Ventricular fibrillation and asystole clinic diagnostics treatment. Fibrillation and flutter of the ventricles of the heart - what is it, description, treatment. Ventricular fibrillation and sudden cardiac death

Ventricular fibrillation is an irregular contraction of the myocardium, which is manifested by uncoordinated contraction of individual sections of the heart muscle. The compression frequency reaches 300 or more. This is an extremely dangerous condition leading to the death of a person if urgent care is not provided. medical care. Ventricular fibrillation on an ECG is reflected by characteristic uneven waves of different amplitudes and oscillation frequencies up to 500-600 per minute. ICD disease code 149.0.

Fibrillation (flickering) of the ventricles of the heart often causes the death of the patient. Irregular heart rhythm disrupts blood circulation, until it stops completely. The ventricles contract to no avail and do not pump blood. Respiratory function is depressed and blood pressure drops dramatically. This leads to brain hypoxia and death. Therefore, when myocardial flutter appears, you need to proceed with emergency therapeutic measures to prevent inhibition of vital functions.

To understand why pathology appears, you need to remember the anatomy of the heart. It consists of 4 chambers - 2 atria and 2 ventricles. Thanks to impulses coming from the brain, the cardiac mechanism works rhythmically, ensuring normal blood circulation. Violation of the supply of impulses or the way they are perceived by the heart muscle leads to asynchronous contraction of the myocardium and a malfunction of the heart.

A change in rhythm develops through the mechanism of re-entry or re-entry. The impulse performs circular movements, causing erratic contractions of the myocardium without a diastole phase (the heart does not relax). With fibrillation, many re-entry loops occur, which leads to complete disorder in the functioning of the heart.

The main cause of dysfunction is a violation of the passage of impulses through the atrioventricular node. Ventricular fibrillation and flutter occurs due to non-conduction of the impulse or the appearance of scarring on the heart muscle after a heart attack. Changes are observed in the first hour of the onset of pathology.

Almost half of the patients who died as a result of developing ventricular fibrillation were found to have blood clots in the coronary vessels, which led to fatal outcome.

Ventricular flutter maintains the appearance of rhythmic contractility of the ventricles, but with fibrillation the rhythm is not regular. But with both dysfunctions, the heart’s work is ineffective. The pathology often develops in patients who have suffered an acute heart attack, in whose electrocardiogram a Q wave was noted. This is a sign that there have been changes in the cardiovascular system. morphological changes leading to fatal ventricular arrhythmias.

Fibrillation is also caused by primary changes in the electrophysiological functions of the heart muscle. In this case, structural heart disease is not observed. The cardiogram showed an elongated Q-T interval and supraventricular tachycardia.

Fibrillation is preceded by ventricular tachycardia, which occurs due to rapid contraction of the ventricles due to unstable impulse delivery. This state lasts for up to half a minute, accompanied by palpitations. If the process is delayed, fibrillation develops, the person faints, blood circulation stops, and vital organs and systems suffer. Resuscitation procedures must be carried out immediately to save the patient’s life.

People at risk of developing pathology include:

have had a heart attack;
having a history of fibrillation;
with congenital heart defects;
with cardiac ischemia;
with cardiomyopathies;
with myocardial damage (consequence of injuries);
drug users;
with changes in water-electrolyte metabolism.

The most common cause of atrial fibrillation is hypertrophic cardiomyopathy. It causes sudden cardiac death in humans young when performing heavy physical work. Specific cardiomyopathy caused by oncology (sarcoidosis) is also a cause of ventricular flutter. In addition, the pathology appears for unknown reasons (idiopathic form), but doctors are inclined to argue that its appearance is associated with a disruption of the autonomic system. nervous system.

Clinical picture and diagnosis

The first sign of fibrillation development is short-term fainting. unknown etiology. They are caused by extrasystole or ventricular tachycardia. This is the primary phase of the disease, which is not accompanied by circulatory disorders.

Paroxysm of ventricular fibrillation leads to loss of consciousness and convulsions. This happens because the pumping mechanism of the heart does not function. Circulatory arrest and clinical death occur. This is the secondary phase and is considered extremely severe. The clinical picture of changes is expressed in the following symptoms:

clouding of consciousness;
lack of pulse and breathing;
spontaneous urination and defecation;
lack of pupillary reaction to light;
dilated pupils;
bluish skin.

The main criterion for the patient’s emergency condition is the absence of respiratory function and pulsation in large blood vessels (cervical and femoral arteries). If resuscitation is not carried out within 5 minutes, then irreversible pathological disorders occur in the tissues of the brain, nervous system, and other internal organs. The clinical diagnosis is established on the basis of a cardiac cardiogram. After bringing the patient out of critical condition, to establish the real reason development of pathology, an examination consisting of various diagnostics is prescribed.

The use of cardiac monitoring helps determine the electrical function of the heart.
An ECG makes it possible to trace the rhythm of myocardial contractions and abnormalities in the functioning of an internal organ.
In laboratory blood tests, magnesium, sodium, and hormones that affect the functioning of the myocardium are checked.
A chest x-ray is taken to determine the boundaries of the heart and the size of large vessels.
An echocardiogram helps to detect foci of myocardial damage, areas of reduced contractility, and pathologies of the valve system.
Angiography coronary vessels is carried out using a contrast agent, which makes it possible to identify narrowed or obstructed areas.

In rare cases, a CT or MRI is performed.

Ventricular fibrillation ECG

The process of development of fibrillation goes through four phases, which are characterized by certain changes on the ecg.

Phase 1 – tachysystole. Duration 2 seconds, accompanied by rhythmic contractions of the myocardium, consisting of 4-6 ventricular complexes. On the ECG this is expressed as high-amplitude fluctuations.

Phase 2 – convulsive (20-50 sec.), in which there is frequent convulsive non-rhythmic compression of the fibers of the heart muscle. The cardiogram shows high-voltage waves with different amplitudes.

Phase 3 – flickering (up to 3 minutes) – multiple chaotic contractions of individual zones of the heart muscle of different frequencies.

Phase 4 – agony. Observed 3-5 minutes after phase 3. It is determined by depression of cardiac activity, which is displayed on the cardiogram in the form of irregular waves, an increase in the area of areas that do not contract. The ECG records a gradual decrease in the amplitude of oscillations.

On an ECG, the outlines of the ventricular complexes do not have clear boundaries, they differ in different amplitudes, the teeth vary in height and width, and can be sharp and rounded. Often it is impossible to determine them. The intervals between waves are erased and pathological curves are formed.

First aid

If a person experiences symptoms of tachycardia (dizziness, shortness of breath, heart pain, nausea), then an ambulance should be urgently called. If a person is unconscious, you need to check his pulse. If the heartbeat cannot be heard, immediately begin chest compressions. To do this, you need to press rhythmically on the chest (up to 100 presses per minute). During the manipulation, between compressions, you need to allow the chest to straighten. If Airways the patient is clean (there is no aspiration of stomach contents into the lungs), then normal blood oxygen saturation is maintained for at least 5 minutes. This helps buy time to provide more qualified assistance.

For patients with a history of severe cardiac pathologies accompanied by arrhythmias, doctors advise purchasing a portable defibrillator. By following the recommendations of the instructions and having undergone appropriate training, relatives will be able to provide the necessary urgent assistance to a patient during an attack of ventricular fibrillation, thus prolonging his life until the arrival of the cardiac team.

Treatment measures

Emergency care for ventricular fibrillation is carried out according to a protocol, which indicates the algorithm of the measures to be performed. First
They check for pulsation in the large arteries, and if there is none, then proceed to CPR (cardiopulmonary resuscitation). First you need to make sure that the airways are clean, and if they are blocked, remove the foreign body. To do this, the person is turned on his side and given 3-4 sharp blows with the edge of the palm between the shoulder blades. After this, they try to remove the foreign object from the throat with their finger.

Next they practice a precordial blow, which is applied to the lower third of the sternum. In some cases, such manipulation leads to the resumption of the cardiac mechanism. If this does not happen, then perform indirect cardiac massage and artificial ventilation. If it is not possible to restore the heart rhythm in this way, then specific measures are taken.

The resumption of the functional activity of the cardiac system is carried out in intensive care wards using a defibrillator, which applies electric pulse discharges to the heart area. Electric discharges of increasing energy are produced (from 200 to 400 J). If fibrillation reappears or persists, then administer Adrenaline every 3 minutes, alternating with shocks with a defibrillator. The manipulation is carried out under the control of an ECG, which displays the heart rhythm. When registering ventricular tachycardia, the discharge force is halved. At the same time, mechanical ventilation is performed.

Treatment of ventricular fibrillation after stopping the attack and to prevent their recurrence in the future can be carried out conservatively, as well as using surgical intervention. Often, patients are fitted with a pacemaker, which maintains a normal heart rhythm if the patient is prone to developing serious arrhythmias that cause fibrillation. Its work is based on applying a series of impulses to restore sinus rhythm. Besides surgical method treatment is indicated to eliminate dysfunction of the valve mechanism.

Medications

Along with the behavior of electronic defibrillation, the patient is given intravenous medications. Administration is carried out slowly and if ineffective, the dosage is increased.

If the resuscitation measures taken do not lead to the appearance of heartbeat and breathing within half an hour, then they are stopped. At positive result the patient is transferred to the IT ward.

Traditional treatment

Ventricular fibrillation is fatal dangerous pathology, which cannot be treated with any folk method. Only emergency resuscitation carried out by qualified specialists. After stopping the attack, patients undergo long-term inpatient treatment, which is aimed at eliminating the causes that caused ventricular fibrillation.

After medication therapy or surgery, doctors may recommend patients drink infusions medicinal herbs, improving cardiac activity, as well as soothing teas. In addition, they are advised to strictly adhere to dietary nutrition limiting the consumption of salt, fatty and high-calorie foods. The diet mostly consists of dishes containing vegetables and fruits rich in mineral components (potassium, magnesium) and vitamins. This diet reduces the load on the myocardium and supplies it with useful substances.

About the principles proper nutrition says the nutritionist. He also develops a diet according to a specific clinical case.

Prevention and prognosis

After the patient is discharged, the main recommendation is given by the doctor to the patient’s relatives - they should not hesitate to provide emergency care if symptoms of fibrillation appear. It is urgent to call an ambulance, because if the patient’s condition is incorrectly assessed, he can be lost. In addition, the cardiologist strongly recommends that the patient get rid of bad habits, as well as:

timely treatment of heart diseases;
stick to a diet;
give up alcohol;
reduce physical activity;
avoid stress.

Such patients need to limit physical work, but this does not mean that they should lead a sedentary lifestyle. TO good result lead to regular classes in a health group, especially if they are held outdoors. Have a positive effect on the body hiking before bedtime. They calm and saturate the body with oxygen. If possible, it is worth signing up for the pool. Classes under the supervision of an instructor also help strengthen the cardiovascular system.

A positive outcome of the disease depends on the initiation of resuscitation measures. If they began to be carried out in the first minutes of circulatory arrest, then 70% of patients survive. If medical care is provided later, when the blood flow has stopped for more than 5 minutes, the prognosis is not good. Even if the patient remains alive, the changes in the nervous system and brain that have occurred are irreversible. Such violations do not allow a person to live full life and they often die from hypoxic encephalopathy.

Ventricular fibrillation is characterized as uncoordinated, arrhythmic, scattered contractions occurring in separate groups of muscle fibers of the cardiac ventricles. The frequency of such contractions reaches more than 300 per minute. All this is accompanied by the fact that the heart cannot perform pumping functions, and the blood supply to the entire body stops. This situation requires immediate resuscitation measures. If you do not start them within ten minutes, the patient will die.

As you can see, ventricular fibrillation requires special attention, as it often causes sudden cardiac death. Sudden cardiac death occurs due to sudden cardiac arrest. If its activity is not immediately restored, the person will die within just a few minutes. Since cardiac arrest occurs due to dysfunction of the electrical system that controls the rhythm of the heart, restoration is carried out by electric shock. As we have already said, fibrillation mainly leads to this. First, let's talk about why it occurs.

Causes

Most often, ventricular fibrillation is a complication coronary disease heart or myocardial infarction. Cardiomyopathies may be the cause of various etiologies, among which the main role should be given to hypertrophic cardiomyopathy. In this case, sudden cardiac death occurs during intense physical activity in young people. Fibrillation can also occur due to heart defects and due to impaired myocardial properties, even when there are no obvious heart diseases.

In addition, some risk factors can be identified that also affect fibrillation.

Hypoxia.
General cooling of the body.
Acid-base disorders.
Violations of water and electrolyte status.
Endogenous and exogenous factors affecting the myocardium.
Mechanical irritations of the heart and so on.

Despite the fact that ventricular fibrillation mainly occurs due to ischemic heart disease and heart attack, it is worth paying attention to the violation electrolyte balance, especially for disturbances in the metabolism of calcium and potassium.

Intracellular hypokalemia, a companion to hypoxic conditions, increases myocardial excitability, which leads to the appearance of paroxysms of disruption of sinus rhythm. Hypokalemia also leads to decreased myocardial tone. Cardiac activity may also be disrupted due to the fact that the ratio and concentration of Ca++ and K+ cations changes. These disturbances lead to changes in the cell-extracellular gradient, which can cause disturbances in the processes of myocardial contraction and excitation. Fibrillation can be caused by a rapid increase in the concentration of potassium in the plasma against the background of the fact that its level in the cells is reduced. The myocardium cannot fully contract with intracellular hypocalcemia.

Symptoms

Definitely, importance in considering this topic should be given to the symptoms that characterize ventricular fibrillation. Their timely recognition will help to provide emergency assistance in time and save a person’s life.

There are two forms of fibrillation.

Primary. It is not associated with AHF (acute heart failure) and does not have signs of ALVF (acute left ventricular failure). It develops due to electrical instability of the myocardium in the necrosis zone and occurs suddenly in the first two days of myocardial infarction. Approximately sixty percent of her episodes develop in the first few hours. This form does not lead to death as often as the other, secondary form and can be stopped in eighty percent of cases.
Secondary form. It develops against the background of significant heart failure, but in more late dates myocardial infarction. This period may be the patient’s activation period, that is, the second, third or fourth week. The basis of the origin of this form is damage to the pumping function of the myocardium. Ventricular fibrillation can develop against the background of atrial fibrillation or without any warning signs at all. Unfortunately, with this form, resuscitation has very little effect and mortality occurs in seventy percent of cases.

Since the pumping function of the heart ceases during fibrillation, sudden stop blood circulation and, as a result, clinical death. In this case, the person loses consciousness, which can also be accompanied by the following manifestations:

convulsions;
involuntary urination;
involuntary defecation;
dilated pupils that do not respond to light;
diffuse cyanosis;
absence of pulsation in large arteries;
lack of breathing;
Without effective assistance begin to develop irreversible changes in the nervous central system and other parts of the body.

Diagnostics

If the above symptoms occur, the doctor assumes that the patient has ventricular fibrillation. The diagnosis is confirmed by an electrocardiogram.

On ECG ventricular fibrillation manifests itself as chaotic flickering waves that have different durations and amplitude. The waves are combined with non-differentiated teeth. The frequency of contractions, as we said at the beginning, is more than three hundred per minute. Depending on the amplitude of such waves, two more forms of fibrillation can be distinguished:

large wave;
shallow wave, which is characterized by flicker waves less than 0.2 mV and a lower likelihood of hasty defibrillation.

Treatment

It is very important that immediate assistance was provided urgent Care with ventricular fibrillation. If there is no pulse in large arteries, you should do indoor massage hearts. It is also important to perform artificial ventilation. The last measure is necessary in order to maintain blood circulation at a level that ensures the minimum need for oxygen by the heart and brain. These and subsequent measures should restore the function of these organs.

Usually the patient is sent to an intensive observation ward, in which the heart rhythm is constantly monitored using an electrocardiogram. This way you can determine the form of cardiac arrest and begin the necessary treatment.

In the first seconds of fibrillation, it is important to electropulse therapy, which is often the only method of effective resuscitation. If electropulse therapy does not bring the expected result, closed heart massage and artificial ventilation are continued. If these measures have not been taken before, they are being taken. There is an opinion that if after three defibrillator discharges the rhythm has not been restored, it is important to quickly intubate the patient and transfer him to a ventilator.

After this, ventricular fibrillation continues to be treated with the introduction of sodium bicarbonate solution. Administration should be carried out every ten minutes until a satisfactory level of blood circulation is restored. It is better to administer medications through a system filled with a five percent glucose solution.

In order to increase the effect of electrical pulse therapy, intracardiac administration of a solution of adrenaline hydrochloride is prescribed. In combination with cardiac massage, it enters coronary arteries. However, it is worth remembering that intracardiac administration can cause complications such as damage to the coronary vessels, pneumothorax or massive hemorrhage into the myocardium. Drug stimulation also involves the use of mesaton and norepinephrine.

If electric pulse therapy is ineffective, in addition to adrenaline hydrochloride, it is possible to use novocainamide, anaprilin, lidocaine and ornid. Of course, the effect of these drugs will be less than the electropulse therapy itself. Artificial ventilation and cardiac massage continue, and defibrillation itself is repeated after two minutes. If after it the heart stops, a calcium chloride solution and a sodium lactate solution are administered. Defibrillation continues until the heartbeat returns or until signs of brain death appear. Heart massage stops after a distinct pulsation appears in the large arteries. The patient should be closely monitored. It is also very important to carry out preventive measures to prevent recurrent fibrillation of the ventricles of the heart.

However, there are situations when the doctor does not have a device at hand to carry out electropulse therapy. In this case, you can use a discharge from a regular electrical network, where the alternating current voltage is 127 V or 220 V. There are cases when the activity of the heart was restored after a blow to the atrial region with a fist.

Complications

Unfortunately, it is almost impossible to avoid serious complications after fibrillation has occurred. This can only happen if defibrillation was carried out in the first seconds of an attack, but even then the likelihood that complications will not arise is small.

Cardiac arrest itself is accompanied by total myocardial ischemia. After circulation has been restored, myocardial dysfunction often occurs. After resuscitation, arrhythmias and pulmonary complications, such as aspiration pneumonia, may occur. May also develop neurological complications which arise due to impaired blood supply to the brain.

Prevention

It should be remembered that ventricular fibrillation occurs due to cardiovascular diseases. That is why the essence of prevention is effective treatment underlying disease. The person must follow the doctor's instructions and healthy image life.

A healthy lifestyle involves giving up alcohol and tobacco. It is very important to eat right and lead an active lifestyle. However, it is important not to overdo it with loads. Secondary prevention includes active treatment of heart failure and ischemia. Antiarrhythmic drugs are used for this.

Speaking about flutter and ventricular fibrillation, it should be remembered that we are talking not just about a person’s health, but about his life. Therefore, paying attention to yourself and your loved ones can prolong your life, which should be happy and filled with meaning!

From this article you will learn: what kind of arrhythmia is called ventricular fibrillation, how dangerous it is. The mechanism of development of arrhythmia, causes and main symptoms of fibrillation, diagnostic methods. Treatment, first aid and professional cardiac resuscitation techniques.

Article publication date: 07/05/2017

Article updated date: 06/02/2019

Ventricular fibrillation is a life-threatening form of heart rhythm disturbance () caused by uncoordinated, asynchronous contraction of individual groups of cardiomyocytes (myocardial cells) of the ventricles.

Conduction of electrical impulses in normal conditions and in ventricular fibrillation

Normally, the rhythmic contraction of the heart muscle is provided by bioelectric impulses that generate special nodes (sinus in the atria, atrioventricular at the border of the atria and ventricles). The impulses sequentially spread throughout the myocardium, excite the cardiomyocytes of the atria and then the ventricles, causing the heart to rhythmically push blood into the vessels.

The conduction system of the heart is responsible for the rhythmic contraction of the entire myocardium (heart muscle)

In case of pathology various reasons(cardiomyopathies, myocardial infarction, drug intoxication) the sequence of the bioelectric impulse is disrupted (it is blocked at the level of the atrioventricular node). The ventricular myocardium generates its own impulses, which cause chaotic contraction of individual groups of cardiomyocytes. The result is ineffective heart function, and cardiac output drops to a minimum.

Ventricular fibrillation is a dangerous, life-threatening condition; it ends in death in 80% of cases. The patient can only be saved by emergency cardiac resuscitation measures (defibrillation).

It is impossible to cure fibrillation - arrhythmia occurs suddenly, most often (90%) against the background of serious organic changes in the heart muscle (irreversible transformations of functional tissue into non-functional). It is possible to improve the prognosis and prolong the life of a patient who has survived an attack by implanting a cardioverter-defibrillator. In some cases, the device is installed for prophylaxis when arrhythmia is predicted to develop.

Cardiac resuscitation measures are carried out by the ambulance team or intensive care unit doctors. Subsequently, the patient is treated and monitored by a cardiologist.

The mechanism of pathology development

In the walls of the ventricles there are groups of cells capable of independently generating bioelectric impulses. With complete blockade of the atrioventricular node, this ability leads to the appearance of many isolated impulses circulating through the cardiomyocytes of the ventricles.

Atrioventricular block is the cause of ventricular fibrillation

Their strength is sufficient to cause weak, isolated contractions of individual groups of cells, but not enough to contract the ventricles as a whole and for a full cardiac ejection of blood.

The frequency of ineffective ventricular fibrillation varies from 300 to 500 per minute, while the impulse does not weaken or interrupt, so the arrhythmia cannot stop on its own (only after or artificial defibrillation).

As a result, the strength of heart contractions, ejection volume, and blood pressure rapidly drop, resulting in complete cardiac arrest.

Causes of the disease

The immediate causes of fibrillation are disturbances in the conductivity and contractility of the ventricular myocardium, which develop against the background of cardiovascular diseases (90%), metabolic disorders (hypokalemia) and certain conditions (electric shock).

Group of reasons	Specific pathologies
Cardiovascular pathologies	Arrhythmias (ventricular,) Heart and valve defects (, stenosis mitral valve, cardiac aneurysm) Hypertrophic (with thickening of the walls of the heart) and dilated (with enlargement of the heart chambers) cardiomyopathy (pathology of the heart muscle) Cardiosclerosis (scarring of the heart muscle) Myocarditis (inflammation of the myocardium)
Electrolyte imbalance	Potassium deficiency causes repolarization (electrical instability of the myocardium) Accumulation of intracellular calcium (myocardial repolarization)
Drug intoxication	Cardiac glycosides (digoxin, digitoxin) Catecholamines (adrenaline, norepinephrine, dopamine) Sympathomimetics (salbutamol, epinephrine) Antiarrhythmic drugs (amiodarone) Narcotic analgesics (chlorpromazine) Barbiturates (phenobarbital) Drug anesthesia (cyclopropane)
Injuries	Mechanical heart injuries Blunt and penetrating chest injuries Electrical injuries
Medical procedures	Coronary angiography (diagnostic method with the introduction of a catheter into the vessel bed) Electrical cardioversion (electrical impulse treatment) Coronary angiography (diagnosis of the heart with the introduction of contrast agents) Defibrillation (electrical pulse restoration of heart rhythm)
Hyperthermia and hypothermia	Hypothermia and overheating, febrile conditions (with sudden changes temperature), burns
Hypoxia	Oxygen deficiency (suffocation, traumatic brain injury)
Acidosis	Increase in acidity internal environment body
Dehydration	Bleeding (as a result of large fluid loss)

Tetralogy of Fallot (a combination of four cardiac anomalies) is one of possible reasons development of ventricular fibrillation

Risk factors for developing ventricular fibrillation:

age (after 45 years);
gender (in women it develops 3 times less often than in men).

Characteristic symptoms

Ventricular fibrillation is a life-threatening condition with severe symptoms, equivalent clinical death.

During arrhythmia, the function of the ventricles is impaired, blood does not enter the vascular system, its movement stops, and rapidly increases acute ischemia(oxygen starvation) of the brain and other organs. The patient is unable to move and quickly loses consciousness.

Death in 98% occurs within an hour from the appearance of the first signs of ventricular fibrillation (the time period can be much shorter).

All symptoms of fibrillation appear almost simultaneously:

heart rhythm disturbance;
severe headache;
dizziness;
heart failure;
sudden loss of consciousness;
interrupted breathing or complete absence of it;
severe pallor of the skin;
uneven cyanosis (blueness of the nasolabial triangle, tips of the ears, nose);
absence of pulse in large arteries (carotid and femoral);
dilated pupils of the eyes that do not respond to bright light;
convulsions or complete relaxation;
involuntary urination, defecation (optional).

The period of clinical death (until changes in the body become irreversible) lasts for 4–7 minutes from the moment of complete cardiac arrest, then comes biological death(when the process of cellular decay begins).

Diagnostics

Ventricular fibrillation is diagnosed based on external symptoms(absence of pulse, breathing, reaction of pupils to light). The electrocardiogram consistently records several stages of arrhythmia development:

Short tachysystole or ventricular flutter (15–20 seconds).
Convulsive stage (contraction frequency rapidly increases, rhythm is disturbed, cardiac output weakens, takes up to 1 minute).
Actually fibrillation of the ventricles of the heart (quite large, but chaotic and frequent (300–400) flickering waves without pronounced intervals and teeth are recorded, changing height, shape, length, the stage lasts from 2 to 5 minutes).
Atony (small, short-length and low-amplitude waves appear, lasting up to 10 minutes).
Complete absence of heart contractions.

Since any condition with similar symptoms is a direct threat to life, resuscitation measures begin immediately, without waiting for ECG data.

Manifestation of pathology on the ECG

Treatment

It is impossible to cure fibrillation; this form of arrhythmia is fatal dangerous complication, which usually occurs unexpectedly. In some cardiovascular diseases, it can be predicted and prevented by installing a pacemaker or cardioverter-defibrillator.

Treatment of fibrillation consists of first aid and cardiac resuscitation, in 20% the victim’s life can be saved.

First aid

If cardiac arrest as a result of ventricular fibrillation did not occur in a hospital, first aid must be provided before the arrival of a professional medical team. There is very little time allotted for it - the heart must be started within 7 minutes, then the victim’s chances rapidly decrease.

First stage of emergency care

Call out to the person, give him a boost, hit him hard on the cheek, and perhaps the person will come to his senses.

Place your hand on your chest; its movement indicates the presence of breathing.

Place your ear on your chest in the sternum area (a palm below the subclavian fossa), so you can hear the sound of your heartbeat or feel how your chest rises in time with your breathing.

With your middle and index fingers pressed together, try to feel the pulse on any available large blood vessel(carotid, femoral artery).

Absence of pulse, breathing, or chest movements is a signal for first aid.

Second stage of emergency care

Lay the victim face up on a flat surface.

Tilt his head back, try to determine with your fingers what is interfering with breathing, clear the airways of foreign objects, vomit, and move the receding tongue to the side.

Ventilate the lungs: hold the victim’s nose with one hand and forcefully blow air “mouth to mouth.” At the same time, evaluate how much the chest rises (artificial respiration prevents the lungs from collapsing and stimulates the movement of the chest).

Kneel to the side of the victim, fold your hands on top of each other (crosswise), begin to rhythmically press on the lower third of the sternum with crossed palms on outstretched arms.

For every 30 rhythmic compressions on the chest, do 2 deep breaths"mouth to mouth".

After several cycles of direct massage and ventilation, assess the condition of the victim (perhaps he has a reaction, pulse, breathing).

Direct cardiac massage is performed intensively, but without sudden movements, so as not to break the victim’s ribs. Do not try to start the heart with an elbow strike to the sternum - only very qualified specialists can do this.

First aid is provided before the arrival of the medical team, who must be called before resuscitation begins. The time during which it makes sense to provide first aid is 30 minutes, after which biological death occurs.

Professional Cardiac Resuscitation Techniques

After the arrival of doctors, measures to restore the functioning of the heart and hemodynamics continue in the ambulance and in intensive care unit hospitals.

Apply:

Electrical defibrillation of the heart (with the help of electrical impulses of different frequencies and strengths, disturbances in the conductivity and excitability of the ventricular myocardium are eliminated and rhythm is restored). If there are no serious organic changes in the myocardium, in the first minutes a defibrillator restores heart function in 95%; against the background of serious pathologies (cardiosclerosis, aneurysm), stimulation is only 30% effective.
Apparatus artificial ventilation lungs (the lungs are ventilated manually, using an Ambu bag, or connected to an automatic device, supplying the respiratory mixture through a tube or mask).

Introduction medicines correct disturbances in electrolyte metabolism, eliminate the consequences of accumulation of metabolic products (acidosis), maintain heart rhythm, and have a positive effect on the conductivity and excitability of the myocardium.

After an attack of ventricular fibrillation, patients spend some time in intensive care units, during which time the attending cardiologist decides how to improve the prognosis (options being considered are implantation of a cardioverter-defibrillator or a pacemaker).

Complications of the post-resuscitation period

Resuscitation measures (direct massage, defibrillation) manage to save the lives of 20% of patients.

Typical complications of the post-resuscitation period:

chest injuries and rib fractures (due to intense direct massage);
hemothorax and pneumothorax (collection of blood or air in pleural cavity lungs);
aspiration pneumonia (due to the contents of the stomach, nasopharynx and oral cavity entering the respiratory tract and lungs);
disturbances in the functioning of the heart (myocardial dysfunction);
arrhythmia;
thromboembolism (blockage pulmonary artery blood clot);
disturbances in the functioning of the brain (against the background of hemodynamic disturbances and oxygen starvation).

The result of restoration of cardiac function and hemodynamics after long time(10–12 minutes after the onset of clinical death) irreversible changes in brain tissue caused by oxygen deficiency, coma, total loss mental and physical disability. Only 5% of cardiac arrest survivors do not have significant brain problems.

Forecast

The appearance of ventricular fibrillation is a poor prognostic sign, the cause of cardiac arrest and death (80%).

In most cases (90%), arrhythmia becomes a complication of serious cardiovascular diseases ( birth defects, cardiosclerosis, cardiomyopathies) with organic changes in the myocardium (small or large foci of scarring). With coronary heart disease, the mortality rate is 34% in women and 46% in men.

It is impossible to cure fibrillation; it is only possible to prolong the patient’s life (20%) emergency measures resuscitation. The effectiveness of first aid directly depends on the time of cardiac arrest - in the first minute it is 90%, after 4 minutes it decreases by 3 times (30%).

In some cases, it is possible to predict its occurrence in advance and prevent it by implanting pacemakers or defibrillators (Brugada syndrome). The same methods improve the prognosis after an attack of fibrillation.

Ventricular fibrillation is the most common cause sudden death over the age of 45 (about 70–74% annually).

Ventricular fibrillation is an extreme degree of instability of the heart rhythm. It’s hard to imagine, but the pulse can reach 400–600 beats per minute. However, such an increase simply affects the wear and tear of the heart muscle. But what is extremely dangerous is that asynchrony occurs in the contraction of individual adjacent sections of myocardial fibers (heart muscle).

The resulting desynchronization leads to loss of systole efficiency, leading to impaired cardiac output, up to circulatory arrest. Perhaps short-term, but this may well be enough to cause death if urgent resuscitation assistance does not arrive.

It is worth understanding that, according to the frequency of exposure, small-wave ventricular fibrillation and large-wave ventricular fibrillation are distinguished, but in both cases such exposure leads to asynchronous reductions myocardium.

The most effective way removal from the state of ventricular fibrillation is a short-term exposure to an electrical impulse. True, this requires high voltage (up to 7000 volts when exposed through an unopened chest).

Ventricular fibrillation is a heart rhythm disorder that is characterized by chaotic and ineffective contraction of the heart muscle at a high frequency (about 300 beats per minute or higher). This pathology seriously threatens a person’s life and requires immediate medical attention.

Attention. This condition is considered the most dangerous type, since ventricular fibrillation almost instantly stops the flow of blood in the organs, increases metabolic disruptions, causes acidosis and damage to brain tissue. Most deaths due to asystole occur due to existing ventricular fibrillation.

In this condition, the muscle fibers of the ventricles contract very quickly, randomly and ineffectively, as a result of which the heart is not able to pump even small ones, which provokes circulatory failures in the body of the same severity as when cardiac activity stops.

Most often, ventricular fibrillation affects representatives of the stronger sex, middle and old age. As a rule, pathology occurs mainly in patients with any disease of the cardiovascular system.

Important. Ventricular fibrillation is an extremely life-threatening condition that requires immediate intervention. medical workers. Even timely resuscitation measures from passers-by, performed using the correct technique, can save the patient.

Causes of ventricular fibrillation

Diseases not associated with disruption of the heart and blood vessels rarely provoke the occurrence of this type of arrhythmia. Most often, fibrillation develops with cardiac diseases associated with the functioning of valves, myocardium, or impaired oxygen supply to the heart.

Ventricular fibrillation occurs when there is the following pathologies:

– in case of myocardial infarction, if a large area of the myocardium is affected. In this case, fibrillation most often occurs in the first 12 hours after the development of a heart attack.
Often this condition develops through for a long time after suffering myocardial necrosis.
Hypertrophic and dilatational.
All kinds of disruptions in the cardiac conduction system.
Congenital heart valve defects.

What else can trigger the formation of ventricular fibrillation:

Electric shock;
Disturbances in the electrolyte system;
Shifts in acid-base balance;
Taking certain medications - barbiturates, painkillers,...

Ventricular fibrillation develops due to a malfunction in the electrical activity of muscle fibers - they begin to contract unevenly, being in different contractile phases, as a result of which the heart rate reaches enormous numbers - up to 400-500 beats per minute.

Attention. An attack of such chaotic myocardial activity provokes a complete disruption of hemodynamics, as a result of which the oxygen supply of all organs is disrupted, primarily the cortex suffers greatly cerebral hemispheres brain. If the patient is not provided with proper medical care within five minutes, the outcome of the disease is unfavorable and death occurs due to cardiac arrest.

Ventricular fibrillation in children

Atrial fibrillation is very rare among children and is usually a complication of other types of disorders.
heart rhythm (for example, ventricular tachycardia).

In young patients, ventricular fibrillation develops due to the following provoking factors:

failure of electrolyte balance;
taking arrhythmogenic drugs;
disturbance of the sympathetic-parasympathetic balance (especially with increasing concentrations of catecholamines);
hypo- or hyperthermia;
primary electrical disease (for example, long interval between Q and T waves);
hypoxia;
ischemia.

For reference. With this pathology, continuous waves of various shapes and sizes are recorded on the electrocardiogram with an amount of 200-300 per minute (high-wave ventricular fibrillation) or 400-500 per minute (small-wave ventricular fibrillation).

Symptoms of VF in young patients can be different and depend on:

type of tachycardia,
duration of illness,
age,
the presence of any heart defects.

Paroxysmal ventricular tachycardia is characterized by a feeling of heartbeat, discomfort in the chest, weakness, dizziness, anxiety, and in some cases the patient may lose consciousness. When the attack lasts for a long time, symptoms of circulatory failure are observed.

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Infants with this pathology may develop:

rapid shallow breathing,
dyspnea,
paleness and cyanosis of the skin,
lethargic state
hepatomegaly,
swelling.

Non-paroxysmal ventricular tachycardia of recurrent type does not manifest itself in most young patients and is usually discovered by chance during a routine medical examination.

Urgent management of ventricular tachycardia requires initial differential diagnosis with a supraventricular increase in heart rate with an expanded ventricular complex. If the type of heart rhythm disturbance cannot be determined, therapy is carried out by supplying humidified oxygen and intravenous injection ATP.

Attention. Young patients with significant disruptions in blood flow and serious condition, which is accompanied by disturbances of consciousness and fainting.

Classification of ventricular fibrillation

Regarding previous infarctions of the muscular lining of the heart, ventricular fibrillation is divided into primary, secondary and late.

Primary VF develops on the first or second day after myocardial necrosis. It demonstrates that the muscle membrane is characterized by electrical instability, which occurs due to acute oxygen starvation of the muscle.

Attention. Approximately 60% of primary ventricular fibrillation develops within four hours, and most - within twelve hours after the death of the heart muscle. This pathology is characterized by a high percentage of deaths.

If there is failure of the left ventricle of the heart and cardiogenic collapse, in some cases in patients who have had a heart attack, secondary ventricular fibrillation is formed.

In cases where VF develops two days after necrosis of the heart muscle, it is called “late.” Approximately half of patients with this diagnosis die. Typically, this type of disease begins two to six weeks after myocardial infarction. Most often, this VF affects patients with a damaged anterior wall of the organ.

For reference. Doctors classify ventricular fibrillation into two types. If the heart rhythm is regular, the beat rate is 200-300 per minute, they speak of ventricular flutter. With an abnormal heart rhythm and a frequency of about 500 beats per minute, we are talking about flickering of the heart chambers.

What is the danger of fibrillation?

When chaotic work of the muscle fibers of the ventricles occurs, full cardiac output becomes impossible. In addition, the force of contractions of the organ and the pressure in the vessels quickly decrease, which immediately leads to asystole - cardiac arrest.

The body's blood circulation is disrupted very quickly, the circulation of oxygen to tissues and organs is disrupted, and acute oxygen starvation of all systems occurs. The cerebral cortex reacts extremely sharply to hypoxia, and irreversible changes in the brain occur.

Attention! 80% of cases of death are a disappointing figure for the prognosis of ventricular fibrillation.

This condition seriously threatens life, so it is urgently necessary to stop it with the help of resuscitation actions, know correct technique performing chest compressions, because timely assistance can bring the patient back to life and increase the prognosis for a full recovery.

Ventricular fibrillation - symptoms

VF occurs in exactly the same way as asystole, which is why the following clinical manifestations are observed:

Almost immediately the patient loses consciousness;
Breathing and pulsation are not detected, observed a sharp decline blood pressure;
Skin cyanosis is detected;
The pupils dilate and do not respond to light;
Due to oxygen starvation, relaxation of the sphincters is possible Bladder and rectum - involuntary urination or defecation.

For reference. By the end of the first minute of ventricular fibrillation, the patient remains unconscious, convulsive muscle contractions and dilated pupils are observed. In the second minute, breathing disappears, the pulse cannot be felt, the skin turns blue, the veins in the neck dilate and enlarge, and a puffy face is observed.

Ventricular fibrillation provokes the development of clinical death. When these symptoms appear, there are only five minutes to save the patient and return him to life.

Diagnostic methods

Ventricular fibrillation can be diagnosed only during instrumental examination methods. The key method is electrocardiographic examination of the heart. The advantages of recording an electrocardiogram are the speed of the examination and the ability to carry it out anywhere.

Signs of development of ventricular fibrillation on the ECG:

Absence of QRS complexes and any intervals and waves;
Registration of fibrillation waves with a frequency of 300-400 per minute, chaotic, variable in length and amplitude;
Absence of isoelectric line.

An electrocardiogram can record large-wave VF - if the contraction force is more than half a centimeter based on the length of one cell. This type is typical in the first minutes of the disease.

For reference. Gradually, the heart cells are depleted, the acid-base balance shifts to the acidic side, metabolic changes increase - small-wave fibrillation is recorded. This condition poses the greatest danger to the patient and is characterized by the most unfavorable prognosis.

Urgent Care

VF therapy involves urgent medical care, since this type of arrhythmia is fatal in a matter of minutes, and the heart rhythm does not recover on its own.

For reference. The patient requires immediate defibrillation, but if necessary equipment missing, the medic applies a small and quick kick into the anterior wall of the chest into the cardiac zone, which makes it possible to stop fibrillation.

If the heart rhythm disturbance is not eliminated in this way, the specialist performs chest compressions and artificial respiration.

Ventricular flutter is a ventricular tachyarrhythmia that has a regular rapid rhythm (about 200-300 beats per minute). Most often, the condition may be accompanied by a decrease in blood pressure. Possible loss of consciousness, pallor, diffuse cyanosis skin, agonal breathing, convulsions, dilated pupils.

In addition, it can provoke sudden coronary death. Diagnosis of such pathology is carried out on the basis of electrocardiographic studies and clinical data. if ventricular flutter occurs, includes immediate defibrillation and cardiopulmonary resuscitation.

What is ventricular flutter?

A similar phenomenon is disorganized electrical activity of the myocardium, which is characterized by frequent and rhythmic contraction of the ventricles. The frequency of such contractions exceeds 200 beats per minute. It can also develop into fibrillation (flicker), which will be frequent, up to 500 beats, but irregular and erratic ventricular activity.

In the cardiology department, specialists classify fibrillation and flutter as dangerous arrhythmias that can lead to ineffective hemodynamics. In addition, they are the most common reasons arrhythmic death. According to epidemiological data, fibrillation and flutter most often occur in individuals whose age ranges from 47 to 75 years. Characteristic feature is that they occur three times more often in men than in women. In 70-80% of cases, the cause of sudden death is ventricular fibrillation.

What are the reasons why pathology occurs?

Ventricular flutter can occur against the background of various heart diseases, in the presence of various extracardiac pathologies. Quite often, organic myocardial damage that develops against the background of ischemic heart disease can be complicated by ventricular fibrillation and flutter. Besides this pathology accompanies the following diseases:

Other reasons

Less common development this violation may occur as a result of intoxication with cardiac glycosides, electrolyte imbalances, high levels of catecholamines in the blood, electrical injuries, cardiac contusions, hypoxia, acidosis, hypothermia. Also, ventricular tachycardia can be caused by some of the drugs, for example, sympathomimetics, barbiturates, narcotic analgesics, antiarrhythmics.

Another cause of flutter is cardiac surgery procedures. These include coronary angiography, electrical cardioversion, and defibrillation in the cardiology department.

Pathogenesis of ventricular flutter

Development similar disease is directly related to the re-entry mechanism, which has a circular nature of circulation of the excitation wave passing through the ventricular myocardium. It causes the ventricles to contract frequently and rhythmically, and there is no diastolic interval. The re-entry loop can be located around the perimeter of the entire infarction zone or the area of the ventricular aneurysm. A table of normal heart rates by age will be presented below.

The main role in the pathogenesis of ventricular fibrillation is played by multiple random re-entry waves, which provoke contraction of individual myocardial fibers while contractions of the ventricles are completely absent. This phenomenon is due to the electrophysiological heterogeneity of the myocardium: at the same time, different parts of the ventricles can be in the period of repolarization and in the period of depolarization.

What does it trigger?

Ventricular fibrillation and flutter are usually triggered by ventricular and supraventricular extrasystole. The re-entry mechanism can also initiate ventricular and Wolff-Parkinson-White syndrome, atrial fibrillation, and then support them.

As flutters and flickers develop, the stroke volume of the heart rapidly decreases and then becomes zero. As a result, blood circulation stops instantly. Paroxysmal flutters and ventricular fibrillation are always accompanied fainting states, and a stable form of tachyarrhythmia entails first clinical and then biological death.

Classification of ventricular flutter

During the development process, heart diseases such as ventricular fibrillation and flutter go through four stages:

The first is the tachysystolic stage of ventricular flutter. The duration of this stage is a maximum of two seconds. It is characterized by frequent, coordinated heartbeats. On the ECG, this stage corresponds to 3-6 ventricular complexes with a sharp high-amplitude fluctuation.

The second stage is convulsive ventricular tachyarrhythmia. Its duration is from 15 to 50 seconds. It is characterized by frequent, local contractions of the myocardium of an irregular nature. The ECG reflects this stage in the form of high-voltage waves of varying magnitude and amplitude.

The third stage is the stage of ventricular fibrillation. The duration of this stage is 2-3 minutes. It is accompanied by multiple irregular contractions of individual zones of the myocardium, having different frequencies.

The fourth stage is atony. This stage develops approximately 2-5 minutes after ventricular fibrillation occurs. The fourth stage is characterized by small, irregular waves of contractions, an increasing number of areas that have stopped contracting. The ECG is reflected in the form of irregular waves, the amplitude of which gradually decreases.

Cardiologists distinguish between ventricular fibrillation and flutter according to their clinical development. So, there are constant and paroxysmal forms. In this case, flutters of the second form can be recurrent in nature, that is, they can be repeated several times during the day.

Symptoms

Heart disease - ventricular fibrillation and flutter, in fact, correspond to clinical death. If flutter occurs, then for a short time it is possible that low cardiac output, consciousness and arterial hypotension. Occasionally, ventricular flutter may result in spontaneous restoration of sinus-type rhythm. Most often, such an unstable rhythm transitions to ventricular fibrillation.

Ventricular flutter and fibrillation are accompanied by the following symptoms:

If similar symptoms are observed and it is determined that ventricular fibrillation and flutter have occurred, then the patient needs urgent medical care. The central nervous system and other organs will be irreversibly damaged if normal heart rhythm is not restored within 4-5 minutes.

Complications

Death is the most unpleasant outcome of such deviations. As a result, the following complications may occur:

Diagnosis of ventricular flutter

Ventricular fibrillation and flutter can be recognized and diagnosed using clinical and electrocardiographic data. If such a deviation exists, then on an electrocardiographic study it will be displayed in the form of regular, rhythmic waves having almost the same shape and amplitude. They resemble a sinusoidal type curve with an oscillation frequency of 200-300 per minute. Also on the ECG there is no isoelectric line between the waves, P and T waves.

If ventricular fibrillation is observed, then waves with a heart rate (heart rate) of 300-400 vibrations per minute will be recorded, which continuously change their duration, shape, direction and height. There is no isoelectric line between the waves.

Ventricular fibrillation and flutter must be differentiated from cardiac tamponade, massive pulmonary embolism, supraventricular arrhythmia, and paroxysmal ventricular tachycardia.

A table of normal heart rates by age is given below.

Treatment of ventricular flutter

If ventricular flutter or fibrillation develops, immediate resuscitation should be provided, which is aimed at restoring sinus heart rhythm. Initial resuscitation should include precordial shock or artificial respiration in tandem with indirect massage hearts. Specialized cardiopulmonary resuscitation includes mechanical ventilation and electrical defibrillation of the heart.

Simultaneously with resuscitation measures, solutions of atropine, adrenaline, sodium bicarbonate, procainamide, lidocaine, amiodarone, and magnesium sulfate should be administered intravenously. In parallel with this, repeated electrical defibrillation is required. In this case, with each series, the energy should be increased from 200 to 400 J. If a relapse of ventricular fibrillation and flutter occurs, which occurs as a result of complete atrioventricular heart block, then it is necessary to resort to temporary stimulation of the cardiac ventricles with a rhythm that exceeds the frequency of their own oscillations.

special instructions

If the patient does not recover spontaneous breathing, cardiac activity, consciousness within 20 minutes, or does not react to pupil light, then resuscitation measures must be stopped. If resuscitation is successful, the patient is transferred to the ICU for further observation. Subsequently, the attending cardiologist decides whether it is necessary to implant a cardioverter-defibrillator or a dual-chamber pacemaker.