Atrial flutter and atrial fibrillation

Overview of atrial flutter and atrial fibrillation occurred in the atrium of the impulse frequency than the faster tachycardia arrhythmias. Beware the ectopic pacing point up the frequency of 250 -350 times / hours atrial contraction fast and coordination of atrial flutter. If the frequency of "350 / sub-without rules, compared with atrial fibrillation. They may have sustained paroxysmal and chronic type of two types. Etiopathologic etiology and pathogenesis of atrial flutter and fibrillation of the same basic causes, the most common of rheumatic heart disease, mitral stenosis, followed by coronary heart disease, hyperthyroidism heart disease, cardiomyopathy (including Keshan disease), myocarditis, Hypertensive heart disease. There are other constrictive pericarditis, sick sinus syndrome. Paroxysmal atrial fibrillation could not find a few obvious cause, said idiopathic atrial fibrillation. In recent years, some people think may be related to HIV infection or transmission organizations degeneration or autonomic function unstable factors. Pathogenesis of atrial fibrillation and flutter to the pathogenesis : The main excitement is back and ectopic pacing points higher self-discipline, and return to multiple micro-reentrant agitated or more reasonable theory. Clinical manifestations on hemodynamics and cardiac function and the impact caused by the symptoms, mainly depend on the recovery of ventricular rate and the severity of the original heart. BURSTING or continuing-at the onset of ventricular often faster rate, palpitations, chest tightness and panic symptoms more notable. Ventricular rate closer to the normal function of the circle smaller, lighter symptoms. Rapid atrial fibrillation, left atrial pressure and pulmonary venous pressure can be increased dramatically acute pulmonary edema. After atrial fibrillation also can lead to heart room thrombosis, shedding some of thrombosis can cause systemic arterial embolization. Atrial fibrillation is the main signs is absolutely irregular rhythm, heart sounds, ranging from strong or weak, the pulse of patients is significantly lower than the number of cardiac, as a short pulse basis. Atrial flutter when the pacemaker rules or irregularly, depending on atrial and ventricular conduction ratio which, according to the rules if the transmission ratio as three : 1 or 6:1, and so on. Legal rules were ventricle. An electrocardiogram, atrial flutter ① P wave disappeared, substituting shape, spacing and amplitude of absolute rule, Sawtooth was kind of atrial flutter wave (F-). Frequency 250 -350 per minute meeting. ② the most common atrioventricular ratio of 2 : 1, generated about 150 minutes fast and ventricular legal rules, This was followed by four : a proportion of the atrioventricular form every 70-80 minutes on the ventricular rate. Sometimes atrioventricular proportion constant, caused irregular ventricular law. ③ QRS morphology more with the same sinus rhythm, but also interested indoor difference conduction. (Chart 3-3-10) 2, atrial fibrillation ① P wave disappeared, substituting patterns, spacing and amplitude is absolutely irregular wave of atrial fibrillation (f waves), the frequency 350 -600 per minute meeting; ② QRS interval absolutely irregular shape and amplitude can often range. (Chart 3-3-11) in the treatment of atrial flutter and atrial fibrillation, the exception of the etiology and treatment of incentive, It should be noted ventricular rate control, ectopic rhythm and the conversion to prevent recurrence. 1, atrial flutter episodes of ventricular rate fast, it is appropriate treatment of digitalis. General should use the West to Portland intravenous injection, ventricular rate control in each of the following 100 minutes, if sustained atrial flutter. to consider or quinidine synchronous DC conversion. Atrial flutter Minute rate -- a success rate of over 95%, and electric energy required for smaller, more use of quinidine security, conditional to first use. Quinidine or oral amiodarone may also terminate the attack and repeated the author, requires long-term service quinidine or amiodarone prevention. 2, atrial fibrillation (1) acute atrial fibrillation should first address the treatment of the primary disease. Fast heart rate and symptoms, the first choice to Portland West intravenous heart rate to slow down. Some patients with West to Portland can be converted to sinus rhythm. If symptoms continue to be a serious, viable electrical cardioversion therapy. No serious cardiovascular damage, the choice of digitalis, calcium channel blockers or beta blockers can be extended to the atrioventricular node refractory period. slower atrioventricular often can effectively reduce heart rate. (2) chronic atrial fibrillation Atrial fibrillation enable cardiac output decreased, as a change of sinus rhythm is beneficial to the patient. But whether it is electrical cardioversion or drug cardioversion is quite dangerous, and after cardioversion must also maintain long-term medication, the relapse rate was high. Therefore, in considering the complex legal, it should be based on the patient's specific conditions, it is estimated that cardioversion and the success rate to maintain the possibility of sinus rhythm, Weighing the pros and cons and make a decision. Cardioversion available after quinidine or similar drug relapse prevention. If unsuccessful or cardioversion of atrial fibrillation recurrence, then calcium antagonists, beta blockers, digitalis or ventricular rate control.