How to live with atrial fibrillation?

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Atrial fibrillation (AF)
is the most common rhythm disorder. It is registered everywhere and occurs in almost all age groups, but the frequency of its occurrence increases with each decade of life.

If you consult a doctor in a timely manner, correctly selected treatment and the patient follows all the doctor’s orders, the prognosis for this disease is quite favorable and the patient’s quality of life does not suffer significantly.

This applies to patients of all age groups, including the elderly.

Normally, the human heart has a conducting system. It is similar to electrical wiring and its function is to conduct impulses from the sinus node located in the left atrium to the heart muscle, causing it to contract. With atrial fibrillation, the function of one “power source” (sinus node) is taken over by multiple arrhythmic foci in the atrium and the heart contracts chaotically. That is why this arrhythmia is also called delirium cordis (delirium of the heart).

These arrhythmic foci can be quite small and multiple, and then this form of AF is called atrial fibrillation

(from Latin fibrillatio - small contractions, trembling). With larger and more organized foci of arrhythmia, they speak of atrial flutter (reminiscent of the flutter of a bird or butterfly wing). Atrial fibrillation is always chaotic and absolutely arrhythmic contractions of the heart. Atrial flutter can be either regular or irregular in shape. In the first case, the rhythm is correct, but in the second, it is as chaotic as in atrial fibrillation. These forms of MA can be distinguished only by ECG. However, the methods of diagnosis and treatment, as well as prevention of these forms of the disease, are the same. Although with atrial flutter there is a greater effect from surgical treatment methods.

Like any disease, MA has its own course. It begins, as a rule, with a suddenly developing episode (paroxysm), which can end as suddenly as it began.

In this case, restoration of normal (sinus) rhythm can occur both spontaneously (on its own) and with the help of special medications - antiarrhythmic drugs.

The further course of this disease is completely unpredictable. After the first paroxysm, this ari often lasts for many years, and then it can appear at the most unexpected moment. Or, conversely, after the first episode, rhythm disturbances become more and more frequent. And, as a rule, with the increase in frequency and lengthening of paroxysms of MA, it gradually turns into a permanent form, that is, it settles in the patient’s heart forever.

In some cases, when paroxysms are repeated quite often and exhaust the patient, the transition of the arrhythmia to a permanent form brings him relief, because each episode of failure and recovery leads to complications.

In any case, you can live with this arrhythmia, you just need to master the basic principles of managing it. However, it should be understood that it is almost impossible to cure this disease once and for all, like many other diseases (bronchial asthma, diabetes mellitus, hypertension, coronary heart disease, etc.) - you can only coexist with MA, control its symptoms and prevent the development of complications.

A special cohort consists of patients with frequent relapses of AF. In this case, we are talking about either incorrect treatment (the patient does not take the medications, or takes them in an insufficient dose, and the problem can be solved with the help of an arrhythmologist). However, in some cases, an increase in paroxysmal AF is a natural course of the disease, indicating that the paroxysmal form of AF will soon become permanent. This process can be interrupted using surgical treatments.

Atrial fibrillation is usually divided into the following forms:

1.According to development mechanisms;
A. atrial fibrillation B. atrial flutter:

correct form
irregular shape

2.By heart rate (HR);

tachysystolic (heart rate 90-100 per minute and above)
bradysystolic (heart rate 60 per minute and below)
normosystolic (heart rate 60-80 per minute)

3. According to the frequency of occurrence of arrhythmia;

paroxysmal (occurring periodically, each such paroxysm (episode of arrhythmia) lasts no more than 7 days and often goes away on its own, sometimes requiring the use of special medications to restore the rhythm)
persistent (lasts more than 7 days and requires active rhythm restoration)
permanent (lasts more than a year and an attempt may be made to restore the rhythm)
constant (lasts more than a year, rhythm restoration is not indicated due to its ineffectiveness)

Naturally, all these forms are combined with each other. For example, the diagnosis may indicate a paroxysmal tachysystolic form of atrial fibrillation, an increase in paroxysms.

The main reasons for the development of MA are:

1. diseases of the cardiovascular system:

hypertonic disease
heart defects
previous heart attacks
previous myocarditis (inflammatory heart disease)
toxic (alcoholic) cardiomyopathy

2. diseases of the bronchopulmonary system:

bronchial asthma
chronic obstructive pulmonary disease
pneumonia

3. diseases of the gastrointestinal tract:

peptic ulcer
erosive gastroduodenitis
HP infection (Helicobacter pylori gastroduodenitis)
cholelithiasis
chronic pancreatitis
inflammatory bowel diseases

4.endocrine disorders:

thyroid disease (thyrotoxicosis)
diabetes

5. infections (ARVI, influenza, sepsis)
6. bad habits:

alcohol abuse
drug use
heavy smoking

7.violation of the work and rest regime (work without days off and holidays, frequent business trips)
8.exacerbation of any concomitant pathology

9.oncological diseases, especially after courses of radiation and chemotherapy

10. combination of factors

AF can be detected when recording an electrocardiogram, when measuring blood pressure (the “arrhythmia” icon flashes on the tonometer screen), or the patient himself feels an unusual heartbeat.

If AF is detected, the patient should immediately contact an arrhythmologist or cardiologist. He will be offered an outpatient examination or, if necessary, hospitalization.

The optimal time to seek medical help is within 48 hours from the moment of the development of MA, since in this case it is possible to restore the rhythm as quickly, effectively and safely as possible.

In the latter case, artificial restoration of sinus rhythm with the help of drugs is called drug cardioversion. In the case when the heart rhythm is restored using an electric current (defibrillator), we talk about electrical cardioversion

One way or another, any form of this disease needs treatment. The global cardiological community has long developed a strategy for the management of such patients and identified the main goals of treating patients with atrial fibrillation.

The drug Anaprilin - reviews

Tayra
https://otzovik.com/review_1314196.html

I have mixed opinions about this drug. I took it for the first time almost 13 years ago. Then it helped me a lot against tachycardia. I took the course for no more than 3 weeks. I did not observe any side effects.

The cardiologist prescribed me anaprilin again 2 years ago (more precisely, it was prescribed as a replacement for a drug that was no longer available in pharmacies). Without hesitation, I purchased and began taking it according to the regimen indicated by the doctor. As a result, I received a whole group of side effects. Namely, severe weakness, very low blood pressure (even though I took a small dose of the drug), fatigue. In general, I had to stop taking anaprilin ahead of schedule.

As for one-time help, as neurologists sometimes advise, I can’t say much - yes, it slows down the pulse, but it won’t solve the problem!

I won’t recommend it because I’m not happy with the side effects at all.

Mireya
https://otzovik.com/review_510788.html

I first tried anaprilin when the emergency doctor discovered that I had high blood pressure (120*90), (my normal blood pressure is 110*70). He gave me an anaprilin tablet and told me to put the tablet under my tongue. According to him, anaprilin acts faster this way.

What I would like to note is that yes... my blood pressure dropped to 90*60, but for me this is already too much... And what’s more, I burned the mucous membrane of my tongue with anaprilin, and the dry mouth did not go away for a long time. After one anaprilin tablet, I treated my tongue with olive oil for a week, since it did not want to obey me and was very painful. I had difficulty chewing food. The skin was peeling off the tongue...

Now I’ll think next time whether to take anaprilin or not. Thanks to bitter experience... Most likely I did something wrong when I took anaprilin, although it seemed like I was only following the doctor’s orders from the ambulance...

Milkiboy
https://otzovik.com/review_4515745.html

Greetings, dear readers, we all know about a drug called Anaprilin “every grandmother has them on hand”, but I will not talk about their direct purpose, but about the fact that with their help you can fight fear...

I myself am very shy, I often experience panic attacks, I had difficulty communicating with the opposite sex...

On the Internet, in search of a solution to my problem, I found a description of these tablets. Indeed, after taking it, I felt some relief and was not so afraid to communicate with people I didn’t know, panic attacks became significantly less

And so let's move on to the method of reception:

Place two tablets under your tongue and hold them until you feel slight weakness and an incomprehensible calmness; as soon as you feel this, spit out the remaining medication and rinse your mouth with water. “Do not swallow saliva or the tablets themselves.”

I also do not recommend abusing Anaprilin because this will lead to a worsening of the situation and also heart problems.

kotenych
https://irecommend.ru/content/pomogaet-ot-volneniya-v-slozhnykh-situatsiyakh-primenyat-s-ostorozhnostyu

Hi all.

I’ll say right away that I didn’t use Anaprilin for its intended purpose, since I don’t have any problems with my heart or blood pressure. But I had the opportunity to experience in practice its other properties, which not everyone knows about.

But first, a little theory (here please correct me if I make mistakes). Anaprilin is an adrenaline receptor blocker. In a stressful situation, this same adrenaline is released in the body in large quantities and begins to affect our body. This is where the physical reaction to stress comes from when it is strong enough: sweating, flushing, trembling hands, rapid heartbeat. Anaprilin blocks these receptors, and they become insensitive to adrenaline. That is, all (or many) physical symptoms disappear (or weaken), and you can behave adequately.

Therefore, Anaprilin can be used in situations such as interviews, public speaking, important exams, etc. Usually 40 mg is enough (but you should always try to get by with a smaller dose). If you don’t swallow it, but put it under your tongue, then 10-20 mg is enough.

I want to warn those who were delighted and ran to buy!

Anaprilin is a heart medicine, so it should be used with extreme caution. You can drink it as rarely as possible and only for a serious reason. Firstly, tolerance to it develops very quickly, meaning you will need to constantly increase the dose to get any effect. I highly do not recommend drinking more than 60-80 mg at a time! Secondly, if taken frequently, you can get serious heart problems. So, no more than a couple of times a month and no more than 40 mg at a time.

Nadezhda S

I couldn’t believe my eyes when 4 years ago I was prescribed Anaprilin to prevent migraines. It was recommended to me back in my senior year. Although we didn’t have the Unified State Exam then, we were no less worried. Since the middle of the year, I began to experience tachycardia when hearing the word “exam,” and in the end, looking at my redness and paleness, they sent me to the hospital. As a result, I took these pills for some time to normalize the nervous system itself with valerian in pills. Now I remember - that would be something to worry about. Graduated with 2 or 3 B's. Apparently, I have an excellent student complex, which I have almost overcome by now, resorting to therapy of common sense and not caring about what is happening :)

And so I was prescribed Anaprilin for migraines. At that time, I had a headache at least once a week, for three days. Sometimes it happened like this: 3rd headache, then 2nd it doesn’t hurt, and then it hurts again.

I drank them for a while but didn’t find any significant changes. There was still a positive change, which is why I give it 5 stars out of 10. The interval between headaches has increased to an average of 5-6 days. That is, the total number of attacks per month decreased, but the migraine itself also tormented me for three days, and the strength of these pains did not decrease.

After the next appointment, the doctor realized that this effect did not suit me or her, she canceled Anaprilin and allowed me to take sumatriptan drugs. They didn’t cause headaches any less often, but there was a real opportunity to relieve the pain for 12 hours.

Elena Lyubimova

Anaprilin was prescribed to me by a doctor several years ago. This medicine is very accessible and inexpensive. I had a slight heart rhythm disturbance, that is, signs of arrhythmia and migraine. The doctor who prescribed this drug was young and inexperienced, and at that time I didn’t particularly understand drugs.

After taking the first tablets, I felt bad and I began to study the instructions for using Anaprilin. In the end, I found the reason myself. The thing is that I always have low blood pressure, and Anaprilin also lowers it. That's why I felt bad. And the doctor who prescribed me the drug Anaprilin simply did not take this into account.

As far as I know, according to the stories of acquaintances and friends, Anaprilin is a good drug, it helps a lot in the treatment of arrhythmia and tachycardia, it just didn’t suit me at all. Before taking Anaprilin, you must carefully study the instructions and take into account contraindications so as not to end up in the same situation as me. It’s also good that I stopped taking this medication at the right time.

Galinka Malinka

I take anaprilin tablets very rarely in order to quickly lower my blood pressure. If you have high blood pressure, emergency doctors and your local physician recommend taking anaprilin.

Anaprilin acts faster if you put it under the tongue, but there is a chance of burning the mucous membrane under the tongue. I myself have encountered this problem, and therefore I put anaprilin tablets under my tongue and wash them down with a little water to further relieve dryness and burning in my mouth.

The price and cost of anaprilin tablets is affordable. You can buy anaprilin at a pharmacy without a prescription. Instructions for anaprilin are included with the tablets without fail.

Reviews about anaprilin tablets are different, so read and draw the appropriate conclusions for yourself...

For those who are not suitable for anaprilin, emergency doctors also advise taking capoten (captopril), capoten (captopril) tablets have a sour taste and do not cause such a burning sensation as anaprilin. The action of anaprilin and capoten is the same.

Be healthy and watch your blood pressure! Now you can measure your blood pressure for free in any pharmacy. After all, it is better to prevent a disease than to treat it for a long time and sometimes unsuccessfully...

These include:

1. Rhythm control/pulse rate control
If rhythm disturbances occur more than once or twice a year, constant use of antiarrhythmic drugs is necessary.

Tactics to actively restore and maintain normal (sinus) rhythm using AAP are called rhythm control tactics. It is preferable in those patients with paroxysmal, permanent and persistent forms of the disease who lead an active lifestyle and do not have solid concomitant pathology. With fairly frequent, prolonged episodes of AF, ongoing planned antiarrhythmic therapy is also mandatory. Often, an increase in paroxysms is a natural course of the disease. But in some cases, this form of MA is caused by improper treatment, when the patient takes medications in insufficient doses or is not treated at all. It is the arrhythmologist who is called upon to select the treatment regimen that will help the patient cope with the disease. If it is unsuccessful, the patient may be recommended to consult a cardiac surgeon - arrhythmologist for surgical treatment of AF.

If this arrhythmia becomes permanent, active rhythm restoration is not indicated due to ineffectiveness. Under the influence of a long-term arrhythmia, the structure and function of the heart change and it “gets used” to living with it; it is no longer possible. In such patients, pulse control tactics are used, that is, with the help of medications, a heart rate that is comfortable for the patient is achieved. But no active attempts are made to restore the rhythm.

The following are currently used as antiarrhythmic drugs:

beta blockers (metoprolol, bisoprolol, carvedilol)
propafenone
amiodarone
sotahexal
allapinin
digoxin
drug combination

2.Prevention of complications:
prevention of stroke and thromboembolism

With AF, there is no single, coordinated ejection of blood from the heart; some of the blood stagnates in its chambers and, in the form of blood clots, can enter the vessels. Most often, the blood vessels of the brain are affected and a stroke develops.

In order to prevent it, drugs that affect blood clotting are prescribed - warfarin, rivaroxaban, dabigatran, apixaban, which reliably (more than 90%) protect against stroke.

While taking these drugs, the patient should monitor for bleeding and monitor the complete blood count and creatinine quarterly. (when taking rivaroxaban, dabigatran and apixaban)., or test the INR (international normalized ratio) at least once a month when taking warfarin. This is necessary in order to correctly calculate the dose of the drug and monitor its safety.

Acetylsalicylic acid (aspirin, cardiomagnyl, thromboass) is not routinely used for the prevention of thromboembolism, since the degree of protection against venous thrombosis when used is only 25%.

prevention of heart failure

Heart failure (HF)

– a complication of many heart diseases, including AF. This condition is caused by the lack of full pumping function of the heart, as a result of which the liquid part of the blood stagnates in the tissues and organs, which is manifested by shortness of breath and edema.

For the prevention and treatment of heart failure, ACE inhibitors (enalapril, lisinopril, perindopril, etc.), veroshpiron (eplerenone), and diuretics (torasemide, furosemide, hypothiazide) are used.

3. Surgical treatment is used if there is no effect from medications and is carried out in specialized cardiac surgery clinics.

Types of surgical treatment of MA:

implantation of a pacemaker for bradyform MA
radiofrequency ablation of the pulmonary veins and other arrhythmogenic areas
with paroxysmal tachyform of atrial fibrillation and flutter

Surgery for arrhythmias in general and AF in particular is the “last cartridge” used when drug therapy is unsuccessful.

After surgical treatment, in order to prevent recurrence of arrhythmia, patients are prescribed planned antiarrhythmic therapy.

Thus, treatment of atrial fibrillation is a way of life that involves the patient “working on himself.” And an arrhythmologist helps him with this.

A patient with MA should avoid colds, lead a healthy lifestyle, get rid of bad habits and avoid factors leading to its development, and strictly follow all the recommendations of his doctor. The doctor will help you choose an individual treatment regimen and recommend what to do if a recurrence of arrhythmia develops, and will also promptly refer you to a cardiac surgeon - arrhythmologist, if indicated.

It is important to understand that the selection of antiarrhythmic therapy takes some time, requires repeated examinations by a doctor and a number of dynamic studies (general clinical tests, study of thyroid hormone levels, cardiac ultrasound and Holter ECG monitoring, electrocardiogram registration) and this should be treated with understanding. In some cases, it is necessary to replace one drug with another.

Living with atrial fibrillation is not an easy process and it is very important that the patient feels supported and helped by the doctor. We are happy to help you with this and are ready to offer follow-up programs for a cardiologist, arrhythmologist and cardiac surgeon in our clinic.

Anaprilin

When used simultaneously with hypoglycemic agents, there is a risk of developing hypoglycemia due to the increased effect of hypoglycemic agents.

When used simultaneously with MAO inhibitors, there is a possibility of developing undesirable manifestations of drug interactions.

Cases of the development of severe bradycardia have been described when using propranolol for arrhythmia caused by digitalis drugs.

When used simultaneously with drugs for inhalation anesthesia, the risk of suppression of myocardial function and the development of arterial hypotension increases.

When used simultaneously with amiodarone, arterial hypotension, bradycardia, ventricular fibrillation, and asystole are possible.

When used simultaneously with verapamil, arterial hypotension, bradycardia, and dyspnea are possible. Cmax in the blood plasma increases, AUC increases, and the clearance of propranolol decreases due to inhibition of its metabolism in the liver under the influence of verapamil.

Propranolol does not affect the pharmacokinetics of verapamil.

A case of severe arterial hypotension and cardiac arrest has been described when used simultaneously with haloperidol.

When used simultaneously with hydralazine, the Cmax in the blood plasma and the AUC of propranolol increase. It is believed that hydralazine may reduce hepatic blood flow or inhibit the activity of liver enzymes, resulting in a slower metabolism of propranolol.

When used simultaneously, propranolol can inhibit the effects of glibenclamide, glyburide, chlorpropamide, tolbutamide, because Non-selective beta2-blockers are able to block pancreatic beta2-adrenergic receptors associated with insulin secretion.

The release of insulin from the pancreas due to the action of sulfonylurea derivatives is inhibited by beta-blockers, which to some extent prevents the development of the hypoglycemic effect.

When used simultaneously with diltiazem, the concentration of propranolol in the blood plasma increases due to inhibition of its metabolism under the influence of diltiazem. An additive depressant effect on cardiac function is observed due to the slowing of impulse conduction through the AV node caused by diltiazem. There is a risk of developing severe bradycardia, stroke and minute volume are significantly reduced.

With simultaneous use, cases of increased concentrations of warfarin and phenindione in the blood plasma have been described.

When used concomitantly with doxorubicin, experimental studies have shown increased cardiotoxicity.

When used simultaneously, propranolol prevents the development of the bronchodilator effect of isoprenaline, salbutamol, and terbutaline.

With simultaneous use, cases of increased concentrations of imipramine in the blood plasma have been described.

When used simultaneously with indomethacin, naproxen, piroxicam, acetylsalicylic acid, the antihypertensive effect of propranolol may be reduced.

When used simultaneously with ketanserin, an additive hypotensive effect may develop.

When used simultaneously with clonidine, the antihypertensive effect is enhanced.

In patients receiving propranolol, severe arterial hypertension may develop if clonidine is abruptly discontinued. It is believed that this is due to an increase in the content of catecholamines in the circulating blood and an increase in their vasoconstrictor effect.

When used simultaneously with caffeine, the effectiveness of propranolol may be reduced.

With simultaneous use, it is possible to enhance the effects of lidocaine and bupivacaine (including toxic ones), apparently due to a slowdown in the metabolism of local anesthetics in the liver.

When used simultaneously with lithium carbonate, a case of bradycardia has been described.

With simultaneous use, a case of increased side effects of maprotiline has been described, which is apparently due to a slowdown in its metabolism in the liver and accumulation in the body.

When used simultaneously with mefloquine, the QT interval increases, and a case of cardiac arrest has been described; with morphine - the inhibitory effect on the central nervous system caused by morphine is enhanced; with sodium amidotrizoate - cases of severe arterial hypotension have been described.

When used simultaneously with nisoldipine, an increase in the Cmax and AUC of propranolol and nisoldipine in the blood plasma is possible, which leads to severe arterial hypotension. There is a report of increased beta-blocking action.

Cases of increased Cmax and AUC of propranolol, arterial hypotension and a decrease in heart rate have been described when used simultaneously with nicardipine.

When used simultaneously with nifedipine in patients with coronary artery disease, severe arterial hypotension may develop, increasing the risk of heart failure and myocardial infarction, which may be due to an increase in the negative inotropic effect of nifedipine.

Patients receiving propranolol are at risk of developing severe hypotension after taking the first dose of prazosin.

When used simultaneously with prenylamine, the QT interval increases.

When used simultaneously with propafenone, the concentration of propranolol in the blood plasma increases and a toxic effect develops. Propafenone is believed to inhibit the hepatic metabolism of propranolol, reducing its clearance and increasing serum concentrations.

With the simultaneous use of reserpine and other antihypertensive drugs, the risk of developing arterial hypotension and bradycardia increases.

With simultaneous use, the Cmax and AUC of rizatriptan increases; with rifampicin - the concentration of propranolol in the blood plasma decreases; with suxamethonium chloride, tubocurarine chloride - the effect of muscle relaxants may change.

With simultaneous use, the clearance of theophylline decreases due to a slowdown in its metabolism in the liver. There is a risk of developing bronchospasm in patients with bronchial asthma or COPD. Beta blockers may block the inotropic effect of theophylline.

When used simultaneously with phenindione, cases of a slight increase in bleeding without changes in blood clotting parameters have been described.

When used concomitantly with flecainide, additive cardiodepressive effects are possible.

Fluoxetine inhibits the CYP2D6 isoenzyme, which leads to inhibition of the metabolism of propranolol and its accumulation and may enhance the cardiodepressive effect (including bradycardia). Fluoxetine and, mainly, its metabolites are characterized by a long T1/2, so the likelihood of drug interactions remains even several days after discontinuation of fluoxetine.

Quinidine inhibits the CYP2D6 isoenzyme, which leads to inhibition of the metabolism of propranolol, while its clearance decreases. Increased beta-blocking action and orthostatic hypotension are possible.

With simultaneous use in the blood plasma, the concentrations of propranolol, chlorpromazine, and thioridazine increase. A sharp decrease in blood pressure is possible.

Cimetidine inhibits the activity of microsomal liver enzymes (including the CYP2D6 isoenzyme), this leads to inhibition of the metabolism of propranolol and its cumulation: an increase in negative inotropic effect and the development of a cardiodepressive effect are observed.

With simultaneous use, the hypertensive effect of epinephrine is enhanced, and there is a risk of developing severe life-threatening hypertensive reactions and bradycardia. The bronchodilator effect of sympathomimetics (epinephrine, ephedrine) decreases.

With simultaneous use, cases of decreased effectiveness of ergotamine have been described.

There are reports of changes in the hemodynamic effects of propranolol when used simultaneously with ethanol.