Ectopic lesions in the heart. Atrial rhythm on ecg. Criteria for classifying heart rhythms as lower atrial

Atrial rhythm is a special condition in which the function sinus node weakens, with the source of impulses being the lower pre-middle centers. Frequency heart pulse at the same time significantly weakens. The number of blows ranges from 90 to 160 per minute.

Origin of the disease

The source of the atrial rhythm is the so-called ectopic focus located in the fibers of the atria. In cases where the functioning of the sinus node is disrupted, other parts of the heart are activated that are capable of producing impulses, but when normal operation hearts that are not active. Such areas are called ectopic centers.

Automatic centers located in the atria can provoke an ectopic rhythm, which is characterized by a decrease in sinus and an increase in atrial impulse. The heart rate during atrial rhythm is similar to sinus rhythm. But with atrial bradycardia the pulse slows down, and with atrial tachycardia, on the contrary, it increases.

Left atrial rhythm comes from the lower part of the left atrium, the right atrial rhythm comes from the right atrium. This factor is not important when prescribing treatment. The mere fact of the presence of an atrial rhythm will be sufficient.

Causes of the disease

Atrial rhythm is a disease that can develop in people of any age, it occurs even in children. Malaise in in rare cases lasts for several days, or even months. However, this illness usually lasts no more than a day.

There are often cases when the disease is hereditary. In this variant, changes in the myocardium occur during intrauterine development. In children at birth, ectopic foci are noted in the atria. An ectopic rhythm in a child can occur under the influence of certain cardiotropic viral diseases.

Ectopic rhythms can also occur in completely healthy people under the influence of external factors. Such disturbances are not dangerous and are transient.

The following ailments lead to ectopic contractions:

• inflammatory processes;
• ischemic changes;
• sclerotic processes.

Ectopic atrial rhythm can be caused by several diseases, including:

• rheumatism;
• ischemic disease hearts;
• heart disease;
• hypertension;
• cardiopsychoneurosis;
• diabetes.

Additional diagnostic procedures will allow you to determine the exact cause of the pathology and allow you to create a course of treatment for the disease.

Symptoms

Symptoms of atrial rhythm can be expressed in different ways, depending on the underlying disease. Characteristic signs not observed with ectopic rhythm. The patient may not feel any disturbances. And yet, several main symptoms accompanying the disease can be noted:

• unexpected manifestation of abnormal heart rate;
• dizziness and shortness of breath with prolonged course of the disease;
• profuse sweating;
• pain in the chest area;
• nausea;
• paleness skin;
• darkening of the eyes.

The patient may worry and feel panic; an uneasy feeling does not leave him.

Short-term attacks are characterized by failure of heart contractions and subsequent cardiac arrest. Such conditions do not last long and usually occur at night. The disease is accompanied by minor painful sensations. Your head may feel hot.

The painful condition can pass quickly, or it can drag on for a long time. With a prolonged course of the disease, a blood clot may begin to form in the atrium. There is a high risk of getting into big circle blood circulation As a result, a stroke or heart attack may occur.

In some cases, the pathology may not manifest itself in any way and can only be determined on an ECG and be irregular. If the patient has no complaints about his health, no heart disease, then this condition is not classified as a pathological manifestation and is considered as a normal phenomenon.

Diagnostics

Diagnosis of atrial rhythm is made based on ECG readings. This method is the most informative. An electrocardiogram allows you to clarify the diagnosis and study ectopic rhythms in details. On ECG this violation expressed quite specifically.

The atrial rhythm may be expressed at a slow pace. This condition is observed when the sinus node is depressed. Accelerated atrial rhythm is diagnosed when increased activity ectopic centers.

For a more detailed study of the disease, the doctor may prescribe a Holter ECG.

Treatment

Atrial rhythm does not always require treatment. In cases where a person does not experience any pain and his heart is functioning smoothly, no therapy is required. The doctor diagnoses the condition as normal.

In other cases, treatment is prescribed concomitant diseases, which contributed to the development of the disease. Treatment is carried out in the following areas:

• elimination of vegetative-vascular disorders using sedatives;
• accelerated atrial rhythm is treated with beta-blockers;
• heart rate stabilization;
• prevention of myocardial infarction.

If therapeutic measures did not bring the desired result, and the patient’s condition worsens, then doctors prescribe electropulse therapy.

In some cases, atrial rhythm is the cause of a malfunction of the heart. To prevent this from happening, you should consult a doctor for any heart-related ailments. It is important to have an electrocardiogram regularly. This is the only way to prevent unwanted complications of the disease.

Traditional methods

Atrial rhythm can be treated folk ways. You can start treatment only after consulting your doctor. It is also important to know the cause that caused the disease.

A medicinal plant such as calendula can help with atrial rhythm. For treatment, an infusion is prepared, for which 2 tsp is taken. calendula flowers and pour a glass of boiling water. The medicine must infuse well. This will take an hour or two. Ready product consume twice a day, drink half a glass at a time.

Cornflower infusion also helps eliminate unpleasant consequences illness. The medicine is prepared from 1/3 tablespoon of cornflower flowers; you can also use the leaves of the plant. The raw materials are poured with a glass of boiling water. They also drink the infusion - twice a day, half a glass in the morning and evening.

These normalize the heart rhythm medicinal plants, How:

• mint;
• motherwort;
• blackberry;
• hawthorn;
• rose hip;
• cottonweed;
• chamomile.

During therapy it is necessary to avoid stressful situations and emotional turmoil. Otherwise, the treatment will not bring the desired results.

To keep your heart healthy, it is important to avoid bad habits. Alcohol and smoking are contraindicated. Breathing exercises have a general strengthening effect.

Not last place Proper nutrition also plays a role in the treatment of heart disease. To normalize cardiac activity, it is important to consume foods rich in calcium. The diet must certainly include cereals, vegetables and fruits. But from spicy food, coffee and strong tea is better to avoid.

In order for the treatment of atrial rhythm to be effective, it is important to know the reasons that provoked the disease and, first of all, to address the symptoms of concomitant diseases.

In some cases, emergency care is required for children with ectopic rhythms. Normally, the pacemaker of the heart is the sinus node.

However, under certain conditions, impulses occur outside the sinus node.

It happens:

With increased automaticity of the conduction system below the sinus node (active rhythms);

When the activity of the sinus node decreases (replacement rhythms);

In the event of a unidirectional blocking of impulse conduction, a mechanism of re-excitation (re-entry) occurs.

All processes arise as a result of changes in cellular metabolism. The latter may be a consequence of dysregulation on the part of the neurovegetative and endocrine systems. Disorders of cellular metabolism in the form of hypoxic dystrophy and electrolyte shifts are often detected or intensified in children with infections, somatic and surgical diseases(infectious-toxic cardiopathy with ARVI, sore throat, pneumonia, peritonitis, etc.), and also occurs with carditis of any nature.

Supraventricular ectopic rhythms (SER) can be atrial or nodal. Clinical manifestations vary depending on the cause of ectopia and the severity of the arrhythmia. SER caused by neurovegetative dysregulation, in most cases, are not accompanied by any clinical symptoms and can be detected by cardiac auscultapy or ECG. However, with severe bradycardia or its replacement by tachycardia, patients often experience discomfort and even pain in the heart, weakness, sometimes a feeling of lack of air, dizziness and even fainting are possible, i.e. conditions that require emergency care. All children with heart pain, attacks of weakness, dizziness, or fainting should have an ECG recorded, since heart rhythm disturbances may be the cause of such conditions. If SER occurs with infectious-toxic cardiopathy, carditis or is a manifestation hereditary syndrome(Morphan, Ehlers-Danlos, etc.), the clinical picture of the underlying disease is noted.

The nature of the arrhythmia is revealed by ECG. In children, atrial rhythms often occur (Fig. 10.11). Impulses often come from the right atrium, where there are many cells of the conduction system. Atrial impulses and rhythms are characterized by changes in the P wave compared to the sinus wave (shape, height, duration, direction), but only in some leads. They are most distinct in lead III. The P-Q interval may be slightly shortened; the QPS complex has a normal supraventricular shape.

Atrial superior anterior rhythm: P wave in leads I, II, III, aVR, V5-V6 is positive, P wave in leads aVR, V,-V2 is negative; P-Q interval > 0.12-0.11 s; the shape and amplitude of P are somewhat different from the sinus complexes (more noticeable in lead III).

Rice. 10.11. Atrial rhythm in a newborn baby 5 days of life. Heart rate 110 per minute.

Right atrial infero-posterior rhythm: the P wave in leads I, aVL is positive, low, in leads II, III aVF is negative or smoothed, in leads V1-V6 it is smoothed (P in lead V, can be negative or biphasic).

The rhythm of the coronary sinus (one of the variants of the rhythm from the lower part of the right atrium): the P wave in leads I, aVL is positive, but often smoothed, in leads II, III, aVF it is negative, in leads V1-V6 it is biphasic, smoothed or positive, low; P-Q interval often Left atrial superoposterior rhythm: the P wave in leads I, aVL is negative, less often smoothed, in leads II, III, aVF is positive, in lead V1 “shield and sword” (the first part is rounded, the second is sharp) or positive, in leads V1-V6 are negative or smoothed.

Left atrial infero-posterior rhythm: the P wave in leads I, aVL is positive, low or slightly negative, in leads II, III, aVF negative, in lead V, “shield and sword” or positive, in leads V1-V6 negative.

AV impulses and rhythms (nodal) are characterized by a negative P wave in all leads, where it is positive in sinus rhythm. A negative P wave is layered on the QRS complex or located behind it (depending on the characteristics of conduction). The shape of the QRS complex is supraventricular, but some deformation is possible.

Individual impulses or heart rhythm may be ectopic long time remains ectopic. Persistent SER usually does not cause arrhythmia as such, there are no changes in R-R. In children, alternation and change of sinus and ectopic rhythms, migration of the rhythm source are more often observed. Migration, as a rule, causes arrhythmia, since the rhythm from different places has different frequency.

Supraventricular rhythm migration is characterized by arrhythmia during auscultation and significant R-R inequality on the ECG (more than 0.10-0.15 s), a change in the same lead of the P wave, its shape, amplitude, duration, direction, and sometimes a change in the P-Q interval . To detect rhythm migration, recording several cardiac cycles is not enough; longer recording is needed. The presence of migration is clarified during functional tests with physical activity, holding your breath. Often after exercise the rhythm becomes sinus. Long-term monitoring (stationary or Holter) helps to identify rhythm migration.

Very frequent attacks of arrhythmia, lack of effect of drug therapy or the need for it permanent use, a sharp decline physical capabilities, the difficulty of stopping attacks, the need to resort to electrical pulse therapy are indications for referring the child to the cardiology center for special electrophysiological studies and resolving the issue of surgical treatment, which consists in the destruction of abnormal pathways.

Rhythms from areas below the sinus node are usually of lower frequency than the sinus node, but with pronounced sinus bradycardia and sometimes with active SER the frequency may be greater than sinus or even age-related.

Long-term or sometimes constant ectopic rhythms with tachycardia are called differently in the literature: “accelerated ectopic rhythm”, “non-paroxysmal ectopic tachycardia”, “chronic ectopic tachycardia”. Replacement rhythms with a decrease in sinus node activity begin after a longer interval than the previous one.

SERs are often of a substitutive nature in SSSU. There are several variants of this syndrome:

Severe sinus bradycardia (Fig.

Change from sinus bradycardia to supraventricular ectopic tachycardia;

Change sinus tachycardia replacement SERs with a frequency less frequent depending on age;

Sinus node arrest with replacement SER;

Eimoauricular block.

If ectopic arrhythmia is detected in a child, it is necessary to exclude carditis and congenital heart pathology (conducting a clinical and biological blood test, assessing the boundaries of the heart,

Rice. 10.12. Sick sinus syndrome in a 12-year-old child. Heart rate 40 per minute.

If the specified pathology is detected therapeutic tactics determined by the underlying disease. In case of infectious-toxic cardiopathy, it is necessary to treat the underlying disease, prescribe drugs that improve myocardial trophism (vitamin B15, benfotiamine, cocarboxylase, potassium orotate, riboxin, less often nerobol).

In the absence of organic pathology, but the presence of symptoms of vegetative-vascular dystonia, if ectopic rhythms are recorded mainly in the supine position, and after exercise sinus rhythm is restored, it can be assumed that EDS is the result of neurovegetative dysregulation. This is often noted with constitutional anomalies. In such cases, if there is no pronounced tachycardia or bradycardia, an age-based regimen without load limitation is recommended. For severe vegetative dystonia, sedative therapy is indicated: baths, showers, physiotherapy, herbal medicine, less often medications. With severe tachycardia and bradycardia, regular monitoring of children and limitation of heavy loads are necessary. The appearance of cardialgia and decreased performance are indications for therapy, which is carried out taking into account the nature of the heart rhythm. In case of bradycardia, be careful, under control

lem clinical symptoms and ECG, sympathostimulants (belladonna, ephedrine preparations) can be used.

Treatment may be required in case of syncope, which sometimes occurs when tachycardia changes to bradycardia or with persistent bradycardia. Fainting occurs more often during physical activity. If a child faints, you need to lay him down without a pillow and let him smell the solution ammonia. For severe bradycardia, it is advisable to use atropine or ephedrine.

ECG analysis reveals various electrolyte disturbances (Fig. 10.13; Table 10.2).

Let's give side effects and complications arising from the use of AAP.

These drugs have properties local anesthetics or block sodium channels.

Group IA drugs slow down conduction velocity or prolong repolarization and have a pronounced proarrhythmogenic effect.

Rice. 10.13. ECG signs of high-grade hyperkalemia in a 13-year-old child with chronic renal failure.

Table 10.2. ECG changes in electrolyte disturbances

Quinidine. The effect of the drug is associated with hepatotoxic effects and thrombocytopenia, prolongs the QT interval (most common reason torsade de pointes), increases plasma levels of digoxin and potentiates the action of muscle relaxants.

Procainamide. The effect of the drug is associated with a negative inotropic effect, the development of renal failure(lupuslike syndrome) and agranulocytosis; reduces the release of acetylcholine.

Disopyramide produces a significant negative inotropic effect, has anticholinergic activity, reduces the release of acetylcholine and causes hypoglycemia.

Group IB drugs slow down conduction velocity and shorten repolarization.

Lidocaine causes seizures.

Mexilitine. The effect of the drug is associated with an increase in plasma levels of liver enzymes and an increase in plasma concentrations of theophylline.

Tocainide causes agranulocytosis and pulmonary fibrosis.

Diphenylhydantoin causes hypotension and multiple interactions with medicines, reduces the plasma level of other AAPs.

Moricizine gives an unexpressed negative inotropic effect, has a variable effect on plasma coumarin levels, and causes arrhythmia.

Group 1C drugs slow down the conduction velocity and have different impact for repolarization.

Flecainide produces a negative inotropic effect and increases plasma concentrations of propranolol and digoxin; Recent studies show an increase in the number of deaths after myocardial infarction, mainly due to an increased proarrhythmogenic effect.

The peculiarity of the heart muscle is that it has its own automatic function, which is not subject to anyone else. This means that there are certain cells in the heart that are grouped into centers of automaticity.

The cells that produce impulses that make the heart beat are called the conduction system. Thanks to these centers, an impulse is generated, which is transmitted to the underlying centers.

The heart contracts as fast as the impulses occur. The most important center of first-order automatism is the sinus or sinoatrial node. It is located in the right atrium. It is there, in healthy heart an impulse occurs, leading to contraction of the atria and then the ventricles. But situations arise when the work of the sinus node stops or is disrupted. Then others become active atypical cells hearts, which are also capable of producing impulses, but are inactive during normal operation of the sinus node.

These cells or groups of cells are called ectopic centers. They set the pace for the heart. If the function of the pacemaker is taken over by the cells of the atria, then the ectopic rhythm that they produce is called atrial. That is, the source of impulse are special cells of the atria, which became active and began to produce ectopic rhythms as a result of disruption or cessation of the work of the center of first-order automaticity - the sinus node.

1 Causes of occurrence

Why does atrial rhythm occur? Due to suppression of work or cessation of the production of impulses in the sinus node. This can occur with organic heart lesions (coronary heart disease, arterial hypertension, cardiomyopathies, sick sinus syndrome, myocarditis, cardiosclerosis), heart defects, rheumatism, electrolyte imbalance in the body, autonomic dysfunction nervous system, intoxication with alcohol, nicotine, carbon monoxide, some medications.

Atrial rhythm may accompany endocrine disorders(diabetes mellitus), chest injuries, may occur in children at birth. It can also be found in healthy person as an accidental finding on an ECG during a medical examination. It should be noted that atrial ectopic contractions can be either single with most contractions from the sinus node, or only atrial contractions can be observed if the sinus node is completely blocked. The atrial rhythm may be constant or may occur for a longer or shorter period of time.

2 Differences between atrial rhythm and sinus rhythm

Atrial rhythms can be slow, substitutive. They occur when the function of the sinus node is suppressed. With such rhythms, the heart rate is less than normal. And accelerated ones can be observed, when there is an increase in the pathological activity of the ectopic centers of atrial automaticity. In this case, the heart rate will be higher than normal. Depending on where the activity of the ectopic centers is observed, a right atrial or left atrial rhythm is distinguished. But it is not necessary for a doctor to know from which atrium the impulse originates; it is enough to simply diagnose the rhythm from the atria.

• ventricular contractions are correct, R-R intervals are the same, heart rate is 45-60 beats per minute;
• each ventricular complex is preceded by a P wave, but it is deformed or negative;
• the P-Q interval is shortened or of normal duration;

ECG signs of atrial accelerated rhythm:

• Heart rate 120-130 per minute, R-R intervals are the same
• each ventricular complex is preceded by a P wave, but it is deformed, biphasic or negative, jagged or reduced
• P-Q interval may be prolonged
• ventricular complexes are not changed.

These are the main differences between atrial rhythm and sinus rhythm on the ECG.

3 Symptoms of atrial rhythm

The atrial rhythm may not manifest itself clinically and is detected accidentally during an ECG. There are no specific complaints or symptoms. More often, symptoms are associated with the manifestation of the underlying disease. Complaints may include a feeling of palpitations, interruptions in heart function, or cardiac arrest. Worries general weakness, fatigue. If the heart is damaged, there may be an increase in shortness of breath, pain in chest varying severity and duration, swelling. It should be noted that if the patient has no complaints, no diseases of the heart or other organs are detected, then the atrial rhythm should be considered as a normal variant.

4 Children and atrial rhythm

In a newborn child, the conduction system of the heart is not perfect, as is the regulation of the autonomic nervous system. This leads to the fact that the child at birth, or in young children, may experience an atrial rhythm. This may be a variant of the norm and when the centers of automatism mature, as well as when adjusting the balance of the autonomic nervous system, the atrial rhythm can be replaced by the sinus one.

Atrial rhythm can be observed in children with minor anomalies of cardiac development - the presence of an accessory chord, mitral valve prolapse. But sometimes atrial rhythm in a newborn baby or in young children may not be a harmless symptom, but evidence of more serious problems with the heart - heart defects, infectious lesions heart muscle, intoxication, hypoxia. In this case, we can talk about pathology.

It is observed in newborns who have had infections in utero, who have been exposed to nicotine or alcohol intoxication by the mother, in premature babies, with an unfavorable course of pregnancy, or complications during childbirth. Children diagnosed with atrial rhythm must be examined and consulted with a cardiologist. Very often, the rhythm from the atria is functional in nature and accompanies disorders of the autonomic nervous system.

With an imbalance of the autonomic nervous system, a predominance of the sympathetic department may be observed - sympathicotonia, or parasympathetic division- vagotonia. With sympathicotonia, there will be complaints of rapid heartbeat, pale skin, chilling, headache, anxiety. ECG signs of atrial rhythm with a predominance of the sympathetic part of the ANS: the R-R intervals are the same, the heart rate depends on the age of the child, there is an increase in heart rate relative to the norm, high P waves, a shortening of the P-Q interval.

With vagotonia, children may complain of interruptions in heart function, dizziness, nausea, and may experience fainting states, sweating, disturbances in work gastrointestinal tract, may decrease arterial pressure. ECG signs with a predominance of the parasympathetic part of the ANS: normal ventricular contractions, heart rate less than normal, flattened P waves, prolongation of the P-Q interval.

To determine the cause of the rhythm disturbance, pediatricians or cardiologists conduct functional tests, which allow us to determine the nature of the disorders - functional (imbalance of the autonomic nervous system) or organic (heart damage). If the disorders are functional, then tests with physical activity, orthostatic, and atropine will be positive.

Whatever the cause of heart rhythm disturbances in children, it requires active examination and consultation with a doctor.

5 Diagnostics

The most accessible instrumental method is conducting an ECG. An ECG is included in the mandatory list of examinations during medical examination. Allows you to evaluate the work of the heart and identify the source of disturbances, the state of the myocardium, and assess conductivity. For more accurate diagnosis apply:

• 24-hour Holter ECG monitoring,
• transesophageal electrophysiological study.

6 Treatment of atrial rhythm

If the atrial rhythm is not accompanied by any other pathology from the of cardio-vascular system or other organs and systems, the patient feels well and is completely healthy - this is a variant of the norm, and no treatment is required. In all other cases, the underlying disease is treated. If disorders of the autonomic nervous system have occurred, they may be prescribed sedatives, adaptogens.

If the patient has tachycardia, the doctor may prescribe drugs that reduce heart rate, for example, b-blockers. If you have a tendency to slow your heart rate - medicines, capable of increasing heart contractions: atropine preparations, tincture of Eleutherococcus, ginseng, sodium caffeine benzoate. You must remember that you cannot self-medicate. Treatment for both adults and children should be prescribed only by a specialist, after full examination and installations accurate diagnosis, taking into account contraindications and concomitant pathologies.

Ectopic, also characterized as replacement, rhythms are contractions of the heart caused by automaticity manifested in other parts of the myocardium or conduction system. Arise if the activity of the sinus node is stopped or weakened, which can happen either permanently or temporarily. The further away the source is sinus rhythm(we will apply this name to rhythms of an ectopic nature), the frequency is usually lower and less frequent than the impulses of the sinus node.

Reasons for rhythm changes

Non-sinus rhythms can occur due to changes occurring in the area of ​​the sinus node, as well as in other conducting sections. These modifications can be:

• sclerotic;
• ischemic;
• inflammatory.

Ectopic disorders are classified in different ways. There are several forms:

1. Supraventricular rhythm of ectopic nature. Its causes are an overdose of cardiac glycosides, as well as autonomic dystonia. It rarely happens that this form is due to increased automaticity ectopic focus. In this case, the heart rate will be higher than with an accelerated or replacement rhythm of an ectopic nature.
2. Ventricular rhythm. Typically, this form indicates that significant changes have occurred in the myocardium. If the ventricular rate is very low, ischemia may occur, affecting important organs.
3. Atrial rhythm. Occurs often in the presence of rheumatism, heart disease, hypertension, diabetes mellitus, ischemia, neurocirculatory dystonia, also even in healthy people. As a rule, it is present temporarily, but sometimes it lasts for a long period. It happens that atrial rhythm is congenital.

Changes occurring in the myocardium due to neuroendocrine influences can also occur in children. This means that in the child’s heart there are additional foci of excitation that function independently of each other. Such violations are divided into several forms:

• active: and extrasystole;
• accelerated: atrial fibrillation.

begin to develop in cases of cardiac organic pathology. Very rare, but there are cases when this type can be diagnosed in healthy child, even in a newborn.

Against the background of infection viral in nature V early age seizures occur paroxysmal tachycardia, which can occur in a very severe form, called supraventricular. This is possible with congenital heart defects, atropine overdose and carditis. Attacks of this form often occur when the patient awakens and changes body position.

Symptoms of the disease

We have learned that non-sinus rhythms depend on the underlying disease and its causes. It means that specific symptoms not visible. Let's look at some signs that indicate that it is time to see a doctor yourself or together with your child if his condition worsens.

Let's take paroxysmal tachycardia as an example. Most often it begins as unexpectedly as it ends. At the same time, its precursors, such as dizziness, chest pain, and so on, are not observed. At the very beginning of the crisis there is usually no shortness of breath or heart pain, but these symptoms can appear during a prolonged attack. Initially, there arises: a feeling of anxiety and fear that something serious is happening to the heart, motor restlessness, in which a person wants to find a position in which the disturbing state will stop. Next, hand trembling, darkening of the eyes and dizziness may begin. Then it is observed:

• increased sweating;
• nausea;
• bloating;
• the urge to urinate, even if the person has not consumed much liquid, occurs every fifteen or ten minutes, and about 250 ml of light, transparent urine is released each time; this feature persists even after an attack, then gradually disappears;
• urge to defecate; this symptom It is not observed often and occurs after the onset of a seizure.

Seizures short duration may occur during sleep, and the patient may experience a sharply increased heart rate due to some kind of dream. After it ends, heart activity returns to normal, shortness of breath disappears; a person feels a “fading” of the heart, followed by a heartbeat, which indicates the beginning of a normal sinus rhythm. It happens that this impulse is accompanied painful sensation. However, this does not mean that the attack always ends so abruptly; sometimes heart contractions slow down gradually.

Separately, it is worth considering the symptoms that occur in children with the development of ectopic rhythm. Each mentioned form of disorder of this nature has its own symptoms.

Extrasystoles are characterized by:

• interruptions in cardiac function;
• a feeling of “fading” of the heart;
• feeling of heat in the throat and heart.

However, there may be no symptoms at all. Vagotopic extrasystoles in children are accompanied by overweight body and hypersthenic constitution. Paroxysmal tachycardia at an early age has the following symptoms:

• fainting;
• feeling of tension and anxiety;
• dizziness;
• pallor;
• dyspnea;
• stomach ache.

Diagnosis of the disease

Diagnosis of the disease, in addition to the symptoms indicated by the patient, is based on ECG data. Some forms of ectopic rhythm disturbances have their own characteristics that are visible in this study.

The atrial rhythm is different in that the configuration of the R wave changes, its diagnostic signs are not clear. With a left atrial rhythm, there is no change in the PQ interval; it is also equal to 0.12 s or exceeds this level. The QRST complex does not differ, since excitation through the ventricles occurs in the usual way. If the pacemaker is located in lower sections left or right atrium, then the ECG will show the same picture as with coronary sinus rhythm, that is, positive PaVR and negative P in the third and second leads aVF. In this case we're talking about about the lower atrial rhythm, and it is very difficult to find out the exact localization of the ectopic focus. The right atrial rhythm is characterized by the fact that the source of automatism is P-cells, which are located in the right atrium.

IN childhood A thorough diagnosis is also carried out. Atrial extrasystoles are characterized by a modified P wave, as well as a shortened P-Q interval with an incomplete compensatory pause and a narrow ventricular complex. Extrasystoles of an atrioventricular connection differ from the atrial form in that there is no P wave in front of the ventricular complex. The right ventricular extrasystole is characterized by the fact that the main R wave has a standard upward lead, and the left ventricular one is distinguished by the downward lead of the same tooth.

With paroxysmal tachycardia, embryocardia is detected during the examination. In this case, the pulse has a small filling and is difficult to count. Reduced blood pressure is also observed. The ECG shows a rigid rhythm and ventricular aberrant complexes. In the period between attacks and with the supraventricular form, extrasystole is sometimes recorded, and during the crisis itself the picture is the same as with group extrasystole with a narrow QRS complex.

Treatment methods

When diagnosing non-sinus rhythms, treatment is aimed at the underlying disease. Accordingly, it is very important to identify the cause of cardiac dysfunction. For vegetative-vascular disorders it is usually prescribed sedatives, with strengthening of the vagus - preparations of belladonna and atropine. If there is a tendency to tachycardia, beta-blockers, for example, obzidan, anaprilin and propranolol, are considered effective. Known drugs are cordarone and isoptin.

Extrasystoles of organic origin are usually treated with panangin and potassium chloride. Sometimes antiarrhythmic drugs such as ajmaline and procainamide may be used. If extrasystole is accompanied by myocardial infarction, it is possible to use panangin together with lidocaine, which are administered by intravenous drip infusion.

Intoxication with digitalis can lead to the occurrence of polytopic extrasystoles, which is why it occurs. In this case, you need to urgently stop the drug, and use potassium preparations, Inderal, and lidocaine as treatment. To relieve intoxication associated with cardiac glycosides, the doctor may prescribe diuretics and unithiol.

With the supraventricular form, you can massage the carotid sinus on the left and right for about twenty seconds. They also apply pressure on abdominal Press And eyeballs. If these methods do not provide relief, your doctor may prescribe beta blockers, such as verapamil or procainamide. Drugs should be administered slowly while monitoring pulse and blood pressure. It is not recommended to alternate propanol and verapamil intravenously. Digitalis can be used only if it has not entered the patient’s body for the next few days before the attack.

If the patient's condition worsens, electropulse therapy is used. However, it cannot be used in case of intoxication with cardiac glycosides. Cardiac pacing can be used continuously if attacks are severe and frequent.

Complications may include heart problems, or rather their exacerbation. To avoid this, you should apply for timely medical care and do not start treatment of underlying diseases that provoke the development of ectopic rhythm. For clear and coordinated work of the heart, it is simply necessary to maintain healthy image life and avoid stress.

Atrial rhythm is a condition in which the function of sinus contraction is weakened. In this case, the lower atrial center acts as a source of impulses. There is a weakened heart rate, with heart beats ranging from 90–160 per minute. This article explains how atrial rhythm is determined on an ECG.

What are we talking about?

Many people who are diagnosed with atrial rhythm do not understand what this means. A healthy person has the only way transmission of electrical impulses causing sequential excitation of all cardiac sections. Due to this, a productive contraction occurs, leading to a satisfactory blood release into the arteries.

This route originates in the right atrium. After which it passes to the most distant ventricular tissues through the conduction system. However, due to various reasons, the sinus node loses the ability to generate the electricity necessary to release impulses to distant parts.

The transmission process is changing cardiac excitement. A replacement contraction is formed. It turns out that the impulse arises out of place. For information, atrial rhythm is the appearance of much-needed excitation anywhere in the heart, only in the non-location of the sinus node.

How does atrial rhythm occur?

Outside the border of the sinus node, an extraneous impulse appears, exciting the heart before the signal emanating from the main one. This situation indicates an advance of the secondary atrial contraction. Based on the reentry theory, there is no parallel excitation. This is influenced by local blocking of nerve impulses. During activation, this area experiences an extra extraordinary contraction, which disrupts the main cardiac impulse.

Diagnostics allows you to determine the presence of pathologies of the heart muscle

According to some theories, the endocrine, vegetative nature of the formation of the precardiac impulse is assumed. Usually this situation occurs in a child who is in adolescence or in an adult suffering from hormonal changes, which may occur due to age or pathological manifestations.

In addition, there is a theory of the occurrence of an impulse formed by the atria as a result of hypoxic, inflammatory processes occurring in the myocardium. This pathology can occur with regular inflammatory diseases. It has been noted that in children suffering from influenza and tonsillitis, the likelihood of myocarditis with further changes in atrial contraction increases.

At the heart that is main muscle organism has a special property. It has the ability to contract regardless of the nerve impulse emanating from the main organ of the central nervous system. Since it is he who controls the activity of the neurohumoral system. The correct route originates in the region of the right atrium. Then spread along the septum occurs. Impulses that do not pass along this route are called ectopic.

Types of atrial contraction

Based on the unevenness of the intervals, atrial rhythm is of the following types:

• Extrasystole is characterized by extraordinary contractions that occur during normal heart rate. This condition does not always have clinical picture. It happens that a healthy person, for one reason or another, experiences extrasystole. In this case, sometimes there is no need to contact a cardiologist. It manifests itself as fear, tingling in the area of ​​the heart and stomach.
• For atrial fibrillation heartbeats can reach up to 600 per minute. The atrial muscles are characterized by a lack of rhythm, flickering appears, with characteristic chaotic behavior. As a result, the ventricles of the heart completely go out of rhythm. This condition is quite serious and can lead to a heart attack. With this pathology, the patient suffers from shortness of breath, panic, dizziness, sweating, and fear of death. Loss of consciousness may occur.
• During pacemaker migration the source of contractions seems to move through the atria. There is a manifestation of successive impulses emanating from different atrial sections. The patient experiences tremors, fear, and stomach emptiness.
• Atrial flutter characterized by frequent regular contractions of the atria, systematic ventricular contractions. At this state more than 200 beats per minute occur. It is more easily tolerated by the patient than flickering, since it has a less pronounced circulatory disorder. It manifests itself as a rapid heartbeat, swollen neck veins, increased sweating, and lack of strength.

is carried out by a cardiologist who, based on obvious signs, confirms or denies the presence of extrasystoles

How to distinguish atrial rhythm from sinus rhythm

The atrial rhythm is slow, replacing. It occurs during suppression of the sinus node. Usually, with this arrangement, the heart contracts less than normal. In addition, there are accelerated impulses, during which the pathological activity of the center of atrial automation increases. In this situation, the heart rate is higher than the heart rate.

Based on where the activity of the ectopic center occurs, left atrial and right atrial contractions are distinguished. To alleviate the patient’s condition, electrocardiography does not necessarily have to determine which atrium is producing the pathological impulse. The doctor will need to diagnose the altered contractions.

The atrial rhythm on a replacement ECG has the following signs:

• correct contraction of the ventricles at regular intervals;
• contraction frequency varies from 45 to 60 per minute;
• each ventricular complex has a deformed, negative wave;
• intervals are characterized by shortness or normal duration;
• the ventricular complex is not changed.

Accelerated atrial rhythm has the following signs on the ECG:

• cardiac impulses range from 120 to 130 per minute;
• each ventricular contraction has a deformed, biphasic, negative, jagged wave;
• intervals are lengthened;
• the ventricular complex is unchanged.

Atrial extrasystole is determined by a premature, extraordinary contraction. Ventricular extrasystole characterized by a change in the contractile complex followed by a compensatory pause.

Features of atrial and ventricular rhythm that should be differentiated from each other

Signs on ECG

On an electrocardiogram, the doctor judges the atrial rhythm by the presence of deformation of the P wave. Diagnostics records the disturbed amplitude and its direction in comparison with the normal impulse. Usually this tooth is shortened. Right atrial contraction appears negative on the ECG. The left atrial rhythm has a positive wave and a rather bizarre shape. It looks like a shield with a sword.

Important! With an atrial rhythm, the P wave can be either negative or positive.

If the patient suffers from migration of the driving rhythm, then the electrocardiogram shows a changed wave shape and a longer P Q segment. Moreover, this change is cyclical. Atrial fibrillation characterized complete absence prong. Which is explained by the inferiority of systole.

However, the ECG shows an F wave, characterized by uneven amplitude. Using these waves, ectopic contractions are determined. There are cases when the atrial rhythm is asymptomatic, appearing only on the ECG. However, if the patient is found to have this pathology, he requires specialist supervision.