Bradycardia – symptoms, causes, treatment

Update: December 2018

Bradycardia is a type of arrhythmia where the frequency
heart contractions slow down and become less than 60 contractions per
a minute This is not an independent disease, but a symptom
indicating a dysfunction of the cardiovascular system.

is heа может встречаться у абсолютно здоровых людей, например у
athletes or healthy people who are in a state of sleep – this
physiological bradycardia due to good training
сердечной muscle.

Pathological is accompanied by heart disease, which in
eventually lead to the development of heart failure. ABOUT
causes, symptoms of bradycardia and its treatment options
article.

AV blockade can have three degrees of severity:

  • Expressed – HR less than 40 beats / minute
  • Moderate – 40 to 50 beats / minute
  • Light – 50 to 60 beats / minute

With легкой и умеренной брадикардии нарушений кровообращения не
develops, because heart shrinking and with enough force
pushes the blood out. A pronounced causes a disruption to all
organs and systems, there are numerous violations
blood circulation, which is associated with their oxygen starvation, since
the amount of oxygen entering the tissues with blood is
insufficient for normal functioning of the human body.
Severe bradycardia is accompanied by paleness of the skin and
mucous membranes, seizures and loss of consciousness may occur.

Withчины брадикардии

Etiological factor in the development of bradycardia is
malfunction of the sinus node that produces
electrical impulses for normal heart function (their frequency in
rate is more than 60 per minute) or process disorder
spread of these impulses along the cardiac conduction system.
ABOUTсновные причины возникновения такого симптома можно разделить по
bradycardia:

Extracardiac form

Such bradycardia develops with:

  • neurocirculatory dystonia
  • IRR (see vascular dystonia)
  • neurosis
  • with pressure on the carotid artery (tight scarf, tie, handkerchief)
    or on the eyeballs (Danini-Ashner reflex)
  • a brain tumor
  • swelling of the brain, meningitis, brain contusions, hemorrhage – conditions,
    which are accompanied by increased intracranial pressure
  • gastric and duodenal ulcer
  • tumors of the mediastinum organs – diaphragm, esophagus, etc.
  • endocrine pathology – myxedema, in proportion to severity
    hypothyroidism
  • hypothermia (low body temperature)
  • diets, fasting
  • Meniere’s syndrome
  • hypertension (see drugs for high blood pressure)
  • renal colic

ABOUTрганическая форма

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

Bradycardia is most often caused by a sinus lesion.
or pathology of the cardiac conduction system (blockade).

  • Sinus node weakness – occurs in cases where the frequency
    electrical impulses in a given node is reduced, which is not
    meets the natural needs of the body. With этом
    possible appearance of sinus bradycardia, in which the heart
    is reduced normally, but rarely, and also – failure of the node and
    sino-atrial blockade (the node is functioning, but its impulses are not
    spread through the cardiac conduction system).
  • Heart block – bradycardia may result from blockade
    heart (violation of the conduction of impulses from the atria to the ventricles),
    however, not all impulses reach the ventricles (incomplete blockade)
    or all the electrical impulses do not pass to the ventricles (complete
    blockade), while the ventricles contract in isolation from each
    friend

Drug bradycardia

Withчиной лекарственной брадикардии может быть чрезмерный прием
some drugs:

  • Quinidine
  • Сердечных гликозидов (Дигоксин, Строфантин, Коргликон,
    Digitoxin)
  • β-blockers (Timolol, Bisoprolol, Propranolol, Atenolol,
    Acebutolol, Metoprolol, Esmolol, Betaxolol, Pindolol, Sotalol,
    Nadolol, Esatenolol)
  • Morphine
  • Calcium channel blockers (nifedipine, verapamil),
  • Симпатолитиков (Бретилат, Резерпин, Раунатин и др.)
  • Antiarrhythmic drugs (Amiodarone, Phenytoin, Procainamide,
    Дронедарон, Пропафенон, Тримекаин, Аденозин и пр.)

After their abolition, bradycardia is stopped independently and not
requires treatment.

Toxic bradycardia

Toxic genesis bradycardia develops at extreme
intoxication of the body:

  • uremia (severe intoxication of the body with protein products
    exchange caused by impaired renal function)
  • Hepatitis intoxication (see how Hepatitis C is transmitted)
  • severe intoxication in infectious diseases – sepsis,
    typhoid fever
  • phosphate poisoning that slows the conduction of impulses in
    heart muscle (see how household chemicals affect health)
  • sometimes bradycardia may be due to hyperkalemia or
    hypercalcemia (increased concentration of calcium or potassium in
    blood).

Physiological bradycardia in healthy people or
athletes

Hard Workers Good
тренированных людей, athletes, a rare contraction of the heart may
be the norm (35-40 beats / min. during the day), because the heart
forced to experience maximum loads and its rare reduction
enough to ensure the blood supply of tissues and cells of all
organism. Withчинами такой особенности является вегетативная
регуляция ритма сердца у профессиональных athletes.

Physiological decline in heart rate may be when exposed to:

  • Cold
  • Chest massage
  • Smoking – chronic nicotine poisoning (see what they do
    cigarettes)

In some individuals, a pulse of less than 60 per minute is normal, i.e.
physiological peculiarity, since such bradycardia is not
worried, not manifested by dizziness, weakness, increased
fatigue, fainting.

Other types of bradycardia

Senile bradycardia occurs in the elderly and is
причиной естественного старения organism. Idiopathic
bradycardia is the slowing down of the unexplained heart rhythm (not
diagnosed) Genesis.

Symptoms of bradycardia

ABOUTсновными проявлениями, признаками, симптомами брадикардии
are:

  • bouts of Morgagni-Edems-Stokes, accompanied by loss
    Consciousness and vertigo that occurs when there is a contraction
    pulse;
  • the presence of instability in arterial blood pressure
    (hypertension, hypotension), poorly treatable and
    arising on the background of the contraction of the heart rhythm;
  • increased body fatigue (decreased tolerance to
    load), occurring against the background of cardiac rhythm reduction;
  • symptoms of chronic circulatory failure in
    background bradycardia, difficult to conservative treatment;
  • angina attacks that occur with tension or even in
    the rest.

Moderate bradycardia usually does not cause
circulatory disorders and does not manifest clinically. Symptomatology
usually occurs when pulse reduction is less than 40 beats per minute,
The patient most often has organic lesions of the heart. With этом
Bradycardia has marked clinical symptoms:

  • weakness Брадикардия симптомы лечение причины
  • fatigue
  • frequent dizziness
  • feeling short of breath
  • fainting and fainting
  • you may also have difficulty breathing
  • chest pain
  • decrease or increase in blood pressure
  • memory impairment
  • attention
  • short-term visual impairment
  • bouts of confused thinking

With ослаблении сократительной функции сердечной мышц и нарушении
blood circulation in the brain hypoxia occurs. With этом
symptoms of bradycardia can be complemented by loss of consciousness, cramps
(attacks of Morgagni-Adems-Stokes). These states are dangerous for
patient stopping respiratory and cardiac activity.

Diagnostics

Withзнаки брадикардии терапевт выявляет при обследовании и сборе
patient complaints – a rare pulse, heart tones of normal sonority,
possibly respiratory arrhythmia. Advice is then recommended.
cardiologist. Diagnostic methods:

  • ECG – allows you to fix the decrease in heart rate,
    наличие атриовентриуклярной  или синоатриальной блокады. Not
    always using a one-time ECG can detect bradycardia, with
    her suspicions are monitored daily for ECG.
  • Ultrasound of the heart is indicated for organic bradycardia.
    Ultrasound echocardiography can detect an increase in the size of the heart,
    reduced ejection fraction less than 45%; degenerative and
    sclerotic myocardial changes.
  • Load cycle ergometry – assesses pulse rate increase
    for a given physical exertion.
  • CPEFI – if ECG and Holter monitoring methods are not
    detect transient blockades, transesophageal
    electrophysiological study that allows you to explore
    heart pathways, identify functional or organic
    Bradycardia character.

Bradycardia treatment

  • Functional bradycardia, as well as bradycardia, having
    average severity, not accompanied by
    clinical symptoms do not need a conservative
    treatment.
  • Organic, toxic or extracardiac bradycardia
    genesis requires, above all, the treatment of the main
    diseases.
  • Drug bradycardia requires the abolition of drugs that
    caused bradycardia (or correction of their reception).

For the treatment of severe bradycardia, accompanied by disorders
гемодинамики (головокружение, weakness, снижение давления),
shown:

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

Atropine – the amount of atropine, if necessary, can
increase to 3 mg. Patients who have suffered a heart attack
myocardium, atropine should be used with caution, as this
treatment may cause aggravation of myocardial ischemia and an increase in the area
his defeats.

Isadrin – effective effect on cardiac contractility
have beta-adrenostimulyatory (isoprenaline). This drug
must be entered intravenously. If bradycardia is associated with
using calcium antagonists or beta-blockers
Glucagon is administered intravenously. If intoxication takes place
beta adrenergic blockers, glucagon is also administered (calculation of the dose
carried out by a doctor individually).

With asystole (no heartbeat) is needed
emergency assistance – call the resuscitation team, which conducts
cardiac pacing.

Temporary endocardial stimulation is performed by administering
through the lumen of the endocardial electrode catheter to the right sections
of the heart (when this is carried out catheterization of the superior vena cava through
subclavian or jugular veins). If you hold a temporary
endocardial stimulation is not possible,
percutaneous pacing is recommended. And if her
impossible to carry out (or in case of its inefficiency), it is shown
intravenous administration of adrenaline (dose calculation
carries a doctor).

Attacks of Morgagni-Adams-Stokes are stopped by reanimation
ambulance crews, while complex drugs are appointed
the same as with circulatory arrest. If necessary
An indirect heart massage is performed.

The presence of a complete AV block is recommended cardiac pacing. With
This patient is indicated surgical treatment of bradycardia, the main
the purpose of which is to install a pacemaker –
device, which is an artificial pacemaker of the heart. is he
supports or imposes a sick person’s heart
physiological rhythm of heart contractions. Pacemaker
is a microprocessor that is able to generate
electrical impulses for normal stimulation of the heart
muscle.

What is dangerous bradycardia?

With умеренной или физиологической брадикардии прогноз
satisfactory. Presence of organic heart disease
adversely affects the prognosis. Seriously aggravates the consequences.
bradycardia presence of Morgagni-Adams-Stokes attacks, if not
resolved the issue of conducting electrostimulation. Heterotopic
tachyarrhythmias combined with bradycardia increase the likelihood
thromboembolic complications. With стойком снижении ритма сердечных
cuts may develop disability of the patient.

Does the army in bradycardia?

In the list of diseases when a draftee is considered unfit for
conscription, bradycardia is absent,
since it is not a disease, but a diagnostic sign of pathologies
the work of the heart. With диагностировании брадикардии молодой человек
must undergo a CVS examination, and only on the basis of
revealed / not revealed disease the question of
suitability to service. According to art. 42-48 are unfit for service
boys with diseases – AV-blockade and sick sinus syndrome
node. With отсутствии этих патологий призывник не освобождается от
the passage of military service.

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