It is poorly tolerated and is characterized by QRS complexes of the same height and no isoelectric line between them and the T wave is absent. Differences between the QRS and ST-T can not be identified. The ups are the same as ups, which means that the ECG can be inverted. The frequency is 200-250 h 1 min. If it persists through defibrillation, it usually leads to ventricular fibrillation. In rare cases, it terminates itself.
The more damaged myocardium, the lower the amplitude of the flutter of teeth, though it usually exceeds 10 mm in some leads. In a healthy heart ventricular flutter teeth are the same as in ventricular fibrillation.
Ventricular fibrillation and atrial flutter often exist together or one violation goes to the other. By analogy with atrial flutter can talk about a typical or atypical flutter or ventricular fibrillotrepetanii ventricles. On the other hand, there may be an intermediate situation between ventricular tachycardia and atrial flutter before they will be well established atrial flutter. From the clinical and prognostic point of view of ventricular flutter is an emergency situation that must be addressed in the same way as ventricular fibrillation.
Ventricular fibrillation. If for any reason (electrolyte imbalance, ischemia), there is an asynchronous repolarization of myocardial fibers, is the ventricular premature complex, usually premature, and often two or more, unless there is severe disease of the heart can cause ventricular fibrillation in the most vulnerable period of the ventricles. The mechanisms responsible for atrial flutter and ventricular fibrillation and in the ventricles, are basically the same as in atrial fibrillation: repetitive micro-reentry or the formation of pulses in multiple foci. Data in favor of repeating micro-reentry etiology more.
ECG records the uneven teeth of various shapes and heights, as well as an increased frequency (300-500 in 1 min), QRS complex and ST-T segment is becoming indistinguishable from each other. If the teeth are relatively broad and frequent, the outlook for the elimination of ventricular fibrillation with defibrillation is much better than when they are slow and low. However, it was experimentally shown that a significant fibrillation is not a greater synchronization of electrical activity in comparison with fine fibrillation.
The more damaged myocardium, the lower the amplitude of the flutter of teeth, though it usually exceeds 10 mm in some leads. In a healthy heart ventricular flutter teeth are the same as in ventricular fibrillation.
Ventricular fibrillation and atrial flutter often exist together or one violation goes to the other. By analogy with atrial flutter can talk about a typical or atypical flutter or ventricular fibrillotrepetanii ventricles. On the other hand, there may be an intermediate situation between ventricular tachycardia and atrial flutter before they will be well established atrial flutter. From the clinical and prognostic point of view of ventricular flutter is an emergency situation that must be addressed in the same way as ventricular fibrillation.
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| Ventricular flutter. Ventricular fibrillation |
Ventricular fibrillation. If for any reason (electrolyte imbalance, ischemia), there is an asynchronous repolarization of myocardial fibers, is the ventricular premature complex, usually premature, and often two or more, unless there is severe disease of the heart can cause ventricular fibrillation in the most vulnerable period of the ventricles. The mechanisms responsible for atrial flutter and ventricular fibrillation and in the ventricles, are basically the same as in atrial fibrillation: repetitive micro-reentry or the formation of pulses in multiple foci. Data in favor of repeating micro-reentry etiology more.
ECG records the uneven teeth of various shapes and heights, as well as an increased frequency (300-500 in 1 min), QRS complex and ST-T segment is becoming indistinguishable from each other. If the teeth are relatively broad and frequent, the outlook for the elimination of ventricular fibrillation with defibrillation is much better than when they are slow and low. However, it was experimentally shown that a significant fibrillation is not a greater synchronization of electrical activity in comparison with fine fibrillation.
Ventricular fibrillation is characterized by partial, unsynchronized contractions of the ventricles, which are not accompanied by efficient pumping activity of the heart, which leads to heart failure.
Most susceptible to such disruption, patients with ischemic heart disease, especially in the acute phase of myocardial infarction, and patients with frequent or repetitive ventricular premature reentry and significant cardiomegaly with poor ventricular function, who already had a ventricular fibrillation outside the hospital or have some electrolyte imbalance and metabolism. It was believed that patients with acute myocardial infarction and primary ventricular fibrillation (ventricular fibrillation in the absence of violations of the pumping function) in the acute phase does not have a more favorable prognosis than patients without atrial fibrillation. However, recent studies have shown that infarct with primary ventricular fibrillation occurring in the first few hours, is characterized by a higher hospital mortality and could happen again, as a harbinger of heart failure. Moreover, patients who had ventricular fibrillation during acute anterior wall infarction have a poorer prognosis than patients with inferior wall infarction.
In the study of hospitalized coronary patients, mostly with myocardial infarction, ventricular fibrillation was detected in almost 50% of patients with the phenomenon of R / T, 25% of cases - with late arrhythmia and almost 10% with stable ventricular tachycardia. Other studies have shown the close relationship between the primary ventricular fibrillation, and the phenomenon of R / T. Ventricular fibrillation causes sudden death in nearly 70% of outpatients, and it often develops as a result of ventricular tachycardia. In the remaining 30% half of the deaths were caused by the rhythm of the "pirouette" and the other half - underactivity arrhythmias.
Ventricular fibrillation may occur with a favorable clinical course or the terminal stages of any disease. In very rare cases, ventricular fibrillation terminated by itself. In general, it causes cardio-pulmonary failure and death of the patient, if not immediately taken care (intensive care, cardiovascular events).
Patients in whom ventricular tachycardia was eliminated, not associated with acute myocardial infarction should continue to be treated to prevent new attacks with the help of drugs, implants minidefibrillyatora (if required), or surgery, but if the ejection fraction is very low, eliminating the possibility of such violations is limited . According to some authors, in individuals with arrhythmia Lown type II or IV, but without the occurrence of sustained ventricular tachycardia or fibrillation, ventricular tachycardia, in response to programmed stimulation is an indicator of poor prognosis, especially in cases where the ejection fraction is less than 40%. However, other researchers have reported contradictory results. In terms of these conflicting data, the current practice in post-MI patients with EPS can not be recommended.
Patients with heart failure, which happened outside the hospital and, most often due to ventricular fibrillation, should be thoroughly examined (coronary angiography, ECG, exercise, EPS). The choice of treatment depends on the results of the survey, there is currently no consensus as to what treatment or the treatment system of choice are preferred.
Chaotic ventricular rate. The term "chaotic ventricular rate" applies to those cases in which more or less simultaneously, there are ventricular tachycardia, ventricular flutter, atrial rhythms, and pop-up as a result of various sinus dysfunction or AV block. This rhythm is often observed in moribund states, and usually leads to heart failure (apparent isoelectric line).
Most susceptible to such disruption, patients with ischemic heart disease, especially in the acute phase of myocardial infarction, and patients with frequent or repetitive ventricular premature reentry and significant cardiomegaly with poor ventricular function, who already had a ventricular fibrillation outside the hospital or have some electrolyte imbalance and metabolism. It was believed that patients with acute myocardial infarction and primary ventricular fibrillation (ventricular fibrillation in the absence of violations of the pumping function) in the acute phase does not have a more favorable prognosis than patients without atrial fibrillation. However, recent studies have shown that infarct with primary ventricular fibrillation occurring in the first few hours, is characterized by a higher hospital mortality and could happen again, as a harbinger of heart failure. Moreover, patients who had ventricular fibrillation during acute anterior wall infarction have a poorer prognosis than patients with inferior wall infarction.
In the study of hospitalized coronary patients, mostly with myocardial infarction, ventricular fibrillation was detected in almost 50% of patients with the phenomenon of R / T, 25% of cases - with late arrhythmia and almost 10% with stable ventricular tachycardia. Other studies have shown the close relationship between the primary ventricular fibrillation, and the phenomenon of R / T. Ventricular fibrillation causes sudden death in nearly 70% of outpatients, and it often develops as a result of ventricular tachycardia. In the remaining 30% half of the deaths were caused by the rhythm of the "pirouette" and the other half - underactivity arrhythmias.
Ventricular fibrillation may occur with a favorable clinical course or the terminal stages of any disease. In very rare cases, ventricular fibrillation terminated by itself. In general, it causes cardio-pulmonary failure and death of the patient, if not immediately taken care (intensive care, cardiovascular events).
Patients in whom ventricular tachycardia was eliminated, not associated with acute myocardial infarction should continue to be treated to prevent new attacks with the help of drugs, implants minidefibrillyatora (if required), or surgery, but if the ejection fraction is very low, eliminating the possibility of such violations is limited . According to some authors, in individuals with arrhythmia Lown type II or IV, but without the occurrence of sustained ventricular tachycardia or fibrillation, ventricular tachycardia, in response to programmed stimulation is an indicator of poor prognosis, especially in cases where the ejection fraction is less than 40%. However, other researchers have reported contradictory results. In terms of these conflicting data, the current practice in post-MI patients with EPS can not be recommended.
Patients with heart failure, which happened outside the hospital and, most often due to ventricular fibrillation, should be thoroughly examined (coronary angiography, ECG, exercise, EPS). The choice of treatment depends on the results of the survey, there is currently no consensus as to what treatment or the treatment system of choice are preferred.
Chaotic ventricular rate. The term "chaotic ventricular rate" applies to those cases in which more or less simultaneously, there are ventricular tachycardia, ventricular flutter, atrial rhythms, and pop-up as a result of various sinus dysfunction or AV block. This rhythm is often observed in moribund states, and usually leads to heart failure (apparent isoelectric line).
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