Download 08_Cardiac arrhythmyas

Cardiac Arrhythmias. Classification.
Extrasystoly. Paroxismal tachycardia.
Heart blocks. Atrial fibrillation.
Etiology. Pathogenesis. Clinical pattern
of an attack. ECG signs. Cardiac rrhythm
disorders dangerous for patient’s life.
Principles of treatment and prophylaxis
Department of propedeutics of
internal medicine
Ass. Prof. N.Z. Yarema
Etiology.
• Violations of rhythm of cardiac activity cause
such defeats of myocardium:
• organic: IHD,defects of heart, AH, myocarditis,
cardiomyopathy;
• ·
toxic: medicines, alcohol;
• ·
hormonal : thyrotoxicosis, myxedema,
pheochromocytoma, climax;
• ·
functional : neurogenic, sporting;
• ·
anomalies of development of heart - more
frequent all WPW.
Pathogenesis
• Theories of origin of arrhythmias:
• Pathological automatism (presence of
ectopic focuses)
• Mechanism of re-entry
• trigern (starting) activity.
Classification of violations of
rhythm and conductivity of heart
• I. Violations of formation of impulse
• Sinus tachycardia
(more than 90 complexes are for a minute)
• Sinus bradycardia
(less than 60 complexes are for a minute )
• Sinus arrhythmia
• Stop (refuse) of sinus node
• Migration of supraventricular driver of rhythm
• Extrasystolia (a synonym is premature
depolarization):
• auricle (atrial)
• auricle-ventrical (atrioventricular)
• ventrical
• Tachycardia:
•
supraventricular:
•
sino - auricle
•
(sinoatrial)
•
auricle (atrial)
•
auricle - ventrical
•
(atrioventrical)
• ordinary
(to 30 in a hour)
• frequent
(30 and anymore in a hour)
• allorythmia (bi-, thre-, quadrigeminia)
• polymorphic
• twin
• early
(R on T)
• chronic
• paroxysmal
•
noudle
• ІІ. VIOLATION OF LEADTHROUGH OF
IMPULSE
- Sinoauricular of blockade
- Atrioventricular blockades:
•
І st.
•
ІІ st.
• ІІІ st.
Description of normal sinus
rhythm
• correct rhythm with frequency of heartbeats
60-100 per 1 min.
• the P wave is positive in II, III, AVF leads,
negative - in the AVR leads, permanent
form of P wave
• a complex QRS follows by every P waveR
(if there is not а-v-blockade).
• Interval of P-Q>0.12 (if there are not
additional ways of leadthrough).
Sinus tachycardia
•
•
•
•
•
•
ECG is criteria:
correct rhythm
sinus P waves are ordinary configuration.
100-180 beats per 1 min.
gradual beginning and completion
Reasons: physical and emotional loading,
pain, fever, hypovolumia, hypotension,
anaemia, thyrotoxicosis, action of certain
matters (coffeine, alcohol)
Sinus bradycardia
•
•
•
•
•
•
ECG is criteria:
correct rhythm
less than 60 beats per 1 min
sinus P waves
interval of PQ >0,12 sec.
Reasons: increase of parasympatic tonus,
myocarditis, myxedema, hypothermia,
mechanical icterus, syndrome of weakness
of sinus knot.
• a-normal sinus rhythm
• б- sinus tachycardia
• в- sinus bradycardia
• г- sinus arrhythmia
Extrasystolia
 premature excitation and reduction of heart
or his separate parts is as a result of increase
of activity of hearths of ectopic automatism.
Auricle extrasystolia
ECG of sign:
• premature reduction after which incomplete
scray pause
• the P wave is changed, negative
• a complex QRS is not changed or aberrant.
• a- from the overhead departments of auricle
• б- from the middle departments of auricle
• в- from the lower departments of auricle
• г- is blocked auricle extrasystole
А-V- extrasystoles
• with simultaneous excitation of atriums and
ventricles.
• EKG-signs:
• the P wave is not determined
• an extraordinary complex QRS is not
extended
• incomplete scray pause
With previous excitation of
ventricles
EKG-signs:
• an extraordinary complex QRS is not
extended
• P wave is after QRS
• complete scray pause
Ventrical extrasystolia
• EKG of sign:
• complex QRS wide without a previous P
wave
• complete scray pause
• Treatments need frequent monotopic,
politopic, group and early as R/T
extrasystoles.
• a- sinistroventrical extrasystole
• b- dextraventrical extrasystole
Paroxysmal tachycardia
Supraventricular tachycardia
• EKG is signs:
• frequency of reductions of atriums - 120250 per 1 min.
• auricle complexes are preceded the
complexes of QRS
• the complexes of QRS are not changed
Atrioventricular tachycardia
• EKG-signs:
• 150-200 heart beats per 1 min.
• retrograde P wave (negative) after QRS or
accumulates on him
• a- auricle paroxysmal tachycardia
• б - atrioventricular tachycardia with previous excitation of
ventricles
• в - atrioventricular tachycardia with simultaneous
excitation of atriums and ventricles
Ventrical tachycardia
• EKG is criteria:
- >140 hearts beats per 1 min.
- the complexes of QRS are extended
 EKG is at paroxysmal ventrical tachycardia
Trembling and fibrilation of
atriums
• EKG is criteria of trembling:
• frequency of auricle waves 250-350 per 1
min. ( waves of f)
• EKG is criteria of fibrilation:
• waves of f
• wrong rhythm (different R-R)
• absence of P wave
Trembling and fibrilation of
ventricles
• EKG is criteria:
• Sinus wave curve with frequent, rhythmic, wide
and high waves, excitation of ventricles with
frequency 200-300 per 1 min.
• it is not possible to distinguish the elements of
ventrical complex
• Treatment:
• electric cardioversion 200-300 Dzh. At
unefficiency the repeated cardioversion
• a- trembling of ventricles
• b- blinking and fibrilation of ventricles
Sinoauricular blockade
• EKG is criteria:
• periodic fall of cardiac cycles
• increase of pause between the waves of Р-Р
in 2 times
Atrioventricular blockade Іst
• permanent lengthening of interval of P-Q anymore as on
0,20s
• a- auricle form
• б- key form
• в- distal form blockade
А-v blockade ІІ ст
• the periodic stopping of leadthrough of impulse is
from an auricle to the ventricles. There are three
types:
• I type (Mobit I) is the gradual lengthening of
interval of P-Q with the subsequent fall of QRST
( periods of Samoylov-Venkenbach)
• ІІ type (Mobit ІІ) is a fall of complexes of QRST
without the gradual lengthening of interval of P-Q
• ІІІ type (Mobit ІІІ) of fall every second, or 2 and
more complexes successively
А-v blockade ІІІ ст
 complete autonomy of reduction of auricle
and ventricles.The intervals of P-P and R-R
are permanent, but R-R>P-P.
EKG is at the complete blockade of right
bundle of bunch of Hiss
EKG is at the complete blockade of left
bundle of bunch of Hiss
Syndrome of Wolf-ParkinsonWhite
• reduction of interval of P-Q (R)
• a presence in composition a complex QRS
of additional wave of excitation is d-wave
• deformation and increase of duration of
complex QRS
• discordant displacement of RS-T and
change of polarity of wave T (inconstant
sign)
EKG is at the syndrome of WPW
Conclusions
• It is necessary to know for successful diagnostics
and treatment of arrhythmias:
• basic nosotropic mechanisms of their development
• ·
to own the methods of diagnostics of
arrhythmias
• ·
to distinguish of high quality, potentially
malignant and malignant arrhythmias
• ·
to understand algorithms diagnostic at the
therapeutic going near the different types of
arrhythmias
Thank
you