Atrial Fibrillation of the Heart: Causes and Methods of Treatment

Atrial fibrillation is one of the most common forms of disturbance of the heart rhythm. Another name for the pathology is atrial fibrillation.

In the presence of this disease a person complains of sudden attacks of tachycardia. At these moments, it seems to him that the heart is about to "jump out of the chest." Sometimes other sensations are possible, as if the heart stops for a few seconds, after which it starts beating with redoubled force. During the period of "fading" of the heart, a person starts to shake hands, he feels strong weakness and trembling all over his body.

The illness is characterized by severe interruptions in the work of the heart muscle. The atria cease to contract normally, instead they "shake", which results in a decrease in the amount of blood entering the ventricles. Sometimes they begin to produce an arrhythmic vibration that causes a person to have groundless attacks of fear, panic attacks, as well as a severe deterioration in the general condition.

Atrial fibrillation is accompanied by frequent attacks of tachycardia, which leads to acute shortage of air, dyspnea, vertigo. Sometimes nausea is possible with subsequent calls for vomiting. In some patients, such ailments cause syncope - a short-term loss of consciousness. Like many other heart diseases, atrial fibrillation has a close connection with the patient's age. The risk of developing pathology increases significantly after reaching a patient of 40 years of age, but especially severe attacks of the disease become in 70-80 years.

What it is?

Under atrial fibrillation is meant a violation of the contractile function of the heart muscle caused by disorganization of the atrial activity. This pathology is characterized by a sudden increase in heart rate, up to 600 beats per minute.

In this case, the number of contractions of the ventricles and atria also becomes arrhythmic, that is, these processes do not coincide with each other in time.

Why does atrial fibrillation develop?

The causes of the development of atrial fibrillation are divided into 2 groups:

• cardiac, directly related to the work of the heart;
• extracardiac - other factors due to which there was a violation of the contractile function of the heart muscle.

Let's take a closer look at each of these groups.

Cardiac causes of MA

To this group of reasons for the development of atrial fibrillation are:

• postoperative conditions;
• diseases of the coronary arteries of the heart;
• persistent arterial hypertension;
• heart defects (congenital and acquired);
• cardiomyopathy.

Much more extracardiac causes the development of atrial fibrillation.

Extracardial causes of MA

This group includes:

• previous surgical interventions in the heart;
• endocrine diseases (diabetes mellitus, thyrotoxicosis, etc.);
• obstructive processes occurring in the organs of the respiratory system, and having a chronic character;
• viral pathologies;
• Gastrointestinal diseases;
• diseases caused by disorders of the central nervous system.

Factors predisposing to the development of atrial fibrillation may also be:

• uncontrolled intake of medications;
• antibiotic therapy;
• chronic fatigue syndrome;
• frequent stress;
• emotional outbursts;
• excessive physical exertion;
• alcohol abuse;
• excessive smoking;
• the abuse of coffee and other beverages containing caffeine in large quantities (for example, the so-called "power engineers").

Atrial fibrillation may occur not only in elderly patients, but also in young people. In this case, we can talk about the development of a pathology such as mitral valve prolapse. Such a disease is latent in most cases, so it can be detected only during a preventive examination.

Classification

Atrial fibrillation has its own variants, according to which its symptoms also differ. The disease is classified according to the following criteria:

• clinical course;
• the frequency of contraction of the cardiac ventricles.

Consider these forms of arrhythmia separately.

Types of arrhythmia in the clinical course

Atrial fibrillation according to the classification according to the clinical course is:

1. Paroxysmal. This form of atrial fibrillation is characterized by a sudden onset of an attack, the duration of which can reach 6-7 days. But, as a rule, it does not last longer than a day. The pathological state passes independently, and does not require medical intervention.
2. Persistent. This form of atrial fibrillation can last up to 7 days. It is stopped only by taking medications.
3. Chronic, which can bother the patient for a long period of time, not succumbing to medical treatment.

Even if the disease is mild, it can not be considered safe for human health. Any malfunction in the work of the heart is a threat, therefore it is unacceptable to ignore them!

Classification of MA by the frequency of contraction of the ventricles

If we consider the classification of atrial fibrillation by the frequency of ventricular contractions, then it can be:

• bradisystolic, at which the frequency of ventricular contractions decreases to 60 beats per minute;
• normosystolic with a frequency of contractions from 60 to 90 beats / min .;
• tachysystolic, when the frequency of contractions of the cardiac ventricles exceeds 90 beats per minute.

Symptoms

Quite often atrial fibrillation can occur without noticeable symptoms, therefore it is practically impossible to detect it without passing special diagnostic tools. As a rule, the detection of pathology occurs completely by accident, when examined for other abnormalities in the patient's state of health.

If the arrhythmia does manifest itself, the signs of its occurrence may be as follows:

• sudden increase in heart rate, accompanied by pulsation of the cervical veins;
• loss of strength, general weakness;
• fast fatiguability;
• heart pain resembling angina pectoris (feeling of pressure in the heart);
• systematic dizziness;
• violation of coordination of movements at the time of attack;
• shortness of breath even with mild physical exertion and in a state of absolute rest;
• profuse sweating;
• semi-fainting condition;
• syncope;
• polyuria.

When the pathology turns into a chronic form, the patient stops suffering discomfort and other unpleasant sensations in the heart area. Gradually a person begins to get used to living with a disease.

Diagnostics

To make an accurate diagnosis, the patient must undergo a special medical examination. The diagnostic scheme consists of the following activities.

1. Visual examination of the patient, during which the presence of the underlying disease that caused the development of atrial fibrillation can be established.
2. Anamnesis based on the patient's complaints.
3. Clinical studies of urine and blood. Such procedures will also help to identify pathologies that can cause MA.
4. Biochemical blood test.
5. An electrocardiogram that helps to detect irregularities in the heart.
6. Test for hormones.
7. HMEGG - cardiogram monitoring, conducted over several days by Holter's method. The procedure helps to accurately establish the periods when arrhythmia outbreaks occur, even if the patient's condition has not changed.
8. Echocardiography, which helps to identify structural changes in the heart muscle.
9. Transesophageal echocardiography, which helps to detect thrombi in the atria or their ears. It is performed by inserting a probe into the patient's esophagus.
10. Radiography of the chest.
11. Load test, conducted using a special simulator. During the physical exercise, the doctor evaluates the work of the heart muscle.

How to treat atrial fibrillation?

Treatment of arrhythmia depends on its shape. So, the methods of therapy used in paroxysmal MA, are not suitable for arresting a pathological condition in the chronic form of the disease.

Features of treatment of paroxysmal atrial fibrillation

In this case, all efforts are directed to the restoration of sinus heart rhythm. If more than 48 hours have passed since the development of paroxysm, the question of the further treatment strategy is decided individually for each person. In this case, after taking warfarin or similar drugs should take at least 3 weeks. However, all measures aimed at getting rid of pathology require obligatory hospitalization of the patient.

To restore the heart rate, the following methods are used:

• drug therapy with novocainamide, corglitone, strophanthin (intravenously) and cordarone (oral);
• treatment with drugs that reduce the heart rate - beta-blockers (Carvedilol, Nebilet and others), antiarrhythmics (Propanorm, Allapinin), antiaggregants (Aspirin Cardio, TromboAss, etc.);
• cardioversion, which is used when ineffective drug therapy. Such manipulation is carried out in a special intensive care unit of cardiology, and requires the mandatory introduction of intravenous anesthesia. The technique of the procedure is based on the use of a non-strong discharge of electric current, by means of which the doctor "makes" the heart beat in the right rhythm.

If the arrhythmia attacks are often repeated, the doctor can make 2 decisions:

1. Translate the paroxysmal form of MA into a permanent, and only then treat the pathology.
2. Conduct emergency surgical intervention.

In addition to the above, there are also other methods, the use of which helps to get rid of the disease. there are other approaches with which you can forget about unpleasant symptoms for a long time.

Therapy with warfarin and new anticoagulants

If atrial fibrillation occurs, all patients, except those who have reached the age of 65, but also patients with a low risk of complications, oral anticoagulants are prescribed. As a rule, tableted preparations are used.

Starts taking Warfarin with a minimum dose of 2.5 mg, but gradually it will increase to 5 mg. In this case, the patient must regularly undergo control studies to assess the positive dynamics treatment, as well as in order to understand how the drug affects the general health of the patient. If there is no possibility of controlling INR, the patient may be prescribed other drugs - Aspirin or Clopidorgel.

Such widely known anticoagulants as Dabigatran, Apixaban, etc., have long been not considered novelties, therefore they are referred to as ordinary oral anticoagulants. This can not be said of Edoxaban. This drug has already passed 3 phases of clinical tests. But, while it is not registered, its application in AI is not carried out.

When is surgery indicated?

Surgical treatment for atrial fibrillation has its goals. For example, if there is a heart disease that caused arrhythmia, heart surgery prevents new outbreaks of the disease. Although, of course, we can not exclude the possibility of a recurrence of pathology.

So, with other cardiac pathologies, it is more appropriate to use laser ablation. It is held at:

1. Constant atrial fibrillation accompanied by fast-progressing heart failure;
2. Ineffectiveness of drug antiarrhythmic therapy;
3. Intolerance to drugs used to treat AI.

Radiofrequency ablation involves exposure to the sick atrial sites of a special electrode with a radio sensor at the end. The electrode is inserted into the femoral artery, but before this patient is administered a general anesthesia. The process is controlled by X-ray television. The procedure is absolutely safe, besides the risk of injury is reduced to a minimum.

Pacemaker implantation

In some cases, the doctor may decide to introduce a special device to the patient - the pacemaker. This device is also called an artificial heart rate driver. With it, you can normalize the heart rate.

The pacemaker can be single-chamber (stimulates atrium reduction only) and two-chamber (stimulation of atrial and ventricular contractions occurs). Modern instruments can easily adapt to the rhythm of a person's life, which gives him the opportunity not to think about the intensity of the physical exertion. In addition, the device remembers all data about what loads have occurred recently, on the basis of which the doctor will be able to make calculations and assess the patient's heart.

Technique of the operation

The operation for the introduction of an electric pacemaker is carried out in 7 stages:

1. The doctor makes a cut of the skin in the area of ​​the lower part of the clavicle;
2. Under careful X-ray control, a special electrode is inserted into the heart;
3. The doctor tests the work of the electrodes;
4. The ends of the inserted electrodes are fixed in the right place; do this with the help of special hooked tips or corkscrews;
5. In the subcutaneous fat cellulose make a deepening, where the body of the pacemaker will later be placed;
6. The inserted pacemaker is connected to the electrodes;
7. The place of the cut is sewn.

Do not think that the installation of a pacemaker will negatively affect the patient's quality of life. Conversely, with atrial fibrillation, the device makes the heart stronger and more enduring. However, from the moment of surgery the patient should always remember that he is wearing a rather complicated device. In order not to harm himself, he will need to observe precautions.

Nutrition rules

Since arrhythmia is often accompanied by other pathologies of the cardiovascular system, it is very important to maintain a diet to prevent new seizures. It helps to avoid unnecessary strain on the heart, while enriching the body with the necessary vitamins and minerals.

To this end, the diet should be deleted:

• sweets;
• all foods that contain sugar (including fruits);
• salt and salt products;
• smoked products;
• pickles;
• sausages;
• fatty meat and fish;
• fat butter, margarine;
• bakery products;
• confectionery.

Instead of "harmful" food, the patient is recommended to eat more fruits and vegetables - raw, stewed, or steamed. In this form they retain all their useful properties, and enrich the body with fiber, which is very useful for normal metabolism.

Prognosis of life, complications and consequences

In most cases, complications of the disease occur due to late treatment to the doctor, as well as due to non-compliance with all the recommendations of the doctor. Many patients, noticing the first progress, stop treatment, or start taking medicine at their own discretion. Shortness of breath, dizziness, pain in the heart and sharp attacks of lack of air - these are the main reasons for calling a cardiologist.

Is cure for atrial fibrillation completely? There is no single answer, because it depends on many factors. The most favorable predictions of treatment doctors give in the event that it was started at an early stage of development. Complications are possible only if anxiety symptoms of pathology have long been ignored. And it does not matter, consciously a person neglected a hike to the doctor, or wrote off the indisposition for the manifestation of fatigue or physical exhaustion. In this case, delay in visiting the cardiologist's office can be fraught with thrombosis of the heart vessels.

With complete absence of treatment for atrial fibrillation, the predictions are extremely unfavorable. Failure in the work of the atria can lead to the progression of the underlying pathology that caused the occurrence of atrial fibrillation. The consequences of this can be unpredictable.

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