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Bradycardia – a type of arrhythmia, with heart rate less than 60 beats per minute. Occurs as norm option at the trained athletes, but accompanies various cardiac pathology more often. HELL is shown by weakness, semi-unconscious conditions and short-term loss of consciousness, cold then, pains in heart, dizziness, instability. At the expressed bradycardia ( less than 40 beats per minute) leading to development of heart failure operation on implantation of an electropacemaker can be required.

Bradycardia

Bradycardia – a type of arrhythmia, with heart rate less than 60 beats per minute. Occurs as norm option at the trained athletes, but accompanies various cardiac pathology more often. HELL is shown by weakness, semi-unconscious conditions and short-term loss of consciousness, cold then, pains in heart, dizziness, instability. At the expressed bradycardia ( less than 40 beats per minute) leading to development of heart failure operation on implantation of an electropacemaker can be required.

Irrespective of the reason, violation of ability of sinusovy knot to develop electric impulses with a frequency over 60 a minute or their inadequate distribution on the carrying-out ways is the cornerstone of bradycardia. Moderate degree of bradycardia can not cause disorders of haemo dynamics. The rare warm rhythm at bradycardia leads to a lack of blood supply and oxygen starvation of bodies and fabrics, breaking their full functioning.

The physiological bradycardia considered as norm option occurs at physically trained people: at a quarter of young healthy men of ChSS makes 50-60 in a minute; during sleep under the influence of physiological fluctuations of vegetative regulation there is an urezheniye of a warm rhythm for 30%. However, more often bradycardia develops against the background of already available pathological processes.

Classification of bradycardia

On localization of the revealed violations distinguish bradycardia sinusovy, connected with violations of automatism in sinusovy knot, and bradycardia at blockade of heart (sinoatrialny or atrioventricular) at which carrying out impulses between sinusovy knot and auricles or auricles and ventricles is broken. Heart rate can decrease under physiological conditions (at athletes, in a dream, at rest) is a functional or physiological bradycardia; pathological bradycardia accompanies the course of various diseases.

Pathological bradycardia can proceed in a sharp form (at a myocardial infarction, myocardites, intoxications etc.) and to disappear after treatment of the disease which caused it, or a chronic form (at age sclerous diseases of heart). For the reasons of development of sinusovy bradycardia allocate the following forms: ekstrakardialny (neurogenetic), organic (at damages of heart), medicinal, toxic and sinusovy bradycardia of athletes. Sometimes on an etiology bradycardia is subdivided on toxic, central, degenerate and idiopathic.

Bradycardia reasons

The Ekstrakardialny form of bradycardia can develop at neurocirculator dystonia, neurosises with vegetative dysfunction, pressure upon a carotid sine (when carrying a hard collar or a tie), pressing on eyeballs (Ashner's reflex), the increased intra cranial pressure (at meningitis, a brain bruise, subarakhnoidalny hemorrhage, hypostasis or a tumor of a brain), stomach ulcer of a stomach and a 12-perstny gut. The bradycardia developing at a miksedema is proportional to expressiveness of a hypothyroidism.

The myocardial infarction, miokardiodistrofiya, myocarditis, cardiosclerosis can be the reasons of an organic form of bradycardia. These diseases lead to degenerate and fibrous changes in sinusovy knot or violations of conductivity in a myocardium, being followed by development of bradycardia.

At organic defeat of the driver of a rhythm the syndrome of weakness of sinusovy knot develops, and the frequency of generation of impulses in it sharply decreases. This state is followed by sinusovy bradycardia - rhythmical, but very rare reductions of heart; change bradi-and tachycardias or alternation of spontaneous drivers of a rhythm. Extreme extent of defeat of sinusovy knot is shown by automatism function refusal therefore electric impulses of heart cease to be developed by it.

At defeat of the carrying-out ways of a myocardium blockade of carrying out impulses therefore a part of the signals generated by sinusovy knot is blocked develops and cannot reach ventricles - bradycardia develops. Development of a dosage form of bradycardia can be promoted by reception of warm glycosides, a hinidina, β-adrenoblokator, simpatolitichesky medicines (for example, a rezerpina), blockers of calcic channels (for example, verapamil, nifedipine), morphine.

The toxic form of bradycardia develops at the expressed intoxications caused by sepsis, hepatitis, uraemia, a typhoid, poisoning with fosfororganichesky connections and which are slowing down processes of automatism and carrying out in a cardiac muscle. Sometimes also carry the bradycardia caused by a giperkaltsiyemiya or the expressed giperkaliyemiya to this group.

So-called, bradycardia of athletes, is characterized by ChSS till 35-40 in a minute even in the afternoon. As its reason serve features of vegetative regulation of a warm rhythm at the people who are professionally playing sports. Also to bradycardia can give natural processes of aging in an organism; sometimes the reasons of bradycardia and remain obscure - in these cases speak about its idiopathic form.

Bradycardia symptoms

Moderately expressed bradycardia usually is not followed by violations of blood circulation and does not lead to development of clinical symptomatology. Developing of dizziness, weakness, semi-unconscious and unconscious states is observed at bradycardia with ChSS less than 40 beats per minute, and also against the background of organic damages of heart. Also at bradycardia there are a fatigue, the complicated breath, breast pains, fluctuation HELL, violation of concentration of attention and memory, short-term disorders of sight, episodes of the confused thinking.

In general displays of bradycardia correspond to weight of the violations of haemo dynamics developing on its background.

The brain reacts to weakening of sokratitelny function of a myocardium and delay of blood circulation by the first, testing a hypoxia. Therefore bradycardia quite often leads to attacks of loss of consciousness, spasms (attacks or prodroma of Morganyi-Ademsa-Stoksa) which can proceed from several seconds to 1 minute. This most dangerous state at bradycardia demanding rendering urgent medical actions since at a prolonged attack there can come the stop of respiratory activity.

Diagnosis of bradycardia

Signs, characteristic of bradycardia, come to light when collecting complaints of the patient and objective inspection. At survey rare pulse which at sinusovy bradycardia has the correct rhythm is defined, warm tones of usual sonority are listened, respiratory arrhythmia quite often is found. Consultation of the cardiologist is recommended to patients with the revealed bradycardia.

The electrocardiographic research at bradycardia allows to record rare ChSS, existence of sinoatrialny or atrioventriuklyarny blockade. If at the time of registration of the ECG episodes of bradycardia do not come to light, resort to carrying out daily monitoring of the ECG.

At an organic form of bradycardia carry out ultrasonography of heart. Decrease in fraction of emission less than 45%, increase in the sizes of heart, sclerous and degeneratvny changes of a myocardium is defined by method of ultrasonic EhoKG. By means of carrying out a load veloergometriya ChSS gain in connection with the set physical activity is estimated.

At impossibility of identification of passing blockade by the ECGs methods and holterovsky monitoring, it is conducted a chrespishchevodny electrophysiological research of the conducting ways of heart. It is possible to define the organic or functional nature of bradycardia by carrying out ChPEFI.

Treatment of bradycardia

The functional and moderate bradycardia which is not followed by clinical manifestations do not demand therapy. At organic, ekstrakardialny, toxic forms of bradycardia treatment of the main disease is carried out. At medicinal bradycardia correction of a dosage or cancellation of the medicines which are slowing down a warm rhythm is required.

At manifestations of haemo dynamic violations (weakness, dizzinesses) purpose of medicines of a belladonna, root of a ginseng, extract of an eleuterokokk, izoprenalin, ephedrine, caffeine and others in individually picked up doses is carried out. As indications to active treatment of bradycardia serve development of stenocardia, arterial hypotonia, faints, heart failure, ventricular arrhythmia.

Emergence of an attack of Morganyi — Adams — Stokes demands consultation of the heart surgeon and the solution of a question of implantation of an electropacemaker – the artificial driver of the rhythm developing electric impulses with a physiological frequency. The adequate and constant set warm rhythm promotes restoration of normal haemo dynamics.

Forecast and prevention of bradycardia

Adversely existence of organic damages of heart influences the forecast of a course of bradycardia. Considerably emergence of attacks of Morganyi — Adams — Stokes without solution of a question of carrying out electrostimulation burdens possible consequences of bradycardia. The bradycardia combination to geterotopny takhiaritmiya increases probability of tromboembolichesky complications. Against the background of permanent decrease in a rhythm development of an invalidization of the patient is possible. At a physiological form of bradycardia or its moderate character the forecast satisfactory.

Timely elimination of the ekstrakardialny reasons, organic damages of heart, toxic impacts on a myocardium, the correct selection of dosages of medicines will allow to prevent development of bradycardia.

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