Sinus bradycardia

Normally, the heart is controlled by the pacemaker, called the sinus node, which consists of first-order myocyte cells and generates an impulse for the gradual reduction of all parts of the heart. The location of the sinus node is the right atrium, or rather the mouth of the two hollow veins, the lower and upper. From here, a signal is sent to the left atrium, and then to the atrioventricular node. Further on the bundle of His and the fibers of Purkinje, the signal spreads through the myocardium of the ventricles.

With sinus bradycardia, even after exercise, there is no increase in the heart rate, which is due to the presence of factors affecting the sinus node.

The slowdown in the generation of an electric pulse is often associated with various factors in which sinus bradycardia occurs. Is this disease dangerous so that appropriate treatment is provided? Such a question is especially often of interest to young people who need to serve in the army. In some cases, the disease may be weak, or completely asymptomatic. Despite this, it is necessary to carry out the appropriate therapy so that the state of health does not worsen due to a lack of oxygen in the body.

Video bradycardia folk remedies

Description of sinus bradycardia

The main driver of the rhythm consists of nerve cells, which trigger the work of the entire organ. With the help of pacemakers of the first order, spontaneous pulses are created, leading the entire myocardium to contraction. With the proper operation of the heart, rhythmic strokes are performed, which do not contribute to the occurrence of palpable discomfort.

With sinus bradycardia, the frequency of the generated impulses decreases, as a result of which the rate of blood circulation decreases. To the organs and tissues, oxygen and nutrients begin to flow in a smaller quantity. Particularly sensitive to such changes are the myocardium and the brain.

Hypoxia - a pathological condition, which is an oxygen starvation. It develops with various disorders of the respiratory and cardiovascular system, including sinus bradycardia.

The degree of severity of rhythm disturbance, and hence hypoxia, directly affects the patient's well-being. The stronger the oxygen starvation, the brighter the clinical signs. Reduction of the activity of the sinus node is often associated with an increase in the level of action of the parasympathetic, the so-called vagus nerve. This disorder is often determined with various pathologies of the nervous system and diseases of the gastrointestinal tract.

The heart rhythm with sinus bradycardia changes in such a way that the number of heartbeats drops to 50 beats per minute and lower. Rate of heart rate - from 60 to 90 beats per minute in an adult. With bradycardia, there is a decrease in the pacemaker's automaticity. In a number of cases, a low pulse is considered a variant of the norm.

Athlete Miguel Indurain, engaged in cycling, in a calm state had a pulse of 28 beats per minute, whereas on average the normal pulse is 75 beats.

The weakness of the pulse in this case is due to the high degree of exercise of the heart muscle. The athlete's heart was enough to fight twice as often to pump the right amount of blood required for the full operation of all organs and body systems.

Usual people usually have not only frequent heartbeats, but also a number of other symptoms: fatigue, weakness, dizziness. All this indicates a pathological bradycardia, which requires close attention. Therefore, according to the clinical picture, bradycardia is described as physiological and pathological.

Classification of bradycardia:

The course of the disease can take place in two forms.

• It is persistent, that is, proceeds in a chronic form;
• intermittent - the severity of the pathological process then calms down, then grows again with renewed vigor.

Symptoms of sinus bradycardia

The main sign of bradycardia is a slow heartbeat. In adults, it can be less than 40 beats per minute, children - 75 beats per minute, babies - 100 beats and below.

Physiological bradycardia does not cause concern. Its beginning and end can pass for a person imperceptibly, which indicates the absence of a symptom of the process. In the pathological development of the disease, patients focus on the following symptoms:

• "Fading" of the heart, which simultaneously causes fear and anxiety for one's life;
• frequent fatigue and reduced work capacity;
• low blood pressure;
• loss of consciousness and fainting;
• pain in the heart, shortness of breath.

The clinical picture differs in severity of manifestations, for which the heart rate is estimated:

• The mild degree of bradycardia - the heart rate in adults is 60-50 beats / min.
• Moderate bradycardia - the pulse is in the range of 50-40 beats / min.
• Pronounced bradycardia - heart rate is defined below 40 beats per minute.

If you lose consciousness, you should immediately call an ambulance, because of the high risk of cessation of cardiac activity, a fatal outcome is possible.

Basic forms of sinus bradycardia:

• Syndrome of weakness of the sinus node - manifested by the above symptoms, and syncope occurs most often with SSSU. In severe cases, pathology is complicated by shortness of breath and angina pectoris.
• Sinoatrial blockade, which is manifested by sinus bradycardia. For this pathology paroxysmal syncope is characteristic.
• The syndrome of bradycardia, tachycardia, is more characteristic of organic heart lesions, characterized by a change in the rapid heart rate slowing the rhythm. Similar attacks occur suddenly, so it is difficult to diagnose them.
• Stopping the sinus node is a clinically unfavorable condition, as it can provoke the development of sudden cardiac arrest.

When swelling on the legs or severe shortness of breath should be immediately consult a doctor, since these are the first signs of heart failure.

With sinouauric blockade, there is an acute bradycardia, which is manifested by cardiac insufficiency. There are semi-fainting conditions, angina attacks become apparent. What is dangerous is a sinus bradycardia? First of all, the risk of injury, since an accident can occur on the road, also a person can fall and cripple. Because of poor blood circulation, hypoxia of the brain arises, and in the future - disruption of the respiratory system and convulsions. A similar symptom complex is known as Morgagni-Adams-Stokes syndrome.

Atrioventricular blockade causes a strong slowdown in ventricular contraction. Against the background of this pathology, there is a pronounced anxiety, for no reason dizziness begins. This is due to the fact that the work of the ventricles is associated with the movement of blood through a large and small circle of blood circulation. The slowing down of their work negatively affects primarily the functioning of the brain. If the pause between contractions is more than 15 seconds, then the above-described MAS syndrome with convulsions and respiratory failure may develop, or complete loss of consciousness occurs.

To distinguish the physiological bradycardia from the pathological helps atropine test. In the first case, the administration of atropine restores the normal functioning of the heart, and in the second does not give a result.

The causes of sinus bradycardia

All the factors that influence the development of pathology can be divided into two large groups: internal and external. In some cases, there is a joint influence of causes from one and the other group. Correct their definition allows you to accurately establish the diagnosis and further assign effective treatment.

Internal causes of sinus bradycardia

First of all it is necessary to note the physiological aging of the organism. There is a slowdown in many processes, resulting in age-related degeneration of organs and systems, including the heart muscle.

Cardiac diseases are on the second place in the list of external factors provoking the development of bradycardia. These are inflammatory diseases of the myocardium, ischemic heart disease, cardiomyopathy. Some infiltrative pathologies in the form of amyloidosis, sarcoidosis also cause a slowing of the heart rate.

Intra-cardiac causes:

• arterial hypertension;
• atrial fibrillation;
• myocardial infarction;
• heart defects;
• myocarditis;
• cardiac ischemia;
• degenerative disorders of the sinus node;
• Atherosclerotic changes in coronary arteries.

The development of sinus bradycardia is often observed in non-cardiac diseases. These include pathologies of various organs and systems of the body.

External factors of sinus bradycardia

These include:

• disorders of the nervous system (stroke, trauma and infectious lesions of the central nervous system) and peripheral system (neuritis and neuralgia, tumor processes);
• improper use of medicines, as a result of which toxic and poisoning conditions develop;
  alcohol abuse;
• violation of hormonal balance (hypothyroidism, aldosteronism);
• physiological factors of impact associated with starvation, aging, low body temperature;
  hereditary predisposition.

The association of the disease is often found with diverse electrolyte disturbances . When the concentration in the blood of calcium and potassium is elevated, as well as with the lack of the last element, the rhythm of the heart in the direction of deceleration can be violated.

Metabolic pathology associated with the thyroid gland or gall bladder also affects negatively the performance of the heart muscle. First of all, such diseases as cholestasis (bile stasis) and hypothyroidism (insufficient thyroid gland activity) are affecting them.

Diseases of the nervous system can be complicated by a sinus bradycardia, which often becomes one of the first signs of a brain tumor. Neurotic conditions and increased intracranial pressure directly affect the rhythm of the heart, as well as the vegetative-vascular dystonia common at a young age.

In some cases, there may be more than one cause, but several, then the symptoms become fuzzy, and the flow becomes protracted. But sometimes it is not possible to pinpoint the effect factor, then they speak of an idiopathic manifestation of a rhythm disorder.

Types of sinus bradycardia

It was noted that, based on the clinical picture, two main forms of sinus bradycardia have been identified. The first - the physiological and the second - the pathological.

The physiological appearance of sinus bradycardia

This is an asymptomatically occurring form of pathology, which does not reduce a person's ability to work. Pulse may be 40-50 beats per minute. At night, often manifested, because at this time of day the parasympathetic system predominates. There is a slowing of the pulse, breathing becomes less and more equal.

Physiological bradycardia is the main difference between trained people who play sports or lead an active lifestyle. The brain is sufficiently supplied with oxygen and nutrients, despite the more rare cardiac outliers. Under the influence of physical factors (cold, humidity, temperature), bradycardia also develops as a protective reaction that allows temporary discomfort to be transmitted to the body. Therefore, physiological bradycardia is not dangerous to health , in connection with which its treatment is not carried out.

Pathological type of sinus bradycardia

t mainly develops due to the impaired conductivity of the pacemaker in all parts of the heart. Therefore, it is common to distinguish two types of pathological bradycardia:

1. Inhibition of sinus node activity. It develops against a background of various nervous diseases, as well as with cholecystitis and hypothyroidism. In the blood, there may be an increased concentration of acids, or, conversely, a lack of hormones. Increased activity of the parasympathetic nervous system or vice versa hypotonic sympathetic department also affects the work of the pacemaker.
2. The occurrence of cardiac blockade can be expressed in atrioventricular and sinoauric. In the last version, the atrium is poorly impulse, which causes the ventricles to go through the times.

Atrioventricular (AV) blockade is a complex impulse of impulse transmission through the ventricles. In the normal state, each signal must pass through all the fibers of each heart department. Here, some ventricular contractions fall out, which causes heart failure. There are three degrees of severity of the AV blockade:

• The first - is considered easy, the impulse is poorly transmitted from the atria to the ventricles.
• The second is the average, at which some impulses do not reach the ventricles.
• The third one is heavy, since a complete blockade of impulse transmission occurs, which causes the ventricles to be excited by a replacement rhythm driver.

Diagnosis of sinus bradycardia

First of all, a medical examination is carried out, when the following changes are detected when listening to a patient:

• The first tone on the top sounds loudly after about 10 beats. This sign is known as the "cannon shot Strazhesko." It is considered characteristic for a complete AV blockade.
• Listening to the atria allows you to hear the "echo of the systole", which is formed as a result of the sound of deaf tones during the systole period.

Electrocardiography is performed after external examination of the patient. At any kinds of a sinus bradycardia it is possible to define or determine on the cardiogram:

1. Correct sinus rhythm
2. Reduction of heart rate (40 strokes and below)
3. Practically in all leads a positive tooth P

Sinoauric blockade manifests itself on the ECG only in a slow rhythm, while all the teeth are not changed.
AV blockade has such characteristic ECG signs as an increase in the QRS amplitude, loss of some ventricular complexes, atria and ventricles are excited separately

Additional research methods that help determine sinus bradycardia:

• Ashner's test - is considered positive, if after pressing on eyeballs pulse slows down.
• Bicycle ergometry - there is a physical load, against which the possibilities of cardiac activity are assessed.
• Orthostatic test - the heart rate is measured first in the horizontal position, and then in the vertical, after which the difference is calculated.
• Ultrasound of the heart - the structural changes in the myocardium are determined, which can affect the contractility of the heart.
• Transesophageal electrophysiological research is the most informative method, which, despite the complexity of the exercise, gives many important indicators.

The last research is appointed in the case when the variant of operative treatment of the patient is considered.

Treatment of sinus bradycardia

Moderate and light sinus bradycardia does not require medical therapy, whereas a complicated rhythm disorder can be treated in two ways: conservative and surgical.

Pronounced bradycardia often manifests as a syncope of the patient. In this case, one should not panic, but immediately call an ambulance.

Before the arrival of a team of medical workers the following actions are performed:

• The patient is placed on a flat surface.
• The top buttons of the shirt are unbuttoned or if another tight clothing is put on, then it is removed.
• We must try to find a pulse and count the number of heartbeats.
• If the patient is breathing but is unconscious, then you should bring it to my nose for a few seconds with a cotton swab soaked in liquid ammonia or vinegar.
• Absence of breathing and heartbeat is an indication for mechanical ventilation and chest compressions.

All kinds of bradycardia caused by conduction disorder that should be treated in a hospital.

Electrical pacemaker is recommended for implantation in cases where there is a natural aging process, or bradycardia does not give medical treatment.

Each patient should be discharged in the outpatient card are arrhythmic drugs that it is contraindicated. For example, anticholinergics can not be used at the distal AV block as they exacerbate during bradycardia.

Preparations

• Atropine administered in most cases and usually at a dose of 2 mg when administered intravenously and subcutaneously with 0.5-1 mg. Cupping applied every 3 hour.
• Alupenta administered intravenously at a dose of 10 g per 500 ml of physiological saline.
• Izadrin taken at a dose of 2 ml per 500 ml of glucose given intravenously.

Mild bradycardia apply belladonna preparations, Eleutherococcus and ginseng extract.

Using the popular drugs in the treatment of bradycardia:

• Radish with honey - a tool often used to treat coughs, but against bradycardia it effectively. Radish wash, cut off the top and make a hole inside, which put a spoonful of honey. After standing overnight facility ready.
• Pine shoots - very useful in many diseases, including bradycardia. From young runaways prepare an alcohol tincture, which is taken every day for 20 drops.
• Walnuts - good for the heart muscle. By themselves, they are very useful, but they can also interfere with the equal parts of honey, dried apricots, raisins. The resulting mixture is eaten every day, no more than a tablespoon.

Prevention of sinus bradycardia

Specific methods do not exist. Known ways to increase heart rate, which can help prevent the transfer of physiological bradycardia pathological.

• Hot tea and a cup of coffee is often recommended gipotonikam, so they can be used also to increase the heart rate.
• If often it happens bradycardia, seizures, worth to yourself to wear a tincture of ginseng, Siberian Ginseng, or belladonna, which can add 10 drops of always the same tea or coffee.
• drugs should be used regularly prescribed by the doctor.
• To play sports with the youth, in order to avoid abnormal bradycardia in old age.

Video: aetiology and treatment