PADINAW.W.

Vlad Terapiikineticespecificenpatologiacardiovascular
AnImasterKT lect.univ.dr.med.BuhociuElena

KINETOTERAPIANFibrilaiaatrial

Fibrilaiaatrial1
Fibrilaiaatrialesteformadearitmiesusinutcaresentlnetecelmaifrecventnpractica
clinic.Prevalenaeicretecuvrsta,dela0,7%lagrupadevrst5559deani,la18%laceide
peste85deani,faptceiaccentueazimpactulasuprasntiipublice.
Fibrilaiaatrialsecaracterizeazprinactivitateelectrichaoticlanivelatrial,careinduce
contraciaventricularneregulatideobiceirapid.Pacieniipotsfieasimptomatici,saib
simptomeuoaredepild,palpitaii,obosealireducereacapacitiideefortsausprezinte
episoadedesincop,deinsuficiencardiac,orideangin.Multedintresimptome,cai
intensitatealor,suntlegatedegraduldetahicardieasociat.Inafardetahicardie,complicaia
majorafibrilaieiatrialeesteemboliasistemic,deobiceicerebral.Fibrilaiaatrialpoatefi
autolimitat(inparoxismecesepotrepeta)saususinut(esteapreciatadrept"persistent"dac
dureazamaimultdeaptezile).Fibrilaiaatrial"permanent"sereferalaformaclinic
persistentincarecardioversiaaeuatsauseconsidercanumaiesteposibilareinstituirea
ritmuluisinusal.Acelaiindividpoateprezenta,dealungultimpului,maimultetipuridefibrilaie
atrialdeexemplu,aceastapoateevoluadelaformparoxisticlaceapersistent.n
majoritateacazurilor,fibrilaiaatrialseasociazcuhipertensiune,coronaropatie,insuficien
cardiac,valvulopatie,saucardiomiopatie,ceaucarezultatdisfunciamuchiuluicardiac.

1.Cauze2
Cauzaesteotransmitereanormal(haotic)aimpulsurilorelectriceprovenitedelanodul
sinusal.Nusadescoperitncunelementdeclanatorclar,darsaudescoperitunmarenumr
defactoriderisccontrolabili:
Tensiunearterialcrescut
Infarctulmiocardic
Ateroscleroza
Anormalitialevalvelorinimii
Defectecardiacecongenitale
Glandtiroidhiperactivsaualtedezechilibremetabolice
Dozemaridestimulani,precummedicamente,cafein,tutun,saualcool(exist
sindromulinimiidevacan,caresepoatemanifestaprinfibrilaieatrial,nurma
consumuluiunordozemaridealcool)
Sindromulsinusuluibolnav
Bolideplmni
Operaiipecord
Infeciivirale
Stresdatoratpneumoniei,operaiilor,saualtorboli
Apneenocturn

2.Evoluie3
Fibrilaiaatrialare3stagii:

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PADINAW.W.Vlad Terapiikineticespecificenpatologiacardiovascular
AnImasterKT lect.univ.dr.med.BuhociuElena

1. FAparoxismal,careconstdinepisoadescurtedearitmie,deobiceicurevenire
spontanlaunritmnormal.
2. FApersistent,atuncicndaritmiilenecesitinterveniemedicamentoassaumedical
pentruarevenilaritmnormal.
3. FApermanent,atuncicndinterveniilemedicalenuauniciunefectsauaudoarefecte
descurtdurat.

3.Tablouclinic4
PrincipalelesimptomealeFAsuntcelealetahicardiei:
btirapideineregulate
intoleranlaefort
angin,atuncicnddatorittahicardieiextremeseproduceischemie
Deasemenea,simptomecongestive,precumedemidificultirespiratorii.

Demulteoriaritmiaestedescoperitdoarodatcusurvenireaunuiatacvascularcerebralsau
AVCtransient.
SepoatedeasemeneacaFAsnucauzezeniciunsimptom,isfiedescoperitcuocaziaunui
controlderutin.

4.Complicaii
Celemaiimportantecomplicaiidirectealefibrilaieiatrialesuntrisculcrescutdeatacurivasculare
cerebraledatoratfaptuluicatriilenemaigolindusecomplet,apareostagnareasngeluicare
riscsformezetrombicareapoipotajungelacreier,iinsuficienacardiaccareaparentimp
nurmaefortuluicrescutlacareestesupusmiocardul.
Indirect,oameniicaresuferdefibrilaieatrialpotajungemaisedentari,ceeacecreterisculde
obezitate,artriteetc.

Kinetoterapianfibrilaiaatrial
1.Limitelekinetoterapiei
nbazadateloractuale(cutricuGoogleScholarpentruExercisetherapyatrialfibrillation,
Exercisetreatmentatrialfibrillation,Exerciseforatrialfibrillation),exerciiiledeoricefelnupot
amelioranmoddirectfibrilaiaatrial.Desigur,potaveaefectepozitivenpatologiiasociate,de
exempludecondiionarea,obezitateaipatologiileasociateaprutepefondulsedentarismului
indus/accentuatdefibrilaie.
Menioneztotuic

nschimb,exerciiileiunstildeviasanogenpotpreveniapariiaacesteia,cunotacpreamult
efortfizicsaobservatcpoatecreterisculapariieifibrilaieiatriale.

Deasemenea,esteposibilcaeliminarea/reducereafactorilorderiscspoatamelioracazurilede
fibrilaienepersistent.5

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PADINAW.W.Vlad Terapiikineticespecificenpatologiacardiovascular
AnImasterKT lect.univ.dr.med.BuhociuElena

Unnumrdestudiirecente,totuiauobservatoratdubldesupravieuirenurmareducerii
factorilorderisc.6,7,8

Trebuienotatcmajoritateatipurilordeexerciiinusuntcontraindicatecttimpfibrilaiaeste/poate
fiinutsubcontrolcuajutorulmedicaiei.

2.Obiectivelekinetoterapieinfibrilaiaatrial
nbazapunctuluidemaisus(fibrilaianupoateficontrolatprinexerciiu,doarfactoriiderisc,
morbiditatea,imortalitatea6,7,8),sepoateconsideracobiectivelerealizabileprinkinetoterapie
sunt:
Normalizareatensiuniiarteriale
Reducereastresuluiprinexerciiiderelaxare,respiraie,imasaj
Prevenirea/vindecareaobezitii
Cretereacalitiivieii

3.Tipurideexerciii
a) PentrunormalizareaTA
Exerciiilederelaxare,respiraie,mersulcodificat
b) Pentrureducereastresului
Idema)
c) Pentruprevenirea/ameliorareaobezitii
Mersulcodificat,exerciiiaerobelaointensitatecaresnuduclafibrilaie(not,mersvioietc.0
d) Pentrucretereacalitiivieii
Pelngexerciiiledemaisus.,exerciiicugreutimicidarprogresiventimp,nlimitatoleranei.
Considerndcfibrilaiaatrialafecteaznspecialbtrnii,esteimportanticretereaforei
pentruareducerisculdeczturi,iauuraactivitilezilnice.

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PADINAW.W.Vlad Terapiikineticespecificenpatologiacardiovascular
AnImasterKT lect.univ.dr.med.BuhociuElena

BIBLIOGRAFIE
noteledecurs

1. BritishMedicalJournalManagementulFibrilaieiAtriale
http://www.bmj.ro/articles/2010/03/17/managementulfibrilatieiatriale
2. MayoClinicSymptomsandcausesofAtrialFibrillation
http://www.mayoclinic.org/diseasesconditions/atrialfibrillation/symptomscauses/dxc2016
4936
3. CardiothoracicsurgeryUniversityofSouthernCaliforniaKeckSchoolofMedicine
http://www.cts.usc.edu/atrialfibrillation.html
4. NationalHeart,Lung,andBloodInstituteWhatAretheSignsandSymptomsofAtrial
Fibrillation?https://www.nhlbi.nih.gov/health/healthtopics/topics/af/signs
5. NationalHeart,Lung,andBloodInstituteHowisAtrialFibrillationTreated?
https://www.nhlbi.nih.gov/health/healthtopics/topics/af/treatment
6. PathakRK,MiddeldorpME,LauDH,etal.AggressiveRiskFactorReductionStudyFor
AtrialFibrillation(ARRESTAF):Implicationsforablationoutcomes.HeartRhythmSociety
2014ScientificSessionsMay9,2014SanFrancisco,CA.
7. MahajanR,BrooksAG,ShippN,etal.AFandobesity:Impactofweightreductiononthe
atrialsubstrate.HeartRhythm2013May9,2013Denver,CO.
8. AbedHS,WittertGA,LeongDP,etal.Effectofweightreductionandcardiometabolicrisk
factormanagementonsymptomburdenandseverityinpatientswithatrialfibrillation:A
randomizedclinicaltrial.JAMA2013310:20502060.