rheumatism activities, prohibit smoking, avoid cold, and cause bacterial infection.
Complication
Arrhythmia complications Complications, heart failure, shock, syncope, cerebral embolism
The complications of this disease are generally heart failure, shock, syncope and cerebral embolism.
Symptom
Symptoms of arrhythmia Common symptoms Chest tightness, chest pain, chest tightness, heart palpitations, fatigue, pale complexion, gray, gray, dizziness, unable to count every minute... After exhaustion, heartbeat, heartbeat, postprandial heart palpitations
The clinical manifestations of hemodynamic changes in arrhythmias depend primarily on the nature, type, cardiac function, and degree of hemodynamic effects of arrhythmias, such as mild sinus bradycardia, sinus arrhythmia, and sporadic Pre-atrial contraction, once atrioventricular block and other effects on hemodynamics is very small, so no obvious clinical manifestations, more serious arrhythmia, such as sick sinus syndrome, rapid atrial fibrillation, paroxysmal room Upper tachycardia, persistent ventricular tachycardia, etc., can cause palpitations, chest tightness, dizziness, hypotension, sweating, severe cases of syncope, A-S syndrome, or even sudden death, due to different types of arrhythmia The clinical manifestations vary, mainly including the following performances:
1, the performance of coronary insufficiency:
A variety of arrhythmias can cause coronary blood flow reduction, sporadic atrial premature contraction can reduce coronary blood flow by 5%, sporadic ventricular premature contraction by 12%, frequent ventricular premature contraction can be reduced 25%, coronary tachycardia decreased coronary blood flow by 35%, rapid atrial fibrillation decreased by 40%, ventricular tachycardia decreased coronary blood flow by 60%, ventricular fibrillation coronary blood flow may be zero.
In people with normal coronary arteries, various arrhythmias can cause coronary blood flow to decrease, but less cause myocardial ischemia. However, in patients with coronary heart disease, various arrhythmias can induce or aggravate myocardial ischemia. It is characterized by angina pectoris, shortness of breath, peripheral vascular failure, acute heart failure, and acute myocardial infarction.
2, the performance of cerebral arterial insufficiency:
Different arrhythmia have different effects on cerebral blood flow. Frequent atrial and ventricular premature contractions, cerebral blood flow decreased by 8% and 12%, and supraventricular tachycardia decreased by 14% to 23%. Beware. Even when the ventricular rate is extremely fast, it can reach 40%, and the ventricular tachycardia can reach 40% to 75%.
In patients with normal cerebral blood vessels, the above-mentioned hemodynamic obstacles do not cause serious consequences. If the cerebrovascular disease occurs, it is enough to cause insufficient blood supply to the brain. It is characterized by dizziness, fatigue, blurred vision, temporary blindness, and even aphasia. A transient or permanent brain damage such as convulsions, convulsions, and coma.
3, the performance of renal artery insufficiency:
After arrhythmia, renal blood flow also decreased, frequent premature atrial contraction reduced renal blood flow by 8%, and frequent ventricular premature contraction reduced renal blood flow by 10%; atrial tachycardia Rapid renal blood flow decreased by 18%; rapid atrial fibrillation and atrial flutter can be reduced by 20%; ventricular tachycardia can be reduced by 60%, clinical manifestations of oliguria, proteinuria, azotemia.
4, the performance of insufficiency of mesenteric artery blood supply:
In a rapid arrhythmia, blood flow is reduced by 34%, mesenteric arterial spasm, can produce clinical manifestations of gastrointestinal ischemia, such as abdominal distension, abdominal pain, diarrhea, and even bleeding, ulcers or paralysis.
5, the performance of cardiac insufficiency:
Mainly for cough, difficulty breathing, fatigue, fatigue and so on.
Examine
Arrhythmia check
Physical examination:
1. Auscultation: 70% of arrhythmia can be found through auscultation. If you can pay attention to the changes in frequency and rhythm in an orderly manner, you can make a preliminary judgment, such as premature beat, you can hear early heart beat and compensatory Intermittent, such as paroxysmal supraventricular tachycardia, can hear rapid and regular heart beats; while atrial fibrillation hears chaotic heart beats, no matter the intensity, frequency, rhythm, no rules, in short, cardiac auscultation is The basic skills of physicians are also an important method for clinically finding arrhythmias.
2, jugular vein fluctuations: a transient overfilled jugular vein like "pulsation"-like fluctuations, is an important method to observe and diagnose some arrhythmia, such as complete atrioventricular block, visible jugular vein "beating" And can hear the "cannon sound"; atrial fibrillation can be seen in varying intensity, irregular jugular vein filling wave.
Depending on the cause of arrhythmia, electrolytes and acid-base balance should be routinely examined; thyroid function and renal function should be examined; erythrocyte sedimentation rate, anti-O, immune function and myocardial zymogram should be examined.
ECG:
1. Body surface electrocardiogram: It is the most important means of diagnosis of arrhythmia. Clinically, 12-lead ECG can be used to judge the nature and location of arrhythmia from the perspective of the three-dimensional structure of the heart. However, the 12-lead ECG is not easy due to short recording time. The pattern of transient arrhythmia is traced, so the P-wave clear lead (II, III, aVF and V1 leads) is often used clinically for long-term tracing, which is convenient for capturing arrhythmia, pay attention to P and QRS wave morphology, P-QRS Relationship, PP, PR and RR interval, determine whether the basic heart rhythm is sinus or ectopic, and find the origin of P wave and QRS complex when the chamber is independent (selection II, aVF, aVR, V1 and V5, V6 Union), when the P wave is not obvious, try to increase the voltage or speed up the paper speed, and make a long record of the P wave with obvious lead.
2, esophageal electrocardiogram: P wave can be clearly traced, for patients with unclear P-wave recording of 12-lead ECG, it is easy to obtain P-wave information, which is helpful for correct diagnosis.
3, ECG monitoring: In order to overcome the shortcomings of ECG tracing time, the difficulty of capturing arrhythmia, people use ECG monitoring method to diagnose arrhythmia.
(1) Bedside wired ECG monitoring: suitable for critically ill patients.
(2) Wireless ECG monitoring: easy to capture arrhythmia after patient activity.
(3) Holter ECG: also known as Holter ECG, continuously recording ECG for 24h or longer, its appearance solves the arrhythmia problem that can not be diagnosed by ordinary ECG alone, and the occurrence of arrhythmia may be recorded by 24-hour continuous ECG recording. The influence of the autonomic nervous system on spontaneous arrhythmias, the relationship between self-consciousness and arrhythmia, and the evaluation of treatment effects, but it is difficult to record arrhythmias that occur frequently.
(4) Telephone ECG: The transmission of the ECG to the hospital or monitoring center via telephone can help to understand the arrhythmia of the patient during work and life.
4, body surface His electrogram: the use of ECG filtering and superposition methods, recorded His electrogram, can help analyze the relationship between the atrium, His beam and ventricular electrogram and sequence, to assist in the diagnosis of complex arrhythmia.
5, body surface ECG icon test: the use of dozens of individual surface electrodes simultaneously record the ECG of different parts of the heart, easy to analyze the origin of arrhythmia and conduction sequence and speed anomalies, especially for the diagnosis of abnormal channels.
6, signal averaged ECG (signal averaged ECG), also known as high resolution body surface ECG (high resolution body surface ECG), may be recorded on the body surface to the ventricular ventricular myocardium conduction delay caused by local myocardial delayed depolarization of ventricular late potential, ventricular late The presence of potential provides a favorable basis for the formation of reentry, and thus the risk of ventricular tachycardia, ventricular fibrillation and sudden death is correspondingly increased in patients who have recorded ventricular late potential.
Cardiac electrophysiology:
Clinical electrophysiological study is a kind of arrhythmia research method that uses cardiac catheter to record electrocardiogram in various parts of the heart and stimulates myocardial tissue in different parts by pulse electric stimulation. The purpose of invasive electrophysiological examination is to better understand normal and abnormal heart. The status of electrical activity, diagnosis of complex arrhythmia, and the degree of risk and prognosis of arrhythmia, as well as assistance in the selection of treatment methods and treatment options, this method can very accurately reflect the origin of cardiac electrical activity and the conduction of stimulating The sequence has a very important diagnostic and differential diagnostic value for arrhythmias that are difficult to diagnose clinically or cannot be detected by other methods.
Exercise test:
May induce arrhythmia during intermittent arrhythmia, thus contributing to the diagnosis of intermittent arrhythmia, exercise-induced ventricular tachycardia after antiarrhythmic drugs (especially drugs that cause slowing of intraventricular conduction) May be the manifestation of a drug-induced arrhythmia.
Other checks:
Ventricular late potential, ECG spectrum analysis, ventricular rate variability analysis, exercise ECG and tilt test all contribute to the diagnosis of complex or some special arrhythmia, in addition, echocardiography, cardiac X-ray, ECT, CT and MRI The diagnosis of qualitative and non-organic arrhythmias has a value that cannot be underestimated.
Diagnosis
Diagnosis of arrhythmia
diagnosis:
1. Ask your medical history in detail.
2. Carefully observe the jugular vein and heart beat.
3. Carefully auscultate to discover heart rhythm characteristics.
4. Perform routine electrocardiogram examination in time (long II, long V1 lead for not less than 30s).
5. Other examinations necessary (DCG, esophageal pacing, etc.).
6. After comprehensive analysis, a correct diagnosis is obtained.
Differential diagnosis:
The disease can be diagnosed by electrocardiogram examination. The most important reason is to identify the cause of arrhythmia. The effect of carotid sinus massage on tachyarrhythmia can help to differentiate the nature of arrhythmia, in order to avoid hypotension. Accidents such as cardiac arrest should be performed under electrocardiogram monitoring in the supine position. The elderly should be used with caution. Those with cerebrovascular disease should be disabled. Each time the carotid sinus is massaged, the duration of one massage should not exceed 5 seconds. The rate of atrial flutter can be doubled, and supraventricular tachycardia can be immediately converted to sinus rhythm.
