Reflex bradycardia

Author Ольга Кияница


Various pathologies can be accompanied by a slowdown in cardiac activity. In clinical practice, this condition is referred to as refractive bradycardia. The prognostic value at its occurrence is relatively favorable. The treatment of rhythm disturbance is also not always carried out.

Reflex bradycardia refers to a large group of arrhythmias and is manifested by a characteristic symptom - a decrease in the number of cardiac contractions. It can be defined in adults and children, while the severity of the clinic depends on the complexity of the course of the main disease, which provoked the appearance of a rhythm disorder.

To determine the diagnosis of bradycardia, the patient should determine a pulse of 55 beats / min and below. Everything above this indicator indicates normal contractility of the myocardium or tachycardia.

The definition of the presented pathology occurs with the help of instrumental and laboratory methods of research.Among the first main methods is electrocardiography, and from the second - various analyzes, contributing to the detection of concomitant diseases.

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Description of reflex bradycardia

The presented violation of the rhythm can be regarded as a variant of the norm and as a pathology. In the first case, the slowing of the rhythm is observed in various physiological conditions (during sleep, rest, after eating) or athletes who, by means of training, increased myocardial volume, and therefore - the strength of cardiac output.

Pathological refractive bradycardia can be when it develops in the form of a complication, that is, against the background of another disease or pathological condition. In such cases, there is an overexcitation of the parasympathetic department of the nervous system, which in turn inhibits the activity of the main driver of the rhythm - the sinus node.

There are several options for refractive bradycardia:

  • Slow down of rhythm at athletes - in normal state of health is considered as a variant of the norm, but in some cases, after many years of so-called "physiological bradycardia," develops a pathological form with pronounced clinical signs.
  • Bradycardia in the fetus - using cardiotocography, the heartbeat of the baby is determined during fetal development.The heart rate in the normal state should not fall below 110 bpm. At the same time, this indicator becomes as informative as possible from the 20th week of pregnancy. Before that, with the help of heart rate, one can only diagnose that the fetus is alive and develops.
  • Bradycardia in children - heart rate varies according to age. For example, by the year the lower threshold falls at 100 bp / min, and after 12 years - almost approached the adult norm - 70 bpm. If the child is diagnosed with reflex bradycardia, then it can be associated with both psycho-neurological disorders and somatic disorders in the form of thyroid function, brain structures, etc. Also, the rhythm may slow down due to increased temperature or supercooling, so it is important to follow baby what and how he does.
  • Bradycardia in adolescents - at the age from 12 to 16 years old, quite often there are various arrhythmias and reflex bradycardia including. The body is actively growing and, with a lack of any substances or an incorrect physical, emotional load, can respond to various abnormalities of the rhythm disturbance.
  • Bradycardia during pregnancy - often occurs in cases where a woman is actively engaged in sports before pregnancy.In pathological cases, treatment should be administered promptly, so that the fetal development does not occur.
  • Medicinal bradycardia - is associated with the administration of a number of drugs that can slow down heart rhythm and even cause heart failure. Such pharmacological agents include morphine, a group of sympatholytic drugs, cardiac glycosides, and the like.


Symptoms of refractive bradycardia

At the beginning of the development of the pathology, the patient feels fatigue, drowsiness, melancholic mood is observed on the background of the previously active lifestyle. It is difficult to perform the usual work, I want to sit down and do nothing. Such signs should immediately alert and force the measurement of at least a pulse, and then go for an examination to the cardiologist.

Possible variants of manifestation of reflex bradycardia:

  • Asymptomatic course, when the patient notes either of these signs at all, or to a small extent.
  • Transient symptoms - periodic symptoms of bradycardia are noted, but they are not very disturbing or rarely occur.
  • A pronounced clinic - in such cases, the patient may lose consciousness due to abrupt cessation of blood circulation and then the resuscitation brigade can help.

Any variant of the manifestation of refractive bradycardia should not be allowed on the self-adhesive, as a more complex condition can be provoked.

Causes of reflex bradycardia

Clarification of the factors of influence is often engaged in the development of pathological refractive bradycardia. There are several large groups of reasons that play a role in the occurrence of rhythm disturbance:

  • Cardiac - these include those factors that are directly related to cardiovascular diseases: myocardial infarction, endocarditis and myocarditis, cardiosclerosis, heart defects, coronary circulatory disturbances. (CHD).
  • Extracardiac - the group consists of those pathologies that do not belong to the cardiovascular system, but still affect the activity of the heart. In particular, reflex tachycardia can cause hypothyroidism, traumatic lesions and bruises of various organs, tumor neoplasms, infectious processes, metabolic disorders, especially elevated calcium in the blood.

Some patients have a weighty heredity for slowing heart rhythm. In such cases, it is especially important to take cautionary measures to develop bradycardia in one form or another.

Diagnosis of reflex bradycardia

The examination is carried out in the case when the patient makes complaints about the deterioration of his or her health or if close people note the symptoms listed above.

First of all, electrocardiography is carried out, which allows the cardiac activity to be evaluated without any cost. Using ECG, the heart rate is counted, heart rate and other parameters can also be determined.


Additionally, Holter monitoring is often carried out, which helps to "see" bradycardia from objectively healthy people. For this patient, during the course of the day, wears a device that continually registers heartbeats. As a result, after an analysis, a conclusion about the presence or absence of a latent rhythm disturbance is issued.

Informative methods of research in refractive bradycardia:

  • Ultrasound of the heart - helps to detect organic heart lesions.
  • Coronary angiography - Is conducted on suspicion of ischemia or blockage of vessels of coronary vessels.
  • tests with simultaneous recording of ECG and using physical loads, various medical preparations.

In case of asymptomatic bradycardia or idiopathic form, it is extremely difficult to carry out diagnostics. Long-term care may be required before the cardiologist can make a final decision.

Treatment and prevention of reflex bradycardia

Before appointing therapy for rhythm disorder, the following important points are revealed:

  • Does reflex bradycardia bring discomfort during its onset?
  • Have any drugs been taken to restore the rhythm?
  • What are the concomitant diseases?

After the results of the research and refinement analyzes the conclusion is made about the need for specific treatment of the pathology.

Standard therapy for refractive bradycardia often includes:

  • selection of a dose of a medicinal product;
  • a change in the dosage of previously taken drugs that could cause a rhythm retardation;
  • the treatment of the main and concomitant diseases that have become the cause of the rhythm disorder.

Sometimes it is enough to change the habitual way of life or the situation, so that the state of health improves. This is especially true of "delicate" categories of the population - pregnant, children, elderly people.

As a prevention of reflex bradycardia, healthy nutrition, no harmful habits, adequate physical activity, treatment of diseases that can cause cardiac impairment.

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