Treatment of neurogenic bradycardia
Author Ольга Кияница
Neurogenic bradycardia refers to regulatory disorders of the autonomic nervous system, which are formed due to spinal cord injury. The stronger the damage, the greater the likelihood of a slowed-down rhythm. For example, a complete neurological deficiency leads to 100% of cases of bradycardia. If the neurological deficiency is partial, then the percentage of the occurrence of rhythm disturbance is 35-71%.
In severe cases, neurogenic bradycardia is capable of becoming an asystole, that is, a heart stop, so it is extremely important not to delay the onset of an emergency when injured.
The patient who received the injury should first of all be provided with medical assistance. But it is equally important to conduct an examination to determine the cause of the pathology. Therefore, at the pre-hospital stage, objective diagnosis, electrocardiography, ultrasound of the heart is performed, while in the hospital more careful research is done with the help of MRI, radiography and other methods. After setting the cause of the disease, the treatment tactics are chosen, in the extreme case, the external temporal cardiostimulation.
Video External temporal pacemaker
Neurogenic bradycardia can develop not only against the background of injuries and infectious lesions, but with wagon-insulatory crises. The latter pathology is often found in vegetative disorders, when the parasympathetic part of the nervous system has a negative chronotropic effect on the heart. With the prevention of a number of irritating factors, the development of neurogenic bradycardia can be avoided:
- Carotid sinuses that are located on the neck should not be crushed and, if tightly tied, may cause a slowdown in the heartbeat.
- It is necessary to prevent the exacerbation of peptic ulcer in the stomach and duodenum, which often provoke a decrease in the frequency of cardiac contractions.
- It is not necessary to press on the eyeballs, so as not to stimulate the work of the vagus nerve and thereby not cause neurogenic bradycardia.
- It is important to timely carry out substitution therapy for hypothyroidism in order to prevent signs of rhythm disturbance.
To strengthen the cardiovascular system, you must adhere to the following medical recommendations: to eat properly, to refuse harmful habits, to control your weight, blood pressure and blood glucose. Also, appoint a therapeutic physical training with a daily stay in the fresh air for at least 2 hours.
Medicinal treatment of neurogenic bradycardia
Drug therapy is performed when there is a neurogenic shock or other gross violation of the functioning of the autonomic nervous system. After initial examination and implementation of standard research methods (pulse measurement, blood pressure, standard electrocardiography), correction of life-threatening disorders is performed.
- The state of the respiratory system is assessed, and in the absence of respiration, artificial ventilation of the lungs is performed.
- In the presence of damage to the spine, its immobilization is carried out with the help of external fixation.
- With the aid of a catheter, access to the vein is made and an intravenous infusion of crystalloid solutions is performed, which helps maintain the underlying blood pressure to the proper level. Strengthen the infusion effect through dobutamine and dopamine.
- Extremely pronounced neurogenic bradycardia is stopped by atropine sulfate, which, if necessary, is introduced gradually several times in 5 minutes.
- It is important in the nearest hours after an injury to carry out hormonal anti-epithelial therapy, for which glucocorticoids (methylprednisolone) are used in accordance with the established scheme.
During the treatment of patients with neurogenic bradycardia, consultation may be required not only with the cardiologist, but also with the neurosurgeon, as well as the orthopedic traumatologist. With the help of these doctors, spinal damage can be detected, various complications in the form of compression and bruising. As a result, an urgent operation may be performed on the indications.
In the postoperative period, patients with preserved neurogenic bradycardia may need to take cardiotonic drugs, which strengthen the cardiovascular system. In particular, metabolic agents (solcozeryl, mildronate, coenzyme Q10, carnitine) are often used, as well as increasing the resistance of the heart muscle to hypoxia (mexidol or trimethazoline).
Auxiliary treatment of neurogenic bradycardia
With a moderately pronounced violation of the rhythm and the absence of other contraindications, one or another physiotherapeutic method is prescribed. In particular, the effect on the parasympathetic nervous system is through ultrasound, sinusoidal modulated currents, inductothermy, electroshock. The application of ozokerite and paraffin to the neck-collar region is considered to be quite effective.
Most often, electrophoresis of herbal preparations is used today on the upper back of the spine. Pharmacological preparations, such as mezaton, caffeine, and calcium, which are suitable for attenuating excessive activity of the parasympathetic nervous system, can also be used. Potassium iodide and novocaine can also be used in the occipital-occipital way. The latter drug may be administered by endonazal electrophoresis if necessary. Such physiotherapy procedures are performed every other day, with no more than 12 procedures for one course. If necessary, then the physiotherapy will be repeated in a few months.
Treatment of neurogenic bradycardia, associated with the activity of the parasympathetic nervous system, is carried out for a long time, and most commonly the complex treatment is practiced.
Strengthening the severity of neurogenic bradycardia can cause the appointment of psychostimulants on a vegetative basis. The most commonly used are various tincture (zamaniki, ginseng, Chinese lemongrass, aralia), as well as extracts (rhodiola, eleutherococcus). Often, a combination of the above-mentioned drugs with the addition of pharmacological agents (caffetensin, acetophen) with the mandatory selection of the individual dose is used.
A good influence on the nervous and cardiovascular system is provided by various nutritional supplements, rich in vitamins, trace elements and coenzymes. In addition, in order to improve microcirculation, trental and stheronone may be prescribed. As a rule, when performing medical recommendations, patients with neurogenic bradycardia quite successfully recover.
Video Vegetative Nervous System. TREATMENT, by the method of Dr. Bartosh. SCM