What Is Proarrhythmia?

Arrhythmia is caused by abnormal or abnormal sinoatrial node agitation, and the conduction of agitation is slow, blocked, or transmitted through abnormal channels, that is, the origin of cardiac activity and / or the frequency of conduction disturbances that cause cardiac beats And / or abnormal rhythm. Arrhythmia is an important group of diseases in cardiovascular disease. It can occur on its own or with other cardiovascular diseases. Its prognosis is related to the etiology, inducement, evolutionary trend, and whether it causes severe blood flow disorders, which can cause sudden death from sudden onset, and can also involve the heart and cause its failure.

Basic Information

English name

arrhythmia

Visiting department

Cardiology

Common causes

Cardiovascular diseases, infections and other factors

Common symptoms

Heart palpitations, which can cause insufficient blood supply to the coronary, cerebral, and renal arteries

Causes of Arrhythmia

Hereditary arrhythmias are mostly caused by mutations in gene channels, such as long QT syndrome, short QT syndrome, and Brugada syndrome.

Acquired arrhythmias can be seen in various organic heart diseases, among which coronary atherosclerotic heart disease (referred to as coronary heart disease), cardiomyopathy, myocarditis, and rheumatic heart disease (referred to as rheumatic heart disease) are more common, especially In the event of heart failure or acute myocardial infarction. Arrhythmias that occur in basic healthy people or patients with autonomic dysfunction are also not uncommon. Other causes include electrolyte or endocrine disorders, anesthesia, hypothermia, thoracic or cardiac surgery, drug effects and central nervous system diseases, etc., some of which are unknown.

Arrhythmia clinical manifestations

The clinical manifestations of hemodynamic changes of arrhythmia mainly depend on the nature, type, cardiac function and degree of hemodynamic effects of arrhythmia, such as mild sinus bradycardia, sinus arrhythmia, and occasional atrial Presexual contraction, once-atrioventricular block, etc. have little effect on hemodynamics, so there is no obvious clinical manifestations, more severe arrhythmias, such as diseased sinus syndrome, rapid atrial fibrillation, and paroxysmal supraventricular heartbeat Tachycardia, persistent ventricular tachycardia, etc., can cause palpitations, chest tightness, dizziness, hypotension, sweating, and in severe cases, syncope, Alzheimer's syndrome, and even sudden death. Due to different types of arrhythmia, clinical manifestations Different, mainly the following performances:

Manifestations of insufficient coronary blood supply

Various arrhythmias can cause reduced coronary blood flow. Although various arrhythmias can cause reduced coronary blood flow, they rarely cause myocardial ischemia. However, in patients with coronary heart disease, various arrhythmias can be induced. Or worsen myocardial ischemia, mainly manifested as angina pectoris, shortness of breath, peripheral vascular failure, acute heart failure, acute myocardial infarction and so on.

2. Cerebral arterial insufficiency

Different arrhythmias have different effects on cerebral blood flow. In normal cerebrovascular disease, the above hemodynamic obstacles will not cause serious consequences. If cerebrovascular disease occurs, it will be sufficient to cause insufficient blood supply to the brain, which is manifested as dizziness, fatigue, blurred vision, temporary blindness, and even aphasia, Paralysis, convulsions, coma and other transient or permanent manifestations of brain damage.

3. Renal artery insufficiency

After the occurrence of arrhythmia, renal blood flow also decreased. Clinical manifestations include oliguria, proteinuria, and azotemia.

4. Mesentery arterial insufficiency

During arrhythmia, blood flow is reduced, and mesenteric arterial spasm can produce clinical manifestations of gastrointestinal ischemia, such as bloating, abdominal pain, diarrhea, and even bleeding, ulcers, or paralysis.

5. Performance of cardiac insufficiency

Mainly cough, dyspnea, burnout, fatigue, edema, etc.

Arrhythmia check

Physical examination

Should focus on judging the nature of arrhythmia and the impact of arrhythmia on hemodynamic status.

(1) Auscultation of heart sounds Knowing the speed, slowness, and regularity of ventricular beats, combined with the atrial activity reflected by jugular vein beats, helps to make a preliminary differential diagnosis of arrhythmia.

(2) The effect of carotid sinus massage on tachyarrhythmia can help to identify the nature of arrhythmia. In order to avoid accidents such as hypotension and cardiac arrest, the patient should be performed in the supine position with ECG monitoring. The elderly should be used with caution, and those with cerebrovascular disease should be disabled. Each time you massage one side of the carotid sinus, the duration of one massage does not exceed 5 seconds, which can double the ventricular rate of atrial flutter, and also make the supraventricular tachycardia immediately turn into sinus rhythm.

2. Intermittent physical examination

Should focus on the existence of hypertension, coronary heart disease, valvular disease, cardiomyopathy, myocarditis and other organic heart disease evidence. Non-invasive and invasive tests such as conventional electrocardiogram, echocardiogram, electrocardiogram exercise stress test, radionuclide imaging, and cardiovascular angiography can help confirm or rule out organic heart disease.

Body surface electrocardiogram is the most convenient method for diagnosing arrhythmia. The electrocardiogram record at the onset of arrhythmia is an important basis for confirming the nature of arrhythmia. The ECG characteristics of normal sinus rhythm are: P wave appears regularly, and the P wave morphology indicates that the excitement comes from the sinoatrial node (that is, the P wave is upright at , , aVF, V ₄ to V ₆ and inverted at aVR). The frequency of normal sinus rhythm is generally 60 to 100 beats / minute.

Holter monitoring is also called Holter monitoring. By continuously recording the ECG for 24 hours, it may record the onset of arrhythmia and the effect of autonomic nerves on the arrhythmia, etc., which can make up for the shortcomings of body surface ECG that can only be recorded briefly.

Arrhythmia diagnosis

The diagnosis of arrhythmia mostly depends on the electrocardiogram, and some patients can make a preliminary diagnosis based on medical history and signs. Inquire in detail about heart rate, rhythm (rule or not, missing sensation, etc.), onset and end of the attack, and duration. The presence or absence of hypotension, fainting or near-fainting, convulsions, angina pectoris, or heart failure at the time of the attack, as well as the causes, frequency, and treatment history of previous attacks, can help determine the nature of the arrhythmia.

Arrhythmia treatment

The need for treatment should be based on the symptoms of the arrhythmia patient, the type of arrhythmia, and its effect on hemodynamics. Usually includes the control of arrhythmia during the onset, the removal of the etiology and focus, the improvement of the matrix, the prevention of relapse and so on. Treatment methods can be divided into non-drug treatment and drug treatment.

Non-drug treatment

Includes methods to compress the eyeball, massage the carotid sinus, pinch the nose, and force the breath and hold the reflex to stimulate the vagus nerve; electrical cardioversion, electrical defibrillation, pacemaker implantation and ablation, and other electrical treatment methods; surgery and so on.

(1) Reflex-excited vagus nerve method can be used to stop most paroxysmal supraventricular tachycardia, and can be used before or at the same time as drug treatment;

(2) Electrical cardioversion and electrical defibrillation are used to terminate the onset of ectopic tachyarrhythmia, ventricular flutter, and ventricular fibrillation, respectively;

(3) Pacemakers are mostly used to treat chronic arrhythmias such as sinus node dysfunction and atrioventricular block;

(4) Catheter ablation can cure a variety of supraventricular tachycardia, such as pre-excitation syndrome, atrioventricular reentrant tachycardia, etc .;

(5) Surgical treatment is currently used to treat patients with atrial fibrillation and other heart diseases who need thoracotomy.

2. Commonly used antiarrhythmic drugs

There are more than 50 antiarrhythmic drugs in clinical application, and there is no unified classification standard. Most scholars agree to divide the antiarrhythmic drugs into the following four categories according to the different principles of drug action on the heart to guide the rational use of drugs, of which the class I drugs are divided into three subclasses: A, B, and C.

(1) Class I : sodium channel blockers. 1) Class IA Moderately blocks sodium channels, such drugs include quinidine. 2) Class IB is a mild blockade of sodium channels. 3) Class C significantly blocks sodium channels, and such drugs include propafenone.

(2) Class II is -adrenergic receptor blocker, which is effective for blocking -receptor. The representative drug is propranolol.

(3) Class III is a drug that selectively prolongs the repolarization process. Amiodarone belongs to this class.

(4) Class IV is calcium channel blocker. They block calcium channels and inhibit Ca influx. Representative drugs are verapamil.

Taking anti-arrhythmic drugs for a long time has different degrees of side effects, which can cause ventricular arrhythmia or cardiac blockage and be fatal. Therefore, the clinical application should strictly grasp the indications and pay attention to adverse reactions in order to respond at any time.

Arrhythmia prevention

1. Be regular in your life and ensure adequate sleep;

2. The living environment strives to be quiet, to avoid noise, a variety of flowers and plants, which is conducive to Yiyang temperament;

3. Pay attention to the combination of work and rest, and choose appropriate physical exercises, such as walking, Tai Chi, Qigong, etc., to control housework and prevent colds;

4. Try your best to maintain the standard weight, don't be greedy, because obesity will increase the heart load;

5. Pay attention to seasonal, seasonal, and climate changes, because of cold, sweltering weather, and solar terms that have a greater impact on the disease, such as the beginning of spring, summer solstice, beginning of winter, winter solstice, etc., which can easily induce or aggravate arrhythmia, and should be protected in advance. Take measures to keep warm, ventilate, and cool down;

6. The diet is based on the principles of easy digestion, lightness, rich nutrition, low meals and frequent meals, low salt and low fat, high protein, multivitamins, cleanliness, proper cold and heat, and regular quantitative basis. Arrhythmia patients are contraindicated to strong tea, coffee, and cigarettes. , Spirits, fried and over-salty, over-sweet, over-sticky foods, eat less fine grains, pine eggs, animal offal, and edema, limit the amount of water you drink;

7. The normality of mental emotions is closely related to the occurrence of arrhythmia. Try to eliminate the negative emotional stimuli such as tension, fear, anxiety, annoyance, and anger, and maintain a normal mentality;

8. In addition to daily oral medications, patients should also have emergency medicines prescribed by doctors, such as propranolol, Suxiao Jiuxin Wan, Xintong Ding, atropine, etc.