What is sinus arrhythmia and how does it manifest itself?

Normal cardiac activity is ensured by the correct functioning of the conduction system of the heart. However, the rhythm and frequency of cardio-muscular contractions can be disturbed as a result of various failures in the formation and / or conduction of an impulse. One such disorder is sinus arrhythmia. What is fraught with such a phenomenon and how to eliminate it?

Why does arrhythmia occur?

The heart contracts due to the automatism of the sinus (sinus-atrial) node - its ability to generate an excitation impulse with a certain periodicity. The rhythm with which this happens is called sinus, and its normal frequency in a healthy adult at rest is from 55 to 90 beats per minute. Sinus rhythm is directly related to the process of breathing: on inspiration, the frequency increases, and on exhalation, it decreases. Such respiratory sinus arrhythmia is considered physiological. The norm is also an increase in the frequency during physical activity (100 beats per minute or more) and a decrease during sleep (less than 60 beats). Emotional experiences, fever, and even food intake also have an impact on sinus rhythm. Children, the elderly and adolescents during puberty are more susceptible to manifestations of arrhythmia. Rhythm changes of this kind do not need treatment. But if the heart rate differs from normal by more than 10%, such a pronounced sinus arrhythmia is considered a deviation and indicates mainly problems with the sinus node.

Its dysfunctions include:

• sinus tachycardia;
• sinus bradycardia;
• sick sinus syndrome.

There are a number of factors contributing to the formation of cardiac arrhythmias.

• morphological changes in the conduction system arising from various cardiopathologies, organic lesions of the nervous system, vascular diseases or as a result of surgical interventions;
• endocrine disorders;
• metabolic disorders;
• intoxications;
• thromboembolism of the pulmonary artery;
• carotid sinus syndrome;
• genetic features;
• congenital anomalies.

Provoke the occurrence of arrhythmias and addiction to strong tea and coffee, smoking, alcohol. In some cases, disorders are considered idiopathic, that is, arising independently for an unknown reason.

Arrhythmias are diagnosed predominantly by ECG, but most can be suspected clinically. In about 10% of cases, cardiovascular or other pathologies are not identified as a source of rhythm disturbances that have arisen, even with a thorough examination.

Sinus tachycardia

This type of arrhythmia includes a frequency of contractions exceeding 90 beats per minute, sometimes felt as a strong heartbeat. Seizures may be accompanied by shortness of breath, angina pectoris.

Physiological sinus tachycardia is noted in young children and healthy adults with psycho-emotional stress (pain, fear, stress), high physical activity.

• in persons with neurocircular dystonia - in this case, a decrease in frequency can be achieved by holding the breath;
• in diseases accompanied by fever - a rise in temperature by one degree increases the heart rate by approximately 10 beats per minute;
• with thyrotoxicosis, anemia, low oxygen content in the blood (hypoxemia);
• in the presence of cardiac pathologies: myocarditis, left ventricular dysfunction, heart failure, cor pulmonale;
• after drinking alcohol;
• with hypotension, a rapid drop in blood pressure;
• after taking sympathomimetics - agents that activate the sympathetic nervous system (adrenaline, ephedrine, etc.);
• in the presence of addiction to tobacco, strong tea, coffee.

Treatment of pathological sinus tachycardia is aimed at eliminating the causes. With a purely symptomatic purpose, in the absence of contraindications, it is possible to use small doses of antianginal and antiarrhythmic drugs.

In adults, the rhythmic frequency rarely exceeds 160 beats per minute, however, the heart contractions of a young organism with significant physical exertion or stimulation with pharmacological drugs can reach higher values ​​- over 180 beats.

Sinus bradycardia

This is the most common ECG violation of sinus rhythm, in which its frequency is less than 60 beats per minute. Mild physiological bradycardia is not uncommon at rest and during periods of sleep in healthy adults, especially those in good physical shape. It can be combined with a pronounced respiratory arrhythmia, most often accompanied by irregular contractions of the heart muscle and sometimes felt increased pulsation on the left - in the region of the heart. Bradycardia in the elderly is often accompanied by cold extremities, dizziness, short-term loss of consciousness, angina pectoris.

• inflammation and sclerotic processes in the area of ​​the sinus node;
• posterior diaphragmatic myocardial infarction;
• intracranial hypertension;
• reduced thyroid function;
• some viral infections;
• the influence of drugs: sympatholytics, cardiac glycosides, beta-blockers, potassium preparations.

With pathological sinus bradycardia, exercise tolerance is reduced, and symptoms of heart or coronary insufficiency often develop.

Sick sinus syndrome

Reduced automatism and impaired impulse conduction create a complex of electrographic and clinical symptoms combined into a common group - sick sinus syndrome.

• persistent sinus bradycardia with manifestations of cerebral dysfunction;
• bradycardia syndrome - tachycardia (tachybradycardia) - alternate change of tachycardia and slow sinus rhythm;
• sinus node failure leading to sudden cardiac arrest;
• sinoatrial blockade - a violation of the conduction of the impulse to the atria.

Most often, such deviations are observed in the elderly as a result of coronary heart disease, hypertension, myocardial damage.

Treatment includes antiarrhythmic therapy, exclusion of causes of syncope of another etiology. In severe cases, accompanied by the development of pre-syncope, frequent loss of consciousness due to prolonged asystole (cardiac arrest) or a decrease in frequency to less than 40 beats per minute, implantation of a temporary or permanent pacemaker is indicated for patients.

Loss of consciousness can occur unexpectedly: from a sharp change in the vertical position, squeezing the blood flow in the neck, suffocation. As a rule, such attacks become more frequent over time, which leads to the need for surgical intervention.

Diagnosis and examination

Diagnosis begins with an examination by a cardiologist and the collection of an anamnesis of the patient who complained of disturbing symptoms. Further, electrocardiography at rest becomes a mandatory and priority appointment.

1. 24-hour Holter ECG monitoring - to identify and assess the severity of transient arrhythmias (sinus bradycardia, weak sinus node syndrome).
2. Exercise electrocardiographic study (bicycle ergometry) - to detect exercise-dependent arrhythmias, as well as to fix an increase in frequency in patients with weak sinus node syndrome or sinus bradycardia.
3. High-resolution ECG - with computer amplification and filtering of cardiogram sections.
4. Doing drug loading tests (for example, with a weak knot).
5. Atrial electrical stimulation (transesophageal, stepped speeding up or programmable) - for the diagnosis of arrhythmias.
6. Intracardiac electrophysiological study (EPS) - to determine the parameters of the conduction system and various parts of the heart.
7. General and biochemical analysis of blood.
8. Additional research methods for the diagnosis of concomitant diseases.

In the case of physiological sinus arrhythmias and sinus tachycardias, a differential diagnosis is not needed - the conclusion is made on the basis of the ECG transcript. In the case of bradycardia, especially in elderly patients, a separation of physiological and pathological arrhythmias is required, as well as clarification of the causes of the latter. With weakness of the sinoatrial node, the patient is examined against the background of the abolition of antiarrhythmic drugs and glycosides, with the exception of disorders of another etiology that can cause loss of consciousness: neurological, metabolic, cerebrovascular, and the like.

Heart Support and Prevention

If pathological arrhythmia has nevertheless been identified, the main task of the patient is to comply with the recommendations of the attending physician. At the same time, the use of health measures that have a positive effect on the heart and the body as a whole will bring great benefits.

• observance of the daily regimen with alternating periods of work and rest;
• enough sleep;
• reasonable physical activity without overload, weight control;
• after consultation with a doctor - about breathing exercises (for example, Strelnikova's gymnastics or yoga) and physiotherapy exercises;
• dietary adjustments - food should be healthy, rich in vitamins, calcium and magnesium;
• refusal of coffee, tobacco and alcoholic beverages;
• the ability to relax, getting rid of the effects of stress and nervous strain.

A good result is the intake of dietary supplements containing potassium and magnesium, the use of traditional medicine: for example, herbal decoctions of chamomile, sage, mint, raspberry leaves. There are positive reviews about the use of reflexology (acupressure).

Remember that only a doctor can make a decision about the presence of serious heart rhythm disturbances. The patient's task is to undergo regular medical examinations and electrocardiographic examinations for the timely detection of dangerous deviations from the norm.