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    Diagnosis of atrial fibrillation using ECG



    The disease is expressed in frequent and chaotic contractions of the heart muscle, in which the pulse rate reaches 300-700 beats per minute. Frequent and irregular contractions of the heart make normal atrial contraction impossible and often lead to impaired blood circulation, shortness of breath, pain in the heart, and other symptoms. At the same time, the diagnostic and treatment methods used today make it possible to correct the functioning of the heart muscle, which makes it possible to stop or significantly slow down the development of the disease. Therefore, it is important to diagnose the presence of atrial fibrillation in time.

    Atrial fibrillation is not among the dangerous diseases, but very often serves as a harbinger of the occurrence of serious cardiac pathologies.

    Symptoms of atrial fibrillation

    Despite the fact that this disease occurs in representatives of all age categories, statistics show a significant increase in its occurrence after 40 years - it is in people of mature and old age that atrial fibrillation is detected most often.

    As a rule, the patient identifies the need for diagnosis on his own, according to the characteristic sensations that accompany this disease. Nevertheless, there are many cases when atrial fibrillation is asymptomatic.

    The main symptoms include:
    • Sudden increase in the frequency of contractions of the heart muscle. It is felt as a sharp sensation of an increased heartbeat, which in most cases lasts a few seconds or one to two minutes. But in some cases, this symptom is observed much longer, up to several days or weeks, and sometimes forces you to seek emergency qualified help.
    • Instability of the heart muscle. It is felt as interruptions, "fading" of the heart.

    • Feeling of weakness.
    • Shortness of breath, feeling of labored breathing.
    • If there is a history of heart failure, "cardiac edema" appears, usually in the evening, on the legs; when pressing on them, a trace in the form of a hole remains at the place of pressing.

    The appearance of all or several symptoms is the reason for immediate medical attention.

    Causes of pathology

    There are quite a few reasons why atrial fibrillation develops, and in each individual case they are identified by the attending physician after studying the history. The first thing that is usually found out in a patient is the presence of pre-existing diseases of the cardiovascular system. In addition, it is important whether the patient has recently undergone surgery on internal organs located close to the heart - since the development of cardiac arrhythmias in this case is natural and passes naturally over time. Nevertheless, in this case, the patient's condition needs regular monitoring.

    Common causes of the spread of atrial fibrillation are:
    1. Myocardial infarction. This pathology is provoked by stopping the blood supply to the myocardium, which causes the death of part of the muscle tissue and the formation of a scar in this place. As a result of a heart attack, there are manifestations such as angina pectoris and atrial fibrillation. The occurrence and severity of complications are determined by the general condition of the patient and the volume of damaged tissues.
    2. Cardiosclerosis is a pathology that is accompanied by necrosis of cardiac tissues for a number of reasons, which are not always possible to establish. The process of development of the disease consists in the growth of scars and a decrease in the ability of the heart to contract. It is worth noting that atrial fibrillation can be both a precursor of cardiosclerosis and its consequence.
    3. Hypertension is one of the common causes of atrial fibrillation, since high blood pressure increases the load on the heart and blood vessels. Atrial fibrillation is one of the complications of the disease along with angina pectoris and tachycardia.
    4. Thyrotoxicosis - serves as a provoking factor for the appearance of arrhythmia due to a pathological increase in the level of thyroid hormones, which affects the contractility of the heart.
    These are far from the only factors influencing the development of the diagnosis.
    In addition to pathological causes, there are factors that are part of everyday life:

    • stress;
    • smoking;
    • drinking large amounts of alcohol;
    • unstable daily routine, chronic lack of sleep;
    • sedentary lifestyle;
    • obesity;
    • diabetes;
    • a long course of taking drugs that affect the functioning of the heart.

    Whatever caused the symptoms indicating the possible development of pathology, it is recommended to undergo a diagnosis as soon as possible.

    Diagnosis of atrial fibrillation using ECG

    To identify signs indicating that the atrium is working with deviations and the development of fibrillation is possible, any doctor can by measuring the pulse. However, the first serious examination method is an electrocardiogram, which allows you to determine with high accuracy whether atrial fibrillation occurs. ECG is a painless and non-invasive procedure available at any clinic. The graphic result that the electrocardiograph gives is something like a photo, which depicts the rhythm of the heart during the entire procedure.

    With the seeming simplicity of taking a cardiogram, deciphering the results of the examination is actually more difficult than many people think. In part, the accuracy of diagnosis depends on the patient himself. But in many ways, the information content of the ECG is determined by the professionalism of the doctor who makes a description of the study and gives his opinion.

    How to prepare for an EKG

    It is important to do everything on your part to ensure that the results are as correct as possible.

    To do this, it is important to follow a number of recommendations before taking an ECG:

    1. Do not allow excessively dense meals for several hours before the procedure.
    2. Refrain from smoking for 12 hours.
    3. Never drink alcohol.
    4. Do not take drinks with a high content of caffeine.
    5. Avoid stress and increased physical activity during the day before the procedure.
    6. By prior consultation with your doctor, avoid taking medications that affect the functioning of the heart.

    Neglecting at least one of these recommendations will affect the result of the examination, which in this case loses all meaning, since the electrocardiogram data in this case may turn out to be completely unreliable.

    Before the examination, it is better to come in advance and sit quietly for a few minutes. This will allow the heartbeat to return to its natural rhythm.

    How is an EKG done?

    The essence of the procedure is to fix the electrodes at various points on the patient's body. Before starting the procedure, you need to free from clothing all those parts of the body where the electrodes will be located: undress to the waist and expose the legs to the knee. With this in mind, it is best to come to the procedure in loose clothing that is easy to remove.

    After preparing for the procedure, the patient lies down on the couch, where the examination will take place. The medical worker conducting the examination treats the areas of the body in contact with the electrodes with a special gel to increase the adhesion of contacts to the skin. After that, the electrodes are fixed, and within a few minutes the electrocardiograph reads and prints the data in the form of a graph. The most important recommendation during the procedure is to lie absolutely still, because even the slightest movement will be reflected by the electrocardiograph in the form of lines or teeth, indistinguishable from graphic images of the rhythm of the heart. Therefore, before starting the procedure, you must immediately take a comfortable position and relax.

    What does atrial fibrillation look like on an ECG?

    The electrocardiogram obtained as a result of the examination is 12 leads, each of which looks like a line with intervals and teeth. Excitation of the atria on the ECG is fixed in the form of a tooth, after which a short interval is depicted, the picture of which reflects the excitation of the septum between the atria.

    After that, a line is fixed, reflecting the excitation of the ventricles of the heart, followed by repolarization (the phase of muscle relaxation), which looks like an interval and a tooth. When the atrium works without pathologies, all elements of the cardiogram are shown with equal width and the same height. But if changes are recorded in at least one of the indicators, this indicates a violation in the work of the heart muscle.

    With atrial fibrillation, the cardiogram displays rhythm disturbances, extraordinary random phases of excitation of the heart muscle. At the same time, the teeth that fix the excitation of the atria are normal, in the case of the presence of this pathology, there are no on the cardiogram; instead of them, the line segment on the ECG is depicted as repeatedly repeating chaotic wavy lines. The frequency of these lines exceeds 200-400 per minute. Interruptions in the rhythm of the heart are fixed in the form of corresponding teeth, which differ in width and repeat unevenly, through unequal distances. At the same time, the lines that fix the work of the ventricles are displayed without significant deviations from the norm and retain the correct shape.

    The difference between fibrillation and atrial flutter

    There is a deviation in the work of the heart, which is also displayed on the ECG - atrial flutter. This pathology is characterized by the sudden onset and cessation of attacks of palpitations (up to 200-400 beats per minute). Pathological excitations occur more often and with greater amplitude, but at the same time, the correct rhythm of the work of the heart muscle is maintained.

    Like fibrillation, in some cases it can be recorded in the form of rhythm disturbances. However, on the ECG, these two deviations differ. In the presence of fibrillation, fragments of the lines that fix the work of the ventricles will be arrhythmic, the frequency of contractions of the heart muscle will show at a minute interval of 300 beats or more. Most often, experienced doctors pay special attention to the complexes that reflect the work of the ventricles, since these indicators are the most obvious and very important in differential diagnosis. However, in the case of controversial ECG results, the wave pattern is taken into account, which, unlike fibrillation, has the correct shape and the same intervals during flutter. In addition, in the case of atrial flutter, contractions of the heart muscle do not exceed 300 beats per minute. As a rule, these criteria are enough for an experienced doctor to make a correct diagnosis.

    For an accurate diagnosis, differential diagnosis is carried out not only with flutter, but also with other types of arrhythmia:
    • sinus tachycardia;
    • ventricular paroxysmal tachycardia;
    • supraventricular paroxysmal tachycardia.
    Accurate diagnosis in this case is especially important, because when the patient presents, the symptoms and complaints are almost the same in all cases.

    However, the treatment of these diseases and the prognosis of their development can vary greatly. For example, in the case of fluttering, treatment is usually limited to the catheter ablation procedure, as a result of which the pathology is completely eliminated. While fibrillation requires therapeutic and supportive therapy, which will have to be adhered to throughout life.

    Fibrillation treatment

    Regardless of whether atrial fibrillation causes concern or is asymptomatic, this pathology creates a high risk of myocardial infarction and blood clots. Therefore, antiplatelet drugs are prescribed to slow the development of atrial fibrillation. To normalize the rhythm of the heart muscle, additional funds are prescribed, which the doctor determines individually according to the clinical picture. In the case of persistent arrhythmia, surgery is recommended in most cases.

    The form of treatment is determined by the results that the ECG study will show, and from the further prognosis of the development of the disease in a particular patient. The goal of treating this pathology is to reduce the frequency of seizures and prevent the development of more severe diagnoses based on existing disorders.

    Article author: Kristina Borisova
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    Diagnosis of atrial fibrillation using ECG