Update: October 2018
In the good old days of Soviet medicine, general medical
the installation was good and put it like this: “Conclusions
narrow specialists and intermediate survey data
not to give to patients, not to show forms of ready analyzes, for
explanations sent to the attending physician ”.
However, in the era of insurance medicine, manners softened, and in the hands of
any mom can easily have an ECG film with a hand written
functional diagnostician conclusion.
And the conclusions, I must say, are different, for example – Sinus
arrhythmia. Should my mother faint immediately or first run to
to a paid cardiologist, having such an ECG of your child on hand?
What is sinus arrhythmia?
In a greater percentage of cases, sinus arrhythmia is a condition
which does not threaten the life and health of the child. General sinus rhythm
– these are normal heartbeats, the frequency of which is imposed
the main pacemaker (sinus node), the intervals between such
abbreviations are the same. With sinus arrhythmia between the individual
heartbeats intervals become different. In this case, the total frequency
heartbeats per minute remains within the normal range, maybe
increased (tachyarrhythmia) or reduced (bradyarrhythmia).
Unlike adults, for whom normal heart rate
cuts range from 60 to 90 beats per minute, the heart of a child
Beats at different ages in different ways.
|In the first month of life||with a frequency of 140 beats per minute|
|from month to year||Frequency 132 beats per minute is normal|
|from year to two||124 beats per minute|
|for children of two||five years, the rate is 115 beats per minute|
|from 6 to 8 years||106 beats / min|
|from 8 to 10 years||88 beats / min.|
|10-12 years||80 beats per minute|
|12-15 years||75 beats per minute|
There are several options for sinus arrhythmia.
What sinus arrhythmia is not dangerous?
Sinus arrhythmia in children associated with breathing is
name of respiratory arrhythmia. This state does not lead to
impaired blood pumping in the heart, therefore not dangerous for
Its origin is explained by the fact that during inhalation the frequency
heart rate reflex increases while during exhalation
decreases. A similar situation occurs if the child during
carrying out an electrocardiogram to lay on the couch covered with a cold oilcloth. AT
this time the child instinctively holds the breath, and the frequency
heartbeats reduced by a few beats.
If the child ran before the study, and then entered
cold room, on the ECG sinus can also be fixed
artymia However, the claim that sinus arrhythmia has
children – the norm is wrong.
What is the main cause of the respiratory arrhythmia?
ATо всем виновата незрелость нервной системы. The younger child
the easier such episodes arise for him. Most exposed
such rhythm disturbances:
- Infants with postnatal encephalopathy, syndrome
intracranial hypertension (see increased intracranial pressure
in newborns), premature babies.
- Rickets in children, altering the excitability of the nervous system also
provokes sinus respiratory arrhythmia.
- In too full children during physical activity can
проявляться выраженная синусовая arrhythmia.
- A child in periods of rapid growth (6-7, 9-10 years) vegetative
the system does not have time to quickly adapt to new requirements
Therefore, these age gaps can also accompany
дыхательная синусовая arrhythmia. As it happens
maturation of the autonomic nervous system, risks of sinus development
arrhythmias are getting smaller.
Non-respiratory sinus arthmia
This rhythm disturbance can be permanent or
year to several per day. The main pacemaker at the same time
continues to impose the correct rhythm on the heart, however, in a conducting
system of the heart or its cells (cardiocytes) appear such
changes that lead to arrhythmias. Most often such changes
transient, that is, they are not associated with heart disease, but
some other diseases or pathological conditions.
Causes of non-respiratory arrhythmias
In about thirty percent of cases, pathological
sinus arrhythmia in children. Its reasons lie in various
- Hereditary predisposition. If the parents of the child were
susceptible to sinus arrhythmias of non-respiratory origin,
such a predisposition can be transmitted to the child. Although a hundred
There is no percentage dependency.
- Infectious diseases, accompanied by intoxication,
fever or dehydration. Since holding a nervous
impulse, which affects the contraction of the heart muscle, is associated with
fluxes of potassium, sodium and chlorine ions through the membrane of cardiocytes,
any factors that change the water-electrolyte composition of blood and
interstitial fluid can trigger rhythm disturbances.
- Neurocirculatory dystonia (vegetative dystonia).
Violation of the ability of blood vessels (including feeding the heart)
adequately change your clearance in depending on the needs of fabrics
in oxygen can also cause arrhythmias.
- Myocarditis. When inflammation of the heart muscle is bacterial
(for example, in diphtheria) or viral (cytomegalovirus) infection
not only sinus arrhythmia, but also other disorders will be noted
rhythm (atrial fibrillation, beats, heart block). Also
there is a rise in temperature, pain in the heart, deafness
heart tones, signs of heart failure in the form of edema,
shortness of breath, liver enlargement and other symptoms.
- Chronic rheumatic heart disease. Rheumatism, “licking
joints, but biting the heart ”, affects the valve apparatus of the heart and
can cause myocarditis and endocarditis. Debut disease
associated with transferred angina, accompanied by temperature
reaction, inflammation of large joints that pass quickly, and
cardiac lesions, including sinus lesions
- ATыраженная аритмия у ребенка может развиться и на фоне
congenital heart defects.
- Heart tumors are the most rare cause of rhythm disturbances.
How are sinus arrhythmia in children and sport?
Quite often parents whose children are engaged in sports
sections, in case of detection of a sinus arrhythmia in a child, are asked
what are the prospects for sports and how previous
classes are guilty of the development of rhythm disturbances.
It must be said that without predisposition to pathologies
heart rhythm even when practicing professional sports arrhythmia
the heart does not develop in the child. AT том же случае, когда были все
grounds for arrhythmia debut, any exercise
ATо всех случаях, дыхательная аритмия у детей не является
contraindication for classes in sports sections. But baby
should be regularly examined by a cardiologist and he should be treated
control electrocardiographic examination. It is important that
do not miss the possible transition of sinus arrhythmia to more severe
If a child is engaged in professional sports, he must
be observed by a sports doctor with a mandatory ECG every
три месяца и холтеровским мониторированием
respiratory sinus arrhythmia question about admission to the competition
should be decided individually. When confirming non-respiratory
nature of arrhythmias, sports are limited.
What can be seen on the ECG?
Since the driver
rhythm is a sinus node, in front of each ventricular complex
QRS has a P wave. This means that electrical stimulation,
leading to a reduction in myocardium, first spreads to
auricles, and then on ventricles, that is, in the normal mode.
PQ interval, reflecting the time from the atria to
ventricles, maintains normal length. But the RR interval between
the tops of the ventricular complexes lengthen or contract, reflecting
decrease or increase in heart rate. Sinus arrhythmia example
depicted in the figure.
What does the child feel?
Usually negative sensations sinus arrhythmia, especially
respiratory, does not cause. The child may feel more rapid
If a child complains of difficulty breathing, heart pain,
fatigue, weakness, dizziness is a reason to turn to
to the doctor. ATероятно, кроме синусовой аритмии имеется более серьезная
pathology of the heart. The same should be done if the child
there is shortness of breath or swelling, cyanosis of the nasolabial triangle or
Mom can count the number of heartbeats by putting her palm on
the area of the left nipple of the child. Also аритмию можно засечь по пульсу
(clasping the wrist so that the four fingers are on the outside
the edge of its inner surface and the large one on the opposite
parties). If you take a pulse or heartbeat for a minute,
can you tell if there are different gaps between individual blows in
What to do?
If sinus arrhythmia is recorded on the ECG, it is worth a visit.
cardiologist. ATрач назначит контрольное электрокардиографическое
examination, ultrasound of the heart, urinalysis, clinical analysis
blood and its biochemical research.
AT том случае, если не будет обнаружено никаких других
deviations, in addition to sinus arrhythmia, the child will be under
cardiologist with a control electrocardiographic
survey every six months.
Treatment of isolated sinus arrhythmia is not carried out. Child
engaged in physical education in the general group. Also не противопоказаны
playing sports. Some restrictions may apply.
participation in competitions.
For non-respiratory arrhythmias, treatment of those cardiac
the problems that led to her. After the main therapeutic measures
(course of antibacterial or antitumor therapy, correction
heart disease, relieving symptoms of heart failure
a course of cardiac glycosides and diuretics prescribed
antiarrhythmic drugs and courses Elkar or Mildronat, as
AT любом случае, когда имеется синусовая аритмия у детей, лечение
will be selected by a cardiologist, based on the main reason that led to
heart rhythm disorders.