Sinus arrhythmia in children 7 years old. Sinus arrhythmia in a child: causes, symptoms and diagnosis. Classification and types of sinus arrhythmia

Unfortunately, not only adults, but also children suffer from diseases associated with disorders of the cardiovascular system. Problems with heart rhythm in a child can lead to pathological processes in adulthood if they are not treated.

Sinus arrhythmia in children is a phenomenon that requires observation by a pediatrician. Abnormalities in heart rate, strength and consistency in children in most cases are not dangerous, but can sometimes lead to the development of heart failure and even death.

The heart consists of sections that are independently capable of generating impulses of various frequencies. Each of them can work offline. But the sinus section is the only one that is capable of contracting at a frequency of 60 times per minute, and therefore is most responsible for the stable functioning of the heart muscle.

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Classification

Heart rhythm disturbances may manifest as:

Sinus arrhythmia in children is classified as follows:

Depending on the severity of sinus arrhythmia, there are two types:

Norms

The existing norms for a child's heart rate are developed solely for approximate comparison based on average indicators.

After all, each person is unique, so it is impossible to say that a child is sick if his heart rate (HR) does not coincide with the data in the table. Whether the heart rate is normal or not can only be determined for a particular patient by a doctor.

Average heart rates in children vary in a range and are presented in the table:

Safe arrhythmia

The respiratory form of arrhythmia is not dangerous; it appears under the influence of external factors when the child instinctively holds his breath. Such factors may be:

The older the child becomes, the more his nervous autonomic system matures, and sinus arrhythmia is less likely to appear.

However, the presence of arrhythmia in children is not a normal physiological condition, so consultation with a specialist is necessary. This condition may indicate serious heart pathologies.

Causes

The causes of arrhythmia can be either acquired or congenital and vary depending on the forms of sinus arrhythmia:

Connection with sports

Detection of the respiratory form of sinus arrhythmia in a child on an electrocardiogram (ECG) is not a contraindication to sports. It is enough to find out what provoked its appearance and eliminate it.

Other forms need to consult a doctor before engaging in those sports that require significant physical activity. Some types of physical activity are limited.

If a child is professionally involved in sports, then he needs to be examined at least once every three months (including ECG and 24-hour monitoring). To be allowed to compete, permission from the attending physician is required.

Diagnostics

A phonendoscope is a device with which a pediatrician determines the heart rate.

On an ECG, sinus arrhythmia is determined when the RR interval between the apexes of the ventricular complexes lengthens (slows the heartbeat) or decreases (increases the heart rate).

Sensations during sinus arrhythmia in children

Sinus arrhythmia in children 7 years of age or older does not cause any discomfort other than rapid breathing.

There are signs that are a reason to pay attention to the child’s condition and urgently consult a doctor:

• labored breathing;
• pain in the heart area;
• dizziness;
• fast fatiguability;
• weakness;
• swelling;
• dyspnea;
• blue discoloration of the nasolabial triangle;
• fainting.

Treatment

If you suspect a child has sinus arrhythmia, you should visit a specialist - a cardiologist. The doctor will prescribe the following types of examination:

• Ultrasound of the heart;
• clinical blood test;
• blood biochemistry;
• general urine analysis.

Most likely, the child will be registered and required to undergo examinations every six months to keep his heart function under control.

The respiratory form of arrhythmia in a child is not treated, but sports activities may be limited for a while.

Severe sinus arrhythmia requires treatment, first of all, of the reasons that caused it:

• antibacterial therapy for infectious causes;
• therapy of heart disease (surgical method);
• prescription of cardiac glycosides in case of heart failure;
• other treatment methods.

Observation table

For personal convenience and to help the attending physician monitor the child's condition, it will be useful for parents to keep a health chart.

Prevention

Prevention of heart rhythm disturbances in children consists of a healthy lifestyle, namely:

• in a balanced diet;
• moderate exercise, hardening;
• in the absence of stress.

Children should spend more time in the fresh air, go swimming, and do exercises in the morning. Parents also need to understand that a child’s nervous system is much weaker than that of an adult. That’s what childhood is for: relaxing carefree, walking and playing with peers.

There is no need to overburden your child with additional activities after school. It is worth listening to the wishes of your child and allowing him to do what he really wants.

The heart is a unique organ of the human body. Each of its departments is capable of working autonomously, that is, if, for example, the sinus department fails, the rest will continue to work fully, taking on the entire load.

Many examinations help to suspect and diagnose various health disorders. Therefore, doctors strongly recommend that parents have their children examined annually. After all, the same electrocardiogram can reveal the presence of abnormalities in the functioning of the heart. Probably everyone knows that the heart is a rhythmically working organ. Normally, the heartbeat rhythm is set by the so-called sinus node.

Sinus rhythm of the heart - what does it mean?

And there is a normal functioning of our main organ, indicating that the heart muscle is functioning normally.

The above node is a natural impulse generator located in the right atrium. The impulse of movement occurs exclusively from top to bottom. Initially it enters the right atrium, then the left atrium. The impulse then travels through the atrioventricular junction directly to the ventricles. As a result, the heart either relaxes or contracts again, maintaining its main function - pumping blood in the body.

Sinus heart rhythm in children: normal

The norm for this parameter in children differs from the indicators inherent in an adult. Thus, the sinus rhythm of the heart in a 1-year-old child reaches approximately 140 beats per minute. From one month of life to the first year - 132 beats per minute. Over time it slows down. However, this is not yet a reason to state that sinus arrhythmia has occurred in the child. At approximately 3 years old, the above figure reaches 124, but already at 6 years old - 115 beats per minute. At about 7 years old, this figure drops to 106 beats per minute in schoolchildren. At 10 years this figure reaches 88.

In some cases, the child is diagnosed with sinus arrhythmia. This indicates that the distances between adjacent teeth on the cardiogram differ, that is, the sinus node is weak. In such cases, Holter monitoring is needed, as well as a drug test to find out whether pathology is present and whether the regulation of the autonomic system has gone astray. If the examination has established that the arrhythmia arose due to a malfunction of the sinus node, then corrective changes in the vegetative status are prescribed.

If a child experiences fainting due to arrhythmia, other methods are often used, such as implantation of pacemakers.

Sinus heart rhythm in children is disrupted in the same way as in adults. It can signal tachycardia, arrhythmia, bradycardia. However, such disorders occur in children for different reasons than in adults. Thus, according to statistics, arrhythmia occurs in 25% of children in childhood. But this is not at all a sign of a serious illness. Similar disorders are also typical for healthy children. The frequency of these changes increases during puberty. The reasons for this are cardinal, combined or extracardiac. The latter include heart defects, rheumatic carditis, infective endocarditis or cardiomyopathies.

The occurrence of childhood arrhythmia is associated with diseases of the nervous or endocrine system, intoxication, magnesium or selenium deficiency, individual intolerance or drug overdose. This also includes infectious complications. Heart rhythm may be disrupted due to psychological, physical, and emotional overload. Many children suffer from arrhythmia of extracardiac origin. This may be caused by a defect in automaticity, conduction, or a combination of the two. Sinus heart rhythm disturbances may even be asymptomatic. But only a qualified doctor can establish an accurate diagnosis and prescribe the correct treatment.

In reality, it is not always necessary to consider a violation of sinus rhythm as a definite sign of a progressive disease. Sometimes this phenomenon can occur due to breathing, that is, when the respiratory system is immature, and a banal jog or fast walk, high body weight or a period of active growth of the child, prematurity, or can provoke changes in the sinus rhythm of the heart.

In any case, after an electrocardiogram, you should consult a doctor. He will tell you what to do correctly given certain indicators.

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Respiratory sinus arrhythmia in a child is not regarded by doctors as a pathology. Heart rhythm disturbances develop when the function of the sinus node or the conduction of impulses to the myocardium fails.

Arrhythmia does not always indicate pathology, but can be a sign of a number of organic diseases. Treatment options are different for each patient.

What does sinus arrhythmia mean?

The normal heartbeat in a child according to an electrocardiogram (ECG) is sinus rhythm. Impulses for myocardial contraction are generated in the sinus node.

The intervals between the complexes of waves on the ECG are the same. However, in children, heart rate is related to age.

On an ECG, doctors sometimes make a conclusion - sinus arrhythmia. In most children, it is caused by body growth or hormonal changes during puberty. And only in rare cases does it indicate a serious illness.

Sinus arrhythmia is a group of heartbeat disorders in frequency, strength and rhythm. Rhythm disturbances occur when changes occur in the node of the same name, which generates signals for the heart to contract. At a normal heart rate, the intervals between beats may vary.

In this case, the ECG reveals a rapid (tachyarrhythmia) or slow (bradyarrhythmia) heartbeat.

Respiratory arrhythmia

In some children, the frequency of myocardial contractions changes during breathing. When you inhale it increases, when you exhale it decreases. The number of heart beats in a child reflexively decreases during an ECG on a cold couch. The so-called respiratory arrhythmia does not affect the health of children in any way.

The main reason for changes in heart rate lies in the imperfection of the autonomic nervous system. Respiratory arrhythmia occurs in cases of developmental abnormalities or diseases:

• excess weight;
• rickets;
• encephalopathy;
• prematurity;
• intracranial hypertension;
• a period of intensive growth of 4–5 years, when the vegetative system does not keep pace with the physical development of the child.

Most often, sinus rhythm disturbance is detected in children 7 years old. At this age, the deviation is not considered a disease because it is associated with puberty and physical maturation.

During adolescence, hormonal changes in the body occur, which also affects autonomic function. Rhythm disturbances can occur after negative emotions.

By the way! Respiratory arrhythmia is not dangerous for children. As the nervous system matures physically, the problem resolves on its own.

Mild heartbeat disorders do not require treatment. Sedative herbal preparations are prescribed. However, the child should be consulted with a cardiologist and pediatrician.

Types of pathological heartbeat

Non-respiratory arrhythmia is detected in 30% of children. It occurs in the form of attacks or is observed constantly:

• Sinus tachycardia is characterized by an increase in heart rate by 20–30 per minute. Occurs in diseases that occur with elevated body temperature. May appear due to infection or emotional stress.
• Severe cardiac arrhythmia - paroxysmal tachycardia - begins suddenly and is accompanied by dizziness and low blood pressure. The number of heart contractions reaches 160–180 beats per minute. In this case, the organ cannot cope with the function of blood supply. The brain is the first to suffer.
• Sinus bradycardia is a slow heartbeat. The production of signals for heart contraction is reduced by 20–30 beats compared to the age norm. It often develops after stressful situations.
• Sinus extrasystole is characterized by the appearance of extraordinary myocardial contractions, often of functional origin. The cause is also vegetative-vascular dystonia, diseases of the endocrine glands or strong negative emotions.
• Unstable sinus rhythm indicates that the intervals between the waves vary. The most common cause is weakness of the sinus node. The pathology is observed in children with a hereditary predisposition to cardiovascular diseases. But sometimes irregularities in the rhythm are caused by a violation of the autonomic nervous system. To identify the true cause, a Holter study and ultrasound are performed.

Important! Abnormal heartbeat may manifest as loss of consciousness. If a child has ever experienced such an episode, a cardiac examination should be performed.

Children with cardiac abnormalities need a separate sports regimen and vaccination schedule.

Causes of abnormal heartbeat

The source of non-respiratory arrhythmia is previous organic diseases that damage the sinus node.

Causes of pacemaker dysfunction:

• bacterial or viral myocarditis after a sore throat or flu;
• Congenital heart defect;
• vegetative-vascular dystonia;
• rheumatic heart disease;
• pericarditis, endocarditis;
• poisoning;
• cardiomyopathy;
• heart tumors;
• mitral valve prolapse;
• thyroid problems;
• infections, including intestinal forms.

Genetic predisposition plays a leading role in the occurrence of arrhythmia. If parents suffer from heart and vascular diseases, there is a high probability of a child’s heartbeat failure.

What are the dangers of rhythm disturbance?

Organic myocardial diseases occur with severe arrhythmia, which aggravates the course of the disease. Prolonged attacks of atrial fibrillation and paroxysmal tachycardia are dangerous for the development of heart failure.

In some cases, rhythm disturbance is fatal. Sinus arrhythmia, which appears after a serious illness, requires special comprehensive treatment.

Signs of heart palpitations in a child

Sinus arrhythmia in young children is often diagnosed late. It is usually detected during a routine examination. But there are still signs that indicate a heartbeat disorder in newborns.

Symptoms that may alert parents:

• excessive sweating;
• causeless crying;
• lethargy or restlessness;
• insufficient weight gain;
• shortness of breath after physical effort - turning over, crawling;
• pallor or blueness of lips, nails;
• loss of appetite - the baby sucks sluggishly or does not take the bottle;
• interrupted sleep.

Signs of arrhythmia in preschool and older children:

• interruptions in the heart;
• attacks of weakness;
• shortness of breath after physical activity;
• fatigue;
• fainting;
• stabbing pain in the chest.

Important! Such signs cannot be ignored. To find out the cause, your pediatrician will conduct a study and outline a plan for further action.

What to do if your heartbeat fails

Sinus arrhythmia most often does not affect the child’s health. But if it is detected on the ECG, you should visit a pediatric cardiologist.

In such cases, an ultrasound examination (ultrasound) is performed. If necessary, the doctor prescribes Holter monitoring, which records several dozen ECG records over 24 hours, including at night. In addition to instrumental diagnostics, laboratory methods are used - general analysis of urine and blood.

If sinus arrhythmia without organic pathology is detected, children are observed by a cardiologist. In this case, an ECG should be done every 6 months.

For non-respiratory arrhythmia, treatment measures related to the main disease are carried out.

How to treat heart palpitations in children

Most arrhythmias do not require therapeutic measures. Specific treatment is prescribed after a comprehensive study using laboratory and instrumental methods. Depending on the disease, a course of antibiotic therapy and antitumor treatment is carried out. Heart defects require surgical correction of the valves. The choice of medications is related to the clinical manifestations of the pathology.

Types of drug therapy:

• for heart failure, glycosides and diuretics are prescribed;
• antiarrhythmic drugs are used that reduce and increase cardiac conductivity;
• medications containing magnesium, potassium and vitamins;
• restorative treatment – ​​aloe, propolis;
• Mildronate and Elcar are used to improve myocardial metabolism.

In addition to medications, breathing exercises and special massage are prescribed for children with arrhythmia. Dietary nutrition is given great importance. The diet includes products of plant origin containing vitamins and magnesium - nuts, cashews, honey, dried apricots. The frequency of infant feeding is increased to 6 times a day in small portions.

Playing sports

With moderate respiratory arrhythmia, children engage in physical education in a general group. But there are restrictions on participation in competitions. At the same time, you are allowed to play sports. It is recommended to periodically consult a cardiologist so that physical activity does not provoke the transition of arrhythmia to a severe form.

Children who play sports with arrhythmia are observed by a doctor. ECG and Holter monitoring are performed periodically once every 3 months. After the examination results, the sports doctor decides on admission to competitions. If non-respiratory sinus arrhythmia is detected in a child, sports activities are limited. Such children benefit from morning exercises and a walk in the fresh air.

Sinus arrhythmia in children has a favorable course. It only requires observation so that a dangerous pathology does not develop. To do this, it is recommended to do an ECG once every six months. If your child experiences shortness of breath during physical activity, pale face, or fatigue, consult a doctor. A severe form of arrhythmia is easier to prevent than to treat.

• In the first month of life, physiological normal indicators will be 140-160 beats/minute,
• In the first year of life, physiological normal indicators will be 132-135 beats/minute,
• Per year, physiological normal indicators will be 120-132 beats/minute,
• From one to two years, physiologically normal indicators will be 110-125 beats/minute,
• From 2 to 3 years – 115 beats/minute,
• From 6 to 8 years – 90-105 beats/minute,
• From 10 to 12 – 80-85 beats/minute,
• From twelve and more – 75 beats/minute.

- one of many variants of disturbances in the rhythm of cardiac activity, the morphological substrate of which is a violation of the contractility of the heart muscle not at regular intervals, with an unchanged sequence of contractions of the chambers of the heart.

There are several types of this arrhythmia:

1. Non-respiratory types of sinus arrhythmia:
   • Sinus tachycardia,
   • Sinus bradycardia,
2. Actually respiratory sinus arrhythmia:
   • – one of the varieties of sinus arrhythmia, the morphological substrate of which is an increase in the number of heart contractions of more than ninety beats per minute, with a norm of sixty to eighty beats per minute.
   • Sinus bradycardia– one of the varieties of sinus arrhythmia, the morphological substrate of which is a decrease in the number of heartbeats less than sixty.
   • Respiratory arrhythmia– also one of the varieties of sinus arrhythmia, the morphological substrate of which is an increase in the number of heart contractions during inhalation and a decrease during exhalation.
   • Non-dangerous types of arrhythmias– these are physiological types of sinus arrhythmias, as well as in preschool children.
   • Dangerous types of arrhythmias– these are those types of arrhythmias that are characterized by heart disease, endocrine disorders and others.
   • Moderate sinus arrhythmia in children– most often appears in children, the essence of which is mild symptoms or a complete absence of symptoms,
   • Severe sinus arrhythmia– more often manifests itself in older people, and is a sign of organic damage to the heart (rheumatism, myocarditis, endocarditis and others),
   • Severe arrhythmia in children– manifests itself after physical exertion, stress, fear, anxiety.

Symptoms of sinus arrhythmia

Older children experience the following symptoms:

Children in the first year of life may experience:

• Sleep disorder, insomnia,
• Pulsations of the carotid (carotid) arteries,
• Pallor of the skin,
• Poor appetite
• Tearfulness,
• Minor weight gain.

Dangerous accompanying symptoms:

Such dangerous accompanying symptoms as pain in the heart, shortness of breath, cyanosis, edema, fainting and others indicate that, in addition to sinus arrhythmia, the child may have other more dangerous concomitant diseases.

Diagnosis of sinus arrhythmias

• In most cases(about 50%) sinus arrhythmias are detected by chance, according to data from visits to a doctor, during mandatory medical examinations by a pediatrician.
• Diagnosis is made based on complaints(tearfulness, rapid or slow heartbeat, sleep disturbance, insomnia, pale skin, poor appetite, cold sweat, dyspeptic disorders).
• Physical examination methods– auscultation, palpation, percussion, and pulse measurement. When measuring pulse, it is necessary to take into account age-specific heart rate indicators. Laboratory examination methods, such as a general urine test, a general blood test, a biochemical blood test.
• Of course, the gold standard for diagnosis are instrumental examination methods - such as electrocardiography (arrhythmia is recorded both at rest and during light physical exertion, which allows identifying rhythm disturbances associated with disorders of the nervous system).

Signs of sinus arrhythmia on the electrocardiogram will be as follows:

1. The pacemaker is the sinus node,
2. The distance between the RR and TP teeth is different,
3. Sequence and shape of P waves, QRS complex, T,

Ultrasound examination of the heart, echocardiography and stress tests or tests (), Holter monitoring, allow you to diagnose any types and forms of arrhythmias.

Transesophageal electrocardiography, the essence of which is to record sinus arrhythmia through the esophagus. If the child has concomitant diseases of the central or peripheral nervous system, electroencephalography, rheoencephalography, and consultation with a pediatric neurologist are additionally prescribed.

Etiology of the disease

The cause of the disease may be associated with activity in the conduction system of the heart, a disturbance in transformation, in the conduction of nerve impulses. The reason is also associated with structural changes in cardiac tissue (developmental defects) and disturbances in the nervous regulation of the heart.

This arrhythmia is observed in various conditions of the body, both physiological and pathological:

• Physiological conditions most often include physical activity and stressful situations.
• If this arrhythmia occurs while the patient is at rest, then you should think about the presence of some pathological condition of the body.
  This may be a disease of the cardiovascular system, namely:
  • coronary heart disease (myocardial infarction),
  • arterial hypertension,
  • bacterial endocarditis,
  • pericarditis,
  • endomyocarditis,
  • heart defects (stenosis and insufficiency of the heart valve apparatus),
  • diseases of the endocrine system (diffuse toxic goiter, adrenal tumor, hyperthyroidism, hyperparathyroidism, blood diseases such as anemia, diseases of the nervous system (neuroses),
  • neuro-circulatory dystonia (asthenia),
  • respiratory diseases (pneumonia, bronchitis, tonsillitis),
  • hyperthermia,
  • increased tone of the sympathetic nervous system,
  • diseases of the digestive system (intestinal infection), which lead to electrolyte imbalance.

Treatment of sinus arrhythmia in children

• There is no need to treat physiological or functional types of arrhythmias. Parents with functional types of arrhythmias should pay attention to the child’s daily routine, proper, balanced, fractional meals, reducing physical activity and time spent at the computer and TV.
• In the treatment of clinically significant sinus arrhythmia use medicinal, conservative and surgical treatment methods. You should also take into account various concomitant pathologies of organs that can cause sinus arrhythmia, and, if necessary, carry out complex therapy.
• Traditional treatment of arrhythmias involves the use of antiarrhythmic drugs or antiarrhythmic drugs (AAP), the essence of which is to reduce cardiac activity or increase cardiac conduction.

Procainamide or procainamide:

1. Inside: initial dose 15-50 mg/kg/day in 4-8 doses, maximum dose up to 4 g/day,
2. Intramuscular: initial dose – 20-30 mg/kg/day in 4-6 doses, maximum dose 4 g/day,
3. Intravenously: 3-6 mg/kg/day, but not more than 100 mg for five minutes, maintenance dose 40-80 mg/kg/day, maximum dose 2 g/day.

Propranolol (AAP beta blocker):

1. Inside: 1/2-1 mg/kg/day in 3-4 doses, maximum dose 14-16 mg/kg/day,
2. Intravenously: 10-100 mg/kg/day slowly over 10 minutes.

• Analogues of the drugs anaprilin and novocainamide are also used.
• Verpamil, amiodarone,
• Quinidine: orally at a dose of 6 mg/kg 5 times a day.
• Potassium and magnesium preparations to restore electrolyte imbalance, Magne B6 (a source of magnesium is indicated for children from 6 years of age, 4-5 tablets per day), asparkam for potassium deficiency, dosage depends on the age of the child.
• For disturbances in the conduction system of the heart, drugs such as atropine and adrenaline are used.

When treating sinus arrhythmia with drugs, you should pay attention to the dosage, contraindications, and undesirable effects of the drugs.

Minimally invasive surgical intervention is also used– implantation of a pacemaker under the skin in the area (subclavicularis), the essence of which is as follows: an electrode is inserted through the subclavian vein into the right side of the heart, where the pacemaker is located; if there is a disturbance in the conduction system of the heart, the pacemaker registers these disturbances and corrects them.

Radiofrequency ablation or cryo-ablation: The essence of this method is the destruction or destruction (by high-frequency energy or freezing) of that part of the conduction system of the heart, which is the source of sinus arrhythmia.

Take vitamins for the heart: such as (ascorbic acid (C), pyridoxine (B6), polyunsaturated fatty acids (F). This group of vitamins helps strengthen the walls of blood vessels and the heart, and also prevents the development of ischemia, promotes the elimination of cholesterol.

Vitamins, ensuring the elasticity of the muscle and vascular wall, such as thiamine (vitamin B1) prevents rhythm disturbances, rutin (vitamin P) - helps increase the elasticity, strengthening, strength of the vascular wall, silicon and others.

The so-called reflex method takes place in treatment., the essence of which is reflex stimulation of the central nervous system on the activity of the heart (pressing the eyeballs with fingertips and holding for 5 minutes, massage the side surfaces of the neck).

Traditional methods of treatment

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Sinus respiratory arrhythmia does not cause complications.

Non-respiratory types of sinus arrhythmias can cause disturbances in the blood supply to the brain, namely oxygen starvation or cerebral hypoxia, which is characterized by sudden loss of consciousness and dizziness.

With such a long course, sinus arrhythmia can progress and heart failure may occur.

The main thing is to lead a healthy lifestyle:

• Do exercises every morning,
• Go swimming,
• Skiing, light jogging,
• Balanced, small, frequent meals,
• Take vitamins for your heart
• Avoid fried, spicy foods,
• Avoiding heavy physical activity
• To prevent sinus arrhythmia, it is necessary to do an electrocardiogram 4 times a year,
• If you notice the first signs of illness, you should consult a doctor,

Prevention is the best “cure” for a disease.

Arrhythmia and sports

In many cases, the child's parents who has been diagnosed with sinus arrhythmia, they try to completely limit him from any physical activity. There is no need for this, since light physical activity is even good for health.

This refers to the respiratory form of sinus arrhythmia, in which there are no contraindications even for sending a child to sports clubs, but still the child must be monitored by a cardiologist and undergo an electrocardiogram 4 times a year.

Every parent worries about the health of their child, but when a small heart fails, it becomes truly scary. The heart is the “motor” that works and supports a person’s vital activity all his life without rest. One of the most common diagnoses you hear today is sinus arrhythmia. What is hidden behind this mysterious phrase? What is it and what should parents do with this diagnosis? Let's talk about this in this article.

Principles of the human heart

First you need to understand how the heart works. What makes the heart - our muscle “pump” - contract and push blood through the vessels? It turns out that it has a conducting system in which electrical impulses are formed that cause the heart muscle to contract. It consists of two types of special cells. Some automatically, spontaneously generate an impulse, others conduct it.

The conduction system itself begins with the sinus node: a cluster of cells of the first type. This is an automatic center of the first order. Here an impulse is born that causes both atria to contract. Then it rushes along the conduction bundles to the next node - the atrioventricular one, which is an automatic center of the second order. There is a slight delay here, due to which the atria and ventricles contract alternately, and not simultaneously. Then, along a special conductive bundle of His, or rather, along its two legs - right and left - the electrical wave spreads along the muscle fibers of the ventricles of the heart, causing them to contract. The terminal part of the His bundle and the Purkinje fibers into which the bundle passes are an automatic center of the third order.

The functioning of the cardiac conduction system is regulated by the autonomic nervous system. So, during physical activity, when the muscles require increased blood supply, a signal is sent to the nervous system, and from there to the conduction system of the heart, as a result of which the heartbeat increases.

Normally, a person has a sinus heart rhythm. That is, these are the contractions that are set by the sinus node - the very first automatic center. In this case, the intervals between heartbeats are always equal.

Now understanding how the heart works, we can begin to understand the concept of “sinus arrhythmia”.

What is sinus arrhythmia?

Sinus arrhythmia is a group of diseases that is characterized by disturbances in the rhythm, frequency and strength of heart contractions as a result of irregular formation of an impulse in the sinus node or problems with its conduction to the heart muscle.

Sinus arrhythmia occurs as a result of a malfunction of the sinus node. The number of beats per minute may be normal for the child's age, but the intervals between them vary. In addition, sometimes a rapid (tachyarrhythmia) or slow (bradyarrhythmia) heartbeat can be observed.

Sinus arrhythmia is considered the most favorable prognosis for the course of the disease and in most cases requires only regular monitoring by doctors so as not to miss exacerbations and the development of more serious pathologies.

Doctors have identified several periods in a child’s life when the likelihood of this arrhythmia increases sharply:

• at 4-8 months;
• at 4-5 years old;
• at 6-8 years old;
• in adolescence.

It is during these periods that it is best to do an ECG and visit a doctor.

Etiology of sinus arrhythmia

The causes of the disease can be called three types of disorders in the heart:

• improper operation of the conductive system, when there are malfunctions in the formation or conduction of an electrical impulse;
• congenital or acquired anomalies in the development of the heart muscle - myocardium, due to which normal contraction of the heart is impossible;
• operating errors that regulate heart rate.

Arrhythmia can be one of the symptoms of a number of diseases:

• congenital or;
• cardiomyopathy;
• inflammatory heart diseases (endocarditis, pericarditis, etc.);
• poisoning, including drugs;
• malignant and benign tumors of the heart;
• various functional disorders of the nervous system, for example, during stress, anxiety, fear;
• excessive physical activity;
• minor anomalies of heart development that do not pose a threat to health - for example, false chords or mitral valve prolapse;
• various inflammatory diseases leading to dehydration of the body.

In adolescents, arrhythmia is often caused by a hormonal surge, for example, as a result of a mass of positive or negative emotions.

Classification

Sinus arrhythmias are divided into three main types: respiratory, functional and organic arrhythmias.

Respiratory arrhythmia associated with respiratory movements of the chest.

So, when you inhale, the heart rate increases, when you exhale, it decreases. For children, respiratory arrhythmia is the norm, and it is more pronounced the younger the baby is.

Increased respiratory arrhythmia can be observed in various pathological conditions:

Perinatal encephalopathy in infants;

Increased intracranial pressure;

Functional arrhythmia- This is a disruption in heart rhythm that is not associated with breathing movements.

A more rare type of arrhythmia. It is not caused by serious heart pathologies and most often occurs as a result of errors in the functioning of the immune, nervous or endocrine systems. Its causes may be diseases of the thyroid gland, infectious diseases, etc.

Organic arrhythmia is a disruption in heart rhythm caused by organic changes in the myocardium or conduction system.

This type of arrhythmia is characterized by constant, enduring rhythm disturbances and has pronounced symptoms, which significantly affects the child’s well-being. Therefore, this type of arrhythmia requires careful examination and immediate treatment.

This type always accompanies a number of diseases that are characterized by organic changes in the heart, for example, myocarditis,.

All arrhythmias are also divided into three types for reasons:

• congenital (a child is born with such a pathology that arose due to problems during intrauterine development);

• acquired (rhythm disturbances develop due to malfunctions of various systems (most often the autonomic nervous system), as well as concomitant acquired diseases);

• hereditary (this pathology occurs in children whose parents have serious heart problems).

The disease is distinguished by severity:

• Moderate arrhythmia, which occurs mainly in children. Its manifestations are weakly expressed. Treatment is generally not required, but herbal sedatives may be prescribed;

• Severe arrhythmia, which occurs more often in adults than in children, but this does not mean that a child cannot suffer from it. This degree of the disease is characterized by striking symptoms and often accompanies other cardiovascular and systemic diseases, such as rheumatism or cardiosclerosis.

Types of arrhythmia

In addition to sinus arrhythmia, children also experience other heart rhythm disturbances.

Sinus tachycardia– rhythm failure, in which there is an increase in heart rate by 20-30 beats compared to the child’s age norm.

The etiology of such arrhythmia is varied:

• intoxication of the body;
• rheumatic heart disease;
• myocarditis;
• infectious diseases;
• psycho-emotional arousal;
• heat.

Sinus bradycardia– slowing of the heartbeat, which is characterized by a decrease in the production of impulses in the heart by approximately 20-30 beats per minute compared to the age norm. Most often it occurs after the child has suffered psycho-emotional overstimulation.

Extrasystole– rhythm disturbance, which is characterized by the occurrence of extraordinary contractions of the heart (extrasystoles). Extrasystole can be of both organic etiology and functional. Most often the cause is vegetative-vascular dystonia, endocrine diseases or chronic infections. Treatment of functional extrasystole is treatment of the disease that caused it. But organic extrasystole is a companion to serious heart diseases; it requires special treatment and constant monitoring by a cardiologist.

Rhythm Source Migration– change or periodic alternation of automatic centers in which an impulse is formed. For example, it could be the atrioventricular node instead of the sinus node. The causes of the disorder can be both functional disorders and organic damage to the heart. No treatment is required, but periodic medical supervision and regular ECG testing are required.

Paroxysmal tachycardia– sudden attacks of heart rate up to 160-180 beats per minute, which can last from a few seconds to several days or even weeks. The cause of the violation lies in the malfunction of the conduction system. In this case, the heart cannot cope with its work, and an insufficient amount of blood flows to the organs, including the brain. Oxygen starvation begins. This type of arrhythmia poses a threat to the child’s life and often leads to the development of cardiovascular failure.

Blockade– blocking of impulse conduction, which can occur at any point of the conduction system or even at several points at once. The pathology can be caused by organic heart damage, but in children it is predominantly functional blockades. Such disorders do not affect the functioning of the heart, and right bundle branch block is generally considered normal in childhood.

Complete transverse heart block (Morgagni-Adams-Stokes block)- a disorder in which an impulse is not formed and the heart cannot contract. If medical assistance is not provided within 1-2 minutes, the consequences can be disastrous.

Atrial fibrillation- erratic, chaotic heartbeat. This disorder is rare in childhood and most often accompanies severe organic diseases: rheumatism, myocarditis, congenital heart defects, etc. This type of arrhythmia is dangerous not only for the health, but also for the life of the child, since the heart absolutely cannot cope with its duties.

Symptoms of arrhythmia

Often, especially in children, arrhythmia is found only by a doctor during a routine examination, since young children usually cannot describe their sensations or complain. This is what can cause late detection of the disease and problems in its treatment. But there are a number of signs by which a violation can still be recognized.

Symptoms of arrhythmia can be general, that is, the same signs of the disease that occur in all types of arrhythmias, and additional, characteristic only of a certain type.

General symptoms

• poor sleep with frequent awakenings;
• crying for no apparent reason;
• shortness of breath with the slightest physical exertion (turning over, crawling);
• increased sweating;
• decreased appetite to the point of refusing to eat, while the baby sucks sluggishly or does not want to take a bottle;
• poor weight gain;
• cyanosis of nails, lips and feet;
• pale skin;
• lethargy or, conversely, restless behavior for no apparent reason.

Older children can already add their complaints:

• a feeling of interruptions in the work of the heart;
• periodic pain in the heart area, a feeling of compression;
• frequent fainting;
• fast fatiguability;
• constant weakness;
• feeling unwell after physical activity.

Additional symptoms

Extrasystole:

• unpleasant sensations in the heart area, which the child can characterize as a sudden strong jolt or slight freezing.

Paroxysmal tachycardia:

• a sudden attack of heartbeat, the frequency of which can reach 160-180 beats per minute;
• decrease in blood pressure.

Complete heart block(Morgagni-Adams-Stokes blockade):

• the attack most often occurs at night;
• there is pronounced pallor of the skin, sometimes even cyanosis;
• heartbeat reaches 30 beats per minute or is absent altogether;
• loss of consciousness;
• convulsions;
• After an attack, the patient’s face turns sharply red due to a strong rush of blood.

In addition to the general and additional symptoms of arrhythmia, one should also take into account the symptoms of diseases that may accompany this disorder.

Complications

Most arrhythmias do not require treatment, and yet if you have complaints, you should definitely consult a cardiologist.

The main complications of arrhythmias are:

• arrhythmogenic cardiomyopathy;
• vascular heart failure;
• early disability;
• asystole (cessation of heart contractions) and fibrillation (fluttering) of the ventricles, which lead to death.

If emergency treatment is not provided, some types of arrhythmias can be fatal.

Diagnostics

Based on the complaints of the parents and examination of the child, the pediatrician, suspecting a cardiac pathology, will always prescribe the leading examination - an ECG.

Sometimes arrhythmias can be accidentally discovered during a routine medical examination, in particular during an ECG.

If a serious pathology is suspected, the attending pediatrician will always send the child to see a cardiologist, who will prescribe a number of additional examinations, for example, ultrasound of the heart, daily ECG monitoring (Holter study), etc. In addition to these methods, laboratory tests are always prescribed: a complete clinical and biochemical analysis blood, clinical urine analysis.

Forecast

Most isolated arrhythmias do not require therapy. They are benign and have a favorable prognosis. Therefore, most often, constant monitoring by doctors and regular ECGs are sufficient.

An unfavorable prognosis is associated with attacks of paroxysmal tachycardia, atrial fibrillation and complete transverse heart block.

Some types of tachyarrhythmia, which are accompanied by fainting, ischemia of the heart muscle (myocardium), acute cardiovascular failure and low blood pressure, have an equally high risk of death. This also includes long Q-T interval syndrome and pronounced disturbances in the functioning of the sinus node.

Treatment

Treatment of arrhythmia depends on its type, severity and concomitant diseases. Only a cardiologist can select the necessary drugs and methods of therapy.

An isolated type of arrhythmia does not require treatment. At the same time, the child can attend physical education classes and play sports. But you should still limit your participation in competitions.

Respiratory arrhythmia Without accompanying pathologies, it is considered normal and goes away on its own. But if it is caused by a number of reasons listed above, then comprehensive treatment of the underlying disease is necessary.

Therapy functional arrhythmia is to eliminate the reasons that caused it. As a rule, after appropriate treatment, its manifestations disappear on their own.

Organic arrhythmia is always accompanied by serious heart disease, so its therapy, specific and long-term, directly depends on the methods of treating the underlying disease.

Sinus tachycardia and bradycardia also require treatment of the disease that caused them. The doctor may prescribe antiarrhythmic drugs and sedative herbal preparations.

Extrasystole, arising due to functional disorders, does not require therapy and goes away on its own, while organic extrasystole requires complex therapy, and first of all the underlying disease.

Attacks of paroxysmal tachycardia pose a threat to the child's life. Therefore, it is necessary to quickly call an ambulance, and before it arrives, try to stop the attack yourself. You can do this as follows:

• Press your thumbs onto the child’s eyes for a few seconds;
• ask the child to strain, while closing his mouth and pinching his nose with his fingers.

In the interictal period, children suffering from attacks of paroxysmal tachycardia must be observed by a cardiologist.

Blockades caused by functional reasons, like most similar arrhythmias, do not need therapy, since they do not pose a threat to the child’s life and do not interfere with cardiac activity. Attacks of complete heart blocks can go away on their own. But it is better to seek emergency help to avoid negative consequences. For frequent attacks, surgical intervention to install a pacemaker is indicated.

Attack of atrial fibrillation necessarily requires the provision of qualified emergency care and emergency resuscitation measures. As a subsequent therapy, it is necessary to eliminate the underlying disease that caused the attack.

Traditional treatment of all types of arrhythmias:

• antiarrhythmic drugs of two types: reducing or increasing cardiac conduction;
• Cordarone, Verapamil, Anaprilin help with tachycardia;
• for bradycardia, Eufillin, Itrop are prescribed;
• means for relieving pain in the heart area;
• sedatives (sedatives) for vegetative-vascular dystonia;
• vitamins and vitamin-mineral complexes;
• intravenous injections of atropine are indicated for long-term disease;
• adrenaline is indicated for conduction disorders;
• cardiac flickering and fluttering are relieved with quinidine, novocainamide or potassium chloride;
• the reflex method helps to slow down the heartbeat (by pressing on the eyeballs);
• No less effective for these purposes is massage of the side surfaces of the neck, deep breathing, pressure on the abdominal press, inducing the gag reflex;
• Physiotherapy methods are rarely used, based on their appropriateness in each specific situation;
• in severe cases, surgery is indicated to install a pacemaker; its model depends on the type of arrhythmia and the general clinical picture of the disease.

When treating any type of arrhythmia, some rules should be followed:

• reduce all physical activity, but avoid obesity, as it is one of the risk factors;
• provide the child with adequate nutrition and rest;
• carry out nutritional correction; the child should receive low-fat foods with a high content of potassium and magnesium in fractional portions;
• plant-dairy diet, which must include nuts, pumpkin, dried fruits, zucchini and honey;
• avoid eating before bedtime, since a full stomach can affect certain receptors, thereby contributing to disturbances in the functioning of the sinus node;
• exclude foods and drinks containing caffeine from the diet;
• engage in long walks, swimming, and morning exercises with your child, avoiding overwork;
• strictly adhere to the daily routine;
• reduce the time your child spends on the computer and TV;
• try to eliminate or reduce stressful situations in the child’s life.

Summary for parents

If there is the slightest suspicion of arrhythmia or heart disease in general in a child, you should urgently show the child (or teenager) to a cardiologist. The doctor will determine whether the arrhythmia is a harmless functional condition or requires urgent and serious treatment.

Which doctor should I contact?

If the heart is not functioning properly or the child complains, you should contact your pediatrician and perform an electrocardiographic study (ECG). If arrhythmia is suspected, the child is referred for consultation to a cardiologist. In the diagnosis of arrhythmias, an important role is played by a functional diagnostics doctor who performs 24-hour ECG monitoring, transesophageal electrophysiological examination, and echocardiography. If necessary, the child is examined by a cardiac surgeon, deciding whether to implant a pacemaker.