Why does pacemaker migration occur? I49 Other cardiac arrhythmias Arrhythmia according to ICD 10.

To optimize international disease statistics, the World Health Organization created the International Classification of Diseases (ICD). Physicians enjoy the tenth edition revision. In the heading of cardiovascular pathology, atrial fibrillation is listed under the name "fibrillation and atrial flutter" (ICD code 10 - I 48).

Arrhythmia ICD code: I 44 - I 49 - violation of the rate of contractions of the heart, their regularity as a result of a functional or organic lesion of specialized conductive myocardiocytes. In the normal state, electrical impulses are transmitted from the sinus node to the atrioventricular node and to the fibers of the heart muscle through bundles of conductive muscle fibers.

Damage can affect any of these structures, manifested by characteristic changes in the ECG line and the clinical picture. Most often, sinus arrhythmia develops with regular heartbeats (ICD 10 code - I 49.8).

What is flicker and flutter

Atrial fibrillation - random contraction of the atria with different blood filling during diastole. Most of the conductive waves, due to their large number, do not extend to the ventricular myocardium.

A circular conductive wave causes atrial flutter with a rate of contraction from 0 to 350 beats per minute. This condition happens 30 times less often than flicker. Flutter waves can reach the conduction system of the ventricles, causing them to contract in the right or wrong rhythm.

Depending on the speed of the heart rate, atrial fibrillations are bradysystolic (with a slowing of the rhythm below 60 beats), normosystolic (from 60 to 90 beats per minute) and tachysystolic (over 90 beats).

Reasons for development

Heart rhythm disturbance in the form of atrial fibrillation develops as a result of morphological changes in the conduction system of the myocardium, with endogenous and exogenous intoxication, and some other diseases. A rare option is idiopathic (causeless) atrial fibrillation, when a visible background for its development has not been established.

Diseases and conditions leading to atrial fibrillation:

1. Diffuse myocardial sclerosis (atherosclerotic, myocarditis, rheumatic).
2. Focal myocardial sclerosis (postinfarction, myocarditis, rheumatic).
3. Heart valve defects (congenital, acquired).
4. Myocarditis.
5. Cardiomyopathy.
6. Hypertonic disease.
7. Hyperthyroidism.
8. Diseases with severe violations of the water-salt balance.
9. Severe infectious diseases.
10. Syndrome of premature excitation of the ventricles.
11. The hereditary factor also plays a role.

Classification

By duration:

1. first detected - a single attack that first arose;
2. paroxysm of atrial fibrillation - lasts up to a week (but more often up to 2 days), recovers independently in the correct rhythm;
3. persistent - atrial fibrillation lasts more than a week;
4. long-term persistent - lasts more than 12 months, but it is possible to restore the rhythm with the help of cardioversion;
5. permanent - lasts more than 12 months, restoration of sinus rhythm is ineffective or has not been performed.

According to the severity of the flow:

1. Asymptomatic form.
2. Mild form - does not affect the life of the patient.
3. The expressed form is a violation of vital activity.
4. The severe form is disabling.

Clinical picture

With uncontrolled contraction of the atria, their full blood supply does not occur, during diastole there is a deficit of blood flow into the ventricles by 20-30%, which leads to a decrease in ventricular shock output. Accordingly, less blood enters the peripheral tissues and blood pressure in them is reduced. Hypoxia of structures distant from the heart develops.

The nature of the pathology:

1. Insufficient coronary circulation aggravates the work of the heart. A "vicious circle" is established: myocardial hypoxia leads to the progression of atrial fibrillation, which, in turn, deepens hypoxia. Characteristic manifestations of the heart: discomfort and compressive pain behind the sternum, palpitations, arrhythmic pulse with uneven filling.
2. Paroxysm of atrial fibrillation leads to oxygen starvation of the brain, which is manifested by dizziness, fainting, the appearance of a feeling of fear, sweating.
3. Hypoxia of peripheral vessels is manifested by cooling of the skin of the fingers, acrocyanosis.

Complications

Atrial fibrillation disrupts the usual blood flow, contributing to the formation of parietal blood clots in the heart. They are the source of thromboembolism of the arteries of the large (rarely small) circulation. The most common is the blockage of cerebral vessels by thromboembolism with the development of ischemic stroke.

Another dangerous complication of atrial fibrillation is progressive heart failure.

Diagnostics

When collecting an anamnesis in patients with constant atrial fibrillation, characteristic complaints may not be. The symptoms of the underlying disease come to the fore, and only during an ECG is the form of arrhythmia determined.

With paroxysmal atrial fibrillation, the patient makes typical complaints. On examination, his skin is pale, acrocyanosis is observed, on palpation the pulse is incorrect, uneven blood filling, on auscultation the heart rhythm is abnormal.

• with multiple weak non-friendly contractions of the atria, their total electrical potential is not fixed - there is no P wave;

• atrial fibrillation is displayed in the form of small random f waves throughout the ECG line;
• ventricular QRS complexes are normal but irregular;
• with a bradysystolic form, QRS complexes are recorded less often than 60 per minute;
• with tachysystolic form, QRS complexes are recorded more often than 90 per minute.

When formulating a clinical diagnosis, doctors use the ICD codes for cardiac arrhythmias - the 10th revision of the International Classification of Diseases.

Treatment

Relief of the paroxysm of atrial fibrillation must be started immediately: within the first 48 hours, the restoration of the rhythm sharply reduces the risk of developing thromboembolic complications. If therapy is started at a later date, the use of anticoagulants is required for a month under the control of coagulation.

Therapy methods:

1. Reflex methods - pressure on the eyeballs, compression of the carotid artery - are not practiced now. The only possible option is to hold your breath while exhaling.
2. Of the drug treatment for tachyform, antiarrhythmic drugs are prescribed: Verapamil, Kordaron, Obzidan.
3. Having established the cause of the rhythm disturbance, the underlying disease is treated.
4. Full recovery of the heart rhythm is carried out in a hospital. In the absence of contraindications, cardioversion is performed - pharmacological or electrical. Complications of electrical cardioversion can be thromboembolism, sinus arrhythmia, rarely other types of arrhythmias up to ventricular fibrillation and asystole.

For preventive purposes, in case of heart rhythm disturbance, ICD code I 44 - I 49, follow the principles of proper nutrition, lead an active lifestyle (recommended by a doctor), give up bad habits, be in the fresh air. If you already have a pathology that is on the list of causes of atrial fibrillation, do not allow an exacerbation, which will increase the risk of developing a rhythm disorder.

Atrial fibrillation is an abnormal heart rhythm characterized by rapid, erratic excitation and contraction of the myocardium. I 49.0 - according to ICD 10 code for atrial fibrillation, belonging to class IX "Diseases of the circulatory system".

Normally, in a healthy person, with each contraction of the heart, there should first be a contraction of the atria, and then the ventricles. Only in this way is it possible to adequately ensure hemodynamics. If this rhythm is disturbed, arrhythmic and asynchronous contraction of the atria occurs, and the work of the ventricles is disrupted. Such fibrillations lead to exhaustion of the heart muscle, which can no longer work effectively. Restrictive and then dilated cardiomyopathy may develop.

Heart rhythm disturbance in ICD 10 is coded as follows:

• I 49.0 - "Fibrillation and flutter of the ventricles";
• I 49.1 - "Premature contraction of the ventricles";
• I 49.2 - "Premature depolarization emanating from the connection";
• I 49.3 - "Premature atrial depolarization";
• I 49.4 - "Other, unspecified premature abbreviations";
• I 49.5 - "Syndrome of weakness of the sinus node";
• I 49.7 - "Other specified disorders of the heart rhythm";
• I 49.8 - "Disorders of the heart rhythm, unspecified."

In accordance with the established diagnosis, the necessary code is set on the title page of the case history. This encryption is the official and uniform standard for all medical institutions, it is used in the future to obtain statistical data on the prevalence of mortality and morbidity from specific nosological units, which is of prognostic and practical importance.

Reasons for the development of rhythm pathology

Atrial fibrillation can occur for various reasons, but the most common are:

• congenital and acquired heart defects;
• infectious myocarditis (bacterial, viral, fungal damage to the heart);
• IBS atrial fibrillation (usually as a serious complication of acute myocardial infarction);
• hyperproduction of thyroid hormones - thyroxine and triiodothyronine, which have an inotropic effect;
• drinking large amounts of alcohol;
• as a consequence of surgical interventions or invasive research methods (for example, with fibrogastroduodenoscopy);
• arrhythmias after strokes;
• when exposed to acute or chronic stress;
• in the presence of a dysmetabolic syndrome - obesity, arterial hypertension, diabetes mellitus, dyslipidemia.

Attacks of arrhythmia are usually accompanied by a feeling of interruptions in the work of the heart and an arrhythmic pulse. Although often a person may not feel anything, in such cases, the diagnosis of pathology will be based on ECG data.

Consequences of arrhythmia

Atrial fibrillation in ICD 10 is fairly common and carries a poor prognosis if not adequately monitored and treated. The disease can be complicated by the formation of blood clots and the development of chronic heart failure.

Arrhythmia is of particular danger in coronary heart disease, arterial hypertension and diabetes mellitus - in these cases, thromboembolism can lead to cardiac arrest, heart attack or stroke.

Heart failure can form quite quickly and manifest as hypertrophy of the myocardial walls, which will aggravate the already existing ischemia. Arrhythmia in ICD 10 is a common complication of acute myocardial infarction, which can be the direct cause of death.

The above facts speak of the seriousness of the disease and show the need for constant and correct therapy. All kinds of antiarrhythmic drugs, potassium-containing drugs, antihypertensive drugs are used for treatment. Great importance is given to taking anticoagulants and antiplatelet agents. For these purposes, warfarin and acetylsalicylic acid are used - they prevent the development of blood clots and change the rheology of the blood. It is very important to establish the primary cause of the development of atrial fibrillation and block its action in order to prevent all sorts of complications.

The diagnosis of paroxysmal atrial fibrillation (PMA) means a type of arrhythmia, a violation of atrial contraction. Another name for atrial fibrillation is atrial fibrillation. The paroxysmal form of the disease is characterized by the alternation of normal heart function with the occurrence of attacks (paroxysms) of tachycardia. With paroxysm, the atria contract irregularly and often (up to 120-240 beats per minute). This condition occurs suddenly and may end spontaneously. Such attacks require immediate medical attention and treatment.

The paroxysmal form of atrial fibrillation is understood as a form of atrial fibrillation, in which an attack of an abnormal heart rhythm lasts no more than 7 days, with a longer duration of an attack, a permanent form of atrial fibrillation is diagnosed.

Paroxysm in atrial fibrillation is one of the most common manifestations of a violation of the process of atrial contraction. This is a tachycardia attack, which is characterized by an irregular heart rhythm and an increase in heart rate to 120-240 beats per minute.

The ICD 10 classification of diseases assigns the international code I48 to paroxysmal atrial fibrillation.

Attacks of this type of arrhythmia usually begin suddenly. After a while, they stop in the same way. The duration of this state on average takes from several minutes to two days.

The disease is more susceptible to elderly people over 60 years of age. Only in 1% of cases it occurs in young people.

The paroxysmal form of the disease is difficult to tolerate by a person, since with atrial fibrillation, the heart rate becomes high. During an attack, the heart works in an increased load mode, it contracts often, but weakly. There is a high probability of formation of blood clots in the atria due to blood stasis. Thrombus embolism can lead to ischemic stroke.

A frequent complication of pathology is the development of heart failure.

Clinical picture

Dizziness is one of the symptoms of paroxysmal atrial fibrillation

The paroxysm that arose with atrial fibrillation manifests itself as certain clinical signs. Symptoms of the disease may vary in different cases. In some patients, at the time of the attack, only pain in the region of the heart is felt. Others may complain of the following symptoms of the disease:

• severe weakness throughout the body;
• feeling of lack of air;
• strong heartbeat;
• sweating;
• trembling in the body;
• feeling of coldness in the upper or lower extremities.

In some patients, during an attack, blanching of the skin and cyanosis, that is, cyanosis of the lips, is observed.

If the attack is severe, then the standard symptoms are supplemented by concomitant signs:

• dizziness;
• semi-conscious state;
• loss of consciousness;
• panic attacks.

The last symptom often manifests itself, since at the moment of a strong deterioration in well-being, a person begins to seriously worry about his own life.

Important! Symptoms characteristic of paroxysmal atrial fibrillation may indicate other diseases. To accurately determine the cause of their appearance, it is required to undergo a set of diagnostic measures.

At the end of an attack of paroxysmal atrial fibrillation, the patient has a clear increase in intestinal motility. Also by this time there is profuse urination. With an excessive decrease in the heart rate, the patient's cerebral blood supply worsens. It is this change that explains the development of semi-conscious and unconscious states. Respiratory arrest is not ruled out, requiring urgent resuscitation measures.

Possible complications

The paroxysmal form of atrial fibrillation needs mandatory treatment. Otherwise, the disease will lead to serious complications. As a result of untreated pathology, patients develop heart failure, blood clots appear. These conditions lead to cardiac arrest and ischemic stroke. Possible development of Alzheimer's disease.

The most dangerous complication is death.

Diagnostics

The initial stage of diagnosing arrhythmia can be carried out by a therapist or cardiologist using an electrocardiogram

Atrial fibrillation is a sign of a serious illness. With atrial fibrillation, a person may need emergency care. However, a correct diagnosis must be established in order to carry out the necessary therapy.

The most important method for diagnosing paroxysmal atrial fibrillation is electrocardiography. The ECG shows the main signs indicating the disease.

Advice! It is necessary to trust the interpretation of the ECG result to a competent specialist. Self-assessment of the result can lead to an incorrect diagnosis.

Holter monitoring, exercise tests, listening to heart sounds with a phonendoscope, ultrasound and ECHO KG are used as auxiliary diagnostic methods.

Treatment

Only a competent specialist can prescribe the correct treatment. With paroxysmal atrial fibrillation, it may be necessary to use different techniques. They are selected individually for each patient.

The choice of method of therapy directly depends on the duration of paroxysms and the frequency of their occurrence.

If atrial fibrillation bothers a person for no more than 2 days, then doctors take measures to restore sinus rhythm. At a later date, treatment is required to help prevent the development of life-threatening complications.

In difficult situations, the patient is prescribed therapy, the main goal of which is to restore the correct rhythm of atrial contractions. Additionally, you need to take medications that can thin the blood.

Medical treatment

Class III antiarrhythmic drug, has antiarrhythmic and antianginal effects

With paroxysmal disturbance of the heart rhythm, due to which the entire cardiovascular system suffers, it is possible to fight with the use of drugs. To reduce heart rate and restore disturbed rhythm. the drug Kordaron is used. It has a minimal number of adverse reactions, therefore it is suitable for the treatment of most patients.

With the diagnosis of atrial fibrillation, Novocainamide is often prescribed. The drug is slowly introduced into the human body. It is forbidden to rush during the procedure, as an injection can dramatically lower blood pressure, thereby aggravating the situation. In some cases, Digoxin is prescribed, which is able to control the contraction of the ventricles.

Note! The drugs listed above are administered by injection. Therefore, patients should not use them on their own at home. Such drugs are administered during an attack to a person by ambulance doctors or specialists who work in the inpatient department.

If for the first time the prescribed drug showed a good result, then during its use with a new attack, one should not expect the same effect. Each time the effect of the drug will weaken.

Electropulse therapy

Electrical impulse therapy is used to treat atrial fibrillation, the procedure is performed in the clinic in one day, the patient should not eat anything for 6 hours before the session

To eliminate attacks of arrhythmia, a method of electropulse treatment was developed. It is prescribed if the drug course does not give the expected result. An electric current discharge is indicated for patients who have complications due to another paroxysm.

Electropulse treatment is performed according to the standard scheme:

1. Initially, the patient is introduced into a state of medical sleep, anesthesia (the procedure is characterized by high pain).
2. 2 electrodes are placed on the chest area.
3. Next, you need to set the required mode, which corresponds to the discharge of atrial contractions;
4. It remains to set the current indicator and conduct a discharge.

After the discharge, the heart begins its work again. Its functions from now on are performed a little differently. The electric current "recharges" the conduction system, which is why it is forced to start giving rhythmic excitation impulses to the sinus node.

Practice shows that this treatment option in most cases guarantees a positive result.

Surgical intervention

If the attacks of the disease occur too often, then the patient will need surgery. It is used to relieve the symptoms of pathology and eliminate its cause. Thanks to this method, arrhythmia attacks are stopped, since the surgeon destroys the focus of pathological excitation in the heart.

The relief of paroxysm and the prevention of new attacks is the main goal of the operation.

Surgery (catheter ablation) is performed using a catheter that is inserted through an artery. If necessary, the operation is repeated after a certain period of time.

What to do during an attack?

The patient and his relatives should know what to do in the event of a paroxysm. The following procedures help to completely remove or reduce the degree of intensity of the painful condition:

• compression of the abdominal press;
• breath holding;
• pressure on the eyeballs.

At the same time, an ambulance must be called. The doctor injects the patient intravenously with Korglikon, Strofantin, Ritmilen, Aymalin or Novocainamide preparations. Sometimes the attack is removed by intravenous administration of potassium chloride.

Forecast

In prognostic terms, arrhythmias are extremely ambiguous, it is recommended to limit the intake of stimulants (caffeine), avoid smoking and alcohol, self-selection of antiarrhythmic and other drugs

The prognosis for the treatment of paroxysmal atrial fibrillation depends on the disease, against the background of which there was a violation of the rhythm of atrial contraction.

With proper treatment with such a disease, you can live another 10-20 years.

The lack of therapy and the failure to provide timely assistance to the patient during an attack of paroxysmal atrial fibrillation can result in the development of dangerous conditions for him, which lead to death.

Pulmonary edema in myocardial infarction is a pathological process that accompanies heart failure. In this case, the cells of the affected area of ​​the myocardium (heart muscle) die, because due to a failure in the blood flow of the coronary arteries, the supply of oxygen and nutrients to the heart stops. This may be accompanied by the development of edema in the lungs, which is caused by the accumulation in the lung tissues and alveoli of blood plasma released from the vessels. Thus, a heart attack is complicated by problems with the patient's breathing, this is an extremely dangerous condition that can lead to the death of the patient and requires an immediate response.

According to ICD-10, the disease was assigned code 121, and its complication in the form of pulmonary edema - 150.1.

Why does the disease develop?

Cardiologists associate the development of this complex of pathologies with two factors:

1. Blockage of the coronary artery as a result of atherosclerosis, or significant narrowing of the lumen.
2. Too high pressure in the ventricle due to some pathologies of the heart.

As you know, the work of the heart is to pump blood. The heart contracts in cycles, while the myocardium then relaxes, then contracts again. When the heart relaxes (so-called diastole), the ventricle fills with blood, and during systole (contraction), it is pumped by the heart into the vessels.

When a patient develops a heart attack, the ventricles lose the ability to completely relax. This is due to the death of part of the muscle cells - necrosis.

Similar problems with the ventricles are observed in other pathologies:

• ischemic disease;
• aortic stenosis;
• high pressure;
• hypertrophic cardiomyopathy.

But if in a heart attack the cause of ventricular dysfunction is necrosis, in the cases listed, other pathological changes act as such.

It lies in the fact that during a heart attack, blood stagnates in the capillaries of the lungs and the pulmonary circulation. Gradually, hydrostatic pressure increases in them, and plasma penetrates into the lung tissue and interstitial volume, which it "squeezes" out of the blood vessels. This process causes acute respiratory dysfunction and can be fatal to the patient.

Symptoms

In medicine, it is customary to consider the following symptoms as indicators of a heart attack with edema:

• significant pain "under the spoon", behind the sternum or in the region of the heart;
• progressive weakness;
• increased heart rate up to 200 beats per minute, and even more (severe tachycardia);
• increase in blood pressure;
• shortness of breath, shortness of breath;
• the presence of wheezing in the lungs. They are dry at first, gradually turning into wet;
• shortness of breath on inspiration;
• wet cough;
• cyanosis (blue of the skin and mucous membranes);
• the patient breaks into a cold sweat.

As the pathological condition develops, the temperature rises, but does not exceed 38 degrees. A symptom can develop both five to six hours after a heart attack, and a day later.

When the edema completely spreads to the lungs (this is especially true for heart failure with damage to the left ventricle and the heart attack itself), shortness of breath increases. Gas exchange in the lungs continues to deteriorate, and the patient experiences asthma attacks. The liquid gradually enters the bronchi and alveoli, the latter stick together, while wet rales are heard in the lungs of patients.

Consequences of a heart attack with edema

The death of the patient can be prevented if timely and correct assistance is provided to him. If first aid was not provided, then there is a high probability of death due to asphyxia or atrial fibrillation of the ventricles.

The considered type of myocardial infarction can cause the following consequences:

• cardiogenic shock. The patient's blood pressure drops, the pulse becomes thready, and the heart muscle eventually stops;
• cardiosclerosis: after a heart attack, the heart tissue that has died as a result of an attack is scarred;
• atrioventricular blockade: a violation of the conduction of electrical impulses inside the heart, up to the complete cessation of their passage;
• fibrinous pericarditis. This pathology is characterized by an inflammatory process that affects the fibrous-serous membrane of the heart;
• post-infarction aneurysm, in which the part of the wall of the cardiac ventricle that was affected begins to bulge. This pathology can occur several months after a heart attack, and is fixed in about 15 cases out of 100;
• there is a possibility of developing a pulmonary infarction. Part of the lung tissue may also die off and be replaced by scar tissue;
• cerebral infarction.

Diagnosis and assistance to the patient

The initial diagnosis is usually carried out by ambulance doctors called to the scene. It is quite simple for a trained specialist to determine the cause of the patient's ailment, since the clinical picture of the manifestations of infarction and pulmonary edema is visible very clearly and allows a fairly accurate conclusion based on the initial examination.

The diagnosis is confirmed with the help of an ECG, as well as listening to the heart rhythm. When a patient enters a hospital for treatment, he is also given an ultrasound diagnosis of the lungs and heart (or an X-ray examination of those). Additionally, tests are taken: blood is examined for specific proteins and enzymes, as well as for the content of various blood cells.

In diagnosis, it is important to remember that a number of symptoms of a heart attack are similar to those of internal hemorrhage, pneumothorax, perforation of a gastric ulcer, pancreatitis, and some other diseases.

Before the arrival of the ambulance, the patient should be placed in a half-sitting position. To expand the arteries of the heart, nitroglycerin is placed under the tongue, one or two tablets, with an interval of 15 minutes. It is also advisable to let the patient chew and swallow aspirin in the amount of 150 milligrams. Then you should wait for the doctors who will begin professional treatment.

Ways to prevent a heart attack include:

1. Physical exercise.
2. Bringing the body mass index to normal.
3. Rejection of bad habits.

Regular medical examinations and timely treatment of identified diseases are of great importance.

Sick sinus syndrome

Sinus node weakness syndrome, according to modern views on arrhythmias, refers to combined forms. This means that the main clinical and electrocardiographic syndrome is combined with another type of conduction or automatism disorders.

In particular, its manifestation is characterized by persistent bradycardia (possibly due to sinoauricular blockade) in combination with ectopic forms of arrhythmias:

• extrasystole,
• atrial flutter,
• atrial fibrillation,
• supraventricular paroxysmal tachycardia.

Less often, elusive contractions and rhythms or only a slow atrial (atrioventricular) rhythm are observed. The most dangerous sign is repetitive asystole due to the stopping of all sources of rhythm. This phenomenon is called sinoauricular syncope. More often they are provoked by attacks of paroxysmal flicker or tachycardia.

The prevalence of such lesions is typical among the elderly, regardless of gender. But it also occurs in children with cardiac pathology. Per 10,000 population, sinus node weakness is found in 3-5 people.

In the ICD-10, the syndrome is included in the group "Other cardiac arrhythmias" with the code I49.5.

Pathophysiology of changes in the sinus node

The sinus node lies on the border of the vena cava and the right atrium, acts as a pacemaker. The fibers of the nervous system are connected with it, through which the transmission of "orders" about the need for acceleration during physical exertion, stress is carried out. Therefore, the node is an important structure for the adaptation and coordination of cardiac activity with the requirements of the body.

By maintaining the resting heart rate within 60–80 beats per minute, the sinus node ensures full contractions of all chambers of the heart with complete overcoming of vascular resistance and normal blood flow. This function is provided by the accumulation of rhythmogenic (pacemaker) cells capable of generating a nerve impulse and transmitting it further along the conduction system.

The property of automatism and good conductivity of the electrical impulse guarantee sufficient blood supply to the arteries of the brain and heart, and prevent possible tissue ischemia.

Why does knot weakness occur?

Depending on the origin, sick sinus syndrome is divided into primary and secondary.

The causes of the primary syndrome include all pathologies that cause damage directly to the site of the node. This is possible with:

• heart diseases - ischemia of varying severity, hypertrophy in hypertension and myocardiopathies, congenital and acquired heart defects, mitral valve prolapse, traumatic injury, inflammatory diseases (myocarditis, endocarditis, pericarditis), surgical intervention;
• degenerative systemic pathologies with the replacement of muscle tissue with scar tissue (scleroderma, lupus erythematosus, idiopathic inflammation, amyloidosis);
• general muscle dystrophy;
• hypothyroidism and other endocrine pathology;
• malignant neoplasms in the heart and surrounding tissues;
• specific inflammation in the tertiary period of syphilis.

The secondary syndrome is caused by external (in relation to the heart) factors, the absence of organic pathology. These include:

• hyperkalemia;
• hypercalcemia;
• the effect of drugs (Dopegyt, Kordaron, cardiac glycosides, β-blockers, Clonidine);
• hyperactivity of the vagus nerve - with diseases of the genitourinary organs, pharynx, digestion (against the background of swallowing, vomiting, difficult defecation), increased intracranial pressure, hypothermia, sepsis.

However, the combination of bradycardia with another arrhythmia should always suggest a possible loss of function of the sinus node due to myocardial dystrophy.

Clinical and electrophysiological classification

There are variants of the manifestation and course of the syndrome.

Latent - has no clinical symptoms, ECG signs are fuzzy, the patient is able to work, no treatment is required.

Compensated - manifests itself in two forms:

• bradysystolic - characterized by the patient's tendency to dizziness, weakness, complaints of noise in the head, professional restrictions are possible in determining disability, but implantation of a pacemaker is not needed;
• bradytachysystolic - against the background of bradycardia, paroxysmal atrial fibrillation, sinus tachycardia, atrial flutter occur, treatment with antiarrhythmic drugs is prescribed, implantation of a pacemaker is considered as an option to help in the absence of the effect of drugs.

Decompensated - should also be considered depending on the form;

• with bradysystole - persistent bradycardia leads to symptoms of cerebrovascular accident (dizziness, fainting, transient ischemic conditions), accompanied by an increase in heart failure (edema, shortness of breath), the patient is disabled, if asystole attacks occur, implantation of a pacemaker is indicated;
• in the bradytachysystolic form, attacks of paroxysmal tachyarrhythmia become more frequent, dyspnea increases at rest, swelling on the legs appears, and there is a need for an artificial pacemaker in treatment.

A variant is possible - the syndrome of weakness of the sinus node + the presence of stable atrial fibrillation. It is customary to distinguish 2 forms:

• bradysystolic - with a frequency of contractions up to 60 per minute, manifested by cerebral circulation insufficiency and signs of cardiac decompensation;
• tachysystolic - constant atrial fibrillation with a heart rate of over 90 beats per minute.

Clinical manifestations

Among the symptoms of weakness of the sinus node, it is customary to distinguish 3 groups:

• common manifestations - include pallor of the skin, chilliness of the hands and feet, muscle weakness, intermittent claudication when walking;
• cerebral - fainting, dizziness, tinnitus, transient disturbances of sensitivity, emotional lability (now tears, then laughter), memory loss, senile dementia;
• cardiac - a feeling of rhythm interruptions, stops, a rare pulse even during physical exertion, pain behind the sternum, a change in breathing (shortness of breath at rest).

Provocateurs of fainting can be:

• sudden movements of the head;
• coughing and sneezing;
• tight collar.

Usually consciousness returns on its own. There are prolonged fainting when medical attention is required.

Depending on the cause, the syndrome may occur:

• acutely - with myocardial infarction, trauma;
• chronically - with alternating periods of deterioration and improvement - with chronic myocarditis, heart defects, endocrine diseases.

In addition, in the chronic course, there are:

• stable;
• progressing at a slow pace.

Diagnostics

Diagnosis of the syndrome is difficult due to the presence of several arrhythmias at once. Even experienced specialists in functional diagnostics need time and repeated ECG removal to clarify the form.

The most reliable signs are observed during cardiomonitoring of a bedridden patient or Holter monitoring for 1–3 days, followed by data analysis. Depending on the ability to register ECG signs, there are options:

• latent - no signs can be detected;
• intermittent - characteristic changes are detected only during sleep, at night with an increase in the activity of the vagus nerve;
• manifesting - obvious signs can be seen during the day.

For diagnosis, samples with provocation Atropine, transesophageal pacing method are used.

Atropine test consists in subcutaneous injection of 1 ml of Atropine solution, while the frequency of the stimulated node does not exceed 90 per minute.

The transesophageal method refers to electrophysiological studies. It is set by swallowing the electrode, the heart rhythm is stimulated to a frequency of 110-120 per minute. The evaluation is carried out after the cessation of stimulation according to the rate of restoration of one's own rhythm. If the pause is greater than 1.5 seconds, sinus node weakness is suspected.

To find out the nature of the syndrome, additional studies are being carried out:

• Ultrasound of the heart;
• dopplerography;
• magnetic resonance imaging.

General tests, a study of the hormonal background can suggest the cause.

What is the diagnosis on the ECG?

Experts pay attention to different combinations. There are many of them, all possibilities are described in monographs on ECG decoding. Consider the most common signs and examples.

1. A 64-year-old patient with hypertension has 52 bradycardia per minute. In a short segment of the recording, a ventricular extrasystole appears first, then a pause of 1.12 seconds. During the “silence” of the sinus node, 3 elusive contractions “jump” out, of which the first two are from the right ventricle, the third is from the atrioventricular node. In this case, the P waves (atrial) follow at their own pace.
2. A 70-year-old patient with decompensated heart disease was hospitalized with an attack of loss of consciousness. The heart monitor showed: a rare sinus rhythm (up to 50 per minute), followed by paroxysmal atrial fibrillation. It is followed by a straight line lasting 8 seconds, which indicates complete cardiac arrest (asystole). Perhaps, in this case, there is a weakness not only of the sinus, but also of the atrioventricular node.
3. A 68-year-old patient is seen by a cardiologist for coronary disease, she suffered an acute transmural infarction 2 years ago. Since then, she has had intermittent bradycardia. The rhythm is not from the sinus, but from the atrioventricular node. Often, against the background of rare contractions, he feels palpitations. The Holter study recorded attacks of ventricular tachycardia. After an attack, there are clear signs of ischemia in the area around the scar.

Treatment

Treatment of sick sinus syndrome can prevent sudden death from asystole. The main drugs are:

• Teopec,
• Theotard,
• coronary medicines,
• drugs that include atropine with an established relationship with the leading role of the vagus nerve.

In inflammatory diseases, large doses of corticosteroids are used in a short course.

The absolute indications for pacemaker implantation are:

• transition to the Morgagni-Adams-Stokes syndrome clinic;
• bradycardia less than 40 beats. in a minute;
• frequent dizziness, recorded short-term cardiac arrest, the presence of coronary insufficiency, high blood pressure;
• combinations of bradycardia with other arrhythmias;
• inability to select drugs for the treatment of combinations of arrhythmias.

Forecast

The presence of a weak sinus node in a patient increases the risk of sudden death by 5% in addition to other factors. The most unfavorable combination for the course of the disease is the combination of bradycardia and atrial tachyarrhythmias. The most tolerable clinic is observed in patients with isolated bradycardia.

From 30 to 50% of patients die from thromboembolism caused by low blood flow and paroxysms of arrhythmia.

All cardiologists know in which sections you can find a heart rhythm disorder in the ICD-10. This pathology is common among people of all ages. With arrhythmia, the heart rate and coordination are disturbed. Some conditions pose a potential danger to human life and can cause death.

Show all

Definition of pathology

Arrhythmia is a pathological condition in which the regularity of myocardial contractions and heart rate are disturbed. The conductive function of the organ decreases. Often this pathology goes unnoticed for a person. There are 3 large groups of arrhythmias:

• caused by impaired impulse formation (sinus node weakness syndrome, extrasystole, atrial and ventricular tachycardia, flutter and flicker);
• associated with difficulty in conducting an impulse (blockade, premature excitation of the ventricles of the heart);
• combined.

All of them have their own distinctive features. Common clinical manifestations include a feeling of interruption in the work of the heart, difficulty in breathing, fainting, weakness, dizziness. Often there is an attack of angina pectoris. There may be discomfort in the chest.



The development of ventricular extrasystoles

The group of arrhythmias includes ventricular extrasystole. It is characterized by premature excitation of the myocardium. The ICD-10 code for this pathology is I49.3. The risk group includes the elderly. With age, the incidence increases. Single extrasystoles are often detected in young people. They are not dangerous and are not a pathology.

The following factors play a leading role in the development of ventricular extrasystole:

• angina;
• acute myocardial infarction;
• cardiosclerosis;
• myocarditis;
• inflammation of the pericardial sac;
• vagotonia;
• osteochondrosis of the cervical spine;
• hypertonic disease;
• cor pulmonale;
• mitral valve prolapse;
• cardiomyopathy;
• drug overdose.



The classification of extrasystoles is known to all cardiologists. Extrasystoles are early, late and interpolated. By frequency, single, paired, group and multiple are distinguished. This disease is manifested by a feeling of palpitations, weakness, dizziness, a feeling of fear and anxiety of a person.



Atrial fibrillation

Among the diseases characterized by rhythm disturbance, atrial fibrillation occupies an important place. Otherwise, it is called atrial fibrillation. This pathology is characterized by chaotic and frequent (up to 600 per minute) contractions. A prolonged attack can cause a stroke. In many diseases, chaotic waves are formed that make it difficult for the heart to function normally.



This causes defective contractions. The heart cannot work at such a pace for a long time. It is depleted. Up to 1% of the adult population suffers from atrial fibrillation. Allocate cardiac and non-cardiac causes of this pathology. The first group includes congenital malformations, high blood pressure, heart failure, surgery, rheumatism, myocardial infarction.

Arrhythmia can be caused by thyrotoxicosis, low levels of potassium in the blood, drug overdose, inflammatory diseases. In the ICD-10, this pathology is under the code I48. Symptoms are determined by the form of fibrillation. With tachysystolic arrhythmia, a person is disturbed by shortness of breath, rapid heartbeat and chest pain. This pathology is the most severe.

This condition is characterized by seizures. Their frequency and duration are different. Often the condition of patients worsens. Specific signs include Morgagni-Adams-Stokes attacks, fainting, polyuria (increased diuresis). Often worried about excessive sweating. When examining the pulse, its deficiency is revealed. This is due to the fact that not all pulse waves reach the periphery.





Paroxysmal tachycardia

In the international classification of diseases, there is such a pathology as paroxysmal tachycardia. The ICD-10 code for this disease is I47. This is a general concept that combines several pathological conditions. This includes recurrent ventricular arrhythmia, supraventricular (sinus), ventricular and tachycardia of unspecified etiology.



This is a condition in which, against the background of ectopic impulses in the ventricles or atria, the heart rate increases. The latter ranges from 140 to 220 beats per minute. The heart of such people works inefficiently. If tachycardia is accompanied by other diseases (cardiomyopathy), then there is a risk of developing circulatory failure.

The following factors play a role in the development of paroxysmal tachycardia:

• inflammation;
• necrosis of the heart muscle;
• sclerosis;
• increased activity of the sympathetic nervous system;
• heart defects;
• heart attack;
• hypertension.

Men are more often ill. The attack lasts for several seconds or days. With this pathology, neurological symptoms are possible in the form of aphasia, tinnitus and paresis. After an attack, a lot of urine with a low density is released. Possible fainting. Paroxysmal tachycardia often has a poor prognosis.



Risk of ventricular fibrillation

The most dangerous form of cardiac arrhythmia is ventricular fibrillation. This condition can lead to asystole. In this case, emergency assistance in the form of defibrillation is required. Fibrillation (flickering) causes fast, uncoordinated, and ineffective contractions.

The reason is the formation of numerous chaotic impulses. During fibrillation, blood is not ejected from the heart. This can lead to the death of a person. With ventricular fibrillation, the following symptoms are possible:

• loss of consciousness;
• the disappearance of the pulse in the peripheral arteries;
• lack of pressure;
• convulsions.



After a few minutes, neurons begin to die. Irreversible changes occur in the brain. Ventricular fibrillation is characterized by erratic contractions with a frequency of up to 450 beats per minute. This form of rhythm disturbance develops against the background of shock, hypokalemia, coronary artery disease, infarction, cardiomyopathy and sarcoidosis.

Examination and treatment tactics

If you have symptoms of arrhythmia, you should consult a cardiologist. The main method for diagnosing this pathology is electrocardiography. In the case of atrial fibrillation, the absence of sinus rhythm (loss of P waves), unequal distance between complexes, and the presence of small waves are detected. If a person has atrial flutter, then the waves are larger.



The ventricles contract with the same frequency. The heart rate changes. With ventricular fibrillation, the complexes disappear. Waves of different height and width are revealed. The heart rate can reach 300 beats per minute. With extrasystole, extraordinary ventricular QRS complexes appear on the electrocardiogram. P-wave prolapse is also observed.

Additional research methods include ultrasound of the heart, sphygmography and rhythmocardiography. Angiography, x-rays, blood tests, and CT scans may be needed to determine the cause of the arrhythmia. Of great importance are the results of physical examination (auscultation).

Treatment depends on the underlying pathology. With ventricular extrasystole, it is not always required. In the absence of symptoms, treatment is not carried out. It is recommended to lead a healthy lifestyle and diet. With severe symptoms, medications (sedatives, beta-blockers) are prescribed. With bradycardia, anticholinergics are used.



In severe cases, antiarrhythmic drugs (Amiodarone, Kordaron) are indicated. Emergency care for ventricular fibrillation includes resuscitation (ventilation, heart massage). Anti-shock therapy is being carried out. Adrenaline, Atropine and Lykain are used. Defibrillation is required.

With atrial fibrillation, drugs such as Novocainamide Bufus, Procainamide-Eskom, Kordaron, Amiodarone and Propanorm are prescribed. With a prolonged attack, anticoagulants are indicated. In case of complete blockade, the installation of a pacemaker is required. Thus, heart rhythm disturbance is a life-threatening pathology.