Frederick's syndrome

Frederick syndrome is a symptom complex consisting of clinical features of pathology and electrocardiographic manifestations that occur with complete atrioventricular blockade with accelerated contraction of individual muscle fibers of the heart, disturbing the heart rhythm (rhythmic but very rare pulse) and pump function.

In Frederic syndrome, the most frequent violation of stable atrial work, beginning to contract erratically. Rarely does atrial fibrillation appear on the cardiogram instead of atrial fibrillation, and cardiac investigations reveal a failure of stable intracardiac blood flow. All this leads to the cessation of the movement of electric impulses from the atria to the ventricles, which entails complete atrioventricular blockade.

In the phenomenon of Frederic, various functional departments of the heart are affected and the movement of the control electric impulses is disturbed. In the beginning, the human body uses internal reserves. Then pathological processes can already manifest themselves on the cardiogram, and the patient begins to notice different features in his state of health. Such an unstable situation can be violated, the reserves are exhausted, and the patient needs urgent treatment with dubious chances of success.

[1], [2]

Causes of the syndrome

Sources of severe cardiac pathology may include:

• Chronic ischemia of the heart (angina pectoris) in a state of tension and rest.
• Cardiosclerotic manifestations that occur after a heart attack.
• Myocarditis (damage to the heart muscle, inflammatory genesis).
• Severe congenital or acquired changes in heart structures.
• Cardiomyopathy (a change in the cardiac muscle of an unclear etiology).
• Myocardial infarction (coronary heart disease (IHD), leading to necrosis of the myocardium as a result of lack of blood supply).

With all of the above diseases, vascular sclerosis occurs, which results in the proliferation of connective tissue in the cardiac muscle. Inflammation and dystrophic processes of the myocardium greatly influence this growth. In the formation of connective tissue, it is replaced by typical cells (cardiomyocytes) that conduct electrical pulses. All this leads to a change in the functional conductivity and manifestation of the AV blockade.

[3], [4], [5], [6], [7], [8], [9], [10]

Risk factors

Factors that can contribute to the development of the syndrome of Frederic include:

• taking certain drugs (M-holinoblokatory, beta-adrenomimetiki and some sodium blockers);
• excessive physical exertion, when stimulated with pharmaceutical drugs;
• heart and vascular disease of any origin;
• hereditary factor (familial hyperlipidemia);
• cardiopsychoneurosis;
• violation of electrolyte balance.

[11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21]

Symptoms of the syndrome

Using the ECG, you can accurately say that the patient has the phenomenon of Frederick. The clinical manifestations that accompany him in everyday life, requiring close attention are the following:

• A rare but correct pulse.
• The frequency of abbreviations is from 30 to 60 times per minute.
• Fatigue.
• Drowsiness.
• Dizziness.
• Fainting states.
• Cyanosis of the face.
• Convulsions.

All of the above symptomatology is characteristic of the state of brain shortage of oxygen. These symptoms can also indicate other diseases of both cardiovascular and nervous systems.

Only the use of a cardiogram of a high probability allows us to confirm or deny that the patient has the phenomenon of Frederic. Clinical manifestations accompanying him in everyday life, which should pay attention to the patient on a rare but correct pulse with heart rate not less than 30 and not more than 60 times per minute. The drop in heart rate is noted due to the fact that the pumping work of the heart is reduced.

If a person does not attach importance to the listed symptoms, they can worsen, there is a short-term (5-7 sec.) Cardiac arrest, loss of consciousness due to rapid contraction of the ventricles.

The first signs of the syndrome of Frederick

The phenomenon of Frederic can be suspected in the patient's complaints:

• Unstable work of the heart.
• Heart rhythm is reduced.
• Weakness is noted.
• Shortness of breath in combination with irregularities and a slowing of the rhythm.
• Appearance of peripheral edema of ankle joints at the end of the day.
• On an electrocardiogram, atrial fibrillation.

There are no clearly expressed signs of the phenomenon of Frederic, they are more similar to various cardiac diseases.

Diagnostics of the syndrome

Clinic of the disease in the phenomenon of Frederic loses characteristic for atrial fibrillation features. The changes associated with the total transverse blockade begin to come first:

• No complaints about the heart beat and irregularities in the heart muscle.
• There are attacks of dizziness.
• Loss of consciousness.
• Heart sounds are rhythmical.
• Pulse is correct, rare.

Clinically diagnose this syndrome is difficult. This condition can be suspected in the patient only if there is a constant form of atrial fibrillation, as well as loss of consciousness, a thin heartbeat. If atrial fibrillation is combined with an atrioventricular block, the patient's condition worsens, especially with a rare incidence of ventricular contractions (20-30 beats per minute). The patient may have a loss of consciousness. They are associated with insufficient intake of oxygen into the brain, during a period of prolonged cessation of heart activity with the disappearance of bioelectrical activity. During this period, death may occur.

Appears or increases the degree of heart failure. In Frederick's syndrome, the patient's condition largely depends on the established frequency of contraction of the ventricles. In some cases, when the CSF is set within 50-60 beats per minute, the patient may be in satisfactory condition. Disappointing subjective manifestations of atrial fibrillation disappear:

• Palpitation
• Interruptions in the work of the heart
• Pulse - the right rhythmic
• The patient, and often the doctor, with the development of articecticular blockade, it seems that the atrial fibrillation has disappeared, the sinus rhythm has recovered. Blood circulation lasts for a long time at a good level.

[22], [23], [24], [25], [26]

Analyzes

When such a pathology as Frederick syndrome is found, the following tests can be performed for a more complete examination of the patient:

• Clinical analysis of blood - a method of laboratory diagnosis, including the counting of various types of cells in the blood, their size, shape, etc .; hemoglobin level; leukocyte formula; hemacrite.
• Biochemical analysis of blood - a laboratory study, which allows to determine: how internal organs (kidneys, liver, etc.) work; learn information about metabolic processes (lipid, protein, hydrocarbon); determine the body's need for trace elements.
• Lipidogram - a blood test for cholesterol, low-density lipoproteins, high-density lipoproteins, triglycerides and the reasons for the change in the indices of this study.
• A test of Reberg or the clearance of endogenous creatinine. Helps the doctor assess the excretory work of the kidneys, in addition, the ability to isolate or absorb various substances by the kidney tubules.
• Clinical analysis of urine is a study performed in the laboratory, which allows an assessment of the physico-chemical characteristics of urine and microscopy of the sediment.
• The analysis of urine by Nechiporenko is a method of laboratory diagnostics with the help of which it is possible to determine the presence of leukocytes, erythrocytes and cylinders in the urine, it is possible to assess the condition, the functioning of the kidneys and urinary tract.

[27]

Instrumental diagnostics

For the establishment of an adequate diagnosis, the following types of studies can be assigned:

• An electrocardiogram (ECG) can detect tachy- or bradycardia, various blockages of the heart.
• Holter monitoring (XM) is a functional study of CCC (cardiovascular system).
• Transesophageal electrophysiological examination is used to diagnose transient blockades with conventional ECG and XM methods.
• Radiography of chest organs helps to determine the size of the shadow of the heart and the presence of venous stasis.
• Ultrasound examination (ultrasound) of the heart helps to detect pathological changes in the myocardium
• Treadmill test or veloergometry - identifies IHD and estimates the increase in heart rate contractions under the influence of physical activity.

ECG signs of the syndrome of Frederick

When Frederick's phenomenon acquires a persistent character, the ECG records:

• the conducting system in the ventricles is deformed and enlarged;
• the tooth P disappears;
• Noticeably the frequency of ff waves, which reflect atrial fibrillation or record large FF waves, indicating atrial flutter;
• Ventricular rhythm of non-sinus nature - ectopic (nodal or idioventricular);
• The interval RR is constant (the rhythm is correct);
• The number of ventricular contractions is no more than 40 - 60 per minute.

The syndrome of Frederic is 10-27% with the detection of a complete atrioventicular blockade.

[28]

Differential diagnosis

The syndrome of Frederic must be distinguished from bradysystolic atrial fibrillation. With bradisystolic atrial fibrillation, chaotic ventricular contractions are noted, and with Frederic syndrome the distance R-R is the same. Physical exercise contributes to an increase in heart rate with arrhythmia, and with SF, the rhythm is correct. It should be borne in mind that the main difference in the bradysystolic form of atrial fibrillation is incomplete transverse cardiac blockade.

[29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39],

Treatment of the syndrome

If an AV blockade of the heart is detected, serious and prolonged treatment will be required. The goals of such therapy are:

• Preventive measures to prevent sudden death due to malfunctioning of the heart.
• Mitigation of clinical manifestations.
• Prevention of exacerbations (heart failure).

Treatment includes medication and non-pharmacological therapy. Non-drug treatment is based on compliance with dietary guidelines by those patients who have a history of CHD, hypertension and cardiac decompensation. If possible, abolish medicines that aggravate the blockade of the heart. Such drugs include antiarrhythmic drugs, calcium antagonists, and others.

Medication therapy is used to eliminate the causes that caused a complete blockade. Also, its main focus is the treatment of the underlying disease. It is necessary to limit or exclude drugs that degrade AV conductivity.

Reception of anticholinergics, for example, atropine, is prohibited due to the appearance of pathologies from the side of the central nervous system in the patient ("atropine delirium").

Operative treatment

Blockade of the third degree, combined with ventricular fibrillation, requires surgical treatment, the main task of which is the implantation of a constant pacemaker.

One-chamber ventricular stimulation (VVI or VVIR) can be used during surgery. For this procedure, electrodes are placed in the ventricle of the heart, one stimulating the cardiac muscle, and the other causing it to contract. The number of abbreviations is set in advance (usually set to 70 bits per minute).

VVIR mode means the following - two electrodes (stimulating and perceiving) are in the right ventricle and with spontaneous activity of the ventricle its stimulation will be blocked. This is the most optimal method of stimulation.

Prevention

Blockade of the heart is a very serious disease. If the prognosis worsens and additional diseases are present, regular visits to the cardiologist are necessary. If any problems are found during the examination, it is necessary to immediately start their treatment without neglecting the recommendations of the doctor.

To maintain the heart muscle requires the intake of drugs containing magnesium and potassium. The necessary number of these elements will help to choose a doctor.

With Frederick's syndrome, every effort should be made to maintain the heart, but these efforts lead to prolongation of life.

[40], [41], [42], [43], [44], [45], [46], [47], [48], [49]

Forecast

Terms of incapacity for work and prognosis depend on the severity of the underlying disease.

If there was a syncope caused by a sharp decrease in cardiac contractions and cerebral ischemia as a result of sudden cardiac rhythm disturbances (Morgani-Adams-Strokes attack) and no implantation of ECS (pacemaker stimulation), the patient's life expectancy is about two and a half years.

Improving the quality of life of patients is due to constant stimulation.

[50], [51], [52], [53]