There are the following types of arrhythmias.
First, arrhythmias with normal heart rate (heart rate between 60 and 100 beats per minute with irregular heart rhythm) can be seen in the following three conditions.
First, sinus arrhythmia. There can be two types as follows.
1.Respiratory sinus arrhythmia. After the patient holds his breath and activities, the heart rhythm can become neat, but the heart rate accelerates during inspiration and slows down during exhalation.
2, non-respiratory sinus arrhythmia, the patient’s heart rate is fast or slow independent of breathing. These patients do not need to be treated, or only need to remove the cause of the disease can be.
Second, atrial fibrillation (atrial fibrillation). This arrhythmia can have “three inconsistencies”, that is, inconsistent heart sound strength, inconsistent fast and slow, and inconsistent with the pulse (pulse off leakage). Treatment can use propranolol (insulin), verapamil (isoptin), cardiac glycosides such as cetiran and other drugs.
Pre-phase contractions (premature beats). In normal people, the number of preterm contractions can be reduced or disappear after activity; but in patients with organic heart disease, the number of preterm contractions increases after activity, the first heart sound is enhanced, the second heart sound is weakened, and the pulse is dejected. Treatment may include propranolol, verapamil, phenytoin sodium (dalantin), lidocaine, and acetaminophen iodofurone.
Second, arrhythmias with a slow heart rate (heart rate below 40 beats per minute) can be of two types: neat and irregular.
There are two more types of heart rate neatness as follows.
1, sinus bradycardia: heart rate is less than 40~60 beats/min, the intensity of the first heart sound is equal, the heart rate can be accelerated after activity, and the heart beat is consistent with the jugular vein beat. Treatment can be done with atropine, ephedrine and isoproterenol.
2.Complete atrioventricular block: heart rate is less than 40 times/minute, the first heart sound may be of unequal intensity, there are tapping sounds, the heart rate does not increase after activity, and the jugular venous pulsation is not related to the heart rate. Treatment is the same as sinus bradycardia, and a pacemaker can be installed if necessary.
Heart rate irregularities can also be divided into two types.
1. Sinus atrioventricular block: One or several sudden stops in a neat heartbeat, with an interval just double or several times the time between two normal heart sounds. The treatment is the same as sinus bradycardia.
2.Atrioventricular block: Ⅰ degree AV block may have a weakened first heart sound; Ⅱ degree AV block may have heart sound loss and pulse loss; Ⅲ degree AV block has a very slow heartbeat, mostly 30~40 times/minute, the first heart sound varies in strength, and sometimes a loud first heart sound can be heard (i.e. “cannon sound”, for The ventricle is immediately connected to the atrial contraction and the atrioventricular valve is suddenly closed from a lower position). Treatment is the same as sinus bradycardia.
Thirdly, the arrhythmia of rapid heart rate (heart rate over 100 beats per minute), there are two kinds of heart rhythm and irregular heart rhythm.
The neat heart rhythm can be further divided into the following three types.
1, sinus tachycardia: the heart rate is between 100~140 beats per minute, the heart rate is accelerated and slowed down for gradual appearance, the patient is instructed to hold his breath or compress the carotid sinus, which can slow down the heart rate. Propranolol, verapamil and reserpine can be used for treatment.
2. Atrial flutter: The heart rate is between 70 and 160 beats per minute, which is less affected by movement and position. Compression of the carotid sinus can slow down the heart rate in a multiplicative proportion, and the rhythm is irregular when the proportion is unequal. Treatment can be done with drugs such as verapamil, propranolol, acetaminophen and cardiac glycosides.
3, paroxysmal supraventricular tachycardia: heart rate between 150~250 beats per minute, heart rate accelerates or slows down more suddenly, compression of carotid sinus can suddenly restore normal (but may also be ineffective). Treatment may include vagal excitation (e.g., compression of the carotid sinus, eye compression, pharyngeal stimulation, and Valsalva method), as well as drugs such as verapamil, propranolol, cardiac glycosides, neostigmine, etanercept, quinidine, and phenytoin sodium.
Heart rate irregularities can be subdivided into the following two types.
1, paroxysmal ventricular tachycardia: the heart rate is between 160 and 220 beats per minute, the heart rate is slightly irregular, the first heart sound is of unequal intensity, the patient holds his breath or compresses his carotid sinus heart rate does not slow down, and the pulse rate is approximately the same as the heart rate. Treatment can be lidocaine, acetaminophen, procainamide, diisoproterenol, sniff benzylamine and other drugs or electric shock.
2. Atrial fibrillation: The aforementioned “three inconsistencies” can be found on auscultation; in addition, the heart rate can be slowed down when the carotid sinus is compressed. Treatment is the same as for atrial flutter.
In patients with arrhythmias, it is sometimes very difficult to completely prevent the occurrence of arrhythmias, but appropriate measures can be taken to reduce the incidence.