With belladonna poisoning, bradycardia is characteristic. What is sinus bradycardia of the heart? General characteristics and types of disease

Date: 19.10.2019

Violation of the formation and conduction of an impulse in the heart leads to various types. One of them is bradycardia - a decrease in heart rate associated with. Bradycardia is characterized by a rare number of heart muscle contractions (less than 50 per minute in adults, 70-80 in childhood and adolescence, and less than 100 in infants).

Types of bradycardia and the causes of its occurrence

Physiological bradycardia

- impaired conduction of impulses in the atria... It is characterized by conducting them from the sinus node to the myocardium every other time.
(violation of the passage of the impulse through the ventricles), during which part of the ventricular contractions falls out (their number can be reduced to 40 per minute). In this case, there are three degrees of severity. The first (mildest) degree is characterized by a slow conduction of the impulse from the atria to the ventricles. At the second (moderate) degree of severity, part of the impulses ceases to reach the ventricles. For the third degree, a decrease in the number of ventricular contractions is characteristic due to the fact that not all impulses reach them.

Clinical manifestations of bradycardia

The physiological form of this disease has no pronounced clinical manifestations. The main symptoms of bradycardia occur in chronic forms.

These are dizziness and weakness, a rare heart rate and a feeling that the heart is stopping, problems with sleep and memory.
When an acute form of severe bradycardia occurs, caused by sinoauricular blockade, it is noted, accompanied by semi-syncope and. In severe cases, the person may faint. At the same time, his breathing is disturbed, convulsions occur. This condition is called an attack of MAC (after the first letters of the names of the doctors who worked on their study). It is caused by a decrease in the supply of oxygen to the brain ().
With a significant slowdown of ventricular contractions (atrioventricular block), the blood supply to the brain is disrupted. This can cause general anxiety and sudden severe dizziness, a slight darkening of consciousness. With an increase in the pause between heartbeats to 15 seconds, complete loss of consciousness or an attack of MAC may occur. Sometimes it causes, which can cause sudden death.

An injection of atropine is done to determine whether the decrease in the number of heartbeats is caused by a functional component or a heart block. With physiological bradycardia, this procedure brings the number of heartbeats back to normal. The lack of effect means that the cause of the disease lies in pathological disturbances in impulse conduction.

Bradycardia therapy

Treatment of bradycardia is carried out only with pronounced clinical manifestations and a clear violation of the hemodynamic process. If a person's heart rate is reduced to 40 per minute and there are frequent beats, one of the following drugs is used:

Atropine - every 3 hours intravenously (2 mg) or subcutaneously (0.5 to 1.0 mg);
Izadrin - in a glucose solution (5%) by intravenous drip (2 ml per 0.5 l);
Isoproterenol - infusion (drip) administration (up to 4 mg);
Alupent (10 mg of the drug per 500 ml of isotonic sodium chloride solution) - intravenously by drip method or eight-fold ingestion of 20 mg;
Belladonna preparations for the treatment of bradycardia without severe symptoms.
Ginseng or Eleutherococcus extract (the dosage is selected by the doctor for each individual patient);
In case of individual intolerance or existing contraindications to the use of Isadrin or Atropine, tablets of Ephedrine hydrochloride or Ipratropium bromide are prescribed.

The acute form of bradycardia caused by impaired conduction of the impulse requires urgent hospitalization and inpatient treatment, aimed at eliminating the main causes that contribute to a decrease in heart rate. If the bradycardia is associated with the natural aging of the patient's body (after 55-60 years of age, irreversible processes begin) or the therapy carried out with medication turned out to be ineffective, the patient is prescribed electrocardiostimulation (implantation of a special device under the patient's skin that normalizes the number of heart contractions). Consultation with a cardiac surgeon is mandatory for patients in whom bradycardia is accompanied by attacks of MAC (fainting). Their main danger is that during fainting, the risk of cardiac arrest increases.

Traditional medicine in the treatment of bradycardia

Good complementing to the main drug therapy of bradycardia is treatment with folk remedies. It includes the following recipes:

Radish and honey

It helps to speed up the heart rate radish juice with honey. To prepare this product, you must cut the top off the radish. Make a depression inside by taking out some of the pulp with a spoon. Fill it with honey and leave it overnight. The next day, use the resulting syrup during the day, divided into three doses.

Walnuts

Walnuts are a proven remedy in the treatment of many heart diseases, including bradycardia. Take a pound of peeled kernels, mix them with a glass of sugar and the same amount of sesame oil. Pour with a liter of boiling water cut into 4 parts lemons in the amount of 4 pieces. Mix all the components obtained. Take the mixture 30 minutes before meals 3 times a day for a tablespoon.

Lemon and garlic

Lemon and garlic are the most effective treatments for bradycardia. Squeeze juice from 10 with lemon. Chop and add 10 heads of garlic to it. Pour all ingredients with a liter of fresh honey. Insist for 10 days, shaking daily. Take 4 teaspoons on an empty stomach, dissolving each portion for at least a minute.

Pine shoots

Alcoholic tincture of young apical pine shoots. For its preparation, 70 branches are taken and infused in the sun in 300 ml of vodka for 10 days. The dosage for one dose is 20 drops.

Rosehip decoction

Take 10 large berries and boil in 400 ml of water (about 15 minutes). Strain the cooled broth, rub the berries through a sieve into it, mix with three teaspoons of honey. Take half a glass daily before each meal until all signs of bradycardia disappear.

Diagnostics of the sinus bradycardia

Usually, bradycardia is diagnosed already at the doctor's appointment during a listening session.

When listening to the atria, dull tones are clearly felt during the dystolic pause. They are called "echo systole".
Every 5-10 beats at the top, the first high-volume tone is heard. It is called "Guard's cannon-tone". It is caused by the sound of sudden tension of the atrioventricular valve leaflets during the contraction of the ventricles, which were in a relaxed state before the atrial contraction. This is the main evidence for a complete atrioventricular block.

ECG

To confirm the diagnosis is assigned. It shows the following:

With sinoauricular block, sinus bradycardia is characterized by inconstancy of the rhythm, however, the ECG reveals only a decrease in rhythm, the teeth remain in a normal, undeformed state.
Sinus bradycardia caused by atrioventricular block on the ECG looks like this:
1. excitation of the ventricles and atria occurs independently of each other.
2. the frequency of atrial contractions is increased, but occurs in the correct rhythm, as indicated by the amplitude of the extrasystole P wave, it is reduced;
3. the number of ventricular contractions is reduced, this is indicated by the formation of a pointed T wave of a greater height, in some cases with a negative value;
4. the amplitude of the QRS of the extrasystological ventricular complex - increased;
5. part of the ventricular complexes falls out.

This means a decrease in the number of ventricular contractions. With a sharp decrease in heart rate (up to 40 beats / min), every second ventricular complex can fall out. In this case, "Strazhesko's cannon tone" is not heard. In milder forms, every fifth ventricular contraction falls out. Bradycardia is a transient type of disease. This means that it can only be detected if the patient's heart rate is clearly lowered at the time of the ECG. Therefore, doctors, before treating bradycardia, carry out (control) the functional activity of the heart. For its implementation, a portable electrocardiograph is installed for the patient, which monitors the work of the patient's heart muscle in everyday conditions. Monitoring is usually carried out over the course of a day or several days.

How to raise the pulse with bradycardia?

If a person is suddenly dizzy or has any other malaise indicating bradycardia, the pulse should be measured. This function is available in all modern blood pressure monitors. With a decrease in heart rate, you can have a cup of coffee or hot tea. The caffeine they contain will start working after the first sips. You can enhance the effects of these drinks adding a few drops (from 10 to 15) of pharmacy tinctures of eleutherococcus, belladonna or ginseng to them. Taking a hot bath, a short jog or exercise, massage will help to increase the pulse with bradycardia. But using these techniques to increase the heart rate is possible only with physiological bradycardia, when there are no medical contraindications. Medicines are recommended to be used as directed by the attending physician, observing the established dosage, since exceeding it can cause a sharp increase in blood pressure. Some people think that zelenin drops are one of the effective quick-acting drugs... However, this drug has coronary dilatory properties, which leads to a slowdown in the rhythm, so Zelenin drops are more likely to be suitable for rhythm disturbances such as tachycardia. This is a preparation based on plant extracts of belladonna, valerian, may lily of the valley and menthol. But they can cause unwanted side effects in the form of apathy and lethargy. With bradycardia with a decrease in heart rate to 35 beats per minute, it is not recommended to treat at home as it can be life threatening. A person with a disturbed heartbeat needs to be provided with the necessary assistance and immediately call an "ambulance".

Video: doctor's opinion on a heart rate hazardous to health

How to provide first aid?

With a sharp decrease in the pulse with bradycardia, when a person is in a state close to fainting or has lost consciousness, he should be given first aid, which is as follows:

If the patient falls to the floor, then it is necessary to turn him over on his back, raise his legs, putting a sofa roller or pillow under them. It is advisable to keep this position until the arrival of doctors, which cannot be postponed... A person who is conscious must also be laid on a flat surface and his legs raised.
Free your breath by undoing the top button of your shirt and loosening the belt.
If you lose consciousness, try to revive the person by patting him on the cheeks. If that doesn't work, spray your face with water.
In case of deep fainting, inhalation of products with a pungent odor (vinegar, ammonia) can bring a person to life. However, it should be remembered that ammonia (and vinegar) must be handled very carefully, since when brought close to the nasal passages, it can cause a sharp bronchospasm up to respiratory arrest.
If the fainting lasts, and none of the above remedies helps, care should be taken to prevent hypothermia of the patient. To do this, his body is covered with heating pads with warm water.

After the patient returns to consciousness, you need to measure his pulse.
If you know what medications he uses, then you need to give him a drink.
The arrived ambulance team needs to tell in detail about all the actions taken.
Even with injection skills, it is best not to treat yourself. Drugs such as mezaton, atropine, which cause an increase in heart rate, are unlikely to be present in every person's home medicine cabinet, they are dispensed only by prescription. However, in the case of a prolonged course of the disease, the patient is sometimes prescribed them, having previously informed the relatives of the precautions.

Bradycardia in childhood

Sinus bradycardia is often noted in childhood. Its etiology, clinical manifestations and course are similar to the course and symptoms of the disease in adults. The difference is that the diagnosis of bradycardia in a child over 6 years old is made when the heart rate drops to 70-80 beats per minute.

Bradycardia in children is mainly caused by the same reasons as in an adult: increased excitability of the vagus nerve, exposure, various infections and intoxication of the body. In adolescents, the cause of bradycardia can be a lag in the development of the cardiovascular system from the rapid growth of other organs and metabolic disorders. It should be noted that bradycardia in childhood is very often a reaction of the body to cold or heat, fright or overwork. Sometimes it happens that a child faints at the first school line in his life. Most children have mild sinus bradycardia during nighttime sleep or deep inspiration. In many families, bradycardia is an inherited condition that accompanies congenital heart disease. In most cases, children do not notice bradycardia, especially if it does not have a significant effect on the transported blood volume. The first symptoms appear with blood flow disorders and related. These include:

Shortness of breath while walking and when doing exercises in physical education lessons;
Dizziness;
Headache and soreness in the region of the heart;
Increased sweating;
General weakness;
Decreased appetite.

When these symptoms appear in a child, an ECG must be done. With sinus bradycardia, the cardiogram clearly shows that the sinus rhythm is slowed down. This is indicated by the reduced height of the P waves, while their amplitude is slightly expanded. T-waves, on the contrary, are higher, with a wide amplitude. The QRS interval of the ventricular complex is also expanded. The P-Q interval indicating the time of the pulse is also increased.

For the treatment of bradycardia in children, medications are prescribed that help correct carbohydrate metabolism, support normal electrolyte balance, and improve the supply of oxygen to the brain. In addition, the underlying disease is being treated, which causes a slowdown in the pulse. It is recommended to take special vitamin complexes, introduce olive or sesame oil, and seaweed into the diet. In some cases, bradycardia in children goes away with age.

Bradycardia in the fetus

The level of development of modern medicine allows examining the health of a child while he is still in the womb. How the baby feels is determined by. Normally, it is from 120 to 160 beats per minute.... This indicator of the vital activity of the embryo is checked at every planned visit by a woman to a gynecological consultation, starting from eight weeks of pregnancy. With normal development, listening to heart sounds with an ordinary stethoscope is sufficient. But if the doctor detects a decrease in heart rate, then the expectant mother is sent for an additional examination: a CTG (fetal cardiotocogram) is done, through which the conductivity of the embryonic heart muscle, its excitability and contractility is checked, or a Doppler examination. A decrease in fetal heart rate to 110 beats per minute is called basal bradycardia. It can be caused by compression of the fetal head, the mother, and a number of other reasons. This type of bradycardia is not harmful to the health of the baby. But the expectant mother needs to take care of eliminating the causes of it, so that the child's heartbeat returns to normal. Decelerant bradycardia in the fetus is much more dangerous when the heart rate is less than 90 beats per minute... This indicates the suffering of the child, which is caused by oxygen starvation (fetal hypoxia). It develops when a pregnant woman takes certain types of drugs, when she develops or (lack of iron), premature detachment of the placenta, etc.

Fetal bradycardia can occur at any stage of pregnancy. In the first half of pregnancy, lack of oxygen can affect the formation of the baby's organs, causing their underdevelopment. In the second half, oxygen starvation leads to disorders in the development of the central nervous system and problems during childbirth. Bradycardia is dangerous because it can cause the death of a child not only during intrauterine development, but also during childbirth (fetal asphyxia), and even in the first hours after birth.

During pregnancy, the fetal heartbeat is checked by means of a conventional obstetric stethoscope and using dopplerometry, which is prescribed not only to expectant mothers with chronic diseases of the upper respiratory tract (bronchitis, etc.), diabetes mellitus, cardiac disorders, but also to healthy women in accordance with pregnancy management protocol. Starting from the second half of pregnancy, the expectant mother herself can navigate whether there are deviations in the baby's pulse, counting his movements. If the child turns (moves) in the mother's abdomen, performing 10 or more two-minute series, then everything is in order. If the number of episodes is less, there is a reason to undergo additional examination.
To treat fetal bradycardia, drugs are injected into the mother's body. Through the general bloodstream, they enter the child's circulatory system. At the same time, there is an improvement in the uteroplacental blood flow of a woman. Drug therapy is carried out based on the type of bradycardia and its severity, the state of health of the expectant mother, taking into account the duration of pregnancy. Most often, droppers with calcium gluconate, sodium bicarbonate, cocarboxylase, ascorbic acid and glucose, oxygen masks are prescribed. The drugs are administered in the following order:

First, solutions of cocarboxylase and sodium bicarbonate;
Then, a solution of ascorbic acid with glucose;
Finally, calcium gluconate is injected.

If the devices recorded the occurrence of acute bradycardia during childbirth, then atropine is injected subcutaneously (if possible) to the woman in labor and the baby that was born.

Bradycardia in infants

Bradycardia in newborns occurs not only with organic diseases of the cardiovascular system. It can develop as a result of birth trauma, perinatal, pneumonia, toxic-allergic manifestations, metabolic disorders, etc. Sometimes, your baby's heart rate slows down as you exhale during long walks on frosty days. This is a kind of reaction to the cold. This type of disease is characterized by a decrease in heart rate up to 100 beats per minute. Often, neonatal bradycardia precedes or occurs during apnea (respiratory arrest). Of particular concern is the pronounced sinus bradycardia of an infant with a heart rate of less than 70 beats per minute, which indicates a congenital heart block. In this case, the following symptoms appear:

- The kid turns pale, his skin becomes cyanotic.

Cyanosis is one of the clearest signs of possible bradycardia in a newborn

He stops moving, as if freezes. This condition can be accompanied by seizures.
Apnea attacks occur and cardiac arrest of the newborn is possible.

When these signs appear, a screening examination of the baby is carried out, his cardiovascular system is checked in order to exclude it. In the future, the newborn is under the constant supervision of a pediatrician, continuous monitoring of the work of his heart is carried out, if necessary, drugs are introduced to stop bradycardia, which has hemodynamic significance. Treatment is carried out aimed at eliminating the diseases that cause bradycardia. Many people do not always pay due attention to their health. They do not pay attention to the signals that the body gives. Indeed, even a seemingly harmless nocturnal bradycardia can eventually turn into more serious heart rhythm disturbances. Therefore, if you notice that your heart rate is slowing down more and more often, try to take a different look at your lifestyle. Perhaps something needs to be changed in him. And then your heart will always work like a clock, supplying blood to the brain and other organs in time.

In an adult, the normal heart rate is in the range of 65-80 beats per minute. A decrease in heart rate of less than 60 beats per minute is called bradycardia. There are many reasons leading to bradycardia, which only a doctor can determine in a person.

Regulation of heart activity

In physiology, there is such a concept as the automation of the heart. This means that the heart contracts under the influence of impulses that arise directly in itself, primarily in the sinus node. These are special neuromuscular fibers located at the confluence of the vena cava into the right atrium. The sinus node produces a bioelectrical impulse that spreads further along the atria and reaches the atrioventricular node. This is how the heart muscle contracts. The excitability and conductivity of the myocardium are also influenced by neurohumoral factors.

Bradycardia can develop in two cases. First of all, a decrease in the activity of the sinus node, when it generates few electrical impulses, leads to a decrease in heart rate. This bradycardia is called sinus ... And there is a situation when the sinus node is working normally, but the electrical impulse cannot pass fully along the pathways and the heartbeat decreases.

Causes of physiological bradycardia

Bradycardia is not always a sign of pathology, it can be physiological ... So, athletes often have a low heart rate. This is the result of constant stress on the heart with prolonged training. How to understand whether bradycardia is normal or pathological? A person needs to perform active physical exercises. In healthy people, physical activity leads to an intense increase in heart rate. In violation of excitability and conduction of the heart, exercise is accompanied by only a slight increase in heart rate.

In addition, the heartbeat is also slowed down by the body. This is a compensatory mechanism, due to which blood circulation slows down and blood is directed from the skin to the internal organs.

The nervous system affects the activity of the sinus node. The parasympathetic nervous system decreases the heartbeat, the sympathetic nervous system increases it. Thus, stimulation of the parasympathetic nervous system leads to a decrease in heart rate. This is a well-known medical phenomenon that, by the way, many people encounter in life. So, with pressure on the eyes, the vagus nerve (the main nerve of the parasympathetic nervous system) is stimulated. As a result, the heart rate is temporarily reduced by eight to ten beats per minute. The same effect can be achieved by applying pressure to the carotid sinus area of \u200b\u200bthe neck. Stimulation of the carotid sinus can occur when wearing a tight collar, tie.

Causes of pathological bradycardia

Bradycardia can develop when exposed to a wide variety of factors. The most common causes of pathological bradycardia are:

Increased tone of the parasympathetic system;
Heart disease;
Taking certain medications (cardiac glycosides, as well as beta-blockers, calcium channel blockers);
(FOS, lead, nicotine).

Increased tone of the parasympathetic system

Parasympathetic innervation of the myocardium is carried out by the vagus nerve. When activated, the heartbeat slows down. There are pathological conditions in which there is an irritation of the vagus nerve (its fibers located in internal organs, or nerve nuclei in the brain).

An increase in the tone of the parasympathetic nervous system is noted in such diseases:

(against the background of traumatic brain injury, hemorrhagic stroke, cerebral edema);
Neoplasms in the mediastinum;
Cardiopsychoneurosis;
Condition after surgery in the head, neck, mediastinum.

As soon as in this case the factor that stimulates the parasympathetic nervous system is eliminated, the heartbeat is normalized. Doctors define this type of bradycardia as neurogenic.

Heart disease

Heart disease (cardiosclerosis, myocarditis) leads to the development of certain changes in the myocardium. In this case, the impulse from the sinus node passes much more slowly in the pathologically altered part of the conducting system, which is why the heartbeat decreases.

When a violation of the conduction of an electrical impulse is localized in the atrioventricular node, they speak of the development of atrioventricular blockade (AV blockade).

Bradycardia symptoms

A moderate decrease in heart rate does not affect a person's condition in any way, he feels good and does his usual things. But with a further decrease in heart rate, blood circulation is disturbed. Organs are insufficiently supplied with blood and suffer from a lack of oxygen. The brain is especially sensitive to hypoxia. Therefore, with bradycardia, it is the symptoms from the side of damage to the nervous system that come to the fore.

With attacks of bradycardia, a person experiences weakness. Light-headedness and are also characteristic. The skin is pale. Shortness of breath often develops, as a rule, against the background of physical activity.

With a heart rate of less than 40 beats per minute, blood circulation is significantly impaired. With slow blood flow, the myocardium does not receive oxygen in the proper measure. The result is chest pain. This is a kind of signal from the heart that it lacks oxygen.

Diagnostics

In order to identify the cause of bradycardia, it is necessary to undergo an examination. First of all, you should go through. This method is based on the study of the passage of a bioelectric impulse in the heart. So, with sinus bradycardia (when the sinus node rarely generates an impulse), there is a decrease in heart rate while maintaining a normal sinus rhythm.

The appearance of such signs on the electrocardiogram as an increase in the duration of the P-Q interval, as well as deformation of the ventricular QRS complex, its loss of rhythm, a greater number of atrial contractions than the number of QRS complexes will indicate the presence of AV blockade in a person.

If bradycardia is observed intermittently, but in the form of seizures, it is indicated. This will provide data on the functioning of the heart in twenty-four hours.

To clarify the diagnosis, finding the cause of bradycardia, the doctor may prescribe the patient to undergo the following studies:

Echocardiography;
Determination of blood content;
Analysis for toxins.

Bradycardia treatment

Physiological bradycardia does not require any treatment, as does bradycardia, which does not affect overall well-being. The treatment of pathological bradycardia is started after finding out the cause. The principle of treatment is to influence the root cause, against which the heart rate is normalized.

Drug therapy consists in the appointment of medications that increase the heart rate. These are medications such as:

Izadrin;
Atropine;
Isoprenaline;
Euphilin.

The use of these drugs has its own characteristics, and therefore only a doctor can prescribe them.

In the event of hemodynamic disturbances (weakness, fatigue, dizziness), the doctor may prescribe tonic drugs to the patient: tincture of ginseng, caffeine. These drugs speed up your heart rate and increase blood pressure.

When a person has severe bradycardia and heart failure develops against this background, they resort to implantation of a pacemaker in the heart. This device independently generates electrical impulses. A stable set heart rate is conducive to the restoration of adequate hemodynamics.

Grigorova Valeria, medical columnist

Bradycardia is a type of arrhythmia in which the heart rate is less than 60 beats per minute. In trained athletes, bradycardia can be considered normal, but it often indicates heart disease. Severe bradycardia (less than 40 beats per minute) leads to the development of heart failure, as a result of which the implantation of a pacemaker may be necessary.

The disease can develop in two cases. First of all, a decrease in the activity of the sinus node, when it generates few electrical impulses, leads to a decrease in the heart rate. This bradycardia is called sinus. And there is a situation when the sinus node is working normally, but the electrical impulse cannot pass fully along the pathways and the heartbeat decreases.

What it is?

Sinus bradycardia is understood as such a change in heart rate, in which the heart rate decreases to 50-30 beats per minute, due to a decrease in the automation of the sinus node.

The reasons for this condition are varied:

increased tone of the parasympathetic nervous system;
increased intracranial pressure (with cerebral edema, tumor, meningitis, cerebral hemorrhage);
the effect of drugs (digitalis, quinidine);
sclerotic changes in the myocardium affecting the sinus node;
exposure to cold;
poisoning with lead, nicotine;
hypothyroidism (decreased thyroid function);
fasting, typhoid fever, jaundice, etc.

Well-trained athletes and individual young healthy people can have a low heart rate (for example, cyclist Miguel Indurain had a resting heart rate of 28 beats / min. This is normal in the absence of other pathological symptoms such as fatigue, weakness, dizziness, fainting, chest discomfort. cage or shortness of breath.

Degrees

AV block can have three degrees of severity:

Pronounced - heart rate less than 40 beats / minute
Moderate - 40 to 50 beats / minute
Easy - 50 to 60 beats / minute

With mild to moderate bradycardia, circulatory disorders do not develop, because the heart contracts and pushes out blood with sufficient force. A pronounced one causes a disruption in the work of all organs and systems, numerous circulatory disorders occur, which is associated with their oxygen starvation, since the amount of oxygen supplied to the tissues with blood is insufficient for the normal functioning of the human body. Severe bradycardia is accompanied by pallor of the skin and mucous membranes, convulsions and loss of consciousness may occur.

Types of bradycardia

The diagnosis "Bradycardia" as a symptom is always taken into account in the treatment regimen of the underlying disease. Changes can occur and affect any levels of the process of impulse propagation through the heart muscle, therefore it is customary to distinguish between the following types of bradycardia:

Sinus	appears with disorders in the sinus node associated with its functional insufficiency (starvation, vitamin deficiency, rheumatic heart muscle damage, atherosclerosis of the coronary vessels)
Atrioventricular block	violation of the transmission of the nerve signal from the sinus node to the ventricles in the form of a slowdown or complete cessation (cicatricial changes in myocardial infarction, atherosclerosis of the coronary vessels, inflammatory process in severe forms of infectious diseases - myocarditis)
Physiological	typical for persons engaged in physical labor for a long time and athletes, they need a longer process of the filling phase of the ventricles to ensure a strong systolic ejection, the heart rate at the same time reaches 40 per minute with a good pulse
Neurogenic	occurs when the central nervous system is damaged (brain tumors, meningitis, mental illness)
Associated with irritation of the vagus nerve	when taking certain medications and diseases (mediastinal tumors, inflammation of the middle ear, cholelithiasis, gastritis)
Toxic	occurs when poisoning with highly active toxic substances, with renal and hepatic insufficiency, overdose of drugs

Severe bradycardia can occur with reflex action on the active points: when pressing on the eyeball, in the supraclavicular fossa.

Bradycardia in athletes

It is physiological, that is, it reflects the norm. The fact is that during constant training, the heart gets used to working at maximum power in order to meet the increased needs of the body for oxygen and nutrients, for which it has to pump a large volume of blood for a limited period of time.

That is, the heart contracts powerfully and strongly, pushing out in one blow a large volume of blood, which is necessary for the organs and tissues of a training person. When an athlete is not exercising, his heart, accustomed to contracting strongly, still pumps blood through the vessels with powerful jerks.

Due to the good strength of the contractions, the heart may beat less frequently. After all, one powerful contraction is enough to give the blood a strong impulse, and it will flow through the vessels for a relatively long time. Therefore, due to the strength and power of contractions, it is enough for the heart to beat less frequently to pump blood.

Bradycardia symptoms

The physiological form of this disease has no pronounced clinical manifestations.

The main symptoms of bradycardia occur in chronic forms. These are dizziness and weakness, a rare heart rate and a feeling that the heart is stopping, problems with sleep and memory.

In the event of an acute form of severe bradycardia caused by sinoauricular blockade, heart failure is noted, accompanied by fainting and angina pectoris. In severe cases, the person may faint. At the same time, his breathing is disturbed, convulsions occur. This condition is called an attack of MAC (according to the first letters of the names of the doctors who worked on their study of the Morgagni-Adams-Stokes syndrome). It is caused by a decrease in the supply of oxygen to the brain (hypoxia).
With a significant slowdown in ventricular contractions (atrioventricular block), the blood supply to the brain is disrupted. This can cause general anxiety and sudden severe dizziness, a slight darkening of consciousness. With an increase in the pause between heartbeats up to 15 seconds, complete loss of consciousness or an attack of MAC may occur. This sometimes causes cardiac arrest, which can lead to sudden death.

An injection of atropine is given to determine whether the decrease in the number of heartbeats is caused by a functional component or a heart block. With physiological bradycardia, this procedure brings the number of heartbeats back to normal. The lack of effect means that the cause of the disease lies in pathological disturbances in impulse conduction.

Why is bradycardia dangerous?

Physiological, mild and moderate bradycardia, as a rule, does not lead to complications. The main danger of severe bradycardia and MES attacks is asystole (cardiac arrest) and clinical death due to cerebral ischemia. In addition, there is a high likelihood of thromboembolic complications - pulmonary embolism, ischemic stroke or myocardial infarction.

Due to impaired conduction of the impulse with bradycardia, frequent ventricular extrasystole or paroxysmal ventricular tachycardia may develop, which is fraught with the occurrence of ventricular fibrillation and death.

Diagnostics

Diagnosis of bradycardia includes taking anamnesis, examining the patient: determining the pulse, listening to heart sounds, determining respiratory arrhythmia (if any).

Instrumental examination includes an electrocardiogram, as well as daily ECG monitoring.

In the presence of organic forms of bradycardia, ultrasound of the heart, ultrasound echocardiography is indicated.

Bradycardia treatment

Drug therapy consists in the appointment of medications that increase the heart rate. These are medications such as:

Izadrin;
Atropine;
Isoprenaline;
Euphilin.

The use of these drugs has its own characteristics, and therefore only a doctor can prescribe them.

In the event of hemodynamic disturbances (weakness, fatigue, dizziness), the doctor may prescribe tonic drugs to the patient: tincture of ginseng, eleutherococcus, caffeine. These drugs speed up your heart rate and increase blood pressure.

Pacemaker

The operation is performed under general anesthesia and lasts about an hour. A double electrode is inserted into the right ventricle and atrium through the subclavian vein under the control of an X-ray machine. The stimulator is sutured in the subclavian area or under the skin on the abdomen.

The patient spends no longer than a week in the surgical department.

How to treat bradycardia with folk remedies?

Currently, the following alternative methods have proven effectiveness in the treatment of bradycardia:

A mixture of honey, lemon and garlic. To prepare it, wash the lemons and scald with boiling water, then squeeze the juice out of them. Then peel 10 medium heads of garlic and grind them until they become mushy. Mix the prepared garlic gruel with lemon juice until a homogeneous, homogeneous mass is obtained. Then add one liter of honey to the garlic-lemon mass, and mix the whole mixture well. Place the finished mass in a sealed container in the refrigerator and leave for 10 days. Then eat 4 teaspoons every day before meals.
Yarrow decoction. To prepare it, pour 50 g of dry grass with 500 ml of warm water, and then bring it to a boil. Boil for 10 minutes, then leave for an hour. Strain the finished broth and take one tablespoon three times a day.
Walnuts to eat every day. Nuts should be present in the human diet every day. It is best to eat nuts for breakfast.

Usually, the treatment of bradycardia is long-term, and alternative methods can be used indefinitely.

Lifestyle with bradycardia

Mild to moderate bradycardia does not require drastic changes in habitual physical activity or daily activity. It is enough to observe the principles of a healthy lifestyle, the basics of rational nutrition and develop an adequate regime of work and rest.

With severe bradycardia with attacks of MES, the patient should avoid excessive traumatic situations, significant physical exertion.

It is useful for both categories of patients to learn that with bradycardia, it is advisable to eat foods such as walnuts, a mixture of honey, lemon and garlic, as well as a decoction of yarrow, since these products have a beneficial effect on the contractility of the heart muscle. All persons with diseases of the cardiovascular system need to get rid of bad habits, follow a diet with the consumption of low-calorie foods and more often rest in the fresh air.

If bradycardia develops in a pregnant woman, the ability to bear a child depends on the underlying disorder. Typically, mild to moderate bradycardia does not affect the oxygen supply to the fetus. If the expectant mother is taking any medications, she must agree on the possibility of taking them with the attending obstetrician.

Forecast

The presence of organic lesions of the heart adversely affects the prognosis of the course of bradycardia. The possible consequences of bradycardia are significantly aggravated by the occurrence of Morgagni-Adams-Stokes attacks without resolving the issue of electrostimulation. The combination of bradycardia with heterotopic tachyarrhythmias increases the likelihood of thromboembolic complications. Against the background of a persistent decrease in the rhythm, the patient's disability may develop.

With the physiological form of bradycardia or its moderate nature, the prognosis is satisfactory.

Do they take into the army with bradycardia?

In the list of diseases, when a conscript is considered unfit for military service, bradycardia is absent, since this is not a disease, but a diagnostic sign of heart pathologies.

When diagnosing bradycardia, a young person must undergo a CVS examination, and only on the basis of an identified / undetected disease, the question of suitability for service is decided. According to Art. 42-48 young men with diseases - AV block and sick sinus syndrome are recognized as unfit for service. In the absence of these pathologies, the conscript is not exempt from military service.

Update: December 2018

Bradycardia is a type of arrhythmia in which the heart rate slows down to less than 60 beats per minute. This is not an independent disease, but a symptom indicating dysfunction of the cardiovascular system.

It can occur in completely healthy people, for example, in athletes or healthy people who are in a state of sleep - this is a physiological bradycardia due to a good training of the heart muscle.

Pathological is accompanied by heart disease, which ultimately lead to the development of heart failure. This article is about the causes, symptoms of bradycardia and options for its treatment.

AV block can have three degrees of severity:

Expressed - heart rate less than 40 beats / minute
Moderate - 40 to 50 beats / minute
Easy - 50 to 60 beats / minute

Causes of bradycardia

The etiological factor in the development of bradycardia is a malfunction of the sinus node, which produces electrical impulses for the normal functioning of the heart (their frequency is normally more than 60 per minute) or a violation of the process of propagation of these impulses along the cardiac conduction system. The main causes of this symptom can be divided according to the forms of bradycardia:

Extracardiac form

Such bradycardia develops when:

neurocirculatory dystonia
VSD (see)
neuroses
with pressure on the carotid artery (tight scarf, tie, handkerchief) or on the eyeballs (Danini-Ashner reflex)
, meningitis, brain bruises, hemorrhage - conditions that are accompanied by an increase in intracranial pressure
stomach ulcer and
tumors of the mediastinal organs - the diaphragm, esophagus, etc.
endocrine pathology - myxedema, in proportion to the severity
hypothermia (low body temperature)
diet, fasting
hypertension (see)

Organic form

myocardial infarction
, and myocardial dystrophy (contribute to the occurrence of degenerative changes in the sinus node due to the formation of cicatricial changes).

Bradycardia is most often caused by damage to the sinus node or pathology of the cardiac conduction system (blockade).

Weak sinus node - occurs in cases when the frequency of electrical impulses in a given node decreases, which does not correspond to the natural needs of the body. In this case, the appearance of sinus bradycardia is possible, in which the heart contracts normally, but rarely, as well as the failure of the node and sino-atrial blockade (the node functions, but its impulses do not propagate through the cardiac conduction system).
Heart block - bradycardia can be a consequence of heart block (impaired conduction of impulses from the atria to the ventricles), while not all impulses reach the ventricles (incomplete blockade), or all electrical impulses do not pass to the ventricles (complete blockade), while the ventricles contract in isolation. from friend.

Medical bradycardia

Drug bradycardia can be caused by excessive intake of certain drugs:

Quinidine
Cardiac glycosides (Digoxin, Strofantin, Korglikon, Digitoxin)
β-blockers (Timolol, Bisoprolol, Propranolol, Atenolol, Acebutolol, Metoprolol, Esmolol, Betaxolol, Pindolol, Sotalol, Nadolol, Esatenolol)
Morphine
Calcium channel blockers (Nifedipine, Verapamil),
Sympatholytics (Bretilat, Reserpine, Raunatin, etc.)
Antiarrhythmic drugs (Amiodarone, Phenytoin, Procainamide, Dronedarone, Propafenone, Trimecaine, Adenosine, etc.)

After their cancellation, bradycardia stops on its own and does not require treatment.

Toxic bradycardia

Bradycardia of toxic genesis develops with an extreme degree of intoxication of the body:

uremia (severe intoxication of the body with protein metabolism products caused by impaired renal function)
intoxication with hepatitis (see)
severe intoxication with infectious diseases - sepsis, typhoid fever, flu
phosphate poisoning, which slow down the conduction of impulses in the heart muscle (see)
sometimes bradycardia can be caused by hyperkalemia or hypercalcemia (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 heart contraction may be the norm (35-40 beats / min during the day), since the heart is forced to experience maximum stress and its rare contraction is enough to ensure blood supply to tissues and cells the whole organism. The reasons for this feature is the autonomic regulation of the heart rate in professional athletes.

Physiological decrease in heart rate can be when exposed to:

Cold
Chest massage
Smoking - chronic nicotine poisoning (see)

For some people, a pulse of less than 60 per minute is the norm, that is, a physiological feature, since such bradycardia does not bother them, does not manifest itself as dizziness, weakness, increased fatigue, or fainting.

Other types of bradycardia

Senile bradycardia occurs in older people and is the cause of natural aging of the body.
Idiopathic bradycardia is a slowing down of the heart rate of an unexplained (not diagnosed) genesis.

Bradycardia symptoms

The main manifestations, signs, symptoms of bradycardia are:

attacks of Morgagni-Edems-Stokes, accompanied by loss of consciousness and dizziness that occurs when there is a decrease in the pulse;
the presence of instability of arterial blood pressure (hypertension, hypotension), which is difficult to treat and arises against the background of a decrease in the heart rate;
increased body fatigue (decreased tolerance to stress), which occurs against the background of a decrease in heart rate;
the presence of symptoms of chronic circulatory failure against the background of bradycardia, difficult to conservative therapy;
attacks of angina pectoris that occur with tension or even at rest.

Moderate bradycardia usually does not cause circulatory disorders and does not manifest clinically. Symptoms usually occur when the pulse rate is less than 40 beats per minute; the patient most often has organic lesions of the heart. In this case, bradycardia has pronounced clinical symptoms:

With a weakening of the contractile function of the heart muscles and impaired blood circulation in the brain, hypoxia occurs. In this case, the symptoms of bradycardia can be supplemented by loss of consciousness, convulsions (attacks of Morgagni-Adems-Stokes). These conditions are dangerous for the patient by the cessation of respiratory and cardiac activity.

Diagnostics

The therapist detects signs of bradycardia during examination and collection of patient complaints - a rare pulse, heart sounds of normal sonority, possibly respiratory arrhythmia. Then a consultation with a cardiologist is recommended. Diagnostic methods:

ECG - allows you to record a decrease in heart rate, the presence of atrioventriuclear or sinoatrial blockade. It is not always possible to detect bradycardia with the help of a one-time ECG; if it is suspected, daily monitoring of the ECG is performed.
Ultrasound of the heart is indicated for organic bradycardia. Ultrasound echocardiography can determine an increase in the size of the heart, a decrease in ejection fraction less than 45%, degenerative and sclerotic changes in the myocardium.
Load cycle ergometry - evaluates the increase in heart rate at a given physical load.
CPEFI - if ECG and Holter monitoring methods do not reveal transient blockages, a transesophageal electrophysiological study is performed, which allows you to study the pathways of the heart, to reveal the functional or organic nature of bradycardia.

Bradycardia treatment

Functional bradycardia, as well as bradycardia, which has an average severity, not accompanied by clinical symptoms, do not need conservative treatment.
Bradycardia of organic, toxic or extracardiac origin needs, first of all, in the treatment of the underlying disease.
Medicinal bradycardia requires withdrawal of drugs that caused bradycardia (or correction of their intake).

For the treatment of severe bradycardia, accompanied by hemodynamic disturbances (dizziness, weakness, decreased pressure), it is shown:

atropine (intravenous drug administration - 0.5 mg 0.1% solution)
izadrin (intravenously at 2 - 20 mcg / min in 5% glucose solution)
preparations of ginseng root, belladonna, eleutherococcus, caffeine - in individually selected doses
zelenin drops - used for moderate bradycardia, VSD and chronic heart failure. The composition of this herbal antispasmodic is tincture of lily of the valley, valerian, belladonna.

Atropine - the amount of atropine, if necessary, can be increased to 3 mg. Patients who have suffered myocardial infarction should be used with caution atropine, since this treatment can aggravate myocardial ischemia and increase the area of \u200b\u200bits lesion.

Izadrin - beta-adrenostimulants (isoprenaline) have an effective effect on heart contractility. This drug must be administered intravenously. If bradycardia is associated with the use of calcium antagonists or beta-blockers, glucagon is given intravenously. If intoxication with beta-blockers occurs, glucagon is also administered (the dose is calculated individually by the doctor).

In case of asystole (absence of heart contractions), emergency assistance is needed - calling the resuscitation team, which conducts cardiac stimulation.

Temporary endocardial stimulation is performed by introducing an endocardial electrode through the lumen of the catheter into the right heart (in this case, catheterization of the superior vena cava is performed through the subclavian or jugular veins). If temporary endocardial pacing is not possible, percutaneous pacing is recommended. And if it is impossible to carry out it (or if it is ineffective), intravenous adrenaline is indicated (the doctor calculates the dose of the drug).

Morgagni-Adams-Stokes attacks are stopped by ambulance resuscitation teams, while the complex of drugs is prescribed the same as for circulatory arrest. If necessary, an indirect heart massage is performed.

The presence of complete AV block is recommended cardiac pacing. In this case, the patient is shown surgical treatment of bradycardia, the main purpose of which is to install a pacemaker - a device that is an artificial pacemaker of the heart. It supports or imposes on the heart of a sick person the physiological rhythm of heart contractions. A pacemaker is a microprocessor capable of generating electrical impulses to stimulate the heart muscle to function normally.

Why is bradycardia dangerous?

With moderate or physiological bradycardia, the prognosis is satisfactory. The presence of organic lesions of the heart adversely affects the prognosis. The presence of Morgagni-Adams-Stokes attacks seriously aggravates the consequences of bradycardia, if the question of electrostimulation has not been resolved. Heterotopic tachyarrhythmias in combination with bradycardia increase the likelihood of thromboembolic complications. With a persistent decrease in the rhythm of heart contractions, the development of the patient's disability is possible.

Do they take into the army with bradycardia?

In the list of diseases, when a conscript is considered unfit for military service, bradycardia is absent, since this is not a disease, but a diagnostic sign of heart pathologies. When diagnosing bradycardia, a young person must undergo a CVS examination, and only on the basis of an identified / undetected disease, the question of suitability for service is decided. According to Art. 42-48 young men with diseases - AV block and sick sinus syndrome are recognized as unfit for service. In the absence of these pathologies, the conscript is not exempt from military service.

The heart is our devoted motor that works all our life. Any interruptions and stoppages can lead to disaster. The rhythm depends on many reasons. First of all, he is tuned in to adapt to any human activity, to overcome stress conditions and diseases. The number of heart beats at rest in an adult healthy person ranges from 60 to 90 per minute.

It is known that the heart rate decreases by 30% during sleep. This is the only possible rest for the heart that the body can afford. The term "Bradycardia" translated from the medical language means - rare heart contractions. This is not a disease, but a state of rhythm in which less than 60 beats per minute are determined.

However, cardiac bradycardia can be a serious symptom of certain diseases.

How is the heart rate established?

To understand the reasons, consider how rhythm is formed. We consider the heart to be the main organ, but it is very dependent on "direction from the center." From the brain through special nerve fibers "orders" about the required operating mode are sent to the sinus node located in the left atrium.

This accumulation of nerve cells has the "authority" to distribute further "instructions" to the intracardiac fibers and organizes a full systolic release of blood.

Bradycardia is caused by impulses coming from the brain along the vagus nerve. It can occur as a result of physiological and pathological conditions associated with irritation of this nerve.

In a situation where there is an obstacle to the transmission of a nerve impulse from the sinus node further, bradycardia also occurs, because the ventricles begin to work in an autonomous mode, and the frequency of their independent contractions is much lower.

Types of bradycardia

neurogenic - occurs when the central nervous system is damaged (brain tumors, meningitis, mental illness);
associated with irritation of the vagus nerve - when taking certain medications and diseases (mediastinal tumors, inflammation of the middle ear, cholelithiasis, gastritis);
- appears in case of disorders in the sinus node associated with its functional insufficiency (starvation, vitamin deficiency, rheumatic heart muscle damage, atherosclerosis of the coronary vessels);
atrioventricular block - a violation of the transmission of a nerve signal from the sinus node to the ventricles in the form of a slowdown or complete cessation (cicatricial changes in myocardial infarction, atherosclerosis of the coronary vessels, inflammatory process in severe forms of infectious diseases - myocarditis);
toxic - occurs when poisoning with highly active toxic substances, with renal and liver failure, overdose of drugs;
physiological - typical for people who are engaged in physical labor for a long time and athletes, they need a longer process of the filling phase of the ventricles to ensure a strong systolic ejection, the heart rate at the same time reaches 40 per minute with a good pulse.

Severe bradycardia can occur with reflex action on the active points: when pressing on the eyeball, in the supraclavicular fossa.

Decreased thyroid function (myxedema) and decreased sympathetic nerve tone can also lead to a rare pulse.

A sudden attack of bradycardia is called Morgagni - Edems - Stokes. Typical clinical signs:

at first the general anxiety of the patient, the face turns red;
severe dizziness;
loss of consciousness, general pallor and cyanosis of the lips increases;
the patient may suddenly fall;
swelling of the neck veins;
breathing becomes rare and deep;
twitching of the muscles of the face, limbs, then general cramps;
dilated pupils;
incontinence of urine and feces.

A life-threatening situation arises. Attacks appear once every three years or several times a day. Finger determination of the pulse on the forearm and carotid artery is difficult due to the weak pulse wave and low blood pressure. The number of heartbeats can be calculated by the doctor during auscultation or compression of the shoulder with a cuff from a tonometer.

With the cuff applied, you can not only measure the pressure, but also clearly hear the pulsation

To clarify the level of the blockade, electrocardiographic observation in dynamics is used; in stationary conditions, Holter monitoring is used during the day. Electrodes are attached to the patient, which record all changes in the rhythm in the patient's normal motor mode.

Bradycardia treatment

Therapy requires action on the underlying disease or is symptomatic.

With neurogenic bradycardia and a decrease in the heart rate to 40 - 50, you can drink a cup of sweet coffee or strong tea, take 15 drops of Zelenin, belladonna tincture, ginseng. Vigorous physical movement helps to activate the heartbeat.

It is necessary to abolish drugs that affect the rhythm, eliminate an overdose and remove excess potassium, apply anti-inflammatory treatment for rheumatism with hormonal agents, in acute complicated infarction, medications are prescribed that contribute to the localization of the ischemic zone and the early scarring of necrosis.

Symptomatic remedies include drugs based on adrenaline and atropine. They are used in tablet form under the tongue, doctors of the ambulance and hospital are administered intravenously.

First aid for attacks of the Morgagni-Edems-Stokes type is provided before the arrival of the medical team in the amount of resuscitation measures, since bradycardia is life-threatening. If the victim's pulse cannot be determined, the main remedy is an indirect heart massage. It is carried out on a hard surface (road surface, floor). You need to put a bag, a bundle under your head. The massage should be done with moderate strokes of the palms in the lower part of the sternum, kneeling next to the patient. The number of thrusts should be approximately 60 per minute.

The faster the help is, the more chances the patient has

If respiratory arrest is observed, the person providing assistance should make one blow of air into the patient's mouth for three heart shocks. With artificial respiration, the patient's nose is pinched with fingers.

Emergency assistance is carried out before the arrival of specialists or stops when the pulse is restored.

Forecast

Patients with bradycardia are constantly monitored by a cardiologist, the dose of drugs should be taken daily in accordance with the doctor's prescription. A lack of blood supply to the brain, heart and internal organs can cause a complex of symptoms:

frequent dizziness, memory loss, behavior change;
attacks of angina pectoris;
with a sudden fall, bruises and fractures, head injuries are possible;
from the side of the liver, kidneys, functional insufficiency is formed, chronic diseases are exacerbated;
it is impossible to cure bradycardia with conservative methods with a complete blockade, a lethal outcome is possible with the next unexpected attack.