Bradycardia is a decrease in heart rate (HR), accompanied by a decrease in heart rate.
A pulse is considered normal, ranging from 60 to 90 beats per minute. If a person has a heart rate less than 60 units, then this condition is indicated by the term "bradycardia". Translated from the Greek, it means: bradys - slow and kardia - heart.
Reducing the pulse does not always indicate the presence of pathology - it may well be a variant of the physiological norm. For example, bradycardia is often fixed in people who are professionally involved in sports, as well as in people with a “strong heart”.
What it is?
Bradycardia is a type of cardiac arrhythmia in which heart rate drops to below 60 beats per minute. It is considered the norm only for trained people, and for people who are not involved in sports, it is most often one of the signs of heart disease.
Such a disorder is characterized by the appearance of severe weakness, fainting, syncope, cardialgia, cold sweat, dizziness and arterial pressure drops. With a consistently low pulse of 40 beats per minute, heart failure can develop.
Treatment in this case may require the introduction of a pacemaker.
Causes of development
Decrease in the pulse can be triggered by both external factors and pathological causes. Therefore, we can talk about the exogenous and endogenous genesis of such a deviation.
If the slow pulse is physiological in nature, then it is not dangerous. Most likely, it is caused by:
- moderate hypothermia or long-term presence of a person in conditions of high humidity and temperature - such circumstances literally force the body to switch to the "energy conservation" mode;
- biological aging: in patients older than 60 years of age, “islands” of connective tissue begin to form in the heart area; in addition, the metabolism slows down, and therefore the heart begins to function more slowly;
- impact on the reflex zones (for example, when pressing on the eyeballs, or when wearing a tie, the vagus nerve is affected, which leads to a short-term slowdown of the heart rhythm);
- body fitness: in professional athletes, the left heart ventricle gradually grows in size, so the heart can supply the body with the necessary amount of blood even with a reduced number of contractions);
- nighttime sleep - when the body is in a relaxed state, it does not need a large amount of energy; therefore, both the heart and other organs can "rest";
- physical or mental fatigue: in such conditions, the body goes into a "saving mode" to keep as much energy as possible.
Physiological bradycardia does not require treatment, because it is not dangerous to health, and does not lead to oxygen starvation of the heart and brain. But with a consistently reduced heart rate observed in patients over 60-65 years old or athletes, careful medical supervision is necessary. In this case, you should contact your cardiologist.
If the slow pulse is caused by various diseases, then it is already dangerous to health. Pathological bradycardia can be provoked by:
- Heart diseases. So, such a deviation often occurs with coronary heart disease, myocardial infarction, focal or diffuse cardiosclerosis, endocarditis, myocarditis. Another cause of bradycardia is Morgagni-Adams-Stokes syndrome.
- Taking certain medications. Slowing the pulse can be associated with incorrect intake or overdose of beta-blockers, quinidine, cardiac glycosides, morphine, adenosine, Amisulpridom, etc. This condition is life-threatening, as well as extremely dangerous for the patient's health.
- Poisoning. First of all, we are talking about the effects of toxic substances on the body - lead, nicotine or its acid, organophosphorus elements, drugs, etc. These compounds have a negative effect on the tone of the sympathetic and parasympathetic nervous systems, therefore, damage occurs to the cells of the conducting system of the heart and myocardium. The consequence of this effect is a violation of the heart rhythm.
- Hypertensive parasympathetic nervous system. It can occur on the background of neurosis, depressive disorders, peptic ulcer, formation of mediastinal tumors, traumatic brain injury, hemorrhagic stroke, increased ICP, etc. Brain tumors and surgery on the neck, head, or in the mediastinum can also lead to a slowdown of heart contractions.
- Some types of infectious pathologies. Typically, such diseases are accompanied by tachycardia, but typhoid fever, severe sepsis, and several types of viral hepatitis can cause a decrease in heart rate. Infectious pathological processes characterized by a protracted course have the same effect.
- Hypothyroidism. This is an endocrine disease, accompanied by hypothyroidism. With this deviation, there is a decrease in T3 and T4 levels - the main thyroid hormones, and an increase in thyrotropin (TSH). Also with this process is broken, namely, slows down the metabolism. Heart rhythm disturbance occurs, heart rate decreases. At first, bradycardia is episodic, but over time, if you do not treat hypothyroidism, it will become permanent.
Pathological bradycardia is dangerous to health, so it must be treated. Otherwise, there will be a violation of the blood supply to the heart and brain, which would entail more serious consequences.
According to the development mechanism, bradycardia is divided into:
- Sinus Such bradycardia develops due to the hypoactivity of the sinus cardiac node.
- Non-sinus This type of bradycardia is associated with blockade of transmission of electrical impulses between the following heart nodes:
- sinus and sinoatrial;
- sinoatrial and atrioventricular nodes.
For the patient himself, the type of bradycardia does not matter, since both of them are accompanied by the same symptoms. But for the doctor, this information is important, because depending on the type of disorder appropriate therapy is selected.
Depending on the cause, bradycardia is:
- Physiological. Such a symptom may occur in a perfectly healthy person, and may result from the effects of certain factors (they were described earlier). Such a violation occurs in approximately 25% of perfectly healthy men.
- Pharmacological (drug). Slowing the pulse occurs due to the reception of certain medications.
- Pathological. Bradycardia of this type is manifested against the background of cardiovascular and some other diseases.
Pathological bradycardia can occur in acute or chronic form. Acute bradycardia is characterized by sudden development, a high degree of severity of symptoms associated with pathological abnormalities, one way or another traumatic heart. The chronic form of this violation can manifest itself for many years, and is associated with serious violations of the activities of the CAS or the organs that have a direct impact on it.
Pathological bradycardia may be;
- intracardiac arising on the background of heart disease;
- extracardiac, developing as a result of the disruption of other organs or systems that indirectly affect the operation of the CCC.
Depending on the severity of symptoms, bradycardia is divided into:
- pronounced when the pulse drops below 40 beats / min;
- moderate, in which the heart rate ranges from 40 to 50 beats / min;
- light, for which the characteristic heart rate is 50 to 60 beats / min.
Moderate and mild bradycardia does not lead to impaired blood circulation in the heart and brain. However, this cannot be said about a pronounced decrease in the pulse, which indicates that the heart does not cope with its functions and does not ensure the supply of a sufficient volume of blood to the vessels. As a result of such a deviation, the patient has a blanching of the skin and mucous membranes, a faint or fainting, as well as convulsions.
Symptoms and first signs
Light and moderate bradycardia practically does not manifest itself, since it does not cause circulatory disorders. The first warning signs occur when the pulse drops to 40 beats per minute or less.
Under such circumstances, patients may suffer from such symptoms of bradycardia:
- faint and dizzy;
- shortness of breath;
- chest pains;
- drops in blood pressure;
- memory disorders;
- concentration disorders;
- deterioration of mental function;
- short-term visual disturbances.
The severity of symptoms of bradycardia in general depends on the intensity of hemodynamic disturbances.
Reduced heart rate affects brain activity. Due to the violation of the contractile function of the myocardium, hypoxia (oxygen starvation) develops, resulting in the occurrence of seizures and fainting (Morgagni-Adems-Stokes prodrome). Their duration can vary from a few seconds to 1 minute.
Such attacks, concomitant bradycardia, are considered the most dangerous, because they are fraught with sudden respiratory arrest. Therefore, when such symptoms occur, the patient must be given emergency help.
What is the danger of the disease?
If the decrease in heart rate is insignificant, then it does not bear any threat to health. However, a consistently lowered pulse may indicate the beginning of the development of a disease, and it is quite possible that this disease affects the heart. Although it is not uncommon and bradycardia caused by impaired activity of other organs (for example, the thyroid gland).
With the intense severity of sinus bradycardia, the probability of sudden cardiac arrest increases significantly. Such a deviation is accompanied not only by a deterioration of the contractile activity of the myocardium, but also by frequent fainting states. If the disease acquires a malignant course that threatens the life of the patient, the installation of a pacemaker is recommended.
Bradycardia, which is not accompanied by a severe clinical picture, can be detected by means of an ECG. If the patient has signs of such a deviation, the doctor may suspect its presence during the interview. To confirm your concerns, the doctor can measure the patient's pulse.
Based on the collected history and initial examination, a cardiologist (or a specialist with a different profile, depending on the reason for the decrease in heart rate), may order:
- ECG. On the electrocardiogram, a decrease in the heart rate to less than 60 beats per minute. In parallel with it, the syndrome of weakness of the sinus node or blockade is recorded. Along with bradycardia, myocardial ischemia and atrial or ventricular hypertrophy can also be detected.
- Daily monitoring of ECG using a special device - holter. The essence of his work lies in the fact that he at regular intervals (for example, every 15, 30 or 45 minutes) removes the ECG indicator, and records the results on the internal memory. During the decryption of data from the device, the doctor will be able to understand whether cases of bradycardia were recorded, and if so, at what time.
- Ultrasound of the heart. The diagnostic procedure helps to assess the contractile function of the myocardium and to identify structural changes in the heart that can lead to bradycardia (and not only).
- An exercise test that helps determine the body's adaptive abilities during physical activity. Most often resort to bicycle ergometry and treadmill test.
- Electrophysiological studies. It is performed predominantly transesophageal way. Such a manipulation helps to trigger and fix bradycardia if this was not possible with an ECG or daily monitoring. Conducted in the event that the results of the above studies are within the normal range, but the patient complains about the presence of the previously listed symptoms.
- Coronary angiography. This procedure allows you to study the condition of the coronary arteries, and to assess the blood circulation in them, to determine their patency and to identify their defeat atherosclerotic plaques.
- MRI of the heart. The procedure is carried out only according to indications, and is aimed at identifying organic lesions of cardiac tissues with clarifying the location of pathological foci.
How to treat bradycardia?
Before starting treatment, it is important to accurately determine the nature of the disease. If bradycardia has physiological causes, then it does not need treatment. This cannot be said about the pathological decrease in heart rate, which can be dangerous to the health and life of the patient.
Pharmacological stimulation of heart rhythm may be needed only if there are other symptoms characteristic of this condition. The decision to undertake therapeutic activities is taken by a therapist, cardiologist or other specialist (depending on the cause of the violation). Self-treatment in this case should be abandoned, since it is important not to eliminate the symptom itself, but to completely eradicate its cause.
Bradycardia requires compulsory treatment if the patient has:
- pre-unconscious, ending with syncope;
- frequent bouts of reduced heart rate;
- temporary disability;
- chronic pathologies, one of the symptoms of which is bradycardia;
- stable low pulse (less than 40 units).
The goal of treatment in all these cases, above all, is to maintain normal blood circulation and reduce the risk of complications. Usually therapy is carried out on an outpatient basis.
But if serious heart disease or other internal organs occur, and they are accompanied by bradycardia, the patient may need to be hospitalized. Only after this is carried out additional examination and treatment regimen development.
Conservative treatment: what pills prescribed for bradycardia?
Pharmacotherapy is very effective in combating disorders such as bradycardia. Medical drugs normalize the activity of the heart, stimulate blood circulation, prevent the occurrence of other symptoms and complications.
An important point in the pharmacological treatment of bradycardia is to increase heart rate and increase blood pressure, since such measures are necessary to stabilize the blood circulation process. All medicines should be prescribed exclusively by a doctor. Improper use of drugs can lead to severe heart rhythm disorders.
In addition, bradycardia may well be a symptom of another disease that the patient cannot recognize on his own. In this case, the use of drugs that increase the pulse, will be ineffective, or even dangerous (depending on the exact reason for reducing heart rate). Therefore, self-medication with the use of any drugs should be excluded.
List of drugs used in bradycardia:
|Drug name||pharmachologic effect||Recommended dose|
|Atropine||This drug belongs to the group of anticholinergics. Interferes with excitement of a parasympathetic nervous system. The tone of the vagus nerve narrows and the heart rate increases.||0.6 - 2.0 mg 2 - 3 times a day. It is administered intravenously or subcutaneously.|
|These drugs are among the analogues of adrenaline. They accelerate and strengthen heart rate through stimulation of adrenergic receptors in the myocardium and increase in the tone of the sympathetic nervous system.||2 - 20 mcg per 1 kg of patient weight per minute until the heart rate stabilizes.|
(in pill form)
|2.5 to 5 mg 2 to 4 times a day.|
|0.5 - 5 mcg per minute to stabilize the heart rate.|
(sublingually under the tongue)
|2.5 - 5 mg to complete resorption 2 - 3 times a day.|
|Euphyllin||This drug belongs to the bronchodilator (dilating bronchi) means, but has many effects that are useful in bradycardia. It increases and increases the heart rate, and also improves the delivery of oxygen to the tissues.||240 - 480 mg intravenously, slowly (no faster than 5 minutes), 1 per day.|
You need to take medicine as needed, that is, with the development of another attack of bradycardia. Sometimes a doctor may recommend taking these drugs for a certain period of time — a week, a month, etc.
If bradycardia is secondary, the patient may be given other medications. The choice of medication depends on the cause of the illness. For example, in case of pathologies of the thyroid gland hormone therapy is carried out, aimed at normalizing the production of biologically active substances by the body. As soon as the root cause of bradycardia is identified and eliminated, the slowed heart rate should recover on its own.
To combat single attacks, or relieve acute states of bradycardia, such means of traditional medicine are used:
- Water infusion immortelle. 20 g of dry grass pour 0.5 liters of boiling water and insist in a dark place for several hours. Pour into a bottle with dispenser and take 20 drops 2 - 3 times a day. Do not drink medicine in the evening - after 19.00.
- A decoction of the baskets of the harness. 100 g of dry raw material pour 1 liter of boiling water and boil on low heat for 10 - 15 minutes. Cover and insist another half an hour. Ready broth cool, strain and drink 15 ml before each meal.
- Alcohol infusion of Chinese magnolia. 1 part of the fresh fruits of the plant pour 10 parts of alcohol or high-quality vodka. Insist in a dark place in a glass container for a day, then strain. The finished medicine in the amount of 5 ml should be added to tea or boiled water. Drink 2-3 times a day. It is allowed to add honey or sugar to the drink.
- A decoction of the leaves of yarrow. 20 g of dry herb plants brew a glass of boiling water and boil for 10 minutes. Insist to cool and filter. Take 10 - 15 ml 3 - 4 times a day.
Easy bradycardia, which does not adversely affect the general condition of a person, does not require major lifestyle changes. It is enough just to eat right, to perform feasible physical exertion and to balance work and rest.
If the condition is more serious and is accompanied by attacks of MEA, it is necessary to avoid stress and physical overload.
By reducing the heart rate in any case will be useful in the use of food:
- lemon, honey and garlic pastes;
- decoction of yarrow.
These products have a beneficial effect on the contractile function of the myocardium, greatly enhancing it.
Patients with cardiovascular diseases need to give up bad habits and follow a diet low in calories. It is important to regularly take walks in the fresh air, play sports with a focus on cardiovascular exercise (unless contraindicated).
With bradycardia in pregnant women, the ability to bear and give birth to a child directly depends on the cause of the disorder. Light bradycardia does not adversely affect the oxygen supply of the fetus. If a pregnant woman takes any medications, she should definitely discuss the possibility of continuing therapy with her doctor.
Prediction for life
Physiological and mild bradycardia has favorable projections. If this condition is provoked by pathologies, then the prognosis will depend on the outcome of the treatment of the underlying disease, its general course and severity.
For example, HRT with hypothyroidism helps maintain normal levels of thyroid hormones in the body. In this case, the frequency of bradycardia attacks is significantly reduced. Therefore, patient projections are improved.
For patients with end-stage heart failure, the prognosis is poor. This is due not only to the course of the pathology itself, but also to the impossibility of performing an operation to implant a pacemaker.
To prevent the development and recurrence of bradycardia, you must:
- timely and completely treat organic pathologies of the heart;
- engage in the prevention and therapy of extracardiac diseases that can provoke a decrease in heart rate;
- it is correct, and only with the attending physician to select medications that normalize heart rhythm, and to take them strictly according to the scheme developed by the doctor;
- eliminate the effects on the body of factors that trigger disturbances in myocardial activity.
These are very simple rules, compliance with which will reduce the risk of bradycardia, as well as eliminate the development of complications.