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mapa strony: Start. arrow Manuał aptekarski arrow 09.2008 - "Migotanie i trzepotanie przedsionków jako najczęstsze przyczyny udaru."


09.2008 - "Migotanie i trzepotanie przedsionków jako najczęstsze przyczyny udaru." Drukuj Email
 09.2008, nr 25/3 online
 Migotanie i trzepotanie
przedsionków jako
najczęstsze przyczyny udaru.
   Migotanie przedsionków jest najczęstszym zaburzeniem rytmu pracy serca u osób dorosłych, prowadzącym do hospitalizacji. W 15–20 procentach schorzenie to jest przyczyną wszystkich udarów.  Uważa się, że dotyka 2,5 mln osób w Ameryce Północnej oraz 4,5 mln osób w Unii Europejskiej.
   Migotanie przedsionków jest jednym z zaburzeń rytmu pracy serca (arytmią), charakteryzującym się szybką (średnio do 400 uderzeń na minutę), nieskoordynowaną akcją przedsionków.
   W zdrowym sercu węzeł zatokowy, będący elektrycznym stymulatorem serca, generuje impuls elektryczny w górnych jamach serca, czyli w przedsionkach. Impuls ten jest przekazywany do dolnych jam serca (komór) w skoordynowany sposób. W trakcie migotania przedsionków zamiast jednego impulsu, w różnych obszarach przedsionków generowany jest szereg impulsów. Wywołuje to szybką, nieregularną aktywność przedsionków, powodując tym samym szybki  i nieregularny rytm serca.
   Rozpowszechnienie choroby w populacji ogólnej szacowane jest na 0,4 procenta, przy czym częstość jej występowania wzrasta wraz z wiekiem. U osób w wieku 80 lat i więcej, zachorowalność utrzymuje się na poziomie 8 procent.  Ze względu na proces starzenia się społeczeństwa, w przyszłości migotanie przedsionków będzie dotykało coraz większą liczbę osób. W ciągu ostatnich 20 lat liczba hospitalizacji, których przyczyną było migotanie przedsionków wzrosła o 66 proc. Istotnym problemem jest także wskaźnik umieralności wśród osób chorych, który jest dwa razy wyższy niż u osób z prawidłowym, zatokowym rytmem serca.
   Pacjenci z migotaniem przedsionków skarżą się na nierówne bicie serca, „potykanie się” oraz kołatanie serca, czyli szybki i nierówny rytm. Ponadto, na skutek zmniejszenia jego wydolności, chorzy często czują się osłabieni i zmęczeni, mają zadyszkę oraz odczuwają bóle w klatce piersiowej. Większość pacjentów ma trudności w wykonywaniu prostych ćwiczeń fizycznych.
   Istnieją dwa rodzaje migotania przedsionków – przewlekłe i napadowe. Chorzy z przewlekłym migotaniem i przy wolnej akcji serca uskarżają się na nierówne bicie serca, natomiast w przypadku napadowego migotania dochodzi do szybkiej akcji komór, a pacjenci uskarżają się na kołatanie serca.
  Najczęstszą przyczyną występowania migotania przedsionków jest nadczynność tarczycy oraz schorzenia układu naczyniowo–sercowego, nadciśnienie tętnicze, zwężenie lewego ujścia żylnego, zwyrodnienie miażdżycowe, choroba wieńcowa, kardiomiopatia, zespół sercowo–płucny, a także zawał serca. W rzadszych przypadkach chorobę mogą wywoływać wady serca, zatrucia lekami oraz niedotlenienie.
   Najczęstszym powikłaniem migotania przedsionków jest niewydolność serca. Szczególnie niebezpieczne jest powstanie w przedsionkach zakrzepów krwi, które mogą doprowadzić do zatorów tętnic w płucach, nerkach, kończynach oraz naczyniach krezkowych. Szczególnie niebezpieczne są zatory tętnic mózgowych, które prowadzą do udaru niedokrwiennego mózgu.
Trzepotanie przedsionków
   Trzepotanie przedsionków jest kolejnym rodzajem arytmii, objawiającym się zbyt szybką,  ale miarową czynnością elektryczną i skurczową przedsionków (kurczą się z częstością ok. 250-300/min). Trzepotanie przedsionków dzielone jest na napadowe (trwa do 48 godzin) lub utrwalone (trwa dłużej niż 48 godzin).
   Pacjenci z trzepotaniem przedsionków skarżą się na kołatanie serca, duszności, a nawet zawroty głowy. W niektórych przypadkach mogą także odczuwać ból wieńcowy. Charakterystycznym objawem trzepotania przedsionków jest nagłe przyspieszenie lub zwolnienie akcji serca w wyniku zmiany pozycji ciała chorego, a także szybsze tętnienie żył szyjnych.
Najczęstszą przyczyną trzepotania przedsionków są organiczne choroby serca, tj. kardiomiopatia, przetrwały otwór międzyprzedsionkowy, zawał serca oraz zapalenie osierdzia. W rzadszych przypadkach trzepotanie przedsionków występuje u ludzi zdrowych w przebiegu chorób pozasercowych, przy zapaleniu płuc, pęcherzyka żółciowego lub opon mózgowych.
   U większości chorych stosuje się farmakoterapię, która poprawia wydolność serca oraz podtrzymuje jego prawidłowy rytm po umiarowieniu. W leczeniu podaje się pacjentom także leki przeciwzakrzepowe w związku z ryzykiem powstania zatorów.
   Niektóre leki, poprzez modyfikację równowagi elektrycznej serca, wywołują liczne działania niepożądane mogą same nasilać zaburzenia rytmu serca, a przy długim stosowaniu toksyczność narządową (najbardziej narażone są tarczyca, oczy, wątroba i płuca).  Postępem w leczeniu będzie zastosowanie dronedaronu, który okazał się w badaniu klinicznym skutecznym i dobrze tolerowanym preparatem regulującym rytm pracy serca.

Źródło: Informacja prasowa
Warszawa, 2 października 2008
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