Negative r in lead 3. Treatment of supraventricular extrasystoles. Normal distribution of R waves in the precordial leads

A dangerous heart rhythm disturbance in the modern world is ventricular fibrillation. This condition is characterized by sudden cardiac arrest and the need to urgently undertake resuscitation methods to stop the attack. According to statistics, help not provided on time leads to death.

This disease It is more common in the stronger sex in middle age, but over the past decade it has been diagnosed in people of different generations. When an attack occurs, the most important thing is not to panic and not to lose vigilance, only you can provide assistance until the ambulance arrives.

If you notice any symptoms or changes in your condition, contact your doctor immediately. You can't hesitate here for a second. In this article, I would like to dwell in more detail on the causes of the disease, signs of manifestation and emergency care.

Ventricular fibrillation - what is it?

Ventricular fibrillation

Ventricular fibrillation is a type of cardiac arrhythmia in which the muscle fibers of the ventricular myocardium contract chaotically, ineffectively, with high frequency (up to 300 per minute or more). The condition requires urgent resuscitation, otherwise the patient will die.

Ventricular fibrillation is considered to be the most severe form of cardiac arrhythmia, since in a matter of minutes it causes cessation of blood flow in organs, an increase in metabolic disorders, acidosis and brain damage.

Among patients who died with a diagnosis of “sudden cardiac death,” up to 80% had ventricular fibrillation as its underlying cause.

At the moment of fibrillation, chaotic, discoordinated, ineffective contractions of its cells occur in the myocardium, which do not allow the organ to pump even a minimal amount of blood, therefore, paroxysm of fibrillation is followed by acute disorder blood flow, clinically equivalent to that in complete cardiac arrest.

According to statistics, ventricular myocardial fibrillation occurs more often in males, and average age ranges from 45 to 75 years. The vast majority of patients have some form of cardiac pathology, and non-heart-related causes cause this type of arrhythmia quite rarely.

Fibrillation of the ventricles of the heart actually means its stop; independent restoration of rhythmic contractions of the myocardium is impossible, therefore, without timely and competent resuscitation measures, the outcome is a foregone conclusion. If an arrhythmia strikes a patient outside a medical facility, then the likelihood of survival depends on who is nearby and what actions are taken.

It is clear that a medical worker is not always within reach, and a fatal arrhythmia can occur anywhere - in a public place, park, forest, transport, etc., therefore, only witnesses to the event who can at least try to provide hope for salvation can give primary resuscitation care, the principles of which are taught in school.

Proven to be correct indirect massage heart is capable of providing blood oxygen saturation up to 90% within 3-4 minutes of its conduction even in the absence of breathing, so it should not be neglected even when there is no confidence in patency respiratory tract or opportunities to establish artificial ventilation lungs.

If it is possible to support vital organs until qualified help arrives, then subsequent defibrillation and drug therapy significantly increase the patient's chances of survival.

Cardiac fibrillation is formed due to the rapid contraction of the ventricles, which is erratic. The frequency of their contractions exceeds 450 beats per minute, which is an extremely dangerous phenomenon. Help should be quick, it is represented by defibrillation. Lack of help leads to death.

The causes of problems with the ventricles of the heart may be hidden in the pathology of this organ. In some cases, disorders of an extracardiac nature contribute to the formation of fibrillation. Among heart pathologies, coronary heart disease is distinguished during the acute stage of pathology in the coronary vessels associated with blood circulation.

In addition, it is necessary to name the myocardial infarction that the patient once suffered. Death during coronary heart disease occurs in 46% of the male population and 34% of the female population. The pathology is observed within 12 hours after acute form heart attack.

In addition, people who have suffered a myocardial infarction with the presence of a Q wave during paroxysmal ventricular tachycardia fall into the risk category. Ventricular fibrillation also occurs with hypertrophic cardiomyopathy, which often appears in young people after intense exercise.

A small number of patients, about 10%, have dilated cardiomyopathy. causing fibrillation. Pathological conditions that lead to this condition include Brugada syndrome and pancreatic cardiomyopathy. Valve defects hearts also belong to the category at risk.

They are presented as acquired or congenital aortic stenosis. However, you need to pay attention that with mitral valve prolapse, which is characterized by a large value of ventricular contractions, this pathology occurs rarely, and its occurrence during the disease is not due to the disease itself, but to dysfunction of the heart muscle.

There are many reasons why this disease can occur. The main ones are:

Ischemic disease heart, or rather its varieties - myocardial infarction and acute circulatory disorders coronary vessels. Especially often, ventricular fibrillation with cardiac arrest occurs in the first hours of a heart attack.
Dilated and hypertrophic cardiomyopathy. This cause of pathology leads to fibrillation in at a young age, often - in athletes after intense physical activity. With dilated cardiomyopathy, up to half of patients die from cardiac arrest due to ventricular fibrillation.
Heart defects related to valve defects. Particularly dangerous in relation to possible development pathology of aortic stenosis, as it disrupts the filling and expulsion of blood from the left ventricle.
Primary disorders of myocardial electrophysiology, including those leading to ventricular paroxysmal tachycardia (for example, WPW syndrome). Even in the absence of other pathologies and organic lesions of the heart, some people may develop ventricular fibrillation due to congenital diseases.

Less common causes of pathology are overdose and intoxication with cardiac glycosides, sympathomimetics, barbiturates, narcotic analgesics, and arthiarrhythmic drugs.

The disease may develop due to a violation electrolyte balance, hypothermia.

Ventricular fibrillation can also occur after an invasive examination - coronary angiography, or after suffering an electrical shock. Rare, but quite possible causes of pathology are:

mitral valve prolapse;
specific cardiomyopathies, especially with sarcoidosis;
autonomic dysfunctions;
cardiac aneurysm;
chest injuries;
cardiac contusion;
acidosis;
severe hypoxia;
performing electrical cardioversion.

In some cases, the cause of ventricular fibrillation cannot be found, so it is considered idiopathic. Most common reason VF in adults - ischemic heart disease and myocardiopathy. VF can also occur due to electric shock and lightning, hypothermia, and drowning.

Certain medications, especially adrenergic agonists (adrenaline, norepinephrine, dopamine) and antiarrhythmic drugs(mainly class 1: quinidine, flecainide, etacizine, as well as class 3: ibutilide, nibentan, etc.), can cause life threatening arrhythmias transforming into fibrillation.

VF can occur during intoxication of spontaneous circulation if it was preceded by long-term resuscitation; Na bicarbonate is not indicated or may even be harmful in patients with hypoxic lactic acidosis (the latter develops during prolonged cardiac arrest in non-intubated patients).

VF is preceded by tachycardia, arrhythmia, and also if refractory/recurrent VF develops with an overdose of sympathomimetics or endogenous hypersympathicotonia. Develop against the background of electrolyte imbalance and acid-base disorders (hypo- and hyperkalemia, hypomagnesemia, hypercalcemia, acidosis and alkalosis), hypoxia, during anesthesia, surgical operations, endoscopic studies etc.

Classification of the disease according to heart rate includes the following types:

Ventricular flutter is a regular sinusoidal wave with a frequency of up to 300 beats. per minute with the absence of an isoelectric wave. Fluttering usually begins after a paroxysm ventricular tachycardia or an attack atrial fibrillation.
Ventricular fibrillation is irregular heart waves with a frequency of 400-600 beats. in a minute different shapes and amplitudes. If the amplitude of the waves is less than 5 mm, we are talking about small-wave fibrillation, more than 5 mm. - about large-wave fibrillation.

Depending on the time of occurrence, ventricular fibrillation can be paroxysmal, persistent, long-term persistent, permanent (permanent).

Based on the presence of concomitant pathologies, fibrillation can be as follows:

Primary. Its causes are most often due to the presence of acute coronary insufficiency. Primary ventricular fibrillation kills up to half of people with severe forms of coronary heart disease. This pathology has a very high risk of relapse, but it can be treated well with defibrillation.
Secondary. It is expressed by ventricular fibrillation and is diagnosed in persons with myocardial infarction, advanced stages of heart defects, dilated cardiomyopathy, oncological pathologies, etc. Defibrillation in this case gives a poor result. It is divided:

arising against the background of another complication (for example, in a patient with MI complicated by pulmonary edema).

In this situation, the reason for the appearance of ventricular fibrillation is not only a violation of excitability and conduction caused by focal changes myocardium, but also its severe diffuse hypoxia as a result of acute cardiopulmonary failure;

developing as an agonal rhythm. It is observed in cases where another vital function - breathing - stops first, and only then does cardiac arrest occur;

ventricular fibrillation of iatrogenic origin, usually resulting from improper treatment.

Symptoms

You can suspect VF in a person based on characteristic signs:

after 5 sec. the person becomes dizzy and weak;
in 20 sec. the patient loses consciousness;
after 40 sec. from the onset of the attack, the patient experiences characteristic convulsions: the skeletal muscles begin to contract once tonically, and at the same time defecation and urination occur involuntarily;
after 45 sec. from the onset of ventricular fibrillation, the pupils dilate and reach their maximum size after 1.5 minutes.

The breathing of patients with ventricular fibrillation is noisy, frequent, and accompanied by wheezing. By the end of the second minute it becomes less frequent and clinical death occurs.

Symptoms of flutter and ventricular fibrillation are nonspecific. This condition always develops suddenly. Flickering is considered a separate stage of fluttering. This heart pathology is characterized by the following symptoms:

dizziness;
weakness;
loss of consciousness;
convulsions;
noisy breathing;
involuntary mictions and defecation;
dilated pupils;
disappearance of the pulse in the peripheral arteries;
pale or cyanotic skin;
lack of pupillary response.

Depending on the time of appearance of the first signs, primary, secondary and late fibrillation are distinguished. They all have their own characteristics. Primary fibrillation develops in the first two days after a heart attack. Ventricular dysfunction precedes the development of heart failure and other complications.

The secondary form of fibrillation develops with existing heart failure or against the background of cardiogenic shock.
If symptoms of fibrillation occur more than two days after a heart attack, then this form is called late.

The first symptom of this pathological condition is dizziness. It occurs a few seconds after the start of chaotic contraction of the ventricles. After 15-20 seconds, loss of consciousness is observed. The reason is brain hypoxia.

After about 40 seconds it develops convulsive syndrome. At the same time, the function of the pelvic organs is impaired. With ventricular fibrillation, mydriasis (dilation of the pupils) is observed. Within 2 minutes clinical death develops.

It is manifested by the following symptoms:

dilated pupils;
lack of breathing;
disappearance of the pulse;
pale skin;
lack of consciousness.

On the stage clinical death You can still help a person. If this does not happen, then they develop irreversible changes. Biological death occurs. When ventricular flutter and fibrillation occur against the background of ongoing resuscitation measures, complications may develop in the form of aspiration pneumonia and bone fractures.

First - emergency help for ventricular fibrillation:

A precordial blow is a sharp and sharp blow to the lower third of the chest with a fist raised 2/3 of the forearm (the part of the body from the hand to the elbow) above the chest (if the defibrillator is already ready, it is better to use it).
Call an ambulance.
Indirect cardiac massage, preparation for defibrillation.
Defibrillation with a discharge of 200 J. If ventricular fibrillation remains, a second 300 J is immediately performed, and, if necessary, a third with an energy of 360-400 J. Large amounts of energy should not be used immediately, otherwise post-conversion complications may occur.
If the first defibrillation did not help. Intracardiac or intravenous lidocaine 100-200 mg (shortens QT, thereby reducing the defibrillation threshold), or obzidan up to 5 mg (reduces the difference in refractoriness in different parts of the myocardium).
Repeated defibrillation.
If ventricular fibrillation persists - sodium bicarbonate intravenously, lidocaine infusion - 2 mg/min. (or 100 mg IV in a stream every 10 minutes), polarizing mixture, magnesium sulfate as part of a polarizing mixture, or separately, iv in a stream 1-2 g in 1-2 minutes. If there is no effect, repeat after 5-10 minutes.
Third defibrillation.
If ventricular fibrillation persists, continue from step No. 7. The administration of adrenaline 1 mg IV (in Western literature is often recommended at the corresponding stage No. 5, 1 mg every 3-5 minutes), calcium chloride 10% -10.0 IV may also help. When using bicarbonate and potassium supplements, it is important to prevent the development of alkalosis and hyperkalemia.

A patient with ventricular fibrillation undergoes resuscitation, in this case it is chest compressions in accordance with a precisely defined algorithm. It is also necessary to carry out defibrillation as soon as possible.

Defibrillation is carried out by applying two electrodes to the chest, which will send an electrical discharge that will disrupt the chaotic functioning of the heart and allow the rhythm to normalize.

Today, as an alternative, an automatic external defibrillator is used, which should always be located in crowded places, for example, at the airport, train stations, etc. shopping centers, to the cinema.

These devices can provide clear and concise instructions and information to help save lives successfully. You also need to call Ambulance. If the patient survives, he needs implantation of a cardioventer defibrillator, that is, a device that can stop ventricular fibrillation using a precordial shock.

This is a blow with the edge of the palm to the lower part of the sternum, which helps stop fibrillation and restore normal heartbeat. When the rhythm is restored - symptomatic therapy ( vascular agents); correction acid-base balance; prevention of ventricular fibrillation and ventricular tachycardia - lidocaine, magnesium sulfate, potassium preparations.

Ventricular defibrillation is performed as follows: the patient is not given anesthesia, and the discharge begins immediately with a power of 200 J. This is due to the fact that in cases of ventricular fibrillation the patient is in unconscious, between life and death, therefore there can be no talk of any adequate pain relief.

Defibrillation can be performed at any location where the patient has experienced clinical death due to ventricular fibrillation. In this case, a hospital resuscitator or emergency physician uses a portable defibrillator.

If a patient has persistent ventricular tachycardia, he may be hospitalized intensive care unit where defibrillation is performed.

Simultaneously with defibrillation for ventricular fibrillation and flutter, general resuscitation measures are carried out - tracheal intubation, artificial ventilation using an Ambu bag (or a ventilator, depending on the place of care), as well as the administration of adernaline, mesaton and antiarrhythmics (lidocaine, procainamide, amiodarone and etc).

Method of cardiac defibrillation:

Discharge 200 J,
No effect - discharge 360 J,
No effect - administration of the drug,
Within 30-60 seconds resuscitation measures - discharge 360 J,
Repeat the described measures up to four discharges of maximum power.

Since fibrillation of the ventricular myocardium is fatal, and the only way to relieve it - defibrillation with electricity, then ambulance teams and medical institutions must be equipped with appropriate devices, and any health worker, accordingly, must be able to use them.

The heart rate may return to normal after the first shock or after a short period of time. If this does not happen, then a second discharge follows, but with higher energy - 300 J. If ineffective, a third, maximum discharge of 360 J is applied.

After three electric shocks, the rhythm will either be restored or a straight line (isoline) will be recorded on the cardiogram. The second case does not yet indicate irreversible death, so attempts to revive the patient continue for another minute, after which the work of the heart is again assessed.

Further resuscitation measures are indicated if defibrillation is ineffective. They consist of tracheal intubation for ventilation of the respiratory system and establishing access to large vein where adrenaline is injected.

Adrenaline prevents the collapse of the carotid arteries, increases blood pressure, and ensures the redirection of blood to vital organs by spasming the abdominal and renal vessels. In severe cases, the administration of adrenaline is repeated every 3-5 minutes, 1 mg.

Diagnosed this disease exclusively in medical institutions, through tests and examinations. If a patient has an attack with all the above symptoms and he is given first aid on time, then it is necessary to medical institution execute full diagnostics patient to determine the extent and cause of the disease.

At the first stage of diagnosis, the doctor examines general state the patient and from the words of relatives learns about possible complaints and conditions for the manifestation of an attack. In addition, the doctor must find out if the patient has already been diagnosed with diseases that could cause this condition.

After this, you need to perform a physical examination, which includes checking the state of consciousness, breathing and pulse. It is also necessary to inspect skin, study the reaction of the pupils to light, measure the pressure, and listen to the heart.

After the initial examination, a number of tests must be performed, including a complete blood count, which will help determine the presence of other diseases, and a urine test, which can be used to check the condition of the kidneys. The next stage in diagnosing ventricular flutter is examination using special equipment.

Ventricular fibrillation is diagnosed as an emergency. Doctors make a diagnosis based on:

Using a heart monitor. A heart monitor will allow you to read information about the electrical activity of the heart.
Pulse checks. With ventricular fibrillation, the pulse is not detected.

Tests to diagnose the causes of fibrillation. Additional studies may be required to determine the causes of fibrillation:

ECG. During the study, special electrodes that can record cardiac activity are placed on the chest and limbs.

An ECG can detect heart rhythm disturbances or detect conduction abnormalities.

Blood tests. Blood samples may be tested to check levels of magnesium, sodium, hormones and chemical substances which can affect the activity of the heart.

Other blood tests can help detect damage to the heart.

Chest X-ray. An X-ray of the chest will allow the doctor to determine the size and shape of the heart and great vessels.

EchoCG. When conducting this study are used sound waves to obtain an image of the heart. Echocardiography can help detect areas of cardiac damage, areas of decreased contractility and ejection fraction, and valve abnormalities.

Coronary angiography. During this procedure, a liquid contrast agent is injected through a catheter passed from the arteries of the limbs to the arteries of the heart.

After the arteries are filled with dye, they become visible on the X-ray screen, which allows you to identify areas of obstruction within the vessels.

While the catheter is inside, the doctor can perform therapeutic procedures - angioplasty and stent installation to maintain the free lumen of the arteries.

CT or MRI of the heart. Although these tests are most often used to determine the presence of heart failure, they can help identify other problems.

With CT, a special X-ray scanner allows you to obtain multiple images of different sections of the heart. During an MRI, you will be inside a specially designed device that generates a strong magnetic field, which allows you to obtain images of your organs and tissues.

It is extremely difficult to distinguish the symptoms of fibrillation from signs of cardiac arrest, which is associated with very similar manifestations. Therefore, it is necessary to rely on electrocardiogram data, which allows you to make the correct diagnosis.

In the presence of fibrillation, the cardiogram shows the formation of waves different sizes and disappearance of the outlines of the ventricular complex. Waves have rounded or pointed ends of the heights, both upper and lower.

The heart rate can reach high values - up to 300 beats per minute or more. The amplitude of waves is represented by two forms - small and large waves.

There is no isoelectric interval in the form of individual waves; most often they pass each other, and the formation of a curved line of a bizarre shape is observed. An ECG is done in a hospital setting or in ambulances. This examination allows differential diagnosis and establish an accurate diagnosis.

With ventricular fibrillation and flutter, the ECG will show the following signs:

P waves are in most cases absent before ventricular contractions;
chaotic frequent waves instead of the necessary QRS complexes;
with flutter the waves will be rhythmic, with ventricular fibrillation they will not.

According to the display on the ECG, 5 stages of fibrillation are distinguished:

Stage I, lasting 20-30 s, is characterized by a regular rhythm and a relatively high frequency of fibrillar oscillations, forming characteristic “spindle” figures (the frequency of oscillations can exceed 400 per minute);
Stage II is determined by the disappearance of “spindles” and the chaotic nature of the grouping of rhythmic oscillations (stage duration 20-40 s);
Stage III is characterized by the absence of frequent rhythmic oscillations and the presence of sinus-like oscillations of double frequency (stage duration 2-3 minutes);
In stage IV, ordered oscillations disappear;
Stage V represents low-amplitude arrhythmic fibrillary oscillations.

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 carry out electrical pulse 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. Enter medicines better 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 the 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.

Resuscitation measures for ventricular fibrillation are aimed at restoring the sinus rhythm of the heart. The most important ways, with the help of which it is possible to stop the development of pathology - electrical defibrillation and artificial ventilation.

Doctors also practice precordial shock and indirect cardiac massage. Electrical defibrillation is initially carried out “blindly”, without wasting time on performing an ECG. The procedure begins with discharges with a power of 200 J, repeating them if there is no effect, increasing the energy to 360-400 J.

If fibrillation persists or returns after initial success, epinephrine is required every 3 minutes, interspersed with defibrillation, while installing an ECG device and regular monitoring of heart rhythm.

Introduction also applies antiarrhythmic drugs 3 classes, which significantly improve the condition of the myocardium and its conductivity, normalize the rhythm (Bretylium). All drugs are administered intravenously; if there is no effect, the dose is slowly increased.

Other medications used as measures cardiopulmonary resuscitation:

Atropine;
Magnesium sulfate;
Amiodarone;
Lidocaine;
Sodium bicarbonate;
Novocainamide;
Esmolol;
Propranolol;
Amiodarone.

If there is no effect, resuscitation is stopped half an hour after it began. Indications for the end of emergency medical care are the absence of breathing, cardiac activity, consciousness, when the pupils do not respond to light.

On the contrary, if resuscitation was successful, then the patient is transferred to the department intensive care for subsequent treatment and observation.

Surgical intervention is practiced after the end of fibrillation to prevent its attacks in the future. Often a person needs installation (implantation) of a cardioverter-defibrillator or pacemaker in order not to die from severe types of arrhythmia that turn into ventricular fibrillation.

Surgery may also be necessary if there is organic pathology hearts. As a rule, we are talking about eliminating valve disorders - congenital or acquired:

Implantation of a cardioverter-defibrillator, which constantly monitors the heart rhythm.

When the heart rate slows down, it works as a pacemaker. When it detects ventricular tachycardia or ventricular fibrillation, it works like a defibrillator to reset your heart to a normal rhythm.

More effective method than reception medicines.

Coronary angioplasty and stenting.

This procedure to treat severe coronary artery disease, which opens blocked coronary arteries, restores blood flow and blood supply to the heart muscle.

If ventricular fibrillation was caused by an ischemic attack, the procedure may reduce the risk of ventricular fibrillation episodes.

Using a catheter, which is inserted through an artery in the leg, an inflating balloon is applied to the narrowed coronary arteries, which dilates them. Coronary angioplasty can be done during coronary catheterization (angiography),

Coronary bypass surgery.

Surgical intervention to install a shunt to bypass the narrowed section of the artery; a minimally invasive version of the operation is also possible.

Restores normal blood flow, prevents ischemia of the heart muscle and ventricular fibrillation.

Radiofrequency ablation.

Sometimes catheter ablation is performed to stop attacks of ventricular tachycardia. Ablation is usually performed using a catheter at the tip of which is an electrode that delivers radiofrequency pulses.

They help destroy scars or areas of heart tissue that cause abnormal heart rhythms. After an episode of ventricular fibrillation, it is better to undergo examination and treatment in a specialized cardiology center, where there are the most modern methods diagnosis and treatment of heart diseases.

After ventricular fibrillation, the patient is monitored. His condition is constantly monitored using a Holter ECG: this is done continuously for 1-7 days. Treatment is aimed at preventing recurrence of attacks.

If patients have fibrillation due to heart disease, then surgery. Surgeons can install a device that will correct the myocardial rhythm.

The radiofrequency ablation method is also used - this is the introduction of a special device that destroys the pathological focus of abnormal heart rhythm. Drug antiarrhythmic therapy is also carried out. To prevent possible complications anticoagulants are prescribed.

They prevent increased blood clotting and reduce the likelihood of developing a heart attack. They also recommend products that improve metabolism and nourish muscles.

It is vital that a person with ventricular fibrillation receives immediate care followed by treatment in a cardiac hospital. If this does not happen, an unfavorable outcome may occur within 30 minutes - 1 hour.

Complications of ventricular fibrillation include coma and impairment of neurological functions (intelligence, speech, memory, and others). They arise due to the death of brain cells during oxygen starvation, which occurs from the onset of an arrhythmia attack.

As a result serious condition and comas may occur:

aspiration pneumonia, caused by particles from the stomach entering the lungs;
“stunning” of the myocardium, accompanied by a constant decrease in cardiac contractility;
convulsive attacks.

With indirect cardiac massage, fractures of the sternum and ribs often occur. The doctor who assisted the patient should not be blamed for this. It is sometimes believed that such fractures are an indicator of effective resuscitation efforts.

The prognosis for ventricular fibrillation is always serious and depends on how quickly resuscitation efforts begin, how professionally and effectively the specialists work, how much time the patient will have to spend virtually without heart contractions:

If blood circulation is stopped for more than 4 minutes, then the chances of salvation are minimal due to irreversible changes in the brain.
The prognosis may be relatively favorable if resuscitation begins in the first three minutes and defibrillation no later than 6 minutes from the onset of the arrhythmia attack. In this case, the survival rate reaches 70%, but the incidence of complications is still high.
If resuscitation assistance is delayed, and 10-12 or more minutes have passed since the onset of ventricular fibrillation paroxysm, then only a fifth of patients have a chance to remain alive, even if a defibrillator is used. This disappointing indicator is a consequence of rapid damage to the cerebral cortex under hypoxic conditions.

The health prognosis for ventricular fibrillation is most often unfavorable. Even with timely resuscitation, patients become disabled. Life expectancy is decreasing. Adequately carried out resuscitation measures can save 7 out of 10 people.

Stopping blood circulation for 4 minutes or more leads to severe encephalopathy. Ventricular flutter and fibrillation are the main cause of death in patients after resuscitation.

The main measure to prevent ventricular fibrillation and flutter is timely detection and treatment of the underlying disease (coronary artery disease, congenital and acquired defects, cardiomyopathy).

It is necessary to exclude possible risk factors for the development of cardiovascular pathology. For this it is recommended:

exclude stressful situations;
Healthy food;
give up alcohol and cigarettes;
move more;
normalize sleep;
limit physical activity.

Fibrillation most often develops against the background of an acute infarction. To reduce the likelihood of acute cardiac ischemia, you need to treat hypertension, atherosclerosis and thrombosis. Thus, fibrillation is a life-threatening condition and requires immediate resuscitation measures.

Ventricular fibrillation of the heart is the most severe form of heart rhythm disturbance. It leads to cardiac arrest and clinical death within a few minutes. This is a borderline condition requiring immediate resuscitation measures. Therefore, a person’s life after an attack depends on the timeliness and literacy of the actions of people nearby.

According to statistics, the disease affects men over 45 years of age who have various forms of heart pathologies. It is diseases of this organ that are the main cause of the development of ventricular fibrillation.

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Basic concept

Ventricular fibrillation, or fibrillation, is emergency, characterized by uncoordinated contractions of the ventricles of the heart. Often their frequency exceeds 300 beats per minute. During this period, the function of this organ to pump blood is disrupted, and after a while it stops altogether.

The attack is preceded by a condition called “ventricular flutter” - unstable arrhythmic heartbeats with a frequency of 220 to 300 per minute, which quickly turn into fibrillation.

Ventricular fibrillation

The basis of the disease is a violation of the electrical activity of the myocardium and the cessation of full heart contractions, leading to cessation of blood circulation.

Men are three times more likely than women to suffer from ventricular fibrillation. It accounts for about 80% of all cases of cardiac arrest.

The mechanism of pathology development

The essence of the mechanism for the development of ventricular fibrillation lies in the uneven electrical activity of the heart muscle - the myocardium. This causes individual muscle fibers to contract at different rates, resulting in different areas myocardium are in different phases of contraction. The contraction frequency of some fibers reaches 500 per minute. This whole process is accompanied by chaotic work of the heart muscle, which is unable to ensure normal blood circulation. After some time, the person’s heart stops and clinical death occurs. If you do not start cardiopulmonary resuscitation, then after 5–6 minutes irreversible changes in the body and brain death will occur.

Ventricular flutter and fibrillation are the most dangerous species arrhythmias. Their difference lies in the fact that with the first, the correct rhythm of contractions of myocardial cells - cardiomyocytes - is maintained, and their frequency does not exceed 300 per minute. Fibrillation is characterized by erratic contraction of cardiomyocytes and irregular rhythm.

Ventricular flutter and fibrillation

Ventricular flutter is the first stage of fibrillation.

Causes and predisposing factors

There are many factors that influence myocardial conductivity and its ability to contract. Of these, 90% are due to cardiovascular diseases.

The main causes of ventricular fibrillation:

Factor	Pathologies
Cardiovascular diseases	ventricular paroxysmal tachycardia - sudden attack rapid heartbeat, which occurs under the influence of impulses that replace the normal one sinus rhythm hearts; ventricular extrasystole - a violation of the heart rhythm in which an extraordinary contraction of the ventricles occurs; myocardial infarction - massive cell death muscle tissue heart due to insufficient blood supply; acute coronary insufficiency - impaired circulation in the heart; cardiomegaly, or “bull heart”, - abnormal increase size or weight of the organ; Brugada syndrome is a genetically determined disorder of the heart; atrioventricular block - disorder electrical conductivity between the ventricles and atria, leading to arrhythmia; malformations of the heart and its valves; cardiomyopathy is a pathology of the myocardium of unknown nature, characterized by an increase in the size of the heart and its chambers, rhythm disturbances, and heart failure; cardiosclerosis - gradual replacement of the myocardium with connective tissue; myocarditis - inflammation of the heart muscle
Electrolyte imbalance	insufficient intake of potassium into the body, leading to electrical instability of the myocardium; excess calcium accumulation inside cells
Taking medications	Intoxication caused by the following groups of drugs: sympathomimetics - Orciprenaline, Epinephrine, Salbutamol; cardiac glycosides - Digitoxin, Digoxin; drugs against arrhythmia - Amiodarone, Sotalol; narcotic analgesics - Levomepromazine, Chlorpromazine; catecholamines - Dopamine, Norepinephrine, Adrenaline; barbiturates - Seconal, Phenobarbital; medical anesthesia - Chloroform, Cyclopropane
Injuries	electric shock; blunt heart injuries; penetrating chest wounds
Medical manipulations	coronary angiography - the introduction of a contrast agent into the circulatory system of the heart followed by radiography; cardioversion - treatment of heart rhythm disturbances using electrical impulses
Burns, overheating	temperature increase; fever with sudden changes temperature
Insufficient oxygen supply	skull injuries; suffocation
Other reasons	acidosis - a decrease in the pH of the body, that is, a shift acid-base balance towards increasing acidity; dehydration associated with blood loss of various nature; hypovolemic shock - a critical condition resulting from a sudden loss of circulating blood in the body

Myocardial infarction as a cause of ventricular fibrillation.

Risk factors include:

male gender;
age over 45 years.

Clinical picture

Ventricular fibrillation occurs suddenly. Their function is sharply disrupted, which leads to cessation of blood circulation. This process entails the development of acute ischemia (oxygen starvation) of internal organs and the brain. The patient stops moving and loses consciousness.

Main symptoms of the pathology:

heart rhythm failure;
sharp pain in the head;
dizziness;
sudden loss of consciousness;
cardiac arrest;
intermittent or absent breathing;
pale skin;
acrocyanosis (blueness of the skin), especially in the area of the nasolabial triangle, nose and tips of the ears;
inability to feel the pulse in the carotid and femoral arteries;
dilated pupils and lack of reaction to light;
hypotension (relaxation) of muscles or cramps;
sometimes - involuntary defecation and urination.

All signs appear almost simultaneously, with death occurring within an hour from the onset of the first symptom in 98% of cases.

After a complete cardiac arrest, a person can be brought back to life within seven minutes. During this time, changes in the body are considered reversible. Then the irreversible processes of cellular decay begin and biological death brain

Stages of ventricular fibrillation and ECG readings

An attack of fibrillation is manifested by symptoms of clinical death. This condition can be recognized using electrocardiography (ECG) - the most informative method diagnostics

ECG readings

Advantages of ECG:

quick results;
the possibility of carrying out the procedure outside of a clinic or hospital.

Characteristic features of ventricular fibrillation on the ECG:

1. Lack of registration of excitation of the ventricles of the heart on the ECG, that is, the ventricular complex or QRS complex.
2. Determination of irregular fibrillation waves of different duration and amplitude, the intensity of which reaches 400 per minute.
3. Lack of isoline.

Based on the size of the waves, ventricular fibrillation is of two types:

1. Large-wave - excess contraction force above one cell (0.5 cm) when recording electrocardiography. The detection of this type of flicker is noted in the first minutes of an attack and signifies the onset of arrhythmia.
2. Shallow wave - manifests itself with the depletion of cardiomyocytes, increasing signs of acidosis and disorders metabolic processes in the body, which is characterized by a high risk of death.

The sequence of stages of arrhythmia determined on the ECG:

1. Tachysystolic - flutter lasting about two seconds.
2. Convulsive - loss of regular contractions of the heart muscle and an increase in their frequency. The duration of the stage is no longer than one minute.
3. Atrial fibrillation - irregular frequent contractions of varying intensity, without pronounced teeth and intervals. The duration of the stage is 2–5 minutes.
4. Atonic - change from large waves of fibrillation to small ones as a result of myocardial depletion. Stage time is up to 10 minutes.
5. Final - complete cessation of cardiac activity.

Ventricular fibrillation on ECG

Depending on the duration of the attack, ventricular fibrillation is divided into two forms:

1. Paroxysmal - short-term episodes of pathology development.
2. Constant - rhythm disturbance, characterized by clinical symptoms sudden death.

Urgent Care

An ECG is necessary in the diagnosis of ventricular fibrillation, but resuscitation measures should be started immediately, without waiting for its results. Otherwise the person may die.

The main principle of providing emergency care is its beginning in as soon as possible, because the death of the patient can occur within a few minutes. If it is impossible to carry out emergency defibrillation, the victim is advised to undergo chest compressions and artificial ventilation. Proper massage heart rate within 4 minutes ensures blood saturation with oxygen up to 90% even in the absence of artificial respiration. Thus, maintaining vital organs until arrival specialized assistance increases a person's chances of life.

assessment of the patient's condition;
determination of respiration and pulse;
providing the patient with a horizontal position lying on his back with his head thrown back with the lower jaw moving forward;
inspection oral cavity the patient for the presence of foreign bodies;
in the absence of breathing and pulse - immediate resuscitation measures. If there is only one resuscitator, then the ratio of air injections and chest compressions is 2:30. If two people resuscitate, then it is 1:5.

Non-specialized resuscitation measures

Specialized care includes the use of a defibrillator and drug therapy. Before this, an ECG is done (in parallel with cardiopulmonary resuscitation) to confirm ventricular fibrillation, since in other cases the defibrillator may not have the desired effect.

Specialized emergency care is carried out in several stages, of which each subsequent one begins when the previous one is ineffective:

Stage	Order of conduct
First	1. Determining whether the patient has consciousness. 2. Ensuring the opening of the airways. 3. After monitoring the pulse and breathing, perform cardiopulmonary resuscitation (CPR). The frequency of chest compressions is 100 per minute. At the same time, mouth-to-mouth artificial lung ventilation (ALV) is performed. If an Ambu bag is used, then the ratio of mechanical ventilation to chest compressions (CCM) is 2:30. 4. In parallel with CPR - taking ECG readings
Second	1. Conducting an ECG analysis to determine the need for defibrillation. 2. When clarifying ventricular fibrillation using an ECG - defibrillation 360 J + 2 more times if there is no result. 3. At the same time - preparation of instruments for tracheal intubation (aspirator, laryngoscope, air duct, etc.) and solution for endotracheal administration (Adrenaline 3 mg and sodium chloride 0.9% 7 ml)
Third	1. Perform CPR for a minute. 2. Tracheal intubation for half a minute. 3. In parallel - NMS. 4. Insertion of a catheter into the main vein. 5. Intravenous jet infusion of 1 ml of Adrenaline or endotracheal administration of its solution. 6. Ventilation + NMS
Fourth	1. Defibrillation 360 J. 2. Administration of Cordarone (amiodarone) 150–300 mg or lidocaine 1 mg per kilogram of weight intravenously. 3. NMS + mechanical ventilation. 1. Defibrillation 360 J. 5. If ineffective, re-introduce cordarone and NMS + mechanical ventilation after 3–5 minutes. 6. If ineffective - 10 ml of Novocainamide 10% intravenously and repeated cardiopulmonary resuscitation. 1. Defibrillation 360 J. 8. If ineffective, intravenous administration of Ornid at the rate of 5 mg per kilogram of weight every 5–10 minutes until the dose is 20 mg per kg of weight. After each injection of Ornid - defibrillation 360 J

Places for correct installation of electrodes.

If the measures taken have no effect, then the issue of subsequent resuscitation actions is decided.

According to statistics, with the help of a defibrillator, heart function is restored in 95% of cases, if there is no serious organic lesion heart muscle. Otherwise, the positive effect does not exceed 30%.

Complications

After a person returns to life, a mandatory condition is his transfer to the intensive care unit, and then to the intensive care ward. This is due to instability of blood circulation and the consequences of oxygen starvation of the brain and other organs.

Consequences of arrhythmia:

1. Postanoxic encephalopathy - damage to brain neurons as a result of prolonged oxygen starvation. This condition manifests itself as neurological and psycho-emotional disorders of various types. A third of patients who have experienced clinical death develop neurological complications, incompatible with life. The second third experience disturbances in motor activity and sensitivity.
2. Persistent decline blood pressure- hypotension due to myocardial infarction.
3. Asystole - complete cardiac arrest. It is a complication of the attack of ventricular fibrillation itself.
4. Fractures of the ribs and other injuries to the chest as a consequence of intense chest compressions.
5. Hemothorax - accumulation of blood in the pleural cavity.
6. Pneumothorax - the appearance of gases or air in the pleural cavity.
7. Myocardial dysfunction - disruption of the heart muscle.
8. Aspiration pneumonia - inflammation of the lungs as a result of vomit or other substances from the mouth and nose entering them.
9. Other types of arrhythmia (heart rhythm disturbances).
10. Thromboembolism - blood clots entering the pulmonary artery and blocking it.

Thromboembolism pulmonary artery as a complication of resuscitation measures

When cardiac function is restored after 10–12 minutes of clinical death, there is a high probability of developing coma, physical and mental disability. This is due to prolonged hypoxia of the brain and the occurrence of irreversible processes in it. The absence of brain dysfunction is observed in only 5% of people who have suffered cardiac arrest.

Prevention and prognosis

Preventing ventricular fibrillation can significantly prolong a person's life. This is relevant both with the likelihood of developing pathology and after an attack. In the case of the latter, the risk of relapse increases several times.

Preventive measures against ventricular fibrillation:

1. Timely and high-quality treatment of cardiovascular pathology.
2. Regular use of drugs that have an antiarrhythmic effect.
3. Installation of a cardioverter-defibrillator or pacemaker.

Installed pacemaker

The mortality rate from ventricular fibrillation in people over 45 years of age is more than 70% annually. The prognosis is not always favorable and depends on the effectiveness and professionalism of resuscitation measures, as well as on the time the patient is in a state of clinical death.

Death with ventricular fibrillation occurs in 80% of cases. 90% of seizures are caused by medical conditions of cardio-vascular system(heart defects, cardiomyopathies, cardiosclerosis, myocardial infarction). Coronary heart disease causes sudden death in women in 34% of cases, in men - in 46%.

There is no cure for ventricular fibrillation. Emergency resuscitation measures can prolong life in only 20% of patients. Positive result is 90% when providing assistance in the first minute of cardiac arrest. Resuscitation in the fourth minute reduces this figure three times and does not exceed 30%.

Fibrillation, or ventricular fibrillation, is a serious disorder with a high risk of death. A favorable prognosis depends on timely and high-quality first aid. Of particular importance is prevention aimed at preventing the development of pathology.

The appearance of arrhythmic, ineffective and uncoordinated contractions of the muscle groups of the ventricles of the heart is called fibrillation.

In this condition, no pressure is created in the ventricles. The heart stops working as a pump that pumps blood.

Ventricular fibrillation (VF) is characterized by chaotic contractions of myocardial tissue. Their frequency increases from 250 to 480 per minute. The movements of the ventricles cease to be coordinated. As a result, blood circulation stops and the heart stops.

Prevalence, stages of development

Near 75-80% of cases of sudden death, which is caused by heart problems, occurs in VF. This disease occurs in both young and old people.

The risk group includes those patients who have had sudden stop blood circulation. Unexpected death affects 10-30% of such patients.

The chance of experiencing VF in people who suffer from idiopathic dilated cardiomyopathy is 10%. Within 1 year after a major heart attack, the disease affects 5% of patients. For hypertrophic cardiomyopathy – 3%.

Fibrillation is characterized by random contraction of the muscle fibers of the heart. The stages of disease development quickly replace each other: the patient feels weak, loses consciousness, and his pupils dilate. About 2 minutes pass from the onset of the attack to clinical death.

Classification of species

Experts distinguish 3 types of VF after heart attacks: primary, secondary and late. Although discussions regarding classification of this disease are still ongoing.

Primary fibrillation occurs 1-2 days after a heart attack. It shows that the myocardium is characterized by electrical instability, which resulted from acute ischemia.

About 60% of primary VF occurs within 4 hours, 80% - 12 hours after a heart attack. Such fibrillation often leads to sudden death. With left ventricular failure and cardiogenic shock Sometimes secondary VF develops in people who.

If fibrillation begins 48 hours after a heart attack, it is called late. About 40-60% of people who experience this disease die. In most cases, such fibrillation begins 2-6 weeks after a heart attack. More often it developed in those people whose anterior wall of the heart was damaged.

Doctors distinguish between 2 types of fibrillation. If the rhythm of contractions is correct, and their number does not exceed 200-300 per minute, then we are talking about ventricular flutter. With abnormal rhythm and contraction frequency from 200 to 500 per minute. talking about flickering.

Causes of development and risk factors

In most cases, the cause of primary and other types of gastric fibrillation is. Experts identify the following reasons for the development of VF:

(heart attack, coronary circulatory disorders);
hypertrophic cardiomyopathy: death occurs in young people with excessive physical exertion;
dilated idiopathic cardiomyopathy: fibrillation begins against the background of hemodynamic disorders in half of these patients;
problems with the right ventricle (arrhythmogenic cardiomyopathy);
different (most often the cause is);
specific cardiomyopathies;
violation of the electrophysical characteristics of the myocardium.

The disease sometimes develops even in the absence of problems with the heart muscle. Risk factors that in some cases lead to ventricular fibrillation include:

a sharp decrease in blood volume (this causes a drop in pressure and an increase);
severe poisoning (hypokalemia develops and cardiac excitability increases);
hypothermia of the body;
hormonal imbalance that arose due to pathologies of the thyroid gland;
chronic stress or excessive nervous tension;
overdose of drugs: diuretics or cardiac glycosides.

There are cases when the cause of ventricular fibrillation cannot be determined.

Symptoms and signs

You can suspect VF in a person based on characteristic signs:

in 5 sec. the person becomes dizzy and weak;
in 20 sec. the patient loses consciousness;
after 40 sec. from the onset of the attack, the patient experiences characteristic convulsions: the skeletal muscles begin to contract once tonically, and at the same time defecation and urination occur involuntarily;
in 45 sec. from the onset of ventricular fibrillation, the pupils dilate and reach their maximum size after 1.5 minutes.

The breathing of patients with ventricular fibrillation is noisy, frequent, and accompanied by wheezing. By the end of the second minute it becomes less frequent and clinical death occurs.

The patient sometimes has time to complain about:

strong heartbeat;
dizziness and weakness;
heartache.

TO external signs include:

pallor of the skin and mucous membranes;
rapid breathing, shortness of breath;
loss of consciousness;
absence of pulsation in large arteries.

Doctors have 4 minutes to restore heart rhythm. If this cannot be done, then irreversible changes begin in the body.

Find out more about the disease from the video:

Diagnostics and emergency care

Experts determine ventricular fibrillation by external signs. If the doctor is near the patient during the onset of the attack, he will diagnose:

lack of rhythm;
difference between heart rate and pulse;
no difference between I and II heart sounds;
wheezing in the lungs.

Competent resuscitation measures can save a person. If the attack occurred outside the hospital, you must call an ambulance. A person’s complaints, sudden fainting and characteristic convulsions can be used to suspect VF.

Make sure that a state of clinical death has occurred.
We need to start a heart: In the absence of a defibrillator, a sharp blow is given to the sternum.
In cases where the heartbeat is not restored, they begin conduct artificial respiration and heart massage. If resuscitation is carried out by 1 person, then for 2 insufflations he makes 15 rhythmic pressures on the sternum.

More details about resuscitation measures are described in the video:

In a hospital setting or in an ambulance ECG is done. This examination allows for differential diagnosis and establishment of an accurate diagnosis.

With ventricular fibrillation and flutter, the ECG will show the following signs:

P waves are in most cases absent before ventricular contractions;
chaotic frequent waves instead of the necessary QRS complexes;
with flutter the waves will be rhythmic, with ventricular fibrillation they will not.

Treatment tactics

In the hospital, all actions are aimed at restore heart rhythm. These measures are called cardioversion. Doctors perform chest compressions and artificial ventilation. Insufflation of air allows you to provide the body with oxygen.

Gives good results electropulse therapy. The sooner it is carried out, the higher the patient’s chances of survival.

Some argue that after 3 ineffective defibrillator shocks, the patient should be intubated and put on artificial respiration.

VF treatment continues introduction of sodium bicarbonate. Injections are given every 10 minutes until blood circulation is restored.

Increase the effectiveness of electropulse therapy by intracardiac administration of the drug "Adrenaline hydrochloride". But such injections are fraught with complications.

For drug stimulation of the myocardium, “Norepinephrine” and “Mezaton” are used.

If defibrillation is ineffective, then in addition to Adrenaline hydrochloride, "Anaprilin", "Novocainamide", "Lidocaine". The patient continues to undergo cardiac massage and artificial respiration, defibrillation is repeated after 2 minutes.

In cases where the heart stops after electropulse therapy, drugs are administered "Calcium chloride", "Sodium lactate".

Resuscitation measures are carried out until the heart rhythm is restored or signs appear that the brain has begun to die.

Rehabilitation

After ventricular fibrillation, the patient is monitored.

His condition is constantly monitored by: done continuously for 1-7 days.

Treatment is aimed at preventing recurrence of attacks.

If patients have fibrillation due to heart disease, then surgery. Surgeons can install a device that will correct the myocardial rhythm.

Also applies radiofrequency ablation method– this is the introduction of a special device that destroys the pathological focus of abnormal heart rhythm.

Carry out and drug antiarrhythmic therapy. To prevent possible complications, anticoagulants are prescribed. They prevent increased blood clotting and reduce the likelihood of developing a heart attack. They also recommend products that improve metabolism and nourish muscles.

Possible consequences and prognosis

In most cases, complications arise after VF. Better forecast will be in cases where help begins to be provided in the first seconds of an attack. But It is difficult to avoid the negative consequences of such a condition.

When the heart stops total myocardial ischemia. After blood circulation is restored, dysfunction of the heart muscle appears.

The following complications may also develop:

the appearance of arrhythmia;
lung problems: aspiration pneumonia, tissue damage due to rib fractures;
neurological problems (arise due to a temporary deterioration in blood circulation in the brain tissue);
thromboembolism: blockage of blood vessels by blood clots.

When carrying out defibrillation in the first 6 minutes and other resuscitation measures in the first 3 minutes, the probability of survival is 70%. If more than 12 minutes have passed since the onset of the attack, then less than 20% of patients remain alive.

Preventive methods, preventing relapses

Monitoring the work of the heart muscle can reduce the likelihood of developing VF. If the slightest deviation appears, you must consult with doctors and follow their instructions.

give up cigarettes, alcohol, drugs;
focus on plant foods, dairy products;
exclude smoked, fried, fatty foods from the diet;
reduce salt intake;
Lead an active lifestyle, but avoid overload.

After FJ, it is advised to adhere to all medical recommendations and take prescribed medications.

It is difficult to provide competent, timely medical care for ventricular fibrillation. After all, an attack does not always begin in the hospital. Because of this, this disease considered the leading cause of sudden death due to heart problems. You can reduce the likelihood of its development by monitoring the condition and sticking to the basics. the right image life.