Short pulse

Introduction The pulse is the peripheral arterial pulsation caused by the heartbeat wave passing through the blood vessel. The short pulse of the pulse is due to the weakness of the heartbeat contraction, and the amount of blood that is beaten is too small, so that it cannot cause the pulsation of the surrounding artery. This condition can be seen in premature beats, but it is most common in atrial fibrillation. During the normal heartbeat, a premature premature beat occurs, but since the heart is in a state of contraction, the filling of the ventricle is in an insufficient state, so the amount of blood that is beaten is inevitably small, which is not enough to cause the surrounding blood vessels to pulsate, so this is early. Heart beats can only hear heart sounds and can't touch the pulse. Atrioventricular fibrillation, ventricular beats are extremely irregular. Premature heartbeats are also the same as premature premature beats. Pulses are lost due to less cardiac output, and the heartbeat of atrial fibrillation is faster, and the pulse is shorter. obvious. Atrial fibrillation, referred to as atrial fibrillation, is a common arrhythmia in the elderly. Most of them occur in people with significant lesions in the heart. The most common ones are rheumatic heart disease, especially mitral stenosis, followed by coronary heart disease. Other common causes are hypertensive heart disease, hyperthyroidism, and chronic disease. Constrictive pericarditis, digitalis poisoning, etc., a few healthy people can also have atrial fibrillation. Clinically, atrial fibrillation is divided into paroxysmal atrial fibrillation and persistent atrial fibrillation according to the duration of its atrial fibrillation. Recurrent episodes of paroxysmal atrial fibrillation can be converted into permanent atrial fibrillation.

Cause

(1) Causes of the disease

Atrial fibrillation can occur regardless of gender, age, or organic disease. However, the majority of the elderly, atrial fibrillation can be either a heart disease or a clinical manifestation of systemic diseases. There are many causes of atrial fibrillation, mainly diseases of the heart itself. Developed countries are mainly coronary heart disease and myocardial disease, while developing countries have the most rheumatic valvular heart disease. Older people may be caused by hidden hyperthyroidism or atrial septal defect. A small number of atrial fibrillation can not find a clear cause, known as isolated atrial fibrillation or idiopathic atrial fibrillation.

1. Rheumatic valvular heart disease: Rheumatic valvular heart disease is still the most common cause of atrial fibrillation, especially in mitral stenosis combined with regurgitation. Among them, in patients with mitral stenosis, atrial fibrillation was 41%, and the chance of atrial fibrillation in aortic valve disease was small. The average age at which a patient has atrial fibrillation is approximately 37 years old, with a majority of women.

The mechanism of atrial fibrillation in rheumatic valvular heart disease is associated with left atrial enlargement, elevated atrial pressure, and atrial myopathy. Atrial enlargement, increased pressure, and atrial fibrotic lesions result in a non-uniform refractory period in various parts of the atrial muscle, which induces atrial fibrillation.

2. Coronary heart disease: With the increase of the incidence of coronary heart disease, coronary heart disease has become the leading cause of atrial fibrillation in many countries and regions, and the proportion of the elderly is higher. However, atrial fibrillation is not a common clinical manifestation of coronary heart disease. Among patients with significant coronary stenosis in coronary angiography, atrial fibrillation accounts for 0.6% to 0.8%, and acute myocardial infarction accounts for 10% of atrial fibrillation. ~15%.

3. Cardiomyopathy: Atrial fibrillation can occur in all types of cardiomyopathy, the incidence rate is between 10% and 50%, which is more common in adults and can occur in children. Primary congestive cardiomyopathy is the main cause, accounting for about 20%.

4. Hypertensive heart disease: The ratio of hypertension in the cause of atrial fibrillation is 9.3% to 22.6%. The occurrence of atrial fibrillation is related to cardiac electrophysiological abnormalities of hypertrophic myocardium caused by hypertension, hypertrophic myocardial ischemia and hypertrophic myocardial fibrosis. Atrial fibrillation is caused by myocardial hypertrophy and fibrosis, ventricular dysfunction, increased atrial pressure, and enlarged left atrium, plus myocardial ischemia, which induces atrial electrophysiological disturbances.

5. Constrictive pericarditis: the incidence of general patients is 22% to 36%, the incidence of atrial fibrillation in elderly patients can reach 70%, and pericardial effusion can also be associated with atrial fibrillation.

6. Pulmonary heart disease: Atrial fibrillation in pulmonary heart disease has been reported to be 4% to 5%. Often paroxysmal, the cause is related to repeated infections in the lungs, long-term hypoxia, acidosis and electrolyte imbalance.

7. Congenital heart disease: In congenital heart disease, atrial fibrillation is mainly seen in atrial septal defect.

8. Sick sinus syndrome: In 1967, Lown proposed the concept of sick sinus syndrome, including persistent sinus bradycardia, sinus arrest and sinus block and bradycardia - tachycardia Here, the tachycardia includes atrial fibrillation. When sinus bradycardia, the ectopic excitability of the atria is enhanced, and atrial fibrillation is prone to occur.

9. Pre-excitation syndrome: The main complication of pre-excitation syndrome is paroxysmal atrioventricular reentry tachycardia, followed by atrial fibrillation. The incidence of atrial fibrillation is about 12% to 18%. It is generally believed that the incidence of atrial fibrillation in ventricular pre-excitation is related to age, seldom occurs in children, and the incidence of atrial fibrillation is higher in older patients. The mechanism of ventricular pre-excitation of atrial fibrillation is currently unclear, and may be associated with pre-excitation caused by supraventricular tachycardia, leading to atrial electrophysiological instability, or ventricular premature contraction, retrograde atrial resection through the atrioventricular bypass. Atrial fibrillation caused by atrial vulnerability. In addition, bypass anterior refractory period is short and easy to induce atrial fibrillation.

10. Hyperthyroidism Atrial fibrillation is one of the main symptoms of hyperthyroidism. The incidence of atrial fibrillation in patients with hyperthyroidism is 15% to 20%. Elderly hyperthyroidism may have organic damage to the heart muscle, prone to chronic atrial fibrillation.

an examination

Related inspection

Pulse pulse wave velocity

Clinical manifestation

(1) Symptoms:

1 Symptoms: In addition to the hemodynamic changes caused by underlying heart disease, atrial fibrillation causes atrial contraction loss, ventricular contraction becomes irregular, and ventricular rate increases. The most common symptom of the patient is Heart palpitations. If combined with coronary heart disease, patients may have angina pectoris, dizziness, syncope, severe heart failure and shock. Such as combined with rheumatic mitral stenosis, often induced acute pulmonary edema, accompanied by pulmonary hypertension can occur hemoptysis.

2 asymptomatic: some slow and moderate atrial fibrillation, patients can have no symptoms, especially in the elderly, often found in physical examination or ECG.

3 atypical symptoms: seen in slow or moderate-speed atrial fibrillation, patients with no palpitations, may have fatigue, fatigue, pre-cardiac discomfort or slight pain, need to do further related tests before diagnosis.

(2) Signs:

1 The signs of the original heart disease, the signs of atrial fibrillation vary with the original heart disease.

2 three signs of atrial fibrillation: the first heart sounds of the apex are different, the heart rhythm is absolutely uneven, and the pulse is short.

3 embolism sign: patients with atrial fibrillation can occur in the brain, lung and limbs vascular embolism. The incidence of embolism is related to age, atrial size, and underlying heart disease. The incidence of cerebral infarction in patients with atrial fibrillation is five times higher than in the normal population. Atrial fibrillation has a loss of effective atrial contraction, and blood flow in the atria slows down, even stasis, which is conducive to the formation of blood clots. Thrombosis can cause various embolic complications, and mitral stenosis is more likely to cause thrombosis. According to statistics, in patients with mitral stenosis complicated with atrial fibrillation, 40% of patients have left atrial wall thrombosis; in mitral stenosis with sinus rhythm, only 2% have wall thrombosis.

2. Classification

(1) Classification according to the duration of atrial fibrillation:

1 Acute atrial fibrillation is atrial fibrillation that occurs within 24 to 48 hours.

2 chronic atrial fibrillation includes:

A. Paroxysmal atrial fibrillation: refers to the duration of the episode within one month, and lasts for several minutes to several days, and can be spontaneously terminated.

B. Persistent atrial fibrillation: The attack lasts for more than 1 month and requires intervention to restore sinus rhythm. Most organic heart disease, some paroxysmal atrial fibrillation can develop into persistent atrial fibrillation.

C. Persistent atrial fibrillation: refers to atrial fibrillation that cannot maintain sinus rhythm after conversion or conversion.

(2) Classification according to ventricular rate. Can be divided into slow-type atrial fibrillation: ventricular rate ventricular fibrillation. The ventricular rhythm should be controlled as soon as possible, and medication or cardioversion should be applied.

(3) Classification according to the characteristics of seizures:

1 vagus-mediated atrial fibrillation: increased vagal tone as an inducer, more common in patients without structural heart disease; seizures mainly at night, also seen in rest, drinking or after meals; ECG showed sinus bradycardia before seizure Stimulate the vagus nerve or apply stimulants to induce.

2 sympathetic-mediated atrial fibrillation: sympathetic excitation as the cause, more common in patients with structural heart disease, seizures mostly during the day, especially during strenuous exercise or emotional excitement, the electrocardiogram can show accelerated sinus rhythm before the onset, up to 90 times / min or more. Exercise or application of sympathetic stimulants (such as isoproterenol) can often be induced.

History

(1) Symptoms: The heart palpitations can be paroxysmal or persistent.

(2) Asymptomatic.

(3) The symptoms are not typical, or only chest tightness and fatigue.

2. Signs

The heart rhythm is absolutely uneven, the heart sounds are not strong and the pulse is short.

3. ECG

(1) The P wave disappears with the f wave with different amplitude, shape and rhythm; the frequency is 350-600 times/min, and the f wave can be quite obvious, similar to the impure atrial flutter; it can also be slender and difficult to identify.

(2) The RR spacing is absolutely irregular.

In the elderly, there are generally pathological and physiological conduction abnormalities, sometimes coexisting with other types of arrhythmia, such as pre-systolic, paroxysmal supraventricular or ventricular tachycardia, and various atrioventricular block, And the ECG performance is not typical.

Differential diagnosis

1. Atrial fibrillation combined with early and indoor differential conduction: clinical is more common, should pay attention to identification, guidance treatment.

2. Atrial fibrillation with rapid wide deformity QRS wave: common in atrial fibrillation with bundle branch block, ventricular tachycardia, pre-excitation syndrome. Its clinical significance varies widely.

3. Atrial fibrillation and slow ventricular rate: the elderly often have a diminished function of the atrioventricular conduction system, so it is prone to slow ventricular rate. About 70% of atrial fibrillation occurs in organic heart disease. The diagnostic criteria mainly depend on electrocardiogram, especially 24h dynamic electrocardiogram. For patients complaining of angina pectoris, attention should be paid to the occurrence of atrial fibrillation in the onset of angina pectoris. If the abnormality occurs, it is highly suggestive that the underlying disease is coronary heart disease. For newly occurring atrial fibrillation, 24h dynamic electrocardiogram should be recorded, serum T3, T4, and blood ions should be examined simultaneously, and echocardiographic examination of left atrial diameter and left ventricular function should be performed. And whether there is a heart cavity thrombosis.

It is useful for diagnosing the cause and guiding treatment.

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