Bradycardia - Causes, Symptoms and Treatment .MF .
bradycardia Causes Symptoms and Diagnosis Treatment
Complications and prognosis
The key to a good blood supply to internal organs are regular, rhythmic heart beats at a frequency of not less than 60 and not more than 90 beats per minute.These characteristics of heart rate to maintain balanced the influence of the autonomic nervous system on the contractile activity of the heart muscle.Directly myocardial contractility depends on the speed of the electric pulse on the conducting system of the heart - the conduct impulses faster, the more often the heart beats, and vice versa.The path of the pulse is normal to be in one direction - from the sinus node in the atria to the atrio - ventricular (atrioventricular) node, bundle branch block further on between the ventricles by the Purkinje fibers in the walls of the ventricles.
Sometimes in the body as a result of any disease appear imbalance between the influence of the sympathetic and parasympathetic divisions of the autonomic nervous system,
bradycardia - a symptom that accompanies many cardiac and extracardiac some diseases and is characterized by a decrease in heart rate less than 60 per minute.It may occur as in diseases (pathological bradycardia), and against the background of overall health (physiological).Pathological bradycardia danger that the reduction in the heart rate with at least 40 per minute blood flow to the brain is disrupted, and other organs which can be fatal.
Depending on which portion of the conduction system struck and interferes with the normal conduct of pulse release:
1. Sinus bradycardia occurs when the violation pulse formation in the sinus node (sick sinus syndrome)
2. Bradycardia with heart block.
- when sinoatrial blockade
- when intraatrial blockade
- with atrioventricular block
- under siege bundle branch block
According to the severity of the following types of bradycardia:
- mild degree (HR 50 - 60 minutes)
- moderate severity (40-50 min)
- bradycardia (less than 40 beats per minute)
in healthy people often recorded physiological bradycardia.For instance, slower rhythm during sleep up to 30 - 40 per minute is normal, and is due to not only the predominant influence of the vagus nerve on the internal organs in the night, but also the occurrence of atrioventricular block 1 tbsp.This is often seen in children, adolescents and adults up to 40 years.
Another type of physiological bradycardia is a respiratory (sinus) arrhythmia, characterized by an increase in heart rate at inspiration and slowing down on exhalation.This is due to normal fluctuations in pressure in the chest during inspiration and expiration, and also features the promotion of blood through the heart chambers, conjugated with breathing phases.
also functional retardation rhythm common in athletes and people with well-trained muscles.An ordinary man with a load increases the need for oxygen consumption of tissues of the body, this heart must be reduced more often than usual, that is developing tachycardia.At the same athlete trained not only skeletal, and cardiac muscle that allows the heart to effortlessly provide the body with oxygen.
In the absence of any disease listed types of bradycardia significant clinical significance have not.But, like other rhythm disturbances, bradycardia can develop not only in healthy people, but also in cases where the reflex influence on the heart of the nervous system or other organs, either by direct organic lesions of the heart tissue.
main diseases that can cause bradycardia:
Cardiac disease - myocardial infarction in the acute stage and the stage of scarring (cardio)
- Chronic heart failure
rheumatic heart - myocarditis
- bacterial endocarditis
heart - atherosclerosis of the aorta and coronary arteries
cardiomyopathy - heart injuries
2. diseases of the nervous system - injuries and brain tumors
- increased intracranial pressure
- cerebrovascular accident
- neurotic condition
3. Endocrine diseases
- hypothyroidism - deficiency of thyroid function
- adrenal insufficiency (Addison's disease)
4. Diseases of the internal organs
- end stage renal and liver failure
- gastric ulcer and duodenal ulcer 12
5. An overdose of drugs
- beta - blockers (bisoprolol, carvedilol, etc.)
- calcium channel blockers (verapamil, diltiazem)
- cardiac glycosides (digoxin, Korglikon)
6. The pathological processes in the body
- chronic alcohol abuse
- infectiousdiseases (typhoid fever, hepatitis B, meningococcal infection)
- violation of electrolytes due to dehydration, fever (violation of balance of potassium, calcium and sodium in the blood)
- shock of various origins (cardiogenic, arrhythmogenic, traumatic, etc.)
clinical bradycardia symptoms
typically, physiological and easy bradycardia, patients do not feel subjectively.Symptoms Pathological bradycardia determined by the underlying disease that caused the decrease in heart rate.On the part of the heart have been complaints of chest pain, shortness of breath, swelling of the extremities.There are drowsiness, fatigue, tinnitus, constant dizziness, pale skin.
If the heart rate is 50 beats per minute or less, can be confusing for the patient losing consciousness attacks.This is a very dangerous situation called attacks Morgagni - Edemsa - Stokes (MES seizures).Due to acute cerebral hypoxia, cardiac output as the arterial blood can not adequately provide oxygen brain cells.The patient on the background of well-being or prior subjective discomfort pales, loses consciousness and falls.Loss of consciousness may be accompanied by convulsions due to transient cerebral ischemia, but, unlike epilepsy, to attack the MEA is not the aura, typical of an epileptic seizure.Fainting with bradycardia lasts no more than 1 - 2 minutes, after which the patient wakes up, and the skin turns pink.Seizures may occur at different frequencies - one for life to several per day.If the patient has ever developed consciousness loss episode, accompanied by bradycardia, ECG, he should be sure to go through the necessary research and treatment prescribed by the doctor.
bradycardia, which is not manifested clinically identify, as a rule, during the passage of a planned ECG.
If you have specific complaints diagnosed with bradycardia may be suspected even in the survey and examination of the patient, and to clarify its type and the cause of the slowdown in the rhythm, appoint the following diagnostic methods:
1. ECG.Symptoms of bradycardia on the ECG - decrease heart rate less than 60 per minute, combined with sick sinus syndrome or conduction disorders (blockades).
Sinus bradycardia - HR 40 - 60 per minute, sinus rhythm, right.
sick sinus syndrome, shown in the figure - persistent sinus bradycardia, sinoatrial block, against the background of a rare rhythm of atrial fibrillation episodes or ectopic tachycardia
Symptoms of bradycardia may be combined with myocardial ischemia, ventricular hypertrophy or atrial.
2. ECG monitoring is required to be assigned to a patient with complaints of heart intermissions, regardless of episodes of bradycardia on the ECG single or have not been whether registered.It allows you to evaluate the presence of bradycardia during the day, as well as to establish their relationship with exercise and household activity of the patient.
3. ultrasound of the heart to evaluate myocardial contractile function and to identify structural changes in heart tissue caused by arrhythmias.
4. Exercise stress testing can detect the adaptive capacity of the body in relation to physical activity.Used treadmill test and bicycle ergometry.
5. EFI - often assigned Transesophageal electrophysiological study of the heart than endocardial.It lets provoke bradycardia, if it failed to register with the help of an electrocardiogram and daily monitoring, and the patient has specific complaints.
6. Coronary appointed to confirm or exclude koronarogennoy nature of arrhythmias.It allows you to visualize the coronary arteries and to evaluate their permeability, or the degree of damage from atherosclerosis.
7. Cardiac MRI can be assigned according to indications to identify organic heart disease and clarify its localization.
bradycardia therapy for asymptomatic forms of bradycardia, and in the absence of underlying disease is not shown.
When moderate to severe bradycardia, accompanied by clinical symptoms, and even more attacks MEAs appointed treatment of the underlying disease.Upon successful removal of the causative factor bradycardia disappears.
Emergency aid for attack bradycardia, accompanied by manifestations of the disease (dizziness, weakness, drowsiness, lightheadedness) - the patient can take under the tongue half or the whole tablet izadrina 0,005, or one-fourth or half teofedrina tablets.
Emergency aid for attack of MES is as follows:
- put the patient with elevated legs, to provide blood flow to the brain and to
heart - to measure blood pressure, and to calculate the pulse of the carotid (in the neck) or radial (on the wrist) artery
- immediately call an ambulance
- in the absence of consciousness for more than two minutes, accompanied by the lack of heartbeat and breathing, start cardio - pulmonary resuscitation according to the scheme 15 presses on the sternum in two blowing air into the lungs by mouth-to-mouth until spontaneous breathing or arrival resuscitationbrigade, but not more than 30 minutes
ambulance doctor will carry out the following activities:
- temporary pacing using a defibrillator
- atropine 0.1% - 1 ml intravenously (up to 4 ml per day)
- dopamine 200 mg200 ml saline intravenously
- adrenaline 1% - 1 ml per 200 ml of saline intravenously
- eufillin 2.4% - 5 - 10 ml intravenously
- prednisone 50 mg intravenously
In case of mild or moderate bradycardia, is not accompanied bysigns of heart attack, stroke, congestive heart failure, the patient after cupping of an attack bradycardia can be left at home under the supervision of the local doctor from the clinic.
bradycardia, especially accompanied by bouts of MES, signs of heart attack, pulmonary edema or other impending complications, is an indication for hospitalization arrhythmology or cardiology.
the absence of effective treatment of the underlying disease, the presence of AV block 2 - 3 degrees, complete bundle branch block, especially against the background of acute myocardial infarction, as well as in conjunction with ventricular tachyarrhythmias (frequent ventricular premature beats, paroxysmal ventricular tachycardia), the patientIt can be displayed on the implantation of pacemaker indications determined arrhythmology and heart surgeon.
The picture shows an artificial pacemaker sewn under the skin above the breasts with held in the heart of the electrodes.
Lifestyle with bradycardia
mild to moderate bradycardia does not require a fundamental change in the usual physical activities or activities of daily living.Suffice it to observe the principles of a healthy lifestyle, the basics of good nutrition and develop adequate work and rest mode.
In severe bradycardia with attacks MES patient should avoid excessive stressful situations, significant physical exertion.
both categories of patients is useful to know that if bradycardia is desirable to eat foods such as walnuts, a mixture of honey, lemon and garlic, and a decoction of yarrow, since these products have a beneficial effect on the contractility of the heart muscle.All persons with cardiovascular diseases - cardiovascular system to get rid of bad habits, a diet with the consumption of low-calorie foods, and often rest in the fresh air.
If bradycardia occurs in a pregnant woman's ability to bear a child is dependent on the underlying disease.Usually mild to moderate bradycardia does not affect the supply of the fetus with oxygen.If the expectant mother takes any medicines, it must agree on the possibility of receiving the attending obstetrician.
physiological, mild to moderate bradycardia, as a rule, do not lead to complications.
main complication of severe bradycardia and MES seizures are asystole (cardiac arrest) and clinical death due to cerebral ischemia.In addition, the probability of development of thromboembolic complications - pulmonary thromboembolism, ischemic stroke or myocardial infarction.Due to violations of the pulse bradycardia may develop frequent ventricular premature beats or paroxysmal ventricular tachycardia, which is fraught with the appearance of ventricular fibrillation and death.
Weather Forecast for physiological and mild forms of bradycardia favorable.If the patient suffers from a disease that led to the development of moderate to severe bradycardia, the prognosis is determined by the stage of cardiac disease or the nature of extracardiac disease that caused bradycardia.For example, if the patient has hypothyroidism, but with the help of hormone replacement therapy in the body to maintain adequate levels of thyroid hormones by the favorable cardiac prognosis.If the cause was congestive heart failure in the terminal (final) stage, the prognosis would be unfavorable, moreover, it is unlikely that a patient will be susceptible to interference by installing a pacemaker due to total exhaustion and the presence of contraindications to surgery.
therapists Sazykina OJ