Sinus bradycardia - a pathology that is associated with a slowing of momentum primary education pacemaker - sinuauricular education.The rest of cardiac pacemakers have a lower incidence of spontaneous excitation pulses so they are extinguished pulses sinus. considered normal rhythm of heart beats 60-100 fold impact.Values that are less than described above, refer to bradycardia.
Pathological sinus bradycardia - a rate less than 60 beats.per minute, but the increased physical load.Sinus node is education, which is composed of specialized cells have unique properties - automatism.Very often, such as the pathology of sinus bradycardia is overlooked because of its asymptomatic.Identify sinus bradycardia mostly on preventive examinations.The man with the condition when performing simple daily actions feels good, but it is necessary to increase physical activity as sinus bradycardia makes itself felt.
Severe sinus bradycardia - a decrease in heart rate less than 49 beats per mi
Sinus bradycardia causes
sinus node is located on the site of introduction into the right atrium of the superior vena cava.Sinus node - a small degree, the size of 1.5-2 cm. It is supplied with blood from the coronary arteries.All pulses are formed in the site are sent to the underlying segments of conductive fibers of the heart, which take over the function of production of pulses in the case of switching off the sinus node.The cells that make up the sinus node, negatively charged, and their surrounding myocardium is positively charged.Under the influence of the action potential of occurrence of the pulse occurs.The main role in the excitation of potassium ions play, which is the main intracellular ion liquid.
Under normal conditions, slowing sinus rhythm occurs when the effect of the autonomic nervous system during sleep.
Occasionally sinus bradycardia develop as an isolated disease.In this case, sinus bradycardia affects older people.The cause of the isolated senile amyloidosis is sinus bradycardia and other similar conditions that alter the myocardial tissue.
Violation supply sinus as a result of obstruction of the coronary arteries is very rarely leads to sinus bradycardia.
Symptomatic sinus bradycardia is accompanied by hypothyroidism, and in the later stages of liver damage, hypothermia, typhoid and brucellosis.Increased pathological vagal tone also cause sinus bradycardia.Hypoxia, hypercapnia, acidemia, acute hypertension cause sinus bradycardia.But at the same time, the multitude of cases of this condition remains unknown etiology.
Sinus bradycardia occurs in response to a violation in the field of education sinuauricular education, as well as conduction disturbance on the heart muscle.In the first case, a failure of the sinus node, and the second - the blockade.
Sometimes patients seek help after the use of certain medication, which reduces the speed of advance of the myocardium pulse, thereby exacerbate sinus bradycardia.Agents which slow advancement pulse medications include: cardiac glycosides, beta-blockers, quinidine preparations and other anti-arrhythmic agents, as well as verapamil and Diazepam.
Another common pathological process, which is associated with the appearance of sinus bradycardia - a sick sinus syndrome.The cause of this disease - an isolated reduction in functionality of the sinus node, or so-called Lenegre disease, which occurs in the elderly.
Another very common cause of sinus lesions with the occurrence of sinus bradycardia is coronary artery disease.In this sinus bradycardia accompanied by 25-30% of myocardial infarctions.The cause of the symptom sinus likely be cardiomyopathy, hypertension, infiltrative disease (amyloidosis, hemochromatosis, tumors), collagenous diseases, myocarditis, congenital change of heart and neuro-muskulyarnye disorder.
Septic conditions, heavy metal poisoning, increased intracranial pressure also cause sinus bradycardia.
Sinus bradycardia symptoms
emergence of sinus bradycardia tends to reduce emissions blood supply of organs and tissues of the body.This leads to inefficiencies and lack of circulation.If the organs are not available oxygen and nutrients, the body tries to compensate for the process and reduce energy consumption.This results in symptoms of fatigue and general weakness, dizziness in a patient with sinus bradycardia.Reduced supply of oxygen to the brain triggers fainting.During this period, the ECG revealed a long pause or asystole.Severe sinus bradycardia leads to congestive heart failure.
Sick Sinus Syndrome consists of several symptoms: abnormal sinus bradycardia, sinoatrial blockade, stop sinus syndrome, bradycardia, and tachycardia.
Sinus bradycardia when sick sinus syndrome manifests in the form of all of the above symptoms.Fainting is most clearly manifested in the sick sinus syndrome.Also, there may be shortness of breath, angina.Sinus bradycardia syndrome, tachycardia, palpitations worried sick, but the registration of this phenomenon on the ECG is problematic, since such attacks occur suddenly and as suddenly stop.
The occurrence of heart failure indicate swelling in the legs, which gradually rise up to the total development of edema of subcutaneous fat;an increase in the liver;reduced resistance to physical work.Depending on the patient's capacity to perform physical work, identified a number of functional classes.The first functional class include patients with no symptoms of heart failure during exercise.The second functional class includes patients with the occurrence of dyspnea in the non-intensive physical activity.The third functional class consists of people who are experiencing symptoms of heart failure with minimal exertion.The fourth functional class includes patients who even alone suffer from the symptoms of heart failure.
Easy sinus bradycardia is not manifested clinically.The frequency of contractions of the myocardium in this form is about 60-50 beats per minute.
Sinus bradycardia accompanying sinoaterialnuyu blockade of the first degree, is not revealed even ECG, it can only be detected using intracardiac studies.Complete blockage of the sinus node is characterized by a dissociation rate of different parts of the heart.As expressed sinus bradycardia manifests paroxysmal syncope, diagnosis is best done using Holter monitoring.This monitoring should be daily, as a single ECG monitoring did not give any results.Therefore, in some cases it is necessary to resort to trial compression of the carotid sinus or to the test with drug disconnecting innervation of the heart.In healthy people, after compression of the carotid sinus, there is sinus pause of about 3 seconds.In patients with sinus bradycardia pause exceed 5 seconds.When atropine can differentiate the cause of sinus bradycardia.If sinus bradycardia Atropine stopped after compression of the carotid sinus, it is the cause of autonomic disorders.
Another informative test that determines the cause of sinus bradycardia, a pharmacological test.It is the introduction of atropine and propranolol, thus there is proper sinus rhythm, devoid of innervation.When determining the frequency is lower than normative, it is assumed conclusion sick sinus syndrome.
Sinus bradycardia in children
Newborn heart rate significantly higher than that of adults.The adult becomes the baby, the higher the heart rate approaches the adults.In infants the heart muscle is reduced with frequency over 140 bpm.min.If year-old child heart rate is less than 100 per minute, then the diagnosis of sinus bradycardia.In older children, a bradycardia can speak with the number of myocardial contractions per minute 80-60 fold.
cause of sinus bradycardia in children can be a family tendency.In this embodiment, a diagnosis must be peculiar to certain family members.
bradycardia in infants can occur in utero reduction of oxygen in the fetal blood.When the so-called kernicterus may also experience bradycardia.Kernicterus - a state of infants when the amount of bilirubin in the blood of children is much higher than normal, causing it to penetrate into the brain and permeates brain structures.Birth defects of the heart conduction system lead to the development of sinus bradycardia.
Children whose age more than a year, the causes of sinus bradycardia identical reasons adults.Vagal tone may also lead to gastric ulcer and duodenal ulcer.So kids who have combined symptoms of bradycardia and peptic ulcer disease, there is an increased action of the parasympathetic nervous system.Treatment of this disease is appropriate.
moderate sinus bradycardia
moderate sinus bradycardia has indicators of heart rate within 59-49 impacts.Most often, this type of violation occurs without any symptoms.This option sinus bradycardia occurs in vegetative disorders and increased vagal tone.This nerve is an integral department of the parasympathetic nervous system.This nerve is responsible for the function of cardiac contractility.It defines the power and the number of heart beats per minute.When the consumption of drugs that lower prevalence of the parasympathetic nervous system, the activity of the vagus nerve in relation to the heart is minimized.Reduce the impact of the vagus nerve in the pacemaker, you can use atropine.Clinical manifestations may not manefestirovat, but with an increase of physical activity observed deterioration.Syncopal attacks generally do not occur, but there is shortness of breath and fatigue.
If no symptoms at moderate sinus bradycardia, it is not an indication for the use of drugs.Detection and diagnosis is carried out based on analysis of the ECG.This Holter monitoring can be carried out to clarify the diagnosis.At the expressed symptoms of the disease requires the installation of a permanent pacemaker, but it has to be applied in extreme cases.
Sinus bradycardia treatment
Emergency therapy for sinus bradycardia of any etiology is aimed at increasing the heart rate and the elimination of the consequences of circulatory failure.It is necessary to make the patient prone position with their feet.Atropine 1% solution of 1 ml dose of the multiplicity of 3-5.In parallel, feed air mixture with a high oxygen content.If possible, carry a temporary pacing.With the ineffectiveness of these methods is applied at a rate of 10-30 orciprenaline mg min.
treatment of sinus bradycardia as sick sinus syndrome is very effective when you install a permanent pacemaker.
conduction abnormalities Treatment is reduced to appointment of atropine.Antidigoksin unique product, which is used with an overdose of digitalis drugs.It binds to molecules of digoxin special sections and turns it into an inactive substance.Thus, the effect of cardiac glycosides is terminated on the body.Blockades also require setting the pacemaker.
treatment of sinus bradycardia, which arose after the operation is reduced to the formulation of a pacemaker after 7 days after the intervention.
Treatment of the underlying pathology is of extreme importance, since reducing the pathological effects on the sinus node to normal heart rate.