The arrhythmia, called atrial fibrillation more accurately, reflects the disappearance of regular rhythm, said sinus rhythm in favor of a chaotic and irregular.
This is heart disease the most common especially after age 60.
The causes of appearance of the arrhythmia can be schematically cardiac or extra-cardiac:
- Causes the heart: coronary diseases such as heart disease myocardeles cœurl'insuffisance valves of heart, congenital heart disease ...
- Extra-cardiac causes: a problem thyroïdel'obésitéles chronic lung disease (chronic bronchitis) infection with high fever in a patient with a fragile heart.
Sometimes we do not find the cause that triggered the arrhythmia.
The arrhythmia is characterized by an irregular heartbeat and often faster than normal rate (around 120 beats per minute).
The patient complains of palpitations.
One can feel a shortness of breath, fatigue, chest tightness, anxiety.
More rarely, the passage in arrhythmias may be less well tolerated, was complicated by discomfort or shortness of breath that requires hospitalization.
This happens especially when the arrhythmia is very fast on a heart already very tired.
Often the diagnosis is carried by the doctor during a routine examination.
Diseases whose symptoms are similar?
There are other atrial arrhythmias such as atrial flutter, which are rare but occur in the same way as arrhythmia.
It is difficult to avoid the appearance of an arrhythmia unless early treatment of heart disease which is caused by replacing a heart valve for example.
Only an anti-arrhythmic may be effective in preventing relapse.
Finally, it is advisable, as in all patients with heart rhythm problems, avoid stimulants such as tobacco, coffee or tea in large doses, spirits and sparkling wines.
The diagnosis is confirmed by the electrocardiogram (ECG) during episodes of arrhythmia. The ECG is normal apart from the crises.
If your doctor has a strong suspicion of arrhythmia must be a record of 24 hours of ECG, Holter ECG called the 24 H.
Systematically, we realize an echocardiogram to detect heart disease and an underlying blood test for the determination of thyroid hormones.
Sometimes it is necessary to perform a transesophageal echocardiogram to ensure that no clot in the atria.
This is a review done in hospital under general anesthesia. It analyzes the heart via a catheter into the esophagus.
1 / We must restore a normal heart rhythm. Two techniques are possible:
- By drugs 'antiarrhythmic' cordarone ...- by external electric shock.It is performed under general anesthesia in a short well-anticoagulated patients (that is to say whose blood is fluid).
There may be failures.
2 / It is then necessary to maintain normal heart rhythm with medication daily by an anti-arrhythmic.
3 / Then you have to control the heart rate by slowing the heart with drugs of the class of beta-blockers for example.
If the arrhythmia is resistant to these treatments, it is now "burning" the path of conduction charge by sending waves "radio frequency".
There are also new "pace-makers" who diagnose arrhythmias and reduce its duration.
4 / In the beginning anticoagulant therapy with heparin injected is started. Then treatment with anti-vitamin K by mouth may be prescribed.
It prevents the formation of clots in the atria and reduces the risk of stroke. It is sometimes replaced by aspirin at low doses.
Control of the efficacy of this treatment is carried out by blood tests to adjust the level of prothrombin time (PT) and INR.
For the treatment to be effective, the INR should be between 2 and 3.5, or the TP must be between 25 and 40%.
We must also treat the cause.
What should you do?
If poorly tolerated arrhythmia (feeling of discomfort or pain of angina pectoris) made the 15 (SAMU).
Lead a normal life with regular physical activity.
Avoid stimulants (spirits, white wine, champagne, coffee or tea in large doses ...). They may promote relapse, as well as overwork or stress.
It is recommended to see a cardiologist every six months to do an electrocardiogram.
It may be useful to learn how to calculate heart rate by taking your pulse in order to inform the cardiologist recurrence of arrhythmia.
The main constraint is represented by the anticoagulant treatment with anti-vitamin K, which requires regular blood tests, some rules and food which is sometimes difficult to balance.
The external electric shock
This is to convey briefly the heart a small electric shock to stop an arrhythmia.
This treatment is done under general anesthesia of very short duration (few minutes) in the presence of a cardiologist and an anesthesiologist.
We use two paddles on the size of the palm of the hand, placed on either side of the chest, to transmit electrical energy to the heart.
Treatment with anti-vitamin K.
Many patients prone to arrhythmias or having accidents thromboembolic arterial or venous benefit from long term anticoagulant treatment to prevent the occurrence of a blood clot in the heart or vessels.
The anticoagulant therapy is designed to thin the blood, it is also called "AVK" for "vitamin K".
Taking anticoagulants requires:
- Regular medical monitoring. The doctor will decide the dose modifications based on the results of coagulation tests,
- The prohibition of self-medication, including aspirin for headaches, because of possible interference between the drugs may cause bleeding,
- A diet low binding, avoiding regular consumption too (only once a week) of food rich in vitamin K such as cabbage, spinach, broccoli or liver.
You must have a card in his wallet indicating taking this medication.
Should be reported to the dentist, the doctor and nurses.
Arrhythmia is a disease well tolerated but unpredictable, occurring episodic, unpredictable, can last a few minutes as several weeks.
As to the years, crises are more frequent and prolonged, become resistant to treatment to be permanently continuing.
This transition to chronicity is quite well supported.
Some crises may be less well tolerated with the appearance of shortness of breath and need a short hospital stay.
Another relatively rare but serious complication is stroke ("stroke").
The blood pools in the heart and can form a clot.
It from the bloodstream and can clog an artery to the brain or leg.
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