atrial fibrillation in children
Introduction
Introduction to atrial fibrillation in children Atrial fibrillation (AF) is abbreviated as atrial fibrillation. The myocardial fibers in different parts of the atrium are uncoordinated and irregularly trembled. The atrial rate is >350 beats/min. The mechanism of the atrial fibrillation is a multiple reentry loops in the atria. Due to the activity, and because of the expansion of the atrium, the shortening of the atrial refractory period and the transmission and refractory period of heterogeneity, the above-mentioned reentry movement is endless. basic knowledge The proportion of sickness: 0.01% Susceptible people: children Mode of infection: non-infectious Complications: heart failure cardiogenic shock
Cause
Causes of atrial fibrillation in children
(1) Causes of the disease
The disease is more common in severe rheumatic mitral valve disease or congenital heart disease with atrial enlargement, such as atrial septal defect, Ebstein malformation, pre-excitation syndrome, hyperthyroidism, digitalis poisoning Atrial fibrillation occurs.
(two) pathogenesis
The electrophysiological basis of atrial fibrillation is the shortening of the effective refractory period of atrial muscle. It consists of multiple reentry rings in the atrium, generally 4 to 6 or more. The larger the atrial area, the higher the incidence of atrial fibrillation. The origin of the tremor is located at the entrance to the pulmonary vein, and is more common in the left superior vein and the right superior vein.
Prevention
Pediatric atrial fibrillation prevention
Active prevention of congenital heart disease; active treatment of primary disease, prevention and treatment of electrolyte imbalance and acid-base imbalance, such as various gastrointestinal disorders, hyperthyroidism, uremia, rheumatic fever, Kawasaki disease, digitalis drug poisoning and other arrhythmias.
Complication
Complications of atrial fibrillation in children Complications heart failure cardiogenic shock
Often complicated by heart failure or cardiogenic shock, easy to merge with the auricle and atrial wall thrombosis.
Symptom
Symptoms of atrial fibrillation in children Common symptoms Heart palpitations Short chest dizziness Dizziness Pulse short sputum conduction block Pulse leakage Heart failure Anxiety heart murmur
1. Symptoms and signs: The main symptoms are palpitations, shortness of breath and chest tightness. In severe cases, heart failure or shock can occur. The main signs are the first heart sounds, the heart rhythm is not neat, the pulse is leaking, and the atrial fibrillation is easy to merge with the auricle and atrial appendage. Wall thrombus.
2. Clinical classification: Clinically, atrial fibrillation is divided into paroxysmal atrial fibrillation, persistent atrial fibrillation and persistent atrial fibrillation.
(1) paroxysmal atrial fibrillation: the onset of atrial fibrillation lasts for a few seconds to several days, and the sinus rhythm can be restored by itself.
(2) persistent atrial fibrillation: the onset of atrial fibrillation is continuous, and if there is no treatment, the sinus rhythm cannot be restored by itself.
(3) Persistent atrial fibrillation: continuous atrial fibrillation, can not restore sinus rhythm in various clinical treatments, sick children feel palpitations, shortness of breath, chest tightness, dizziness, irregular heartbeat, faster ventricular rate, the symptoms are more obvious, Often cause heart failure, physical examination can be found that the heart rhythm is completely irregular, heart sounds strong and weak also have variations, the original heart murmur can also weaken or disappear, ventricular rate is 100 to 150 times per minute, due to irregular heart rhythm, each ventricular contraction There are significant differences in stroke volume, some of which have very little blood flow, so that the brachial artery is not enough, so the pulse is weak, and the pulse rate is less than the heart rate, there is a short pulse, the heart rate is faster, the pulse is short. The bigger the heart disease is complicated by atrial fibrillation, it generally indicates that the condition is heavier, especially when the ventricular rate is fast, it is easy to cause heart failure.
Examine
Examination of atrial fibrillation in children
The results of the examination showed hypoxemia and acidosis, and other causes of different primary causes, such as rheumatic heart disease, hyperthyroidism and so on.
1. Electrocardiogram: The P wave disappeared from the electrocardiogram, showing slender, fast, irregular tremor waves with a frequency of 400-700 beats/min; the interval of the QRS complex is not uniform, and the frequency is about 150 beats/min.
2. X-ray examination: heart shadow enlargement during heart failure, pulmonary congestion or chest X-ray changes in congenital heart disease and rheumatic heart disease.
3. Echocardiography: see congenital malformations of the heart, or mitral valve rheumatic heart disease.
Diagnosis
Diagnosis and diagnosis of atrial fibrillation in children
In addition to clinical manifestations, the diagnosis relies primarily on electrocardiograms.
1. The P wave disappears and is replaced by a slender, fast and different form of flutter wave (f wave) with a frequency >350 times/min, and is more pronounced at V1 and V2.
2. The ventricular rate is irregular, RR is absolutely not complete, the ventricular rate is about 150 times / min, if there is complete atrioventricular block, the ventricular rate is 40 ~ 60 times / min, QRS wide deformity.
Differential diagnosis includes sinus speed, paroxysmal atrial tachycardia, atrial fibrillation and ventricular tachycardia.
