For some reason, this type of heart rhythm disorder is often called incorrectly. “Sine ary and even “sinusoidal” - all kinds of distortions of the name are allowed by people who are looking for information about it. Here we will dwell in detail on the features of this type of heart rhythm disturbances.
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What is it and how does it differ from other arrhythmias?
The human heart contracts due to the presence of special cells called atypical cardiomyocytes.
They make up the conduction system of the heart. In these cells, a nerve impulse arises and spreads, transmitting it to muscle fibers. The sinus node is a kind of “conductor” of this entire system. The entire organ works at his command. With sinus arrhythmia, the heart contracts either faster or slower than usual (heart rate may be more than 90 or less than 60 beats per minute). This occurs due to the uneven formation of nerve impulses. Such “problems” in the work of the pacemaker can be caused by various mechanisms - damage to the sinus node, changes in the tone of the sympathetic and parasympathetic parts of the nervous system, or rather, an imbalance of their influences, etc.
The prognosis for life with sinus arrhythmia is almost always favorable.
Medicines
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If it is necessary to prescribe medications for the treatment of sinus tachycardia, β-blockers are used. The most common representatives of this group include:
- bisoprolol. Usually prescribed once in the morning. In most cases, the dose of the drug is selected by prescribing a minimum dose, which is gradually increased until the desired result of therapy appears. The maximum daily dose is 20 mg. It is worth noting that, if necessary, discontinuation of the drug should not be done suddenly; it is important to gradually reduce the dosage, which will avoid exacerbation of the disease.
- metoprolol The drug has an effect not only in the form of a decrease in heart rate, but also helps to lower blood pressure, which is important if the patient has arterial hypertension. The clinical effect of metoprolol develops 1.5 - 2 hours after administration. The maximum daily dose of the drug is 200 mg.
- carvedilol. In addition to its main effect, carvedilol has an antihypertensive effect, reduces left ventricular hypertrophy, and has antioxidant and cardioprotective properties. The maximum concentration of the drug in the blood plasma is achieved 1 to 2 hours after administration.
The listed drugs should be taken under control of heart rate (heart rate). It is important to measure your heart rate daily (at least in the morning and evening) to monitor the effectiveness of the drug. A decrease in heart rate below 55 beats per minute is an indication for reducing the dosage of the drug or discontinuing it. If tachycardia persists while taking any of the beta-blockers, the dose or frequency of the drug is increased; if there is no effect after the above steps, the drug is replaced.
The most common side effects that develop while taking β-blockers:
- from the central nervous system (severe weakness, increased fatigue, headache, sleep disturbance);
- from the cardiovascular system (pain or discomfort in the heart, decreased blood pressure, bradycardia);
- from the gastrointestinal tract (nausea, vomiting, abdominal pain, stool disorder in the form of constipation or, conversely, diarrhea);
- from the respiratory system (taking high doses leads to the development of bronchial obstruction, which causes shortness of breath);
- from the endocrine system (hyper- or hypoglycemia, hypothyroid state);
- if you are allergic to the drug, skin manifestations of allergy appear (itching, urticaria) or anaphylactic shock develops.
Contraindications for use:
- arterial hypotension;
- atrioventricular block 2 or 3 degrees;
- bronchial asthma, chronic obstructive pulmonary disease;
- pregnancy and lactation;
- hypersensitivity to the active substance of the drug or any of the excipients.
Physiological and pathological causes
Sinus arrhythmia does not necessarily mean something bad. Malfunctions can also occur for physiological reasons. For example, there is the so-called respiratory sinus arrhythmia. Its appearance is explained by the fact that during inhalation the influence of the sympathetic nervous system increases, and during exhalation - the parasympathetic one. Therefore, the heartbeat speeds up a little at first, and slows down a little as you exhale.
Respiratory sinus arrhythmia is especially common in children and adolescents under 14 years of age. It goes completely unnoticed and does not pose any threat to human health and life.
Sometimes sinus arrhythmia appears at the moment of falling asleep and waking up in elderly people. This is due to the fact that the cortical centers of the brain gradually lose control over the structures that regulate the activity of the sinus node.
Pathological SA can be caused by both heart disease and various external adverse effects that indirectly affect the functioning of the sinus node.
Extracardiac causes of SA:
- constant stress or sudden fear;
- vegetative-vascular (neurocirculatory) dystonia or otherwise “autonomous dysregulation syndrome”;
- neurotic conditions;
- excessive consumption of coffee, alcoholic beverages, smoking;
- intense sports activities;
- taking medications - antidepressants, psychostimulants, cardiac glycosides and even drugs for the treatment of rhythm disorders;
- endocrinological diseases - these primarily include hyperthyroidism (increased thyroid function) and diabetes mellitus. SA in diabetes is due to the fact that prolonged high blood sugar damages nerve endings, including the heart;
- anemia (usually iron deficiency);
- any infectious diseases accompanied by an increase in body temperature;
- Connective tissue dysplasia is a hereditary disease in which a person’s joints bend strongly in different directions. Such people often suffer from minor heart rhythm disturbances, including SA.
Cardiac causes include various organic cardiac pathologies:
- infectious (usually viral) myocarditis;
- congenital and acquired heart defects;
- cardiomyopathy;
- coronary heart disease (angina pectoris or acute myocardial infarction);
- chronic heart failure;
- diffuse or focal myocardiosclerosis.
SSSU classification
- According to the etiology,
SG dysfunction is divided into primary and secondary, arising against the background of another pathology. - According to the course:
acute, accompanied by hemodynamic disturbances and severe symptoms; paroxysmal (attack-like) and chronic form. Among the chronic ones, a latent form is distinguished, in which there are no symptoms or ECG signs, and the diagnosis is established only after EPI (electrophysiological study); compensated brady- and tachybrady-form with variants of decompensation; permanent brady-form of atrial fibrillation against the background of sick sinus syndrome. - Based on the presence of clinical manifestations,
SU dysfunction can be asymptomatic or symptomatic. Manifestations of the latter may include AHF (acute heart failure), hypotension, angina pectoris, syncope (fainting), transient ischemic attack as a consequence of impaired cerebral blood supply.
Symptoms and sensations
Since the work of the heart is not significantly impaired during SA, and its main function (blood pumping) remains at the proper level, in the vast majority of people sinus arrhythmia goes completely unnoticed.
Severe sinus arrhythmia is often accompanied by feelings of fading or abnormal heart function, dizziness, and darkening of the eyes. In my practice, I constantly meet people with increased sensitivity and excitability of the nervous system, prone to hypochondria. Even with mild AS, they may experience anxiety, fear, and chest discomfort. Cold sweat appears on their forehead, their skin turns pale, their hands and feet feel cold, and they feel short of breath. They may faint. As a rule, these are people suffering from neurocirculatory dystonia.
Sinus arrhythmia is dangerous because it can aggravate a person’s existing cardiac disease. Especially with her sudden appearance. In this case, pain occurs, a burning or squeezing sensation in the heart, shortness of breath increases, and swelling of the ankles and legs occurs. This occurs due to deterioration of blood supply to the myocardium (heart muscle). However, it is worth noting that such severe consequences of sinus arrhythmia are extremely rare, especially compared to other rhythm disorders.
Doctor's advice: how to cope with an attack of sinus arrhythmia
The sudden onset of sinus arrhythmia mainly occurs in people suffering from heart disease. To relieve an attack, you can try to use special methods that enhance the influence of the parasympathetic nervous system by irritating the vagus nerve. Such techniques are called vagal tests:
- Valsalva maneuver - you need to inflate your cheeks while exhaling as much as possible for 30 seconds;
- massage of the carotid sinus - you need to feel the carotid artery in the neck near the angle of the lower jaw and begin to press and massage it. But this must be done only on one side, otherwise there is a risk of creating an obstruction to the blood flow to the brain and losing consciousness;
- forced cough - coughing quickly and forcefully;
- cold test - lowering the face into a basin filled with cold water.
However, you should be very careful with vagal tests, as they only eliminate the rapid heartbeat and can significantly slow it down, which can be dangerous.
You should also measure your blood pressure. If it is lower than 90/60 mmHg, then it is better not to perform vagal tests.
Therefore, the first thing to do to relieve an attack of SA is to consult a doctor. If you feel very unwell, you should call an ambulance.
If you want to know everything about tachycardia, we recommend watching the video below at the link. Causes, symptoms, diagnosis and signs that it’s time to see a doctor - talk about all this in 7 minutes. Enjoy watching!
Sinus arrhythmia is very easy to recognize on an electrocardiogram. Its main features:
- unequal distance between the RR teeth (sometimes increased, sometimes decreased), while the difference between the shortest and longest interval exceeds 10% of the average value;
- preservation of sinus rhythm - this means that before each QRS complex there is a P wave, which always remains positive in leads II, III, aVF.
To determine whether it is necessary to further look for the cause of the pathology, I must distinguish respiratory arrhythmia from its other varieties. This is quite easy to do. While taking a cardiogram, I ask the patient to hold his breath. If the rhythm is completely normalized, this is a respiratory arrhythmia.
Non-respiratory forms of SA are as follows:
- periodic – when arrhythmia occurs gradually;
- aperiodic - changes in RR intervals appear suddenly. This form is more common in people with cardiac diseases.
If a person’s ECG reveals non-respiratory SA, I always additionally prescribe Holter (24-hour) monitoring, since these patients often have other heart rhythm disturbances, especially conduction slowdowns (blockades).
Diet for respiratory arrhythmia
The diet should be balanced and varied, with a predominance of raw fruits and vegetables, herbs, dairy products, and fish. It is necessary to limit the consumption of sweet, starchy and too fatty foods, as well as products containing caffeine. Also useful are walks, trips to nature, and engaging in any hobby that will fill the patient’s life with positive emotions and help avoid stress.
What foods are most useful for heart rhythm disorders? Watermelon and melon remove excess cholesterol. Turnips are great for calming heart palpitations. Grapes eliminate swelling and shortness of breath, improve the tone of the heart muscle. Apples reduce the risk of developing tumors, normalize blood pressure, and improve digestion.
Avocado contains enzymes that help the body absorb substances necessary for the correct functioning of the heart. Potatoes and cabbage are sources of potassium, which normalize the functions of the heart muscle. Cereals effectively inhibit the absorption of cholesterol. Pumpkin corrects the water-salt balance and helps reduce blood pressure.
If a person who has been diagnosed with respiratory arrhythmia eats right, devotes time to moderate physical activity and avoids stress, then he will not feel any discomfort.
Treatment
Due to the fact that sinus arrhythmia almost always occurs easily, and sometimes even unnoticed by the person himself, usually no special treatment is required.
It is worth intervening when the patient develops symptoms associated with arrhythmia (dizziness, feeling of heart failure, etc.). But it is not the arrhythmia itself that needs to be treated, but the root cause of its occurrence.
First of all, you need to give up bad habits. I strongly recommend that my patients stop smoking and limit the amount of alcohol consumed as much as possible. You also need to reduce the amount of coffee you drink to 1 cup per day.
Particularly sensitive people suffering from neurocirculatory dystonia and neurotic disorders benefit greatly from sedatives. At first I try to limit myself to herbal preparations like Persen or Novopassit. But if there is no effect from their use, I refer patients to a neurologist to write a prescription for stronger medications (Sibazon, Relanium).
For other patients, I recommend a more thorough examination to find the cause of sinus arrhythmia - check the level of hemoglobin, glucose, thyroid hormones, do echocardiography (ultrasound of the heart), etc.
People suffering from connective tissue dysplasia experience chronic magnesium deficiency, which can trigger the onset of SA. Prescription of drugs containing this element (Magne B6, Magnerot) will be effective for both treatment and prevention.
And finally, if a person has any heart disease, I focus specifically on its treatment - I adjust blood pressure with medications, select the dosage of medications for chronic heart failure, refer for surgery for severe heart defects, etc.
Case study: a young man with connective tissue dysplasia
I would like to present an unusual case of sinus arrhythmia.
A young man, 24 years old, approached me. Recently, he began to experience discomfort in the heart area and began to experience slight dizziness. The patient does not smoke, does not drink alcohol, and does not take any medications. Body temperature is normal. When I began to measure his pulse, it turned out to be irregular. During a general examination, I noticed that the young man had signs of connective tissue dysplasia - thinness, tall stature, hypermobility of the joints (wrist, elbow, knee). Decoding of the cardiogram - sinus arrhythmia. When holding the breath, the rhythm disturbance persisted. An echocardiogram revealed mitral valve prolapse, which is another criterion for connective tissue dysplasia. A blood test showed a low magnesium concentration. I prescribed Magne B6 and recommended including foods rich in this microelement (buckwheat, bananas, nuts, oatmeal) in the diet. Upon re-appointment, the patient noted a significant improvement in his condition. Manifestations of arrhythmia completely stopped. The cardiogram and magnesium levels returned to normal.
