2. Atrial flutter (irregular and regular forms). Symptoms

1) the number of pulses does not exceed 250-300 per min .;

2) pulses through the atrioventricular node are conducted more rhythmically than with atrial fibrillation.

3) The clinically irregular form does not differ from atrial fibrillation. With a regular form, the pulse and heart rate are rhythmic.

4) ECG: Irregular shape - the same signs as with atrial fibrillation, but the f waves are of high amplitude - ―saw teeth‖.

5) The regular shape is distinguished by the same R-R intervals.

Pic 3.12 Atrial fibrillation (upper) and atrial flutter (lower)

Pic 3.13 ventricular flutter and fibrillation

3. Ventricular flutter and fibrillation. Symptoms

1. faint;

2. pallor of the skin;

3. pulse and blood pressure are not determined;

39

4. ECG: individual disordered deformed complexes, on which it is difficult to distinguish individual teeth.

IV. Conductivity disorders - blockade:

1. sinoauricular;

2. atrial;

3. atrioventricular I, II, III degree;

g) intraventricular.

a) sinoauricular block. Symptoms

with auscultation of the heart and palpation of the pulse, periodic loss of heart beat and pulse beat is detected. On the ECG: against the background of the correct sinus rhythm, periodically, cardiac complex falls out (the P wave and QRS complex are not recorded), the duration of the diastole doubles.

Pic 3.14 Sinoauricular block

b) Atrial block. Symptoms

It is detected only electrocardiographically. ECG: there is a change in the P waves, they are deformed, their duration exceeds normal conductivity - up to 0.1 s.

Pic 3.15 Atrial block

c) Atrioventricular. Symptoms

I degree - detected only electrocardiographically by lengthening the P-Q interval of more than 0.2 s;

Pic 3.16 I degree

40

35. degree: type 1 or Mobitz I in case of violation (deceleration) of atrioventricular conduction up to the complete blocking of the pulse.

1) a feeling of "freezing" or a stop in the work of the heart;

2) slight dizziness;

3) with auscultation and palpation of the pulse - periodic loss of heart beat and pulse beat;

4) ECG: gradual lengthening of the P-Q interval until the ventricular QRS complex falls out (Samoilov-Wenckebach periods)

.

Pic 3.17 II degree: type 1 or Mobitz I

Type 2 or Mobitz II is characterized by a constant duration of the P-Q interval with periodic loss of the QRST complex.

"Fading", "interruptions", "stop" in the work of the heart;

1. dizziness, darkening in the eyes, short-term loss of consciousness;

2. heart contractions and pulse are rare, arrhythmic.

Pic 3.18 Type 2 or Mobitz II

AV blocks of the II degree 2: 1 are also secreted when every second ventricular contraction falls out, while the pulse remains rhythmic.

61. degree of blockade (complete transverse blockade of the heart). The atrium contracts under the guidance of the sinus node, and the ventricles - atrioventricular, independent of each other.

1) a rare rhythmic pulse, large in size, heart rate - 30-45 in 1 min. ;

2) increased heart size due to diastolic overflow with its blood;

3) heart sounds are muffled, but loud I tone can be periodically determined (―cannon tone‖ of Strazhesko);

4) Morgagni-Edems-Stokes syndrome, caused by a violation of the regional blood circulation of various organs, primarily Ts.N.S. as a result of the loss of not one, but several contractions of the heart in a row:

41

• sudden loss of consciousness, the patient falls; with a duration of fainting of 15-20 seconds. general muscle cramps (epileptiform) occur;

• deep breathing, pallor of the skin;

ECG: P wave without communication with QRST, correct P wave alternation, correct Q-T alternation (R-R are equal to each other, but R-R is longer than R-P).

Pic 3.18 III degree of blockade

d) Intraventricular block. Symptoms:

With auscultation of the heart, splitting or bifurcation of tones due to asynchronism in the activity of the ventricles.

Allocate: Complete and incomplete blockade of the right and left legs, left anterior and left posterior legs of the bundle of His.

CAUSES, Congenital conduction disorders and acquired due to heart disease.

Signs of a full leg block:

• expansion of the QRS complex for more than 0.11 seconds, discordance of the T wave and QRS complex

With blockade of the right leg in leads V1, V2, R is high (R, RSr types) and the T wave is negative.

With blockade of the left leg, QS prevails in leads V1, V2 and the T wave is positive

Pic 3.19 Right bundle branch block Pic 3.20 Left bundle branch block

Generalized heart rhythm and conduction disorder syndrome

42

REASONS: any diseases and dysfunction of the heart; reflex effects on cardiac conduction and automatism.

GENERAL SYMPTOMS:

1. complaints of palpitations, interruptions in the work of the heart, a feeling of "freezing", "stopping" of the heart, sometimes followed by a strong blow (with extrasystole);

2. irregular heartbeat, tachycardia, bradycardia;

3. pulse deficiency (most characteristic for atrial fibrillation);

4. irregularity of tones during auscultation, polyphony of I tone at the apex (atrial fibrillation), ―cannon‖ tone of Strazhesko (complete atrioventricular block), premature contraction of the heart with a characteristic loud I tone, periodic loss of tones (with blockade);

5. heart rhythm disturbance, especially paroxysmal, can provoke acute coronary, cardiac or vascular insufficiency, or aggravate chronic forms thereof;

6. the type of arrhythmia or blockade can be finally verified using an ECG.