Sotahexal, tablets 80 mg, 20 pcs.

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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.

How to relieve an attack of arrhythmia?

Pathologies of the heart and blood vessels are the most common reasons for providing emergency medical care. Typically, resuscitation measures are carried out for myocardial infarction and other acute conditions, but a contraction rhythm disorder can be no less dangerous. In order to understand how to relieve an attack of arrhythmia, you need to know the features of the course of the disease. Additionally, not all cases require treatment. A consultation with a cardiologist will help you find out all the aspects of treating a pathology such as cardiac arrhythmia: how to relieve an attack, and whether surgery is needed.

Arrhythmia Information

Disorders of the heart, characterized by an irregular heartbeat rhythm, are called arrhythmia. In the medical literature, different forms of the disease are distinguished depending on the clinical picture and cause of occurrence. The most common forms include tachycardia and bradycardia. The disease is primarily dangerous due to hemodynamic disturbances and the risk of severe complications. The most dangerous complication of arrhythmia is ischemic stroke.

Being the most active muscular organ, the heart continuously contracts and delivers oxygen along with nutrients to all tissues. Developed external and internal forms of regulation ensure the constancy of hemodynamics. An electrical impulse that causes contraction of muscle fibers occurs in the sinus node of the upper parts of the heart and spreads through secondary nodes to all parts of the myocardium. A slight delay in the transmission of the signal from the atria to the ventricles allows the chambers of the heart to fill with blood before contracting. Thus, the special rhythm of the heart is set by the sinus node. External nervous and humoral influences can only temporarily change the rhythm.

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Main forms of arrhythmia:

• Fibrillation is the occurrence of frequent and chaotic contractions of the atria or ventricles myocardium. In the most dangerous form of the disease, ventricular fibrillation, the heart rate can reach 600 beats per minute. A common complication of atrial fibrillation is cardiac arrest.
• Tachycardia is the occurrence of rapid heartbeat (more than 100 beats per minute).
• Bradycardia is the occurrence of too rare myocardial contractions (no more than 60 beats per minute).
• Flutter is a disorder of the rhythm of contractions of the atria or ventricles, characterized by rapid and inconsistent heartbeats. It is also a common complication of heart surgery.
• Extrasystole is the occurrence of an additional contraction immediately after systole. Normally, there is a short rest interval between contractions, during which the chambers of the heart fill with blood.

Clarifying the form of myocardial rhythm disturbance is important in order to understand how to relieve an attack of arrhythmia. Treatment of primary pathology of the cardiovascular system is often required.

Causes and risk factors

The mechanism of development of arrhythmia is in many ways similar to other heart diseases. This may be a consequence of abnormal development of the organ in the prenatal period, an infectious disease or injury. In addition, rhythm disorder may be a complication of the primary disease.

Main reasons:

• Damage to the conductive elements of the heart during ischemia and myocardial infarction.
• Disturbance of the heart valves.
• Consequences of heart surgery.
• Toxic myocardial damage.
• Nervous regulation disorders.
• Thyroid diseases.
• Imbalance of electrolytes in the blood.
• Abuse of caffeine and alcoholic beverages.
• Addiction.
• Breathing disorder during sleep.
• Thickening of the myocardium and enlargement of the heart parts against the background of high loads.

There are also risk factors that can increase the likelihood of arrhythmia. The main factors include:

• Obesity and sedentary lifestyle.
• High blood pressure.
• Diabetes mellitus and atherosclerosis of heart vessels.
• Panic attacks.
• Lung diseases.
• Poor nutrition.
• Old age.

It should be borne in mind that the listed risk factors are common to many cardiovascular pathologies, so heart attack prevention is also a measure to prevent arrhythmia.

An important feature is the origin of the rhythm disorder. A person's heart may begin to beat faster due to physical activity. In this case, the natural form of tachycardia is due to the adaptation of the heart to the high needs of muscle tissue. Pathological tachycardia occurs at rest and does not meet the current requirements of the body.

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Symptoms

The disease usually manifests itself during attacks. The rest of the time, the cardiovascular system can operate as usual. That is why the intensity of symptoms largely depends on the frequency of attacks. Some patients do not even notice rare interruptions in the functioning of the heart, while others constantly suffer from insufficient blood circulation. Knowing the characteristics of the course of the disease is important in order to find out how to relieve an attack of arrhythmia at a specific moment.

Possible symptoms:

• Substernal pain.
• Sensation of pulsation in the temple area.
• Dyspnea.
• Dizziness and nausea.
• Brief loss of consciousness.
• Increased sweating.
• Anxiety.

The asymptomatic course of the disease is typical mainly for children and adolescents. The presence of other chronic heart pathologies may aggravate symptoms.

Diagnostic methods

The main way to identify heart rhythm disorders is instrumental diagnosis. Before prescribing therapeutic and diagnostic procedures, the doctor will find out complaints, examine the medical history for previous diseases and risk factors, and also conduct a physical examination. Auscultation of the heart, study of the pulse and tonometry are methods of primary diagnosis. However, outside of attacks, heart function may not be impaired, so additional methods are always required.

Additional diagnostics:

• Electrocardiography is a study of the bioelectrical activity of the heart. To obtain a cardiogram, a special device and electrodes are used that are attached to the patient’s body. Cardiography results indicate a delay in impulse conduction and other disorders of the conduction system.
• Echocardiography – methods of visualizing the heart using ultrasound equipment. A special sensor sends high-frequency sound waves to the myocardial area and forms an image of the organ on the monitor using reflected waves. The method is effective for assessing the severity of the condition and finding the cause of rhythm disturbances.
• Holter monitoring is a long-term study of heart function using a portable cardiogram recording device. During the examination, the patient goes about his normal activities and presses a button on the device if symptoms occur.
• Stress test is a method of recording a cardiogram during physical activity. To stimulate increased heart function, exercise equipment and special medications are used. This procedure is useful if the patient experiences an arrhythmia attack only during exercise.
• Study of heart vessels using angiography. Based on the results, one can judge whether they are blocked or narrowed.
• Blood test for thyroid hormones, minerals and heart attack indicator enzymes.
• Computed tomography and magnetic resonance imaging - scanning the heart and blood vessels to detect the source of the rhythm disorder.

Only a comprehensive diagnosis will help figure out how to relieve an arrhythmia attack in a particular patient. Screening methods are important if there are other heart diseases that can cause arrhythmia.

How to quickly relieve an attack of arrhythmia?

After receiving the results of the examination and making a final diagnosis, the doctor may prescribe medication or surgical treatment. The treatment regimen depends on the form of the rhythm disorder, the frequency of exacerbations and other factors. As a rule, drug therapy is justified for uncomplicated disease.

Medication prescriptions:

• Direct antiarrhythmic drugs as symptomatic treatment.
• Glycosides, beta blockers and other drugs that affect the myocardial conduction system.
• Anticoagulants for blood thinning and stroke prevention.

If the initial prescriptions do not help, you need to make an appointment with your doctor again. The cardiologist can change the dosage and explain how to relieve an arrhythmia attack. In case of fibrillation, resuscitation measures aimed at quickly correcting the rhythm may be required.

Surgical Treatment Options

Surgery is often a more reliable method of rhythm correction. This method of treatment is indicated for severe arrhythmia and ineffectiveness of drug therapy. Depending on the type of pathology, the following methods of surgical correction may be prescribed:

• Radiofrequency catheter ablation is the removal of the affected area in the myocardium using an electric current. This is a fairly simple and safe procedure that does not require open surgery.
• Implantation of devices that normalize heart rhythm during an exacerbation of the disease. A patient with a pacemaker does not need to think about how to relieve an arrhythmia attack.
• Surgery of structural pathologies of the heart and blood vessels.

When the first symptoms of heart rhythm disturbances appear, it is recommended to consult a doctor. Early diagnosis allows for great success. A specialized specialist will be able to explain all the features of such a condition as atrial fibrillation: how to relieve an attack, and what treatment options exist.

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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.

Sotahexal

When taking slow calcium channel blockers such as verapamil and diltiazem simultaneously, a decrease in blood pressure may occur as a result of worsening contractility. IV administration of these drugs should be avoided while using sotalol (except in cases of emergency medicine).

The combined use of class IA antiarrhythmic drugs (especially quinidine type: disopyramide, quinidine, procainamide) or class III (for example, amiodarone) can cause a pronounced prolongation of the QT interval. Drugs that prolong the QT interval should be used with caution with drugs that prolong the QT interval, such as class I antiarrhythmics, phenothiazines, tricyclic antidepressants, terfenadine and astemizole, and some quinolone antibiotics.

When taking nifedipine and other 1,4-dihydropyridine derivatives simultaneously, a decrease in blood pressure is possible.

The simultaneous administration of norepinephrine or MAO inhibitors, as well as abrupt withdrawal of clonidine, can cause arterial hypertension. In this case, withdrawal of clonidine should be carried out gradually and only a few days after stopping Sotahexal.

Tricyclic antidepressants, barbiturates, phenothiazines, opioids, antihypertensives, diuretics, and vasodilators can cause a sharp decrease in blood pressure.

The use of inhalation anesthesia, incl. tubocurarine while taking Sotahexal increases the risk of suppression of myocardial function and the development of arterial hypotension.

With the simultaneous use of Sotahexal with reserpine, clonidine, alpha-methyldopa, guanfacine and cardiac glycosides, severe bradycardia and a slowdown in the conduction of excitation in the heart may develop.

Beta blockers may potentiate withdrawal hypertension following discontinuation of clonidine, so beta blockers should be discontinued gradually, several days before tapering clonidine.

Prescribing insulin or other oral hypoglycemic agents, especially during physical activity, can lead to increased hypoglycemia and the manifestation of its symptoms (increased sweating, rapid pulse, tremor). In case of diabetes mellitus, dose adjustment of insulin and/or hypoglycemic drugs is necessary.

Potassium-sparing diuretics (for example, furosemide, hydrochlorothiazide) can provoke arrhythmias caused by hypokalemia.

When used concomitantly with Sotahexal, the use of higher doses of beta-agonists such as salbutamol, terbutaline and isoprenaline may be required.