Ventricular fibrillation
| Classification according to ICD-10 | |
|---|---|
| I49.0 | Ventricular flutter and ventricular fibrillation |
| ICD-10 online (WHO version 2019) | |
Ventricular fibrillation , short ventricular fibrillation , and ventricular fibrillation (VF English ventricular fibrillation called) is a life threatening pulseless cardiac arrhythmia in which the heart chambers run disordered emotions and the heart muscle can no longer contract sorted. If left untreated, ventricular fibrillation leads to immediate death due to the heart's lack of pumping capacity. In the EKG you can see flicker waves with a frequency of about 300-800 / min. Ventricular fibrillation can e.g. B. occur as a complication of a heart attack (see also sudden cardiac death ) or caused by an electrical accident .
Pathophysiology
As a rule, the entirety of the heart muscle cells work together in a coordinated manner through control via the excitation conduction system. In the sinus node , the excitations are regularly generated and passed on to the atria ; the atrioventricular node forwards them to the ventricles, where they are passed on to all parts of the ventricles via specialized cells - the excitation conduction system. In this way, all parts of the heart muscle are excited in a meaningful process, they contract, the excitation recedes and the heart muscle cells become ready for a new excitation.
In ventricular fibrillation, local disturbances in the conduction of excitation or the process of excitation cause the spreading excitation to hit tissue that is already excitable again and continues to transmit excitation. Circulating waves of excitation occur, so that the heart muscle no longer pumps in a coordinated manner, but twitches in an uncoordinated manner at a high frequency - it "flickers". The pumping capacity of the heart drops suddenly to zero and a cardiac arrest occurs .
therapy
The therapy for ventricular fibrillation is immediate defibrillation . A short, strong current surge (360 J monophasic, biphasic varied with 150 Joules) stimulates all myocardial cells at the same time, so that afterwards the stimulation takes place in the normal way from the sinus node. Defibrillation is the only promising therapy for ventricular fibrillation. The earlier it is done, the higher the chances of success. Every minute without defibrillation reduces the likelihood of successful resuscitation by approximately 10%.
The time until a defibrillator is available must be bridged by first aid measures ( cardiopulmonary resuscitation ) in order to maintain the oxygen supply, especially to the brain, kidneys and heart muscle.
Due to the increasing spread of semi-automatic defibrillators , which are kept ready in public places and are designed for use by laypeople, the time until defibrillation can often be significantly reduced.
These devices increase the chance of survival many times over. With an early cardiopulmonary resuscitation and defibrillation by the emergency services, the patient has a statistical chance of survival of approx. 8 to 10%. This increases to up to 70% through the early use of an automated, external defibrillator by lay helpers.
The use of the so-called precordial punch, which is still used occasionally in the rescue service, is uncertain.
See also
Individual evidence
- ^ Stefan Silbernagl, Florian Lang: Pocket Atlas of Pathophysiology . Georg Thieme Verlag, 2013, ISBN 978-3-13-150944-4 , p. 204 ( limited preview in Google Book Search [accessed December 6, 2016]).
- ^ Franz-Josef Kretz, Jürgen Schäffer: Anesthesia, intensive care medicine, emergency medicine, pain therapy . Springer-Verlag, 2013, ISBN 978-3-662-05730-8 , pp. 616 ( limited preview in Google Book Search [accessed December 6, 2016]).
