Ventricular fibrillation
Definition:
Ventricular fibrillation is a heart rhythm problem that occurs when the heart beats with rapid, erratic electrical impulses. This causes pumping chambers in your heart (the ventricles) to quiver uselessly, instead of pumping blood. During ventricular fibrillation, your blood pressure plummets, cutting off blood supply to your vital organs.
Ventricular fibrillation is frequently triggered by a heart attack.
Ventricular fibrillation is an emergency that requires immediate medical attention. A person with ventricular fibrillation will collapse within seconds and soon won't be breathing or have a pulse.
Emergency treatment for ventricular fibrillation includes cardiopulmonary resuscitation (CPR) and shocks to the heart with a device called a defibrillator.
Treatments for those at risk of ventricular fibrillation include medications and implantable devices that can restore a normal heart rhythm.
Symptoms:
Loss of consciousness or fainting is the most common sign of ventricular fibrillation.
Early ventricular fibrillation symptoms
It's possible that you may have other signs and symptoms that start about an hour before your heart goes into ventricular fibrillation and you faint. These include:
If you or someone else is having signs and symptoms of ventricular fibrillation, seek emergency medical help immediately. Follow these steps:
Causes:
To understand how ventricular fibrillation happens, consider what should happen during a normal heartbeat.
What's a normal heartbeat?
When your heart beats, the electrical impulses that cause it to contract must follow a precise pathway through your heart. Any interruption in these impulses can cause an irregular heartbeat (arrhythmia).
Your heart is divided into four chambers. The chambers on each half of your heart form two adjoining pumps, with an upper chamber (atrium) and a lower chamber (ventricle).
During a heartbeat, the smaller, less muscular atria contract and fill the relaxed ventricles with blood. This contraction starts after the sinus node — a small group of cells in your right atrium — sends an electrical impulse causing your right and left atria to contract.
The impulse then travels to the center of your heart, to the atrioventricular node, which lies on the pathway between your atria and your ventricles. From here, the impulse exits the atrioventricular node and travels through your ventricles, causing them to contract and pump blood throughout your body.
What causes ventricular fibrillation?
It's not always known what causes ventricular fibrillation. But the most common cause is a problem in the electrical impulses traveling through your heart after a first heart attack, or problems resulting from a scar in your heart's muscle tissue from a previous heart attack. Some cases of ventricular fibrillation begin as a rapid heartbeat called ventricular tachycardia (VT). This fast, regular beating of the heart is caused by abnormal electrical impulses that start in the ventricles.
Most VT occurs in people with some form of heart-related problem, such as scars or damage within the ventricle muscle from a heart attack. Sometimes VT can last for 30 seconds or less (nonsustained) and may not cause any symptoms, although it causes inefficient heartbeats. But, VT may be a sign of more-serious heart problems. If VT lasts more than 30 seconds, it will usually lead to palpitations, dizziness or fainting. Untreated VT will often lead to ventricular fibrillation.
In ventricular fibrillation, rapid, chaotic electrical impulses cause your ventricles to quiver uselessly instead of pumping blood. Without an effective heartbeat, your blood pressure plummets, instantly cutting off blood supply to your vital organs — including your brain. Most people lose consciousness within seconds and require immediate medical assistance, including cardiopulmonary resuscitation (CPR). Your chances of survival are better if CPR is delivered until your heart can be shocked back into a normal rhythm with a device called a defibrillator. Without CPR or defibrillation, death results in minutes. Most cases of ventricular fibrillation are linked to some form of heart disease.
Treatments and drugs:
Emergency treatments for ventricular fibrillation focus on restoring blood flow through your body as quickly as possible to prevent damage to your brain and other organs. After blood flow is restored through your heart, if necessary, you'll have treatment options to help prevent future episodes of ventricular fibrillation.
Emergency treatments
If your doctor finds that your ventricular fibrillation episode is caused by a change in the structure of your heart, such as scarred tissue from a heart attack, he or she may recommend that you take medications or have a medical procedure performed to reduce your risk of future ventricular fibrillation. Treatment options can include:
Definition:
Ventricular fibrillation is a heart rhythm problem that occurs when the heart beats with rapid, erratic electrical impulses. This causes pumping chambers in your heart (the ventricles) to quiver uselessly, instead of pumping blood. During ventricular fibrillation, your blood pressure plummets, cutting off blood supply to your vital organs.
Ventricular fibrillation is frequently triggered by a heart attack.
Ventricular fibrillation is an emergency that requires immediate medical attention. A person with ventricular fibrillation will collapse within seconds and soon won't be breathing or have a pulse.
Emergency treatment for ventricular fibrillation includes cardiopulmonary resuscitation (CPR) and shocks to the heart with a device called a defibrillator.
Treatments for those at risk of ventricular fibrillation include medications and implantable devices that can restore a normal heart rhythm.
Symptoms:
Loss of consciousness or fainting is the most common sign of ventricular fibrillation.
Early ventricular fibrillation symptoms
It's possible that you may have other signs and symptoms that start about an hour before your heart goes into ventricular fibrillation and you faint. These include:
- Chest pain
- Rapid heartbeat (tachycardia)
- Dizziness
- Nausea
- Shortness of breath
If you or someone else is having signs and symptoms of ventricular fibrillation, seek emergency medical help immediately. Follow these steps:
- Call 911 or the emergency number in your area.
- Begin cardiopulmonary resuscitation (CPR) to help maintain blood flow to the organs until an electrical shock (defibrillation) can be given. Push hard and fast on the person's chest — about 100 compressions a minute. It's not necessary to check the person's airway or deliver rescue breaths unless you've been trained in CPR. If you are trained, check the airway and then deliver rescue breaths after every 30 compressions.
Causes:
To understand how ventricular fibrillation happens, consider what should happen during a normal heartbeat.
What's a normal heartbeat?
When your heart beats, the electrical impulses that cause it to contract must follow a precise pathway through your heart. Any interruption in these impulses can cause an irregular heartbeat (arrhythmia).
Your heart is divided into four chambers. The chambers on each half of your heart form two adjoining pumps, with an upper chamber (atrium) and a lower chamber (ventricle).
During a heartbeat, the smaller, less muscular atria contract and fill the relaxed ventricles with blood. This contraction starts after the sinus node — a small group of cells in your right atrium — sends an electrical impulse causing your right and left atria to contract.
The impulse then travels to the center of your heart, to the atrioventricular node, which lies on the pathway between your atria and your ventricles. From here, the impulse exits the atrioventricular node and travels through your ventricles, causing them to contract and pump blood throughout your body.
What causes ventricular fibrillation?
It's not always known what causes ventricular fibrillation. But the most common cause is a problem in the electrical impulses traveling through your heart after a first heart attack, or problems resulting from a scar in your heart's muscle tissue from a previous heart attack. Some cases of ventricular fibrillation begin as a rapid heartbeat called ventricular tachycardia (VT). This fast, regular beating of the heart is caused by abnormal electrical impulses that start in the ventricles.
Most VT occurs in people with some form of heart-related problem, such as scars or damage within the ventricle muscle from a heart attack. Sometimes VT can last for 30 seconds or less (nonsustained) and may not cause any symptoms, although it causes inefficient heartbeats. But, VT may be a sign of more-serious heart problems. If VT lasts more than 30 seconds, it will usually lead to palpitations, dizziness or fainting. Untreated VT will often lead to ventricular fibrillation.
In ventricular fibrillation, rapid, chaotic electrical impulses cause your ventricles to quiver uselessly instead of pumping blood. Without an effective heartbeat, your blood pressure plummets, instantly cutting off blood supply to your vital organs — including your brain. Most people lose consciousness within seconds and require immediate medical assistance, including cardiopulmonary resuscitation (CPR). Your chances of survival are better if CPR is delivered until your heart can be shocked back into a normal rhythm with a device called a defibrillator. Without CPR or defibrillation, death results in minutes. Most cases of ventricular fibrillation are linked to some form of heart disease.
Treatments and drugs:
Emergency treatments for ventricular fibrillation focus on restoring blood flow through your body as quickly as possible to prevent damage to your brain and other organs. After blood flow is restored through your heart, if necessary, you'll have treatment options to help prevent future episodes of ventricular fibrillation.
Emergency treatments
-
Cardiopulmonary resuscitation (CPR). This treatment can
help restore blood flow through the body by mimicking the pumping
motion your heart makes. CPR can be performed by anyone, including
family members of those at risk.
In a medical emergency, CPR can be started before emergency medical personnel arrive. But first, call for emergency medical attention and check the unconscious person's breathing. Then begin CPR by pushing hard and fast on the person's chest — about 100 compressions a minute. Allow the chest to rise completely between compressions. Unless you've been trained in CPR, don't worry about breathing into the person's mouth. Keep doing chest compressions until a portable defibrillator is available or emergency personnel arrive.
-
Defibrillation. The delivery of an electrical shock
through the chest wall to the heart momentarily stops the heart and the
chaotic rhythm. This often allows the normal heart rhythm to resume.
The shock may be administered by emergency personnel or by a bystander if a public-use defibrillator — the device used to administer the shock — is available. Most public-use defibrillators are easy to use and give voice instructions as you use them.
Public-use defibrillators are programmed to recognize ventricular fibrillation and send a shock only when it's appropriate. These portable defibrillators are available in an increasing number of public places, including in airports, shopping malls, casinos, health clubs, and community and senior citizen centers.
If your doctor finds that your ventricular fibrillation episode is caused by a change in the structure of your heart, such as scarred tissue from a heart attack, he or she may recommend that you take medications or have a medical procedure performed to reduce your risk of future ventricular fibrillation. Treatment options can include:
- Medications. Doctors use various anti-arrhythmic drugs for emergency or long-term treatment of ventricular fibrillation. A class of medications called beta blockers is commonly used in people at risk of ventricular fibrillation or sudden cardiac arrest. Other possible drugs include angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers or a drug called amiodarone (Cordarone, Pacerone).
-
Implantable cardioverter-defibrillator (ICD). After
your condition stabilizes, your doctor is likely to recommend
implantation of an ICD. An ICD is a battery-powered unit that's
implanted near your left collarbone. One or more electrode-tipped wires
from the ICD run through veins to your heart.
The ICD constantly monitors your heart rhythm. If it detects a rhythm that's too slow, it sends an electrical signal that paces your heart as a pacemaker would. If it detects ventricular tachycardia or ventricular fibrillation, it sends out low- or high-energy shocks to reset your heart to a normal rhythm. An ICD may be more effective than drug treatment at reducing your chance of having a fatal arrhythmia.
-
Coronary angioplasty and stent placement. This
procedure is for the treatment of severe coronary artery disease. It
opens blocked coronary arteries, letting blood flow more freely to your
heart. If your ventricular fibrillation was caused by a heart attack,
this procedure may reduce your risk of future episodes of ventricular
fibrillation.
Doctors insert a long, thin tube (catheter) that's passed through an artery, usually in your leg, to a blocked artery in your heart. This catheter is equipped with a special balloon tip that briefly inflates to open up a blocked coronary artery. At the same time, a metal mesh stent may be inserted into the artery to keep it open long term, restoring blood flow to your heart. Coronary angioplasty may be done at the same time as a coronary catheterization (angiogram), a procedure that doctors do first to locate narrowed arteries to the heart.
- Coronary bypass surgery. Another procedure to improve blood flow is coronary bypass surgery. Bypass surgery involves sewing veins or arteries in place at a site beyond a blocked or narrowed coronary artery (bypassing the narrowed section), restoring blood flow to your heart. This may improve the blood supply to your heart and reduce your risk of ventricular fibrillation.
-
Ventricular tachycardia ablation. In certain
circumstances your doctors may recommend a catheter-based procedure
called ablation to try to get rid of the impulses in your heart causing
ventricular tachycardia. Ablation typically uses catheters — long
flexible tubes inserted through a vein in your groin and threaded to
your heart — to correct structural problems in your heart that cause an
arrhythmia.
Cardiac ablation works by scarring or destroying tissue that blocks the electrical signal that travels through your heart to make it beat. By clearing the signal pathway of the abnormal tissue, your heart may beat normally again.
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