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Arrhythmias of heart

Arrhythmias of heart. Department of propede u ti c of internal medicine. Etiology. Violations of rhythm of cardiac activity cause such defeats of myocardium: organic: IHD,defects of heart, AH, m y o c arditi s, c ardiom y opat hy; · toxic: medicines, alcohol;

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Arrhythmias of heart

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  1. Arrhythmias of heart Department of propedeutic of internal medicine

  2. 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.

  3. Pathogenesis • Theories of origin of arrhythmias: • Pathological automatism (presence of ectopic focuses) • Mechanism of re-entry • trigern (starting) activity.

  4. 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

  5. Extrasystolia (a synonym is premature depolarization): • auricle (atrial) • auricle-ventrical (atrioventricular) • ventrical

  6. 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

  7. with the additional ways of leadthrough • ortodromal • antidromal • ventrical: • unsteady (from 3 ventrical complexes to 30) • steady (more than 30 seconds) • monomorphic • polymorphic

  8. ІІ. VIOLATION OF LEADTHROUGH OF IMPULSE - Sinoauricular of blockade - Atrioventricular blockades: • І st. • ІІ st. • ІІІ st.

  9. III. COMBINED DYSPOIESISS AND LEADTHROUGHS OF IMPULSE • · auricle • Parasystole · from AV of connection • · ventrical • specified at possibility

  10. IV. DISEASE, SYNDROMES And PHENOMENA • Syndromes and ECG phenomena of pre-excitation of ventricles: • syndrome of WPW • syndrome of the shortened interval of PR (Launa - Ganonga - Livayna) • syndrome of early repolarisation of ventricles • innate • purchased • Syndrome of the prolonged interval of QT

  11. Syndrome of weakness of sinus noudle • Syndrome of Morganii-Adams-Stoks • Syndrome of Frederic • Cardiac sudden death (arrhythmical) • asystole • fibrilation of ventricles • electromechanics dissociation • Heart arest

  12. V. ARRHYTHMIAS ARE AT NORMAL OR BROKEN FUNCTION OF CARDIOSTIMULATORS OF DIFFERENT TYPE • Note: In a diagnosis it is needed to specify cardiac surgery interferences and devices, applied for treatment of arrhythmias and asequences heart (with pointing of method and to give interference) - kateterni (radio frequency et al) destruction, implantation of drivers of rhythm and cardioverters - defibrilyatoriv, leadthrough of cardioversion or defibrilyacii (the date of the last is specified) and others like that.

  13. 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).

  14. 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)

  15. Treatment • liquidation of etiologic factor • B-adrenoblockers (propranolol10-40mg, oksprenolol20mg 3 times per days, pindolol 5 mg 3 times on days, nadolol 20 mg 2 times per days, metaprolol 50 mg 2 times per days) • sedative facilities

  16. 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.

  17. Treatment • to the atropine sulfate of 0,5-1 mg or 0,1% solution 1-2 times per day • plathyphylinum hydrotartratum 0,5-1 mg or 0,2% solution 1-2 times per day • extract of beladonnae -0,02 gr. 3-4 times per days • izadrin 5-10 mgsublingval

  18. The first aid is at the attacks of Morgani-Adams-Stoks • to the atropine sulfate of 0,5-1 mg or 0,1% solution intravenously • izadrin 5-10 mgsublingval (at a necessity to repeat) • alupent for 1-5-10 mg on 500 ml of izotonic soluble-sodium chloride • electro-cardiostimulation (temporal or permanent)

  19. Sinus arrhythmia • ECG is criteria: • P wave is sinus origin • interval of PQ >0,12 s • 45-100 beats per 1 min • the rhythm of heart is wrong with the difference of the longest and shortest interval of R-R 0.16 and anymore • Treatment: does not require

  20. a-normal sinus rhythm • б- sinus tachycardia • в- sinus bradycardia • г- sinus arrhythmia

  21. Arest of sinus knot • EKG is criteria: • complete asystole (absence of P and QRST) • the pause of R-R does not make two ordinary intervals, and anymore. • Treatment: how to the syndrome of Morgani-Adams-Stoks

  22. Syndrome of weakness of sinus knot • EKG is criteria: • sinus bradycardia is expressed • refuse of sinus knot with periods asystoles • a duty of sinus bradycardia is with the attacks of auricle tachycardia, fibrilation (syndrome of «tachy-brady») • a sino-atrial blockade is with extra contractions heart beats • slow renewal of function of sine knot.

  23. Treatment • effective treatment does not exist • medical therapy is at the attacks of Morgani-Adams-Stoks • implantation of permanent electro-cardyostimulator

  24. Extrasystolia • premature excitation and reduction of heart or his separate parts is as a result of increase of activity of hearths of ectopic automatism.

  25. Auricle extrasystolia • EKG of sign: • premature reduction after which incomplete scray pause • the P wave is changed, negative • a complex QRS is not changed or aberrant. • Treatment: it is not needed, at presence of clinical symptoms of b-blockers, verapamil, digitalis.

  26. 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

  27. 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

  28. with previous excitation of ventricles • EKG-signs: • an extraordinary complex QRS is not extended • P wave is after QRS • complete scray pause • Treatment: like, as at auricle extrasystolia.

  29. 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.

  30. a- sinistroventrical extrasystole • b- dextraventrical extrasystole

  31. Paroxysmal tachycardia Supraventricular tachycardia • EKG is signs: • frequency of reductions of atriums - 120-250 per 1 min. • auricle complexes are preceded the complexes of QRS • the complexes of QRS are not changed

  32. Atrioventricular tachycardia • EKG-signs: • 150-200 heart beats per 1 min. • retrograde P wave (negative) after QRS or accumulates on him

  33. a- auricle paroxysmaltachycardia • б -atrioventriculartachycardia with previous excitation of ventricles • в -atrioventriculartachycardia with simultaneous excitation of atriums and ventricles

  34. Treatment of paroxysmalsupraventriculartachycardia • atleadthrough to the impulse through an a-v knot: • massage of sinus carotic • izoptin 0,25%-4ml • obzіdan 0,1% - 5ml • dіgoxin 0,025% - 1ml v/v • cordaron 5% - 6 ml

  35. Ventrical tachycardia • EKG is criteria: - >140 hearts beats per 1 min. - the complexes of QRS are extended

  36. EKG is at paroxysmal ventrical tachycardia

  37. 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

  38. 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

  39. a- trembling of ventricles • b- blinking and fibrilation of ventricles

  40. Sinoauricular blockade • EKG is criteria: • periodic fall of cardiac cycles • increase of pause between the waves of Р-Р in 2 times

  41. Inwardly auricle blockade • EKG is criteria: • increase of duration and breaking up of wave Р

  42. Atrioventricular blockadeІst • permanent lengthening of interval of P-Q anymore as on 0,20s • a- auricle form • б- key form • в-distal form blockade

  43. А-vblockade 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

  44. А-vblockade 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.

  45. EKG is at the complete blockade of right bundle of bunch of Hiss

  46. EKG is at the complete blockade of left bundle of bunch of Hiss

  47. Syndrome of Wolf-Parkinson-White • 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)

  48. EKG is at the syndrome of WPW

  49. 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

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