What is a moderate sinus bradycardia. Sinus bradycardia with heart rate. Moderate sinus bradycardia

16.08.2020 Popular treatment

Sinus bradycardia is a violation of the heart rate, in which the atrium cuts per minute takes less than sixty times. Such a disorder has no restrictions on gender or age category.

Often the occurrence of such a variety is determined by the course of heart disease, but not always sources serve pathological predisposing factors.

The presence and degree of expression of symptoms directly depends on the gravity of the course of the alend. For example, with light flow, clinical manifestations can be completely absent, and nonspecific signs will appear with a pronounced heart.

The diagnosis is established on the basis of the data obtained during the patient's instrumental surveys. However, they can be complemented by laboratory research and manipulations performed by a personally cardiologist.

Very often cured sinus bradycardia can be conservative techniques, but sometimes there may be surgical interference.

International Classification of Diseases Refers such pathology to the category of other disorders heart RhythmThe CODE on the ICD-10 will be - І 49. It is also necessary to consider that uncomfortable sinus bradycardia is R 00.1.

Etiology

Normally, the heart rate should vary from sixty to a hundred shots per minute, and all the meanings that will be lower than the above refers to the category of bradycardia. Pathological is the state when the heart rate frequency does not reach sixty blows per minute and does not increase in response to physical exertion. The danger of such a disorder is that it can leak completely asymptomatic.

Nevertheless, there are a large number of reasons that lead to a slowdown in the heart rate and almost all of them are related to the flow of one or another illness. It is because of this that pathological factors are made to divide into several categories.

Causes of sinus bradycardia due to heart diseases are presented:

a wide spectrum is a heart disease, for which damage to the heart muscle;
which can be both primary and secondary;
- The inflammatory process in heart muscles is observed.

Sources like sinus arrhythmia Narkard nature:

diseases of the respiratory system, in particular, or, in which the body receives an insufficient amount of oxygen;
increased intracranial pressure - this can occur against the background of the formation of neoplasms, hemorrhages or brain ethics;
the flow of diseases of infectious origin, for example, or, or;
violation of the functioning of the endocrine system, which is observed when leaked, as well as thyroid gland or adrenal glands.

In addition, influence the development of such an agell may:

disorderly use of medicines, for example, substances for stimulating the work of the heart, diuretic agents or antiarrhythmic drugs;
long fasting;
organism poisoning toxic substances;
addiction to harmful habits;
failure or, on the contrary, increased concentration in the body of such substances such as potassium, magnesium or sodium.

It is also worth highlighting those situations in which sinus bradycardia in children and adults is quite normal:

the effect of cold temperatures on the body;
night Sleep - in the morning almost all people have a decrease in heart rate;
professional sports - this is due to the fact that people engaged in sports, there are features of the neuroregetative regulation of the emission of the heart;
hormonal perestroika children's body in adolescence.

In addition, the influence of burded heredity is not excluded - sine arrhythmias can be observed in several members of one family.

Classification

Depending on the determining etiological factor, there are the following varieties of sinus bradycardia in children and adults:

organic - directly related to pathologies of cardio-vascular system;
extracardial - develops against the high background;
toxic - sources can also serve as other infectious diseases;
hypoxic;
dosage;
endocrine;
sinus bradycardia in athletes.

As you progress, the disease passes three degrees of development:

light sinus bradycardia - leaks completely asymptomatic and does not need treatment. At the same time, the frequency of the contraction of myocardium varies from fifty to sixty walars per minute;
moderate sinus bradycardia - also does not cause concern, because the symptoms are expressed weakly and easily fastened conservative methods therapy;
pronounced sinus bradycardia - This is such if the cardiac rhythm frequency does not reach 49 beats per minute. Such a state is dangerous for the patient's life, which will require immediate medical intervention.

It is worth noting that the appearance of a sinus bradycardia during pregnancy is uncharacteristic - in the female representatives during the period of the child, there is another kind of arrhythmia - sinus tachycardia.

Symptomatics

Light sinus bradycardia proceeds without an expression of any symptomatics, why a person does not even suspect the development of such pathology. Moreover, practical no changes will not be observed even on the ECG. It is possible to detect such a kind of disease only with the help of an intracardiac examination.

Sine arrhythmia can also be a diagnostic surprise, since the signs are expressed weakly and often simply ignore. In such cases, symptoms can serve:

minor dizziness;
fast fatigue;
dyspnea with intense physical exertion.

The pronounced weakness of the sinus rhythm will have, in addition to the above symptoms, such clinical signs:

unfortunate weakness;
attacks of loss of consciousness;
feeling of lack of air;
dyspnea even at rest;
unreasonable anxiety and panic, feeling of fear and fear die;
increased highlighting of cold sweat;
sleep disturbance.

Sinus bradycardia by a child and an adult is fraught with the development of heart failure, such symptoms can be evidenced by the joining:

strong ethnicity lower extremities;
- this is an increase in the liver, while the affected organ can be easily palpable;
reduced performance;
dyspnea when performing everyday affairs.

Patients need to be borne in mind that the above symptoms of sinus bradycardia is based on clinical picture And it can be complemented by signs of the pathology, against the background of which a similar disorder was formed.

Diagnostics

Against the background that the sinus bradycardia of the heart at the child and the adult has nonspecific symptoms, in order to put the correct diagnosis, a complex of diagnostic measures will be required.

The first stage of diagnosis is based on a cardiologist of such manipulations:

study of the history of the disease and life history of the patient - sometimes it will give the opportunity to find out the reason for the occurrence of such arrhythmia from a person;
careful physical inspection is aimed at studying the condition of the skin, evaluating the respiratory function and listening to a person with the help of a phoneneoscope;
a detailed survey of the patient or his parents is to find out which symptoms of sinus bradycardia are present in the patient and with which intensity are expressed. This will help in determining the severity of the course of the disease.

The second stage of diagnostics - laboratory studies, including:

general blood test;
general analysis Urin;
blood biochemistry;
hormonal tests.

The final step in establishing the correct diagnosis provides for the implementation of such instrumental examinations:

After studying the results of all diagnostic measures, the clinician will determine how to treat sinus bradycardia.

Treatment

The liquidation of sinus arrhythmia is to use the following therapeutic methods:

reception of drugs - treatment with preparations is purely individual;
compliance with gentle ration - diet is based on full failure of oily food and enrichment of the menu fresh vegetables and fruit;
the use of methods of traditional medicine;
surgical intervention.

Medicase therapy is aimed at solving several tasks:

elimination of the disease that caused the appearance of the weakness of sinus rhythm;
reducing the manifestation of symptoms;
conclusion from the organism of toxic substances.

You can also get rid of sinus bradycardia by folk medicine, but this can be done only after consulting at the attending physician.

The most effective are considered:

black currant and nettle;
hawthorn and dandelion roots;
rosehip and tea rose;
chamomile and yarrow;
the root of Aira and Rowan.

Treatment of sinus bradycardia surgically implies the establishment of a pacemaker, which will generate normal heart rate rhythm.

Possible complications

The list of what the sinus bradycardia is dangerous, in the absence of therapy, includes:

sudden heart stop;
injuries obtained during a faint;
sharp.

Such complications are characteristic of both a child and an adult.

Prevention and forecast

To avoid the development of sinus bradycardia in pregnant, children or adults, it is necessary only:

completely abandon bad habits;
eat right;
move the active lifestyle. Many patients ask a question - is it possible to play sports during bradycardia? The answer to it is positive, but subject to the prevention of excessive physical overwork;
timely treat diseases that can lead to arrhythmias;
take medicines prescribed by the attending physician, with strict adherence to the dosage and duration of reception;
regularly undergo preventive examinations in a medical institution.

With sinus bradycardia it is possible to achieve complete cure, but provided that all the recommendations of the cardiologist are compliance. However, if the disease was triggered by other pathologies, then you should not forget that they also have their own complications.

Bradycardia is a type of arrhythmia, in which the frequency of heart cuts slows down and becomes less than 60 cuts per minute. This is not an independent disease, but a symptom indicating violations of the cardiovascular function.

She can meet absolutely healthy peopleFor example, athletes or healthy people who are in a state of sleep are physiological bradycardia, due to good training of the heart muscle.

The pathological is accompanied by heart disease, which ultimately lead to the development of heart failure. About the reasons, symptoms of bradycardia and the options for its treatment This article.

Av-block may have three degrees of severity:

Pronounced - heart rate less than 40 wt / minute
Moderate - 40 to 50 dp / minute
Easy - 50 to 60 Ud / Minute

With a light and moderate bradycardia of circulatory disorders does not develop, because The heart is reduced and with sufficient strength pushes blood. And the pronounced causes a violation of all organs and systems, numerous circulatory disorders occur, which is associated with their oxygen starvation, since the amount of oxygen coming to the tissues with blood is insufficient for the normal life of the human body. Pronounced bradycardia is accompanied by the poverty of skin and mucous membranes, cramps and loss of consciousness may occur.

Causes of bradycardia

The etiological factor in the development of bradycardia is a violation of the work of a sinus unit, which produces electrical impulses for normal operation of the heart (their frequency is normal is more than 60 per minute) or a violation of the propagation process of these pulses according to the conductive heart system. The main reasons for the occurrence of such a symptom can be divided into bradycardia forms:

neurocirculatory dystonia
ISR (see Vegeth Vascular Distonia)
non-believe
at a pressure of a carotid artery (tight scarf, tie, shawl) or on eye apples (Danini Ashner Reflex)
a brain tumor
brain swelling. Meningitis, brain injuries, hemorrhage - states that are accompanied by an increase in intracranial pressure
stomach and ulcer duodenal gut
tumors of the mediastinal organs - diaphragms, esophagus, etc.
endocrine pathology - Myxedema proportional to the severity of hypothyroidism

County
Cardiac Glycosides (Digoxin, Stroofantin, Corglikon, Digitoxin)
β-adrenoblockers (thymolol, bisoprolol, propranolol, atenolol, acebotolol, metoprolol, esmolol, betaxolol, pindolol, sotalol, supolyol, eseatenolol)
Morphine
Blockers of calcium channels (nifedipine, verapamila),
Sympatolithics (Bretlat, reserpine, Raunatin, etc.)
Antiarrhythmic drugs (amiodarone, phenytoin, procanamide, droneard, conpaphenon, trimecain, adenosine, etc.)

After their abolition, bradycardia is born independently and does not require treatment.

Toxic bradycardia

Bradycardia toxic genesis develops with extremely intoxication of the body:

uremia (severe inxication of the body by protein exchange products caused by a violation of the kidney work)
inxication with hepatitis (see how hepatitis C is transmitted)
pronounced intoxication for infectious diseases - sepsis, abdominal typhoid, flu
phosphate poisoning, which slow down the pulses in the heart muscle (see how household chemicals affects health)
sometimes bradycardia may be caused by hyperkalemia or hypercalcemia (an increased concentration of calcium or potassium in the blood).

Physiological bradycardia in healthy people or athletes

In persons engaged in heavy physical labor, well-trained people, athletes, a rare reduction in the heart may be the norm (35-40 UD / min. During the daytime), since the heart is forced to experience maximum loads and its rare reduction is enough to ensure the blood supply to fabrics and cells Whole organism. The reasons for such a feature is the vegetative regulation of the rhythm of the heart from professional athletes.

Physiological decrease in heart rate may be when exposed to:

Cold
Massage of chest
Smoking - chronic nicotine poisoning (see what cigarettes do)

Some people have a pulse less than 60 per minute is the norm, that is physiological featureSince such bradycardia does not bother them, does not manifest themselves with dizziness, weakness, increased fatigue, fainting.

Other types of bradycardia

Elder bradycardia occurs in the elderly and is the cause of the natural aging of the body.

Idiopathic bradycardia is the slowdown in the heart rate of an unexplained (non-diagnosed) genesis.

Symptoms of bradycardia

The main manifestations, signs, bradycardia symptoms are:

the attacks of Morgali-Edems-Stokes, accompanied by loss of consciousness and dizziness arising from the presence of a pulse;
the presence of instability of arterial blood pressure (hypertension, hypotension), poorly treatable and arising against the background of the demolition of heart rhythm;
increased body fatigue (reduction in load tolerance) arising against the background of the demolition of heart rhythm;
the presence of symptoms chronic insufficiency blood circulation against the background of bradycardia, severe conservative therapy;
stenicard attacks arising at voltage or even at rest.

Bradycardia of a moderate degree of severity usually does not cause circulatory disorders and is not manifested by clinically. Symptomatics usually occurs when the pulse is demolished less than 40 shots per minute, the patient most often have organic heart lesions. At the same time, bradycardia has pronounced clinical symptoms:

With the weakening of the contractile function of the heart muscles and hypocacy in the brain, hypoxium occurs in the brain. At the same time, the symptoms of bradycardia can be complemented by loss of consciousness, convulsions (attacks of Morgali-Adhes-Stokes). These states are dangerous for the patient to stop respiratory and cardiac activity.

Diagnostics

Signs of bradycardia Therapist identifies when examining and collecting patient complaints - rare pulse, cardiac tones of ordinary sonicity, possibly respiratory arrhythmia. Then consultation of the cardiologist is recommended. Diagnostic methods:

ECG - allows you to fix the imparation of the heart rate, the presence of an atrioventric or sinoatrial blockade. It is not always possible to identify bradycardia using a one-time ECG, if it is suspicious, the ECG daily monitoring is carried out.
Heart ultrasound is shown in the organic form of bradycardia. Ultrasonic EhocHg can determine the increase in heart size, reduced emission fraction less than 45%, degenerative and sclerotic changes in myocardium.
Loading cyergometry - evaluates the increase in the pulse rate at a given physical exertion.
ChPEFI - If the ECG and Halter Monitoring Methods do not detect transient blocks, a percussion-free electrophysiological study is carried out, which allows you to explore the conductive heart paths, identify the functional or organic nature of bradycardia.

Bradycardia treatment

Functional bradycardia. as well as bradycardia having middle degree Severity, not accompanied by clinical symptoms, do not need conservative treatment.
Bradycardia organic, toxic or extracardial genesis needs, first of all, in the treatment of the underlying disease.
Medicinal bradycardia requires cancellation of drugs that caused bradycardia (or correction of their admission).

For the treatment of pronounced bradycardia, accompanied by hemodynamic disorders (dizziness, weakness, pressure reduction), shown:

atropine ( intravenous administration drug - 0.5 mg 0.1% solution)
isadrine (intravenously 2 - 20 μg / min. in 5% R-RE glucose)
ginseng root preparations, beauties, Eleutherococcus, caffeine - in individually selected doses
drops of Zelenina - applied with moderate bradycardia, ITC and chronic heart failure. The composition of this vegetable spasmolytic is the tincture of Lolanha, Valerians, Belladonny.

Atropine - the number of atropine, if necessary, can increase to 3 mg. Patients who suffered a myocardial infarction, atropine need to be used with caution, since this treatment may cause aggravation of myocardial ischemia and increasing the zone of its defeat.

Isadrine - Beta-adrenostimulants (isoprenaline) are effective - effective impact on the reduction of the heart. This drug It is necessary to introduce intravenously. If bradycardia is associated with the use of calcium antagonists or beta-adrenoblockers intravenously entered glucagon. If the inxication of beta-adrenoblockers takes place, glucagon is also introduced (the dose calculation is carried out by the doctor individually).

When asystolia (absence of heart reduction) is necessary emergency help - Calling a resuscitation brigade, which conducts pacidity.

Temporary endocardial stimulation is carried out by administering through the lumen of the endocardial electrode catheter into the right heap departments (at the same time, the catalyterization of the upper floor of the vein is carried out through a subclavian or yarer Vienna). If you do a temporary endocardial stimulation, it is not possible, it is recommended to carry out permissive pacemakers. And if it is impossible to carry out (or in the case of its ineffectiveness), the intravenous administration of adrenaline is shown (the dose of the drug is carried out by the doctor).

The attacks of Morgali-Adams-Stokes are stopped by resuscitation ambulance teams, while the complex of drugs are prescribed the same as when the blood circulation is stopped. If necessary, an indirect heart massage is carried out.

The presence of a complete AV blockade is recommended by pacemaker. In this case, the patient is shown operational treatment Bradycardia, the main purpose of which is the installation of an electrocardiotimulator - the device, which is an artificial driver of the rhythm of the heart. He supports or imposes a patient human physiological rhythm of heart abbreviations. The pacemaker is a microprocessor, which is capable of generating electrical impulses for normal stimulation of the work of the heart muscle.

What is dangerous bradycardia?

With moderate or physiological bradycardia, the forecast is satisfactory. Availability organic lesions Hearts adversely affect the forecast. Seriously aggregates the consequences of bradycardia. The presence of attacks of Morgali-Adams - Stokes attacks, if the issue of conducting electrical stimulation was not solved. Heterotopic tachyrhythmias in combination with bradycardia increase the likelihood of thromboembolic complications. With a resignation of the rhythm of heart abbreviations, the disability is possible to disability.

Do you take in the army when bradycardia?

In the list of diseases, when the conscript is considered unsuitable for the passage of military duty, bradycardia is absent, since this is not a disease, but the diagnostic sign of the pathologies of the heart. When diagnosing bradycardia, a young man must undergo a SCC examination, and only on the basis of a detected / not detected disease is solved by the issue of suitability for service. Under art. 42-48 Yunorals with diseases - AV-blockade and sinus node weakness syndrome are recognized unfastened. In the absence of these pathologies, the conscript is not exempt from the passage of military service.

Sinus bradycardia

Sinus bradycardia is a pathology that is associated with the slowdown in the formation of impulse by the main driver of the rhythm - synoyauricular education. The rest of the rhythm drivers have a lower frequency of spontaneous excitement, so their impulses are extinguished by the pulses of the sinus node. Normal rhythm is considered heart abbreviations 60-100 shocks. Values \u200b\u200bthat will be less described above are bradycardia.

Pathological sinus bradycardia is a rhythm of less than 60 ° C. in min, which does not increase on physical exertion. The sinus assembly is an education that consists of specialized cells with a unique property - automatism. Very often, such pathology as sinus bradycardia turns out to be unnoticed because of its asymptomatic flow. Reveal sinus bradycardia most often on preventive examinations. A person with this state when performing daily simple actions feels good, but it is worth increasing the physical exertion as sinus bradycardia makes itself felt.

Pronounced sinus bradycardia is a gentability demolition of less than 49 beats per minute. At the same time, not every decrease in heart rate (heart rate) less than 60 per minute is considered sinus bradycardia. Athletes have an increased tone wandering nervewhich refers to the parasympathetic nervous system. Its influence slows down the heart impact frequency without bringing harm to health.

Sinus bradycardia causes

The sinus node is located at the place of introduction into the right atrium of the upper hollow vein. The sinus node is a small formation, 1.5-2 cm. It is bloodlinked from coronary arteries. All pulses formed in this node are sent to the underlying segments of the conductive heart fibers, which take on the function of the pulse products when the sinus node is turned off. Cells from which the sinus node consists of is charged negatively, and the surrounding myocardium is charged positively. Under the influence of the potential of action, the impulse occurs. The main role in the process of excitation is played potassium ions, which is the main ion of intracellular fluid.

Under normal conditions, slowing the sinus rhythm occurs when the effect of vegetative nervous system, during sleep.

Rarely sine bradycardia develops as an isolated disease. In this case, the elderly sinus bradycardia suffer. The cause of isolated elder sinus bradycardia is amyloidosis and other similar states that change myocardial fabric.

The violation of the supply of a sinus unit as a result of the obstruction of the coronary arteries very rarely leads to sinus bradycardia.

Systomatic sinus bradycardia accompanies hypothyroidism, and in later stages of lesions of the liver, hypothermia, typhol and brucellosis. Increased pathological tone of a wandering nerve also causes sinus bradycardia. Hypoxia, hypercupnia, acidema, acute hypertension lead to sinus bradycardia. But at the same time, a multitude of cases of this state remains unknown etiology.

Sinus bradycardia arises in response to a violation of the excitation formation in synoyauricular education, as well as in the violation of the conduction on the heart muscle. In the first case, there is a sinus node refusal, and in the second blockade.

Sometimes patients are asked for help after applying some drugs that reduce the rate of movement of the impulse by myocardium, thereby aggravating the sinus bradycardia. Preparations that slow down the progress of the pulse include the following medication tools: Heart glycosides, beta-blockers, quinidine preparations and other antiarrhythmic drugs, as well as verapamil and diazepam.

Another frequent pathological process with which the appearance of sinus bradycardia is associated is the syndrome of the weakness of the sinus node. The reason for this pathology is an isolated reduction in the functionality of the sinus node, or the so-called lender disease, which is found in the elderly.

Another very much frequent cause The defeat of the sinus node with the occurrence of sinus bradycardia is the IBS. At the same time, sinus bradycardia accompanies 25-30% myocardial infarction. The reason for the symptom of the weakness of the sinus node is likely to be cardiomyopathy. arterial hypertension, infiltrative diseases (amyloidosis, hemochromatosis, tumor), collagenous diseases, myocarditis, congenital changes in the heart and neuro-muscular disorders.

Septic states, elevated metals, elevated intracranial pressure also cause sinus bradycardia.

Sinus bradycardia symptoms

The emergence of sinus bradycardia leads to a decrease in blood emissions for feeding organs and body tissues. This leads to insufficiency and ineffective blood circulation. If the organs do not come with oxygen and nutrients, the body tries to compensate for this process and reduce energy consumption. As a result, the manifestations of fatigue and general weaknessdizziness in a patient with sinus bradycardia. Reducing the flow of oxygen to the brain provokes a faint state. During this period, the ECG is detected long pauses, or asystol. Pronounced sinus bradycardia leads to stagnation of circulatory failure.

Sinus node weak syndrome is composed of several symptoms: pathological sinus bradycardia, synoyatrial blockade, stopping sinus node and bradycardia syndrome-tachycardia.

Sinus bradycardia in the syndrome of the weakness of the sinus node manifests in the form of all of the above symptoms. The fainting is most clearly manifested in the sinus node weakness syndrome. Dyspids can also occur, angina. The sinus bradycardia-tachycardia syndrome concerns patients with a feeling of heartbeat, but the registration of this phenomenon on the ECG is problematic, since such attacks arise suddenly and also suddenly stop.

The occurrence of heart failure testify swelling on the legs, which gradually rise up to the development of the total swelling of subcutaneous fatty fiber; There is an increase in the liver; Reduced resistance to physical work. Depending on the patient's capabilities, perform physical work, several functional classes are distinguished. The first functional class includes patients without manifestations of heart failure in exercise. The second functional class includes patients with shortness of shortness of breath with non-intensive physical activity. The third functional class consists of people who experience symptoms of heart failure with minimal physical tension. The fourth functional class includes patients who even suffer from the symptoms of blood circulation symptoms.

Light sinus bradycardia is not manifested by clinically. The frequency of myocardial cuts under this form is approximately 60-50 shots per minute.

The sinus bradycardia, accompanying the sinoneal blockade of the first degree, is not even detected on the ECG, it can be detected only with the help of an intracardiac examination. Full blockade The sinus node is characterized by the disunity of abbreviations of different parts of the heart. Since pronounced sinus bradycardia manifests paroxysmal fainting, the diagnosis is best carried out using Halter monitoring. In this case, monitoring should be daily, since the ECG single removal will not give any results. Therefore, in some cases, it should be resorted to a sample with a carotid sine compression or to the test with drug disconnection of the heart innervation. In healthy people after the compression of the carotid sinus, a sinus pause occurs about 3 seconds. In patients with sinus bradycardia pauses can exceed 5 seconds. When administration of atropine, the cause of sinus bradycardia can be differentiated. If Atropine stopped the sinus bradycardia after the compression of the carotid sinus, the reason is the fault of the vegetative disorder.

The following informative test, which determines the cause of sinus bradycardia, is a pharmacological sample. It lies in the introduction of atropine and propranolol, while the rhythm of the actual sinus node, devoid of innervation arises. When the frequency is determined less than the normative, then the conclusion about the syndrome of the weakness of the sinus node is assumed.

Sinus bradycardia in children

Newborn heart diseases are significantly more than adults. The older becomes the baby, the greater the value of the heart rate approaches the meaning of adults. In newborns, the heart muscle is reduced with a frequency of more than 140 ° C. in min. If a one-year-old child has a heart rate of less than 100 per minute, then there is a diagnosis of sinus bradycardia. For older children, bradycardia can be spent in the number of myocardial abbreviations per minute to a minute of 80-60.

The cause of sinus bradycardium in kids can be a family leaning. In this embodiment, this diagnosis must be peculiar to some members of one family.

Bradycardia in the infant may occur with the intrauterine decrease in oxygen in the blood of the fetus. When the so-called nuclear jaundice appears, bradycardia may also occur. Nuclear jaundice is a state of newborns when the amount of bilirubin in the blood in children is much higher than the norm, as a result of which it penetrates the brain and impresses the structures of the brain. Congenital defects for the development of a conductive heart system lead to the development of sinus bradycardia.

In children whose age is more than a year, the causes of sinus bradycardia are identical to the reasons for adults. The tone of the wandering nerve can also lead to peptic disease Stomach and duodenum. Therefore, kids who combine signs of bradycardia and peptic illness, noted increased action parasympathetic nervous system. Treatment with this pathology will be appropriate.

Moderate sinus bradycardia

Moderate sinus bradycardia has indicators of heart rate within 59-49 beats. Most often, this type of violation takes place without any symptoms. Such a variant of sinus bradycardia occurs in vegetative disorders and an increased tone of the vagus nerve. This nerve is an integral department of the parasympathetic nervous system. This nerve is responsible for the function of the reduction of the heart. It determines the force and number of heart blows per minute. In the consumption of drugs that reduce the predominance of the parasympathetic nervous system, the activity of the wandering nerve against the heart is minimized. Reduce the impact of the wandering nerve on the rhythm driver using atropine. Clinical manifestations may not make it aft, but with an increase in physical exertion, a deterioration is observed. Syncopal attacks do not basically arise, but shortness of breath and fatigue is present.

If symptoms do not occur with moderate sinus bradycardia, then it does not provide an indication for the use of medication drugs. Detection and diagnosis is carried out according to the results of an ECG analysis. At the same time, Holter monitoring can be carried out to clarify the diagnosis. With pronounced symptoms, this disease requires the installation of a permanent pacemaker, but it has to be used in extreme cases.

Sinus bradycardia treatment

Emergency therapy for sinus bradycardia of any etiology is aimed at an increase in heart rate and eliminating the effects of blood circulation deficiency. It is necessary to give the patient the position lying with the legs raised. Atropine is introduced 1% solution with a dose of 1 ml of multiplicity of 3-5 times. In parallel, the air mixture with a high oxygen content is carried out. If possible, there is a temporary pacemulation. With the ineffectiveness of the listed methods, orciprenaline is used at a rate of 10-30 mg per min.

Treatment of sinus bradycardia as a syndrome of a sinus node weakness is very effective when installing a permanent pacemaker.

Treatment of conductivity impairment is reduced to the appointment of atropine. The unique antidigoxin drug, which is used in the overdose of Digitalis preparations. It binds to digoxin with special areas of molecules and turns it into an inactive substance. Thus, the effect of heart glycosides on the body ceases. Blockeds also require a pacemaker.

Treatment of sinus bradycardia, which arose after the operation, is reduced to the handling of the pacemaker 7 days after the intervention.

Treatment of basic pathology is extremely important, since when the pathological impact on the sinus node is reduced, the frequency of heart abbreviations is normalized.

Bradycardia

Bradycardia - type of arrhythmia, with a frequency of heart rate less than 60 shots per minute. It is found as an option of norms in trained athletes, but more often accompanies various heart pathology. It is manifested by weakness, seven-minded states and short-term loss of consciousness, cold later, pain in the heart, dizziness, instead of blood pressure. With severe bradycardia (CSS less than 40 blows per minute), leading to the development of heart failure, an electrocardial implantation operation may be required.

Regardless of the cause, the basis of bradycardia is the violation of the ability of a sinus unit to produce electrical pulses with a frequency above 60 per minute or inadequate distribution to conductive paths.

A moderate degree of bradycardia may not cause hemodynamic disorders. Rare cardiac rhythm in bradycardia leads to a lack of blood supply and oxygen starvation of organs and tissues, violating their full functioning.

In physically trained people, physiological bradycardia is found, considered as an option of the norm: a quarter of young healthy men CSS is 50-60 per minute; During sleep, under the influence of physiological oscillations of vegetative regulation, cardiac rhythm is demolished by 30%. However, more often Bradycardia is developing against the background of already existing pathological processes.

Bradycardia classification

The localization of the identified disorders differ in bradycardia sinus, associated with impaired automatism in the sinus unit, and bradycardia under the blockades of the heart (synoatrial or atrioventricular), in which the pulses between the sinus node and the atrials or atrial and ventricles are disturbed.

The heart rate can decrease under physiological conditions (athletes, in a dream, alone) is a functional or physiological bradycardia; Pathological bradycardia accompanies the course of various diseases.

Pathological bradycardia may occur in acute form (with myocardial infarction. Myocardits. Intoxications, etc.) and disappear after curing caused its illness, or chronic form (With age sclerotic diseases).

For reasons for the development of sinus bradycardia, the following forms are distinguished: extracaricardial (neurogenic), organic (with heart lesions), medicinal, toxic and sinus bradycardia athletes. Sometimes in etiology, bradycardia is divided into toxic, central, degenerative and idiopathic.

Causes of bradycardia

The extrapardial shape of bradycardia can develop with neurocirculatory dystonia. Non-believees with vegetative dysfunction, pressure on carotid sine

From this article you will learn: What is sinus bradycardia, its types. Causes, symptoms, how to treat.

Publication date of Articles: 11/10/2016

Date of renewal of the article: 05/25/2019

Sine bradycardia is the slowdown of the heart rhythm in the form of a decrease in heart rate (heart rate) less than 60 shots in one minute. This condition can be a physiological (optional option, the peculiarity of the body) and pathological (indicative of violations in the body). In 90-95% of cases, the pathological type of sinus bradycardia is a manifestation of various diseases. Therefore, it cannot be considered as an independent disease or diagnosis, but only as a symptom or syndrome.

If the heart is reduced in the range from 50 to 60 times in a minute, in 90-92% of cases in people, it does not appear in any way, or is accompanied by general weakness and ailment. Pronounced bradycardia (less than 50 UD / min) causes a circulation disruption, first of all, in the brain, as a result of which a person cannot fulfill the usual work, to play sports or even walk. The frequency of heart cuts of less than 40 UD / min can signal about the threatening stop of the heart.

Sinus bradycardia is easily diagnosed with usual inspection (calculate the pulse frequency), and such a simple method as an ECG fully confirms its presence. The cure is possible, but for this it is necessary to find out and eliminate the cause. A cardiologist or therapist is engaged in this problem, and if necessary, other specialists (neuropathologist, infectious, endocrinologist).

The essence and danger of sinus bradycardia

A healthy heart is reduced independently without any stimulating effects. This is possible due to spontaneous exciting pulses, which occur in cardiovascular cells. Their largest accumulation is called a sinus node. Its pulses are rhythmic, strong and pass through all the departments of the heart, producing regular myocardial reductions. Therefore, healthy heart rhythm is called sinus (its frequency per minute - 60-90 ° C.)

With sinus bradycardia, the sinus node generates few pulses, the heart is reduced less often than - less than 60 times in min. This leads to a slowdown in blood circulation in all organs and tissues, which is accompanied by oxygen starvation (hypoxia). Most of all suffers from the brain and heart muscle. The more bradycardia is expressed, the harder impairment in the body. The threat to life occurs when the heart rate is slowed down less than 40 / min, and the numbers are less than 30 ° C / min - the signal of the upcoming stop of the heart.

Two types of bradycardia

1. Bradycardia as a version of the norm

If the slowdown of the heart rhythm is caused by the natural reaction of the body on the influence of environmental factors, it is called physiological (optional option). This means that such people are dominated by the braking influence of the nervous system on the heart.

Physiological sine bradycardia hearts happens:

people who are engaged in physical education, physical work and professional athletes;
during sleep;
with a long (more day) body stay in a horizontal position;
as a result of the impact of cold.

With regular exercise, athletes develop physiological sinus bradycardia

The main criterion of the fact that the reduction of heart rate is the norm of the norm:

no complaints;
pulse at least 50 ice / min;
the rhythm of heartbeat (after the same intervals).

2. Bradycardia as a symptom of disease

Bradycardia is considered a pathological (anomalous, illness signal) if the healing slowdown occurs:

without explicit prerequisites (there are no factors that are able to cause physiological bradycardia);
in the form of sudden attacks;
accompanied by irregular pulse (different duration of the time intervals between abbreviations);
accompanied by violation general status Or any other complaints.

Frequent causes of pathology - diseases manifested by bradycardia

The term pathological sinus bradycardia means that it is only a symptom of some kind of disease, and not an independent diagnosis. The most frequent causes of its appearance:

neurocirculatory dystonia (vegetary);
acute and chronic (myocarditis, heart attack, cardiomyopathy,);
cerebral diseases (cunning injury, meningitis and meningoencephalitis, brain tumors);
systematic abuse of alcohol, tobacco and drugs;
intoxication of the body (lead, chemicals, harmfulness in production);
heavy infections (large umnuts, abscesses, sepsis, intestinal infections, pneumonia, etc.);
tumors of neck and chest;
overdose of medicines that slow down heart cuts (for example Verapamil, amiodaron, metoprolol, asparkam);
the pathology of the endocrine system (hypothyroidism is a decrease in the hormonal activity of the thyroid gland, hypocorticism - adrenal insufficiency);
liver renal failurecaused by severe liver and kidney diseases.

Symptoms and manifestations

The clinical picture of sinus bradycardia can be different: from the complete absence of symptoms, to a critical deterioration of the overall state. The manifestations with which it is accompanied is described in the table:

Symptoms and manifestations	Cardiac frequency per minute
Symptoms and manifestations	50–59	39–49	39-30 and less
Complaints - weakness, dizziness, shortness of breath, headache, chest pain	Missing or unsolved expressed	Always arise, expressed	Pronounced, patients are forced to lie
General state	Not broken	Awacing, weakness	Heavy, critical
Consciousness	Not broken	Sleepiness, inhibition	Coma (lack of consciousness)
Arterial pressure	Normal	Below norm	Sharply reduced or missing
Pulse	Slowed down	Slowed down, weakened	Not determined
Breath	Not changed	Frequent, shortness of breath	Surface or absent

The main symptoms of sinus bradycardia

The appearance and course of sinus bradycardia may be sudden, parlor (minutes, hours, days), as well as long, chronic (weeks, months, years). The second option is more favorable, since the body has time to adapt to the deceleration of heartbeat, especially if it is moderate (59-50 ° C.). Sudden rapidly progressive attacks are dangerous, most in those cases when bradycardia precedes - this is the threat of a heart stop.

Treatment methods

Cure sinus bradycardia possible. Treatment consists of two stages:

Symptomatic therapy - urgent Care To eliminate severe bradycardia and its consequences, threatening life.

Special therapy - activities aimed at the treatment of those causal diseases that are manifested by a slowdown in heart rate.

1. Emergency help

Emergency treatment of bradycardia is most appropriate in violation of the overall condition of the patient against the background of a decrease in heartbeat less than 50 ° C. / min:

Put the patient on the back, provide conditions for good access of fresh air (open the window, remove or unbutton clothes, squeezing chest and neck).
Assess the presence of consciousness, breathing, pulse on the arteries of neck and heartbeat. Only with their absence shows resuscitation activities - cardiac massage and artificial respiration.
Reception of drugs (listed in the table).

First aid when detecting symptoms of strong sinus bradycardia

2. Special treatment

Forever eliminate the pathological sinus bradycardia, only by treating causal diseases. In any case, first need to consult a cardiologist or therapist. The specialist will solve the amount of the necessary surveys and consultations of other specialists (this may be a neuropathologist, an endocrinologist, infectious person, etc.). Only after this is appointed optimal treatment.

If against the background of conducted specialized or urgent events, it is not possible to restore normal heart rhythm, patients are installed under the skin a pacemaker - a device that has electrical impulses, and being an artificial driver of the heart rhythm.

Pacemaker

Forecast

According to statistics full cure From sinus bradycardia occurs in 95-97%:

In 90-95% of patients, specific medication therapy is effective. Its duration depends on the cause of the disease: from one-time administration of drugs with the first time arising from the attack, to prolonged treatment for several months or years in chronic diseases.
5-10% of patients are required. This procedure is effective in all cases, regardless of the causes of bradycardia. Rhythm is restored immediately after its installation.

If you do not deal with the treatment of a causal disease, it is impossible to cure bradycardia.

Sinus bradycardia is a type of heart rhythm disorder, when it beats with a smaller than, rather, frequency. The bradycardia pulse decreases to 60 and less shock per minute, leading to insufficient blood supply to the internal organs and the appearance of the clinic.

Sinus bradycardia can be revealed from quite healthy people when it is considered an option for the norm and does not provoke any negative subjective signs.For example, trained professional athletes usually have a rareral pulse than all other people. About a quarter of young men have a pulse of about 50-60 beats per minute, and sleeping adults and children's Chiefs drops by a third.

Sometimes bradycardia reflects individual constitutional features and is also not considered a disease, if there are no symptoms of blood flow disorders in the brain and other bodies.

However, often bradycardia still accompanies cardiac pathology, which is an expression of organic changes in the heart muscle and conductive system. In these cases, the appearance of symptoms is inevitable, and the patient needs treatment, without which health will be bad, and the body will suffer from hypoxia.

Sinusovy, that is, the normal, heart rate is generated from the main sinus node of the conductive system, which sets the desired number of pulses per unit of time, respectively, the needs of a person. With loads, the activity of this nervous node increases, leading to an increase in the heart rate (heart rate), in sleep state, on the contrary, the pulse is cut.

The violation of the sinus unit automatism, a decrease in the number of pulses, the difficulty of conducting them on the fibers of the conductive system cause bradycardia when the heart rate drops to 50-30 beats per minute. Symptomatics usually appears when the pulse becomes 40 shots and below.

Light bradycardia does not pose a danger to life, and its owner himself may not have any concern about this, Without paying attention to the pulse and not engage in its constant calculation, if the body is well, and all organs and systems work correctly.

On the other hand, long and, moreover, the progressive bradycardia serves as a signal to the survey, Since it may be a consequence of not only cardiac pathology, but also the defeat of other organs. Attention from experts to sinus bradycardia caused by an increased risk of cardiac arrest against the background of a pronounced decline in heart rate, so each of its incidents deserves special control and establishing the cause of the anomaly.

Why does Bradycardia arise?

The causes of sinus bradycardia are quite diverse and associated both with diseases of internal organs and with external adverse conditions. These include:

Organic heart damage - scar and diffuse (cardiosclerosis), inflammation () when connective tissue affects and prevents the spread of impulse to myocardium;
The effect of low temperatures, supercooling;
An increase in the tone of the parasympathetic unit of the nervous system (Vagotonia);
on the background of stroke, brain edema, meningoencephalitis, tumors;
Separation of individual groups medicines ( , );
Poisoning with heavy metals (lead), phosphorodorganic compounds, nicotine intoxication;
Myxedema (decrease in the level of thyroid hormones), some infections (abdominal typhoid, cholera), pathology of the adrenal glands;
Fasting, anorexia.

For functional disorders sympathetic innervation An increase in the tone of the wandering nerve occurs, while the sinus rhythm is preserved, bradycardia is combined with, and the pulse increases with physical efforts or the administration of medicines (atropine).

In the case of organic lesion heart structures (cardiosclerosis, inflammation) is available, bradycardia is not liquidated by the introduction of atropine, and during exercise, only a minor increase in heart rate, indicating mechanical obstacles to the conduct of impulses.

So, all the factors causing sinus bradycardia can be divided into extrapardial and cardiac.

Extraacardial changes cause arrhythmia with a healthy heart and its conductive paths. Most often, this form of bradycardia is diagnosed with vegetative-vascular dysfunction, neurotic states characteristic of people of all ages, but especially - young women and teenagers.

Call the sinus bradycardia can carry a close collar, too strong tie, squeeze the carotid sinus. Pressing on the eyeballs contributes to a reflex reduction in the pulse frequency, which is well known to persons with the opposite problem - Tachycardia.

To extracardial reasons Pathology include diseases gastrointestinal tract (ulcer of the stomach and 12-rosewood), endocrine system, brain. In hypothyroidism, bradycardia is all the more pronounced, the stronger the lack of hormones of the thyroid gland.

Cardial version of sinus bradycardia is associated directly with the heart - heart muscle infarction, cardiosclerosis, dystrophic and inflammatory processes, cardiomyopathy, contributing to the degeneration of rhythm driver and impaired its function. In case of structural changes in the sinus unit, it is possible to develop when the heart is reduced rhythmically, but rarely.

the emergence of bradycardia due to sinus node dysfunction

Pronounced sinus bradycardia is extremely dangerous due to the possibility of refusing a sinus rhythm driver to produce pulses, which is fraught with a stop of the heart and death.

Dosage form Bradycardia is associated with the reception of certain groups of drugs - heart glycosides, beta blockers, calcium channel blockers, which are widely prescribed patients with heart disease and hypertension.

So-called toxic variety of sinus bradycardia It may be associated not only with the flow of toxic substances from the outside, but also with severe diseases - sepsis, hepatitis, acute renal failure, abdominal typhoids, etc. C or in blood serum can also cause this form of arrhythmia.

Aging changes caused by aging can proceed with bradycardia without severe heart and sinus hub, which can be considered as a natural result of aging. If a comprehensive examination did not help to identify the true cause of arrhythmia, they speak the idiopathic version of the pathology.

Manifestations and methods for diagnosing sinus bradycardia

Since in bradycardia, delivery of oxygen blood to organs is disturbed, the main target in pathology becomes a brain, very sensitive to hypoxia.

Depending on the severity of the symptoms of brain lesions and other organs, several degrees of the severity of arrhythmias are distinguished:

Light sinus bradycardia, often caused by the disorders of nervous regulation, when the heart rate does not become less than 50 shots per minute, while symptoms, as a rule, is absent;
Moderate sinus bradycardia - heart rate in the range of 40-50 ° C. / min, it is asymptomatic or with insignificant manifestations (weakness, dizziness);
Pronounced bradycardia - with heart rate below 40 per minute, accompanied by a bright clinic of the impairment of hemodynamics, the convulsions are possible and.

The classification in terms of the rate of heart cuts is very conditional and does not apply in the practice of cardiologists because of its subjectivity, because the pulse 50 cannot always be considered as pathology. For a more accurate assessment of the role of arrhythmia for a particular patient, it is important to establish, it leads to hemodynamic violations or not. As a rule, the light and average degree of bradycardia on the meaning of the CSS is hemodynamically significant, that is, blood flow in the organs is stored.

With a pronounced sinus bradycardia, the heart is not able to provide tissues and oxygen organs sufficiently, progresses hypoxia, and the arrhythmia is considered hemodynamically significant.

Sinus bradycardia symptoms are manifested when the heart rate decreases to 40 and less per minute. The most characteristic complaints that are presented by patients:

Dizziness;
Weakness and feeling of fatigue, fast fatigue;
Shortness of breath, feeling of the lack of air;
Pain in the heart, discomfort in the chest;
Episodic impairment of vision;
Attacks of consciousness;
Cramps.

If bradycardia occurs periodically, then the patient feels her dizziness, which indicates a decrease in blood pressure and delivery of oxygen to brain tissue. In hypotonists, this symptom is more pronounced than people with normal or high pressure.

Pronounced bradycardia is often accompanied by fainting - The patient loses consciousness, may fall and get injured. A long fainting is fraught with a circulatory disorder in the brain and even the death of the patient due to the dysfunction of stem structures and the respiratory stop.

fainting in the bradycardic seizure of MAS (Morgali-Adams - Stokes)

Weakness and Fast fatigue - Pretty characteristic signs of bradycardia, because organs and fabrics are not allowed by the food they need. Patients quickly get tired with physical and intellectual load, they need more time to restore forces.

Externally, people suffering from bradycardia makes attention pallor Skin, and if the rhythm violation accompanies heart failure, then cyanosis will be noticeable, swelling will be noticeable.

Heart pain can manifest themselves in bradycardia against the background of vegetative dysfunction or neurosis, but in this case they are transient and are not considered as cardiac pathology. Another thing, if the patient suffers from cardiosclerosis, heart failure, and coronary arteries are amazed atherosclerotic process. In this case, bradycardia contributes to a smaller inflow of blood to myocardium and the development of the attack of angina.

In severe cases, pronounced bradycardia causes deep fainting and convulsions associated with the oxygen starvation of the brain. Episodes of loss of consciousness Against the background of very rare heart abbreviations, which are often observed with a sinus node weak syndrome. Such arrhythmia is lifeless and requires emergency medical care.

Neurological symptoms in sinus bradycardia, associated with brain hypoxia, can manifest themselves with transient paresis, decrease in vision, memory, attention, sleep impairment, speech disorder, when the patient, as it were, "swallows" individual words.

Diagnostic criteria, bradycardia in children

Sinus bradycardia can be diagnosed not only in adults with various diseases, but also in children. As you know, the kids pulse more often - in newborns it reaches 140-160 shots per minute, by the year decreases to 120-125 and only by 12 years old is approaching the norm of an adult.

Due to naturally high CSS, the child is diagnosed with brudicardia at more high indicators Pulse than in adults (less than 60). Newborn about bradycardia says a pulse less than 120 q / min, for children preschool age This indicator will be less than 70, in adolescents - below 62.

The causes of heartbeat demolition in children and adolescents can be congenital heart defects, cardiomyopathy, excessive physical exertion, neurosis. Rearrangement of the cardiovascular system during puberty and peculiarity of this age Vagotonia can be the cause of sinus bradycardia, which, as the adults, it is leveled.

Symptoms of arrhythmia in children and adolescents are similar to those in adults - weakness, fatigue, dizziness. Moms of Breasts notice a quick fatigue of the baby when feeding, poor appetite and dried sleep, shortness of breath is possible.

Diagnostic methods

The diagnosis of sinus bradycardia is established on the basis of typical patient complaints, inspection data and primary surveys, and reliable signs show.

pulse in normal and bradycardia on ECG

At the reception, the cardiologist or the therapist fixes a rare pulse, which retains its rhythm. Cardiac tones for auscultation can be muffled if arrhythmia accompanies valve pathology or myocardium.

Electrocardiography is the main and easiest way to instrumental diagnosis of sinus bradycardia. On ECG characteristic features This arrhy is considered:

Lengthening intervals between ventricular complexes;
Proper sinus rhythm.

Thus, the ECG in sinus bradycardia is approximate to the norm, with the exception of rare heart abbreviations. If during the removal of the cardiogram failed to fix the episode of the bradycardia, then the patient will be proposed. Install the organic lesion of myocardium helps.

Among laboratory methods Diagnostics can be assigned to study the electrolyte composition of blood, hormonal balance, determination of toxins in suspected poisoning, bacteriological analysis to eliminate the infectious nature of arrhythmias.

Treatment of sinus bradycardia

Sinus bradycardia does not always serve as a reason for the appointment of specific treatment. The physiological slowdown in the rhythm of the heart, which is not manifested by any subjective symptoms and, moreover, circulatory disorders in internal organs, does not require therapy.

If Brady Cardia provokes some other disease or condition, then the appointment of the doctor will be in accordance with the causal pathology - the analogues of hormones at endocrine diseasesCorrection electrolyte violations, the purpose of antibiotics in infections, etc. Signs of hemodynamic disorders that are manifested by specific symptoms require drug correction.

It is important to note that in the case of bradycardia, like any other change in the rhythm of the heart, unacceptable self-treatment, even if the received funds seem harmless. Any drug can only be prescribed by the doctor based on the feasibility of bradycardia therapy in principle.

Indications for the beginning of treatment can serve as symptoms as shortness of breath, dizziness and frequent fainting, strong weakness, against the background of the rhythm gentle, as well as the pulse less than 40 ° C. / min, when the lack of blood flow in the organs is inevitable.

The treatment of sinus bradycardia is carried out outpatient, but with severe cardiac pathology, which is a symptom of bradycardia, hospitalization may be required. In these cases, the presence of arrhythmia represents the threat of the patient's life, which is based on a thorough observation.

Sinus bradycardia can be treated with medication and surgically. Medical therapy Includes the use of funds that stimulate the contractile activity of the heart and reduce the effect of the autonomic nervous system on conducting ways in myocardium:

These drugs are usually used during the exacerbation of arrhythmia until the moment is not restored normal value Heart rate, and then cancel them.Possible planting of vegetable agents that increase the frequency of heart cuts and arterial pressure - Eleutherococcus, ginseng, beautification.

With a sinus bradycardia, therapy is shown aimed at improving metabolicism in sinus node and myocardium:

Antioxidants and cardioprotectors (antioxicaps, omega-3, mexidol, riboxin);
Means for improvement exchange processes in cardiomyocytes - Mildronat, Actovegin;
Nootrops - piracetam;
Polyvitamins.

Severe bradycardia with attacks of loss of consciousness against the background of organic myocardial pathology, which is not corrected by drugs, requires cardiac surgery - Installation. The testimony for implantation of the pacemaker serve: CSS less than 40, attacks of Morgali-Adams - Stokes, progressive heart failure.

A few words, let's say about folk remedies whose popularity is not reduced even with accessibility modern treatment. Justified popular treatment It can be considered only in cases where bradycardia is functional in nature, caused by an increased tone of the wandering nerve, and the heart rate is not lower than 40 shots per minute. With organic changes in the heart - vices, ischemic disease, cardiomyopathy - it is not only meaningless, but also dangerous.

Lower the influence of the parasympathetic nervous system on the heart can help herbs with a tonic effect - ginseng, eleutherococcus, as well as plants such as thousands of immortals, a Chinese lemongrass, taken in the form of decoctions and tinctures.

Do not resort to folk remedies without consulting a doctor as well as in combination with already prescribed by medication therapy, since in this case the risk of unwanted side Effects And unpredictable arrhythmia is increasing.

For prophylaxis Bradycardia seizures should be abandoned by smoking and observe a diet, restricting alcohol, animal fats, the amount of liquid consumed and salt. It is important to follow the appointments of the cardiologist and to be treated in a timely manner that may be the cause of the regeneration of the heart rhythm.

Forecast With sinus bradycardia is considered favorable if there is no organic heart lesion. Cardial pathology, a combination of sinus bradycardia with other species, the episodes of syncopal states make the forecast serious and serve as a reason for the installation of the pacemaker.

It can meet with absolutely healthy people, for example, athletes or healthy people who are in a state of sleep are physiological bradycardia, due to good training of the heart muscle.

The pathological is accompanied by heart disease, which ultimately lead to the development of heart failure. About the reasons, symptoms of bradycardia and the options for its treatment This article.

Av-block may have three degrees of severity:

Pronounced - heart rate less than 40 wt / minute
Moderate - 40 to 50 dp / minute
Easy - 50 to 60 Ud / Minute

Causes of bradycardia

neurocirculatory dystonia
ISR (see Vegeth Vascular Distonia)
non-believe
with a pressure of a carotid artery (tight scarf, tie, scarf) or eyeballs (reflex Danyini Ashner)
a brain tumor
brain swelling. Meningitis, brain injuries, hemorrhage - states that are accompanied by an increase in intracranial pressure
gastric ulcer and duodenal ulcer
tumors of the mediastinal organs - diaphragms, esophagus, etc.
endocrine pathology - Myxedema proportional to the severity of hypothyroidism

County
Cardiac Glycosides (Digoxin, Stroofantin, Corglikon, Digitoxin)
β-adrenoblockers (thymolol, bisoprolol, propranolol, atenolol, acebotolol, metoprolol, esmolol, betaxolol, pindolol, sotalol, supolyol, eseatenolol)
Morphine
Blockers of calcium channels (nifedipine, verapamila),
Sympatolithics (Bretlat, reserpine, Raunatin, etc.)
Antiarrhythmic drugs (amiodarone, phenytoin, procanamide, droneard, conpaphenon, trimecain, adenosine, etc.)

After their abolition, bradycardia is born independently and does not require treatment.

Toxic bradycardia

Bradycardia toxic genesis develops with extremely intoxication of the body:

uremia (severe inxication of the body by protein exchange products caused by a violation of the kidney work)
inxication with hepatitis (see how hepatitis C is transmitted)
pronounced intoxication in infectious diseases - sepsis, abdominal typhoid, flu
phosphate poisoning, which slow down the pulses in the heart muscle (see how household chemicals affect health)
sometimes bradycardia may be caused by hyperkalemia or hypercalcemia (an increased concentration of calcium or potassium in the blood).

Physiological bradycardia in healthy people or athletes

Physiological decrease in heart rate may be when exposed to:

Cold
Massage of chest
Smoking - chronic nicotine poisoning (see what cigarettes do)

In some persons, the pulse is less than 60 per minute is the norm, that is, a physiological feature, since such bradycardia does not bother them, does not manifest themselves dizziness, weakness, increased fatigue, fainting.

Other types of bradycardia

Elder bradycardia occurs in the elderly and is the cause of the natural aging of the body.

Idiopathic bradycardia is the slowdown in the heart rate of an unexplained (non-diagnosed) genesis.

Symptoms of bradycardia

The main manifestations, signs, bradycardia symptoms are:

the attacks of Morgali-Edems-Stokes, accompanied by loss of consciousness and dizziness arising from the presence of a pulse;
the presence of instability of arterial blood pressure (hypertension, hypotension), poorly treatable and arising against the background of the demolition of heart rhythm;
increased body fatigue (reduction in load tolerance) arising against the background of the demolition of heart rhythm;
the presence of symptoms of chronic insufficiency of blood circulation against the background of bradycardia, severe conservative therapy;
stenicard attacks arising at voltage or even at rest.

Diagnostics

ECG - allows you to fix the imparation of the heart rate, the presence of an atrioventric or sinoatrial blockade. It is not always possible to identify bradycardia using a one-time ECG, if it is suspicious, the ECG daily monitoring is carried out.
Heart ultrasound is shown in the organic form of bradycardia. Ultrasonic EhocHg can determine the increase in heart size, reduced emission fraction less than 45%, degenerative and sclerotic changes in myocardium.
Loading cyergometry - evaluates the increase in the pulse rate at a given physical exertion.
ChPEFI - If the ECG and Halter Monitoring Methods do not detect transient blocks, a percussion-free electrophysiological study is carried out, which allows you to explore the conductive heart paths, identify the functional or organic nature of bradycardia.

Bradycardia treatment

Functional bradycardia. And also bradycardia, which has an average severity, not accompanied by clinical symptoms, do not need conservative treatment.
Bradycardia organic, toxic or extracardial genesis needs, first of all, in the treatment of the underlying disease.
Medicinal bradycardia requires cancellation of drugs that caused bradycardia (or correction of their admission).

For the treatment of pronounced bradycardia, accompanied by hemodynamic disorders (dizziness, weakness, pressure reduction), shown:

atropine (intravenous administration of the drug - 0.5 mg 0.1% solution)
isadrine (intravenously 2 - 20 μg / min. in 5% R-RE glucose)
ginseng root preparations, beauties, Eleutherococcus, caffeine - in individually selected doses
drops of Zelenina - applied with moderate bradycardia, ITC and chronic heart failure. The composition of this vegetable spasmolytic is the tincture of Lolanha, Valerians, Belladonny.

Isadrine - Beta-adrenostimulants (isoprenaline) are effective - effective impact on the reduction of the heart. This drug must be administered intravenously. If bradycardia is associated with the use of calcium antagonists or beta-adrenoblockers intravenously entered glucagon. If the inxication of beta-adrenoblockers takes place, glucagon is also introduced (the dose calculation is carried out by the doctor individually).

When asystolia (absence of heart abbreviations), emergency assistance is needed - call a resuscitation brigade, which conducts pacemaker.

Temporary endocardial stimulation is carried out by administering through the lumen of the endocardial electrode catheter into the right heads of the heart (at the same time the catheterization of the upper floor of the vein is carried out through the connective or jugular vein). If you do a temporary endocardial stimulation, it is not possible, it is recommended to carry out permissive pacemakers. And if it is impossible to carry out (or in the case of its ineffectiveness), the intravenous administration of adrenaline is shown (the dose of the drug is carried out by the doctor).

The presence of a complete AV blockade is recommended by pacemaker. In this case, the patient shows the operational treatment of bradycardia, the main purpose of which is the installation of an electrocardiomulator - the device, which is an artificial driver of the heart rhythm. He supports or imposes a patient human physiological rhythm of heart abbreviations. The pacemaker is a microprocessor, which is capable of generating electrical impulses for normal stimulation of the work of the heart muscle.

What is dangerous bradycardia?

With moderate or physiological bradycardia, the forecast is satisfactory. The presence of organic lesions of the heart adversely affects the forecast. Seriously aggregates the consequences of bradycardia. The presence of attacks of Morgali-Adams - Stokes attacks, if the issue of conducting electrical stimulation was not solved. Heterotopic tachyrhythmias in combination with bradycardia increase the likelihood of thromboembolic complications. With a resignation of the rhythm of heart abbreviations, the disability is possible to disability.

Do you take in the army when bradycardia?

Sinus bradycardia

Pronounced sinus bradycardia is a gentability demolition of less than 49 beats per minute. At the same time, not every decrease in heart rate (heart rate) less than 60 per minute is considered sinus bradycardia. Athletes have an increased tone of a wandering nerve, which refers to the parasympathetic nervous system. Its influence slows down the heart impact frequency without bringing harm to health.

Sinus bradycardia causes

The sinus node is located at the place of introduction into the right atrium of the upper hollow vein. The sinus node is a small formation, 1.5-2 cm in size. It is bustling from the coronary arteries. All pulses formed in this node are sent to the underlying segments of the conductive heart fibers, which take on the function of the pulse products when the sinus node is turned off. Cells from which the sinus node consists of is charged negatively, and the surrounding myocardium is charged positively. Under the influence of the potential of action, the impulse occurs. The main role in the process of excitation is played potassium ions, which is the main ion of intracellular fluid.

Under normal conditions, the slowdown of the sinus rhythm occurs with increasing the effect of the autonomic nervous system during sleep.

The violation of the supply of a sinus unit as a result of the obstruction of the coronary arteries very rarely leads to sinus bradycardia.

Sometimes patients are asked for help after applying some drugs that reduce the rate of movement of the impulse by myocardium, thereby aggravating the sinus bradycardia. Preparations that slow down the progress of the pulse include the following drugs: cardiac glycosides, beta-blockers, quinidine preparations and other antiarrhythmic drugs, as well as verapamil and diazepam.

Another very frequent reason for the defeat of the sinus node with the occurrence of sinus bradycardia is CHD. At the same time, sinus bradycardia accompanies 25-30% myocardial infarction. The reason for the symptom of the weakness of the sinus node is likely to be cardiomyopathy. Arterial hypertension, infiltrative diseases (amyloidosis, hemochromatosis, tumors), collagenous diseases, myocarditis, congenital changes in the heart and neuro-muscular disorders.

Septic states, elevated metals, elevated intracranial pressure also cause sinus bradycardia.

Sinus bradycardia symptoms

The emergence of sinus bradycardia leads to a decrease in blood emissions for feeding organs and body tissues. This leads to insufficiency and ineffective blood circulation. If the organs do not come with oxygen and nutrients, the body tries to compensate for this process and reduce energy consumption. As a result, there are manifestations of fatigue and general weakness, dizziness in a patient with sinus bradycardia. Reducing the flow of oxygen to the brain provokes a faint state. During this period, the ECG is detected long pauses, or asystol. Pronounced sinus bradycardia leads to stagnation of circulatory failure.

Sinus node weak syndrome is composed of several symptoms: pathological sinus bradycardia, synoyatrial blockade, stopping sinus node and bradycardia syndrome-tachycardia.

Light sinus bradycardia is not manifested by clinically. The frequency of myocardial cuts under this form is approximately 60-50 shots per minute.

The sinus bradycardia, accompanying the sinoneal blockade of the first degree, is not even detected on the ECG, it can be detected only with the help of an intracardiac examination. The full blockade of the sinus node is characterized by the separation of cuts of different parts of the heart. Since pronounced sinus bradycardia manifests paroxysmal fainting, the diagnosis is best carried out using Halter monitoring. In this case, monitoring should be daily, since the ECG single removal will not give any results. Therefore, in some cases, it should be resorted to a sample with a carotid sine compression or to the test with drug disconnection of the heart innervation. In healthy people after the compression of the carotid sinus, a sinus pause occurs about 3 seconds. In patients with sinus bradycardia pauses can exceed 5 seconds. When administration of atropine, the cause of sinus bradycardia can be differentiated. If Atropine stopped the sinus bradycardia after the compression of the carotid sinus, the reason is the fault of the vegetative disorder.

Sinus bradycardia in children

The cause of sinus bradycardium in kids can be a family leaning. In this embodiment, this diagnosis must be peculiar to some members of one family.

In children whose age is more than a year, the causes of sinus bradycardia are identical to the reasons for adults. The tone of the wandering nerve can also lead to the ulcer of the stomach and duodenal. Therefore, kids who combine signs of bradycardia and ulcerative disease, there is an increased action of the parasympathetic nervous system. Treatment with this pathology will be appropriate.

Moderate sinus bradycardia

Moderate sinus bradycardia has indicators of heart rate within 59-49 beats. Most often, this type of violation takes place without any symptoms. Such a variant of sinus bradycardia occurs in vegetative disorders and an increased tone of the vagus nerve. This nerve is an integral department of the parasympathetic nervous system. This nerve is responsible for the function of the reduction of the heart. It determines the force and number of heart blows per minute. In the consumption of drugs that reduce the predominance of the parasympathetic nervous system, the activity of the wandering nerve against the heart is minimized. Reduce the impact of the wandering nerve on the rhythm driver using atropine. Clinical manifestations may not be manefest, but with an increase in physical exertion, a deterioration is observed. Syncopal attacks do not basically arise, but shortness of breath and fatigue is present.

Sinus bradycardia treatment

Treatment of sinus bradycardia as a syndrome of a sinus node weakness is very effective when installing a permanent pacemaker.

Treatment of sinus bradycardia, which arose after the operation, is reduced to the handling of the pacemaker 7 days after the intervention.

Treatment of basic pathology is extremely important, since when the pathological impact on the sinus node is reduced, the frequency of heart abbreviations is normalized.

Bradycardia

Bradycardia classification

Pathological bradycardia may occur in acute form (with myocardial infarction. Myocardits. Intoxications, etc.) and disappear after curing caused its disease, or chronic form (with age sclerotic diseases).

Causes of bradycardia

The extrapardial shape of bradycardia can develop with neurocirculatory dystonia. Non-believees with vegetative dysfunction, pressure on the carotid sine (when carrying a tight collar or tie), pressing on the eyeballs (Ashner reflex), increased intracranial pressure (under meningitis. Brain injury. Subarachnoid hemorrhage, edema, or brain tumor), ulcer of the stomach and 12 pans. Bradycardia developing in myxedema is proportional to the severity of hypothyroidism.

The causes of the organic shape of bradycardia may be a myocardial infarction, myocardiodistracy. Myocarditis, cardiosclerosis. These diseases lead to degenerative and fibrous changes in the sinus node or conductivity violations in myocardium, accompanied by the development of bradycardia.

With organic lesion, the driver of the rhythm develops the syndrome of the weakness of the sinus node. And the frequency of generation of impulses in it is sharply reduced. This condition is accompanied by sinus bradycardia - rhythmic, but very rare heart abbreviations; shift brady and tachycardia or alternating spontaneous rhythm drivers. The extreme degree of damage to the sinus node is manifested by the refusal of the function of automatism, as a result of which they cease to produce electrical heart pulses.

With damage to the myocardium, the blockade of pulses develops, as a result of which part of the signals generated by the sinus node is blocked and cannot reach the ventricles - bradycardia develops.

Development dosage form Bradycardia can contribute to the reception of cardiac glycosides, quinidine, β-adrenoblockers, sympatholytic drugs (for example, reserpine), calcium channel blockers (for example, verapamil, nifedipine), morphine.

The toxic form of bradycardia develops with pronounced inxications caused by sepsis. hepatitis. Uremia, abdominal typhoid. poisoning with phosphorodorganic connections, and slowing the processes of automatic and holding in the heart muscle. This group sometimes also includes bradycardia caused by hypercalcemia or pronounced hyperkalemia.

The so-called bradycardia of athletes is characterized by the heart rate up to 35-40 per minute even during the daytime. Its reason is the features of the vegetative regulation of heart rhythm in people professionally engaged in sports.

Also, natural aging processes in the body can also lead to bradycardia; Sometimes the reasons for bradycardia remain unexplained - in these cases they speak of its idiopathic form.

Symptoms of bradycardia

Moderately pronounced bradycardia is usually not accompanied by circulatory disorders and does not lead to the development of clinical symptoms. The occurrence of dizziness. Weakness, seven and trimming states It is observed in bradycardia from the heart rate of less than 40 blows per minute, as well as against the background of organic lesions of the heart. Also, in bradycardia, fatigue appears, difficulty breathing, chest pain, hesitation, violation of the concentration of attention and memory, short-term vision disorders, episodes of confused thinking.

On the weakening of the contractile function of myocardium and the slowdown in blood circulation first reacts the brain, experiencing hypoxia. Therefore, bradycardia often leads to the attacks of the loss of consciousness, seizures (attacks or arrangements of Morgali-Adhes-Stokes), which can continue from a few seconds to 1 minute. This is the most dangerous state in bradycardia, requiring urgent medical events, so on. With a protracted attack, a respiratory stop may occur.

Diagnosis of bradycardia

Signs characteristic of bradycardia are detected when collecting patient complaints and an objective examination. In case of inspection, a rare pulse is determined, which, with sinus bradycardia, has the right rhythm, the cardiac tones of normal soundness are suspended, the respiratory arrhythmia is often detected. The cardiologist is recommended to consult a cardiologist.

Electrocardiographic study in bradycardia allows you to fix a rare heart rate, the presence of a synoatrial or atrioventric blockade. If at the time of registration of the ECG episodes of bradycardia are not detected, resort to the conduct of daily monitoring of the ECG.

With the organic form of bradycardia, heart ultrasound is carried out. The Ultrasonic EchoCG method determines the decrease in the ejection fraction of less than 45%, an increase in the size of the heart, sclerotic and degenerate changes in myocardium.

With the help of loading cycheroometry, an increase in heart rate is estimated due to a given exercise.

If it is impossible to detect the transient blockade by ECG and Halter monitoring methods, a percussion-free electrophysiological study of the conductive pathways is carried out. With the help of the CPFI, you can determine the organic or functional character of bradycardia.