Sinus arrhythmia - Causes, symptoms and treatment. MF.

The frequent question: "And what is sinus arrhythmia?".Indeed, such a conclusion can be found quite often. Should this be considered a diagnosis and when should measures be taken?

Sinus arrhythmia is a disturbance in the rhythmicity of the generation of electrical impulses in the sinoatrial node, the main rhythm driver located in the right atrium.

On a cardiogram, sinus arrhythmia manifests itself as unequal intervals between cardiac contractions.

Sinus arrhythmia is the norm or pathology?

By interrelation with the respiration process, sinus respiratory arrhythmia and arrhythmia, not associated with respiration, are distinguished. Increasing( no more than twice the baseline) or slowing the heart, associated with the functioning of the respiratory system or physical activity, eating and sleeping is a normal process observed in healthy people, often at a young age. Admission Valsalva eliminates the episode of arrhythmia.

The reception of Valsalva is the patient's actions, which are aimed at creating high pressure in the cavity of the middle ear, thoracic and abdominal cavities. A deep inhalation is carried out followed by a deep exhalation, with straining and holding the breath for 15 to 20 seconds.

However, the expressed pathological uneven nature of heartbeats can indicate various diseases of the cardiovascular system.

Causes of sinus arrhythmia

1) Cardiac( associated with the heart):

- ischemic heart disease( insufficient blood supply and oxygen starvation of the heart muscle causing pain in the heart),
- arterial hypertension,
- rheumatic heart disease,
- cardiosclerosissites of substitution of muscle tissue in the heart for scarring),
- heart failure( the heart does not cope with full blood pumping through the body),
- endocarditis and myocarditis( inflammatory heart lesions by various)
- cardiomyopathies( heterogeneous group of diseases characterized by structural changes in the heart muscle),
- in children it can be congenital and acquired defects, as well as voluminous formations affecting the conduction system of the heart.

2) Non-cardiac:

- neurogenic( various disorders of the nervous system, including vegetative-vascular dystonia and neuroses),
- hypoxic( oxygen starvation as a result of exacerbation of bronchial asthma and other bronchopulmonary system diseases, chronic anemia),
-endocrine( disorders of the thyroid and adrenal glands, diabetes, obesity, climacteric syndrome),
- diseases of the digestive system( gastritis, liver disease, etc.),
- medicinal( uncontrolledreceiving diuretics, cardiac glycosides, antiarrhythmic drugs).Due to uncontrolled intake of diuretics, a violation of electrolyte balance( salt of potassium, sodium, magnesium and calcium) may develop.
- toxic( smoking, alcohol, narcotic drugs),
- infections( brucellosis, typhus) extremely rare,
- mechanical( chest injury, electric shock),
- diseases of the spine.

3) Idiopathic arrhythmia I arise without an objective cause, often has traceable heredity.

Also, sinus arrhythmia is divided into tachyarrhythmia( heart rate increase 100 beats per minute or more) and bradyarrhythmia( palpitations less than 55).

Symptoms of sinus arrhythmia

- episodes of weakness, dizziness, darkening in the eyes,
- fainting,
- a feeling of lack of air,
- headaches,
- a feeling of palpitation( especially pay attention to this complaint in children, as in normal childrenheart palpitations do not feel) and a feeling of pulsation in the temples,
- a feeling of interruption in the heart( with pronounced sinus arrhythmia) described as "sinking heart," "the feeling that the heart was beating, then stopped and ran faster", "a heartbeating ",
- discomfort in the heart area at the moment of interruptions or rapid heart rate.

Infants can have the following symptoms of sinus arrhythmia:

- increased excitability or, conversely, lethargy,
- dyspnea at rest,
- appearance of cyanosis( predominantly in the nasolabial triangle),
- pallor of the skin,
- decreased appetite,
- frequent regurgitation,
- insufficient weight gain,
- increased sweating.

Diagnosis of sinus arrhythmia:

- examination of a specialist doctor( therapist or cardiologist) with collection of complaints and anamnesis, general examination( body type, body weight, pallor of the skin), palpation of the pulse( not only the pulse on the radial artery, but alsopulsation of the cervical arteries and veins, and pulsation in the apex of the heart and in the epigastrium), percussion of the heart( tapping with the purpose of determining the boundaries of the heart), listening to heart tones and noise.
- The general or common analysis of a blood( first of all we are interested in a level of a hemoglobin) and urine.
- Biochemical blood test( total protein, total and direct bilirubin, ALT, ASAT, glucose, creatinine, urea, cholesterol and fractions).
- hormones of the thyroid gland and adrenal glands.
- Electrocardiography( ECG) with stress test( dosed physical load, after which repeat the ECG).
- daily monitoring of the ECG( the device is worn for a day, and you keep a diary of your loads during the day and carry out the given load: climbing the stairs, etc.).
- Echocardioscopy( ultrasound of the heart) to identify the possible organic nature of arrhythmia( areas of cardiosclerosis, heart defects, etc.).

Then, if you need further diagnostics( searching for non-cardiac causes of arrhythmia),

may be prescribed - lung radiography,
- spine X-ray,
- ultrasound of the thyroid and adrenal glands,
- ultrasound of the liver, gallbladder, pancreas and kidneys,
-FGDS,
- MRI of the brain,
- sex hormones,
- consultation of the endocrinologist,
- consultation of the gynecologist( gynecologist-endocrinologist),
- consultation of a neurologist, psychotherapist.

Treatment of sinus arrhythmia

Establish that in your case, sinus arrhythmia is not dangerous and does not require treatment, only a specialist can do after a number of diagnostic procedures.

The treatment does NOT require sinus arrhythmia, which:

- does not affect systemic hemodynamics( there are no pronounced changes in blood pressure, fainting, children are not accompanied by cyanosis or pale skin, dizziness) and manifests only in auscultation and ECG;
- the ECG shows a moderate irregular sinus arrhythmia or the frequency of cardiac contractions does not significantly deviate from the norm;
- sinus arrhythmia is caused by external factors( it is necessary to cancel the established factor).

Recommendations for treatment

- General recommendations of ( compliance with the work and rest regime, full sleep, reasonable physical activity, walking, swimming is best).

- Rational nutrition of with restriction of fatty and overly spicy food, inclusion of seasonal fruits and vegetables in the diet, a diet rich in potassium and B vitamins( meat, nuts, greens, dairy products, tomato paste, dried apricots, avocados, dates, potatoes,apples, champignons, bananas), refusal of alcohol, smoking and psychoactive substances. Do not consume large amounts of food at night, as a crowded stomach increases the risk of arrhythmia.

- Treatment of the underlying cardiological disease ( correction of blood pressure figures, treatment of coronary heart disease and heart failure, etc.).Treatment of the underlying disease for non-cardiological reasons.

- Respiratory gymnastics ( applies regardless of the age of the patient).

- Reflexive methods of treatment of , aimed at slowing down the pace of heartbeats. One is based on the tension of the eyeballs: they should be lightly pressed and held for a few minutes. Another way is to massage the side surfaces of the neck.

- Acupuncture and physiotherapy ( treatment by exposure to heat, magnetic field, types of physiotherapy using electrocutions are excluded).

- Multivitamins .

- Sedative preparations of ( used as herbal preparations( persulin 2 tablets 2-3 times daily up to 1 month, Leonor-forte 1-2 tablets 2 times a day up to 1-2 months, novopassit 1 tablet or50 ml of solution 3 times a day to 1 month), and tranquilizers).

- Nootropics ( glycine 1 tablet 2-3 times a day for 14-30 days, pantogam 250 mg 1-2 tablets 3 times a day 1-3 months, sometimes the course is extended to 6 months, Cavinton 1-2 tablet 3 times a day for 1-3 months), to reduce the manifestations of neurosis and improve blood microcirculation.

- Metabolic drugs ( trimetazidine 35 mg twice a day for 2 months, 1000 mg daily for 1000 mg once a day, the course is unlimited), which improve the metabolism in the heart muscle and, thus, indirectly reduce the frequency of arrhythmia attacks.

- Complexes of microelements containing potassium and magnesium( panangin or asparks 1-2 tablets 3 times a day, the duration of the course is determined by the doctor, regular reception is possible).

- For severe sinus arrhythmia , antiarrhythmic drugs( aymalin, etmozin), calcium channel blockers( verapamil), beta blockers( metoprolol, bisoprolol, anaprilin) ​​are prescribed for tachyarrhythmia, atropine and atropine-like drugs with bradyarrhythmias.

- For sinus bradyarrhythmias, with a heart rate of less than 45 per minute( for professional athletes, the lower limit is less than 35 per grant per minute), consideration should be given to installing a pacemaker. The choice of a specific model is made taking into account the clinical picture and the type of sinus arrhythmia.

Prevention of sinus arrhythmia

- healthy lifestyle,
- stress management, possession of relaxation skills,
- normalized physical activity,
- maintaining normal weight,
- timely diagnosis( medical examination) and treatment of the revealed pathology.

Forecast

The forecast is favorable in most cases. Sinus arrhythmias in children and adolescents often pass independently after the establishment of the hormonal system( in girls after the formation of a regular menstrual cycle).Sinus arrhythmias that do not cause subjective complaints do not endanger life. In the case of pronounced sinus arrhythmias( both brady and tachyform), the prognosis depends on the patient's properly prescribed treatment and adherence.

Is the army with such a diagnosis?

Sinus arrhythmia is common in young men of pre-conscription age. Hence the question arises about their suitability for military service.

Sinus arrhythmia without a serious background disease does not prevent the passage of military service, admission to military schools and schools.

Young people are not recruited for urgent service if the sinus arrhythmia is a manifestation of the following diseases:

- rheumatic heart disease with moderate and severe circulatory failure,
- cardiosclerosis,
- heart defects,
- after a heart surgery,
- severe dysfunction of the left heart,
- paroxysmal rhythm disturbances( tachy- and bradycardia, prolonged failure of the rhythm),
- weakness of the sinus node.

However, in each case the question is solved individually based on a detailed survey, instrumental and laboratory data. It is not excluded hospitalization for the purpose of observation and subsequent expert opinion of the cardiologist.

Therapist doctor Petrova A.V.