Internal illnesses. Sinus tachycardia, sinus bradycardia, sinus arrhythmia, sick sinus syndrome (most important)

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Internal illnesses. Sinus tachycardia, sinus bradycardia, sinus arrhythmia, sick sinus syndrome (most important)

Lecture notes, cheat sheets

Directory / Lecture notes, cheat sheets

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21. sinus tachycardia, sinus bradycardia, sinus arrhythmia, sinus node weakness syndrome

1. Sinus tachycardia

Increased cardiac activity at rest more than 90 beats per minute with the correct rhythm.

Etiology. It occurs due to an increase in the tone of the sympathetic nervous system. There are physiological and neurogenic.

Tachycardia can be observed in diseases of the cardiovascular system, with drug and toxic effects, with acute and chronic infections and anemia.

Clinic. Complaints are determined by the underlying disease. The I tone is strengthened, the II tone is more often weakened, the pendular rhythm and an embryocardia are possible.

On the ECG, the heart rate is more than 90 beats per minute, the duration of the RR interval is less than 0,60 s, the rhythm is correct.

Treatment. In the functional form, psychotropic and sedatives, tranquilizers, neuroleptics (meprobamate, diazepam), and β-blockers (atenolol, egilok in doses that do not reduce the number of heart contractions below 60 beats per minute) are used.

2. Sinus bradycardia

Decrease in heart rate below 60, but not less than 40 per minute.

Etiology. An increase in the tone of the vagus nerve, a decrease in the tone of the sympathetic nerve, a direct effect on the cells of the sinus node (hypoxemia, infection).

Clinic. Manifested by palpitations, fainting. On the ECG, the RR interval is more than 1 s, the rhythm is sinus.

Treatment. With organic bradycardia with a heart rate of less than 40 beats per minute and a tendency to faint, atropine is administered 0,5-1,0 mg intravenously every 3 hours (up to 2 mg) or 0,5-1,0 mg 3-4 times inside and others

3. Sinus arrhythmia

Alternating periods of increased and decreased heart rate due to uneven generation of an impulse in the sinus node.

Etiology. The reasons are fluctuations in the tone of the vagus during breathing, organic pathology of the heart (CHD, rheumatic heart disease, myocarditis, digitalis intoxication).

Clinic. On the ECG, there is an irregular sinus rhythm with a difference between the longest and shortest P-P intervals of 0,16 si more.

Treatment. It consists in the treatment of the underlying disease.

4. Sick sinus syndrome Paroxysms of supraventricular tachycardia (or

atrial fibrillation) followed by a long period of severe sinus bradycardia.

Etiology. Organic heart disease (acute period of myocardial infarction, atherosclerosis, myocarditis, cardiopathy, digitalis intoxication, antiarrhythmic drugs).

Clinic. Possible sinus bradyarrhythmias, loss of individual sinus complexes with prolonged asystole and subsequent restoration of the rhythm.

Depending on the duration of the periods of asystole, there may be dizziness, fainting, seizures of Morgani-Adams-Stokes.

Treatment. With attacks of tachyarrhythmias and paroxysmal tachycardia, antiarrhythmic drugs are indicated: aymalin 50 mg intravenously or intramuscularly, procainamide intravenously or intramuscularly 5 ml of a 10% solution, isoptin intravenously 5-10 mg, inderal (obzidan) 5 mg intravenously carefully, strophanthin 0,5 .0,05 ml of XNUMX% solution, etc.

Author: Myshkina A.K.

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