Srdeční arytmie

24.3.2012 , MUDr. Ján Podhorec

srdecni-arytmie.jpg - kopie
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Srdeční arytmie tvoří širokou skupinu onemocnění, které spojuje chybný sled elektrických impulzů v srdci. Různé srdeční arytmie mají různé příčiny, například nějaké předchozí onemocnění srdce, iontová nerovnováha, zánět srdce a další. Srdeční arytmie jsou rozhodně závažná onemocnění, kterým je nutné věnovat náležitou pozornost a důkladně je léčit.

Srdeční arytmie

Srdeční arytmie představují odchylku od normálního srdečního rytmu. To znamená, že se srdce stahuje nepravidelně. Srdce má schopnost automacie, to znamená, že je schopno samo vytvářet stahy a my je nemůžeme vůlí ovlivnit. Shluk buněk, které samy vytvářejí elektrické signály, se nacházejí v pravé síni a nazýváme je sinoatriální uzel. Vysílají signály ostatním buňkám tvořícím srdeční sval, které na toto podráždění reagují stahem. Celý tento mechanismus je pečlivě regulován. Srdce je tak schopno měnit frekvenci svých stahů a tím i množství krve, které vypudí v poměrně v širokém rozsahu. Někdy se ale stává, že proces vytváření pravidelné elektrické aktivity v srdci selže. V tom případě mluvíme o srdeční arytmii, tedy poruše srdečního rytmu.

Příčiny vzniku srdečních arytmií

Příčiny vzniku srdeční arytmie jsou různorodé. Arytmie vznikají při zvětšení srdce u dlouhodobě neléčeného vysokého krevního tlaku, dále u abnormalit v množství minerálních látek přítomných v krvi, působením stresu, při zánětu srdečního svalu a užívání některých léků, u otrav a jiné. Někdy příčina arytmie není známa. Některé druhy arytmií, resp. náchylnost k jejich vzniku lze zdědit. Všechny příčiny mají jedno společné, a to ovlivnění systému srdce vytvářející a vedoucí elektrické signály.

Typy srdečních arytmií

Srdeční arytmie můžeme dělit podle různých kritérií. Pokud je dělíme podle toho, ve které části srdce arytmie vznikají, rozlišujeme tři typy srdečních arytmií, síňové, supraventrikulární nebo komorové. Srdeční arytmie můžeme dělit i dle mechanismu jejich vzniku na poruchy tvorby a poruchy vedení elektrického signálu. Někdy se vyskytuje i jejich kombinace. Třetí možností jak srdeční arytmie rozdělit je podle srdeční frekvence na bradyarytmie, poruchy rytmu vedoucí ke snížení srdeční frekvence, a tachyarytmie, které naopak srdeční frekvenci zrychlují.

Síňové arytmie

Síňové arytmie jsou takové, kde příčina vzniku poruch rytmu srdce vzniká v síních. Mezi síňové arytmie patří fibrilace síní, flutter síní či síňová extrasystola.

  • Fibrilace síní znamená neuspořádané zrychlené stahy buněk v síních. Tím dochází pouze ke chvění síní a ne k jejich stahům. To má za následek nedokonalé plnění komor, hromadění krve v síních, která se může srážet za vzniku trombů. Tento typ srdeční arytmie se vyskytuje u poruch chlopní, či akutního infarktu myokardu. Projevuje se bolestí na hrudi, únavou a dušností. Léčba spočívá v podávání antiarytmik, pokud tato léčba není účinná, indikuje se elektrická kardioverze, při které se pomocí přístroje snažíme navrátit zpět přirozený rytmus srdce.
  • Flutter síní znamená kmitání síní, tedy rychlé stahy svalových buněk síní, které jsou zapříčiněné přítomností jednoho ložiska se zvýšenou aktivitou. To pak vydává signály k rychlým stahům srdečních síní. Flutter síní se projevuje bušením srdce a může trvat pouze několik vteřin, ale i dnů. Dalšími příznaky mohou být závratě, či bolesti na hrudi. K léčbě tohoto typu srdeční arytmie se rovněž užívají léky ze skupiny antiarytmik.
  • Síňová extrasystola je jednou z nejčastějších abnormalit. Jde o přídatný stah síní mimo běžný srdeční rytmus. Tento přídatný stah může vznikat v sinoatriálním uzlu, ale i mimo něj. Klinické projevy nejsou nikterak výrazné.

Komorové arytmie

Komorové arytmie znamenají poruchy srdečního rytmu komorového původu. Rovněž mohou způsobit zrychlení či zpomalení srdeční akce. Mezi nejčastější komorové arytmie patří komorová tachykardie, komorové extrasystoly a komorová fibrilace.

  • Komorová tachykardie představuje zrychlenou srdeční frekvenci, která vzniká v komorách. Často vzniká u pacientů s kardiomyopatií, po prodělaném infarktu či u poruch iontové rovnováhy. Komory se nepravidelně stahují, což má za následek nedostatečný přívod krve především do mozku, může dojít i ke ztrátě vědomí. Dalšími příznaky jsou dušnost a bušení srdce. Léčba komorové tachykardie spočívá v elektrické kardioverzi.
  • Komorová fibrilace představuje nepravidelné chaotické stahy komor, které vedou k neúčinným stahům, a tudíž nedochází ani k pumpování krve z levé komory do těla. Tento typ srdeční arytmie je zcela neslučitelný se životem. Pokud do 3–5 minut není komorová fibrilace zrušena kardioverzí, pacient umírá především v důsledku nevratného poškození mozku.
  • Komorové extrasystoly jsou přídatné stahy vznikající buď přímo v komorách, či v dolní oblasti převodního systému srdce, který za normálních okolností slouží k vedení vzruchu ze síní na komory. Tyto srdeční arytmie se mohou vyskytovat i u zcela zdravých jedinců. Komorové extrasystoly jsou často bezpříznakové, ale mohou se projevit bušením srdce, bolestmi na hrudi i ztrátou vědomí. K léčbě komorových extrasystol se užívají antiarytmika, při neúčinné léčbě se přistupuje k chirurgickému odstranění ložiska, které způsobuje abnormální stahy. Některým pacientům je nutné pro úspěšnou léčbu implantovat defibrilátor.

Následky srdečních arytmií

Následky srdečních arytmií závisí od jejich typu. Některé se nemusí nikterak projevit a vyskytují se i u zdravých jedinců, například síňové extrasystoly. Nejzávažnější a život ohrožující jsou například fibrilace srdečních komor, kdy srdce není schopno se efektivně stáhnout a vypudit krev do těla. U některých arytmií, např. fibrilace síní, se zpomaluje tok krve, což je faktor příznivý pro vznik krevní sraženiny, trombu. Takto vzniklý trombus se poté může dostat do plic a způsobit tzv. plicní embolii, která je často smrtící komplikací. Krevní sraženina může rovněž být unášena krví například do mozku a následkem může být mozková mrtvice.

První pomoc u srdečních arytmií

Na srdeční arytmie je třeba pomyslet, pokud si pacient stěžuje na bolest na hrudi, dušnost a bušení srdce. Arytmie jsou často příčinou ztráty vědomí. V případě zástavy srdeční činnosti a ztráty vědomí je nutné zahájit první pomoc v podobě masáže srdce. Protože může jít o velmi nebezpečný stav, je nutno zabezpečit lékařskou pomoc co nejdříve. I v případě, že potíže náhle nastoupí i odezní, je vhodné navštívit lékaře. Řádným vyšetřením lze případným dalším obtížím předejít.

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