Atrial flutter and atrial fibrillation
Introduction
Introduction to atrial flutter and atrial fibrillation Atrial flutter and atrial fibrillation are arrhythmias that occur in the atria and have a faster impulse frequency than atrial tachycardia. When the atrial ectopic pacemaker frequency reaches 250-350 beats/min, the atrial contraction is fast and the coordination is atrial flutter. If the frequency is >350 beats/min and irregular, it is atrial fibrillation. Both can have both paroxysmal and chronic persistent types. This disease is a common arrhythmia in cardiology clinics. It occurs in patients with rheumatic heart disease, coronary heart disease, hyperthyroidism, cardiomyopathy, hypertension, etc. It can also occur in No physical heart disease (esthetic atrial fibrillation). basic knowledge Sickness ratio: 0.1% Susceptible people: no specific population Mode of infection: non-infectious Complications: cerebral embolism
Cause
Atrial flutter and atrial fibrillation
The causes of atrial flutter and tremor are basically the same, the most common are rheumatic heart disease, mitral stenosis, followed by coronary heart disease, hyperthyroidism, cardiomyopathy (including Keshan disease), myocarditis, hypertensive heart disease Others have constrictive pericarditis, sick sinus syndrome, etc. A small number of paroxysmal atrial fibrillation can not find obvious cause, called idiopathic atrial fibrillation. In recent years, some people think that it may be associated with viral infection or tissue degeneration. It is related to factors such as instability or autonomic nervous function.
Prevention
Atrial flutter and prevention of atrial fibrillation
The disease is mainly to prevent recurrence: atrial flutter and atrial fibrillation recurrent, after drug or electric conversion, long-term oral quinidine, propafenone, amiodarone and other drugs to maintain, the cause of recurrence is not removed.
The second is to prevent thromboembolism: persistent atrial fibrillation, with cardiac insufficiency and / or mitral valve disease, cardiomyopathy, long-term oral warfarin anticoagulation to prevent thrombosis.
Complication
Atrial flutter and complications of atrial fibrillation Complications
Atrial flutter or atrial fibrillation may also cause thrombosis in the room. Part of the thrombus may cause systemic arterial embolism. Clinically, cerebral embolism is the most common, often leading to death or sickness.
Cerebral embolism refers to the fat in other parts of the brain, blood clots, wall plugs, gas and other emboli into the intracranial artery through the blood flow, causing cerebral artery occlusion and brain dysfunction in the corresponding blood supply area. The source of the embolus is the source of the heart. Sexually common, sudden onset, no aura, common symptoms are hemiplegia or monotherapy, seizures, sensory disturbances and aphasia, sometimes rapid coma and acute symptoms of increased intracranial pressure, physical examination can be found in patients often have aphasia, hemiplegia or single, sensory disturbances, coma and other focal neurological signs, depending on the embolization of blood vessels, other signs of focal nervous system and other parts of the body vascular embolism and signs of primary disease.
Symptom
Atrial flutter and atrial fibrillation symptoms Common symptoms Arrhythmia palpitations with fatigue, pale chest pain with chest tightness, palpitations and heartbeat with heart rate abnormal palpitations, chronic atrial fibrillation, flustering, shortness of acute atrial fibrillation tachycardia
(1) Medical history, symptoms: The clinical symptoms depend on the atrial flutter, the frequency of atrial fibrillation, the rate of ventricular rate at the time of onset, and whether there is a basic heart disease. The light can be asymptomatic or mildly flustered, and the severe heart has obvious heart function. Incomplete, angina manifestations, medical history should pay attention to the atrial flutter, the frequency of atrial fibrillation and the time that has occurred, the application of the drug at each episode, the drug currently being used, and the history of thromboembolism.
(2) Physical examination found: In addition to the clinical manifestations of the original heart disease, the atrial arousal rhythm can be regular, or irregular (depending on the ratio of atrial and ventricular conduction), the cardiac auscultation heart rhythm is absolutely irregular during atrial fibrillation, the heart sound is strong The pulse rate is significantly less than the heart rate. Blood pressure should be measured to exclude high blood pressure. It should be observed whether there is eyeball protrusion and fine tremor in both hands to rule out hyperthyroidism.
Examine
Atrial flutter and atrial fibrillation
The main method of examination is electrocardiogram:
The main signs of atrial fibrillation are absolute irregular heart rhythm, heart sound intensity is not equal, the patient's pulse rate is significantly less than the heart rate, called the pulse short basis, the atrial flutter can be regular or irregular, the atrial and ventricular conduction ratio If the rule is proportionally transmitted as 3:1 or 6:1, etc., the ventricular rule is ruled.
First, the atrial flutter, 1P wave disappears, replaced by the shape, spacing and amplitude absolute rules, a sawtooth atrial flutter wave (F wave), frequency 250-350 times per minute, 2 most common atrioventricular conduction ratio is 2:1, producing a fast and regular ventricular rhythm of about 150 times per minute, followed by a 4:1 ratio of atrioventricular conduction, forming a ventricular rate of 70-80 times per minute, and sometimes the ratio of atrioventricular conduction is not constant, causing irregularities. The ventricular rhythm, 3QRS wave group morphology is the same as sinus rhythm, but also can have differential conduction in the heart.
Second, atrial fibrillation, 1P wave disappears, replace the atrial fibrillation wave (f wave) with abnormal shape, spacing and amplitude, frequency is 350-600 times per minute; 2QRS wave group spacing is absolutely irregular, its shape and amplitude can be Often different.
Diagnosis
Differential diagnosis of atrial flutter and atrial fibrillation
diagnosis
Diagnosis can be based on the cause, symptoms and related tests.
Differential diagnosis
When atrial flutter, atrial fibrillation combined with indoor conduction block or impulse along the pre-excitation syndrome bypass should be compared with ventricular tachycardia and ventricular fibrillation.
(1) Atrial flutter should be differentiated from other rules of tachycardia to distinguish between atrial flutter rate of 150 times/min and sinus tachycardia and supraventricular tachycardia. Carefully search for the waveform of atrial activity, and The relationship between QRS complexes, supplemented by measures to slow down atrioventricular conduction to expose flutter waves, is not difficult to identify. Atrial flutter and atrial rate are around 250 beats/min and are accompanied by 2:1 atrioventricular block. Speed is sometimes difficult to identify.
(2) Atrial fibrillation should be differentiated from other irregular arrhythmias such as frequent premature beats, supraventricular tachycardia or atrial flutter accompanied by irregular atrioventricular block, ECG examination can make a diagnosis, atrial fibrillation with completeness In the case of bundle branch block or pre-excitation syndrome, ECG performance resembles ventricular tachycardia, careful identification of atrial fibrillation waves, and significant irregularities in RR spacing are conducive to the diagnosis of atrial fibrillation.
(3) Atrial fibrillation with frequency-dependent intraventricular conduction changes and ventricular ectopic beats Identification Individual QRS complex malformations are sometimes difficult to identify. The following points are useful for the diagnosis of ventricular ectopic beats: malformed QRS complexes and The previous heart beat has a fixed pairing interval, followed by a longer interval; V1 single-phase or biphasic QRS (non-rSR' type) wave group, V5S or rS type QRS wave group, the following points are favorable for frequency dependence Diagnosis of changes in intraventricular conduction: the ventricular rate is fast, the malformed QRS complex has no fixed distance from the previous heart beat, and most of them are the first early QRS complex after a longer RR interval, and there is no long interval thereafter; The V1rSR type QRS complex has small Q waves in V6; different degrees of QRS complex broadening can be seen on the same lead.
