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What is sinus bradycardia.
This is a decrease in the heart rate emanating from the sinus node to less than 60 per minute.
In every person, deep in the heart muscle (myocardium) there is a so-called conduction system. It is a network of thin nerve fibers that conduct impulses through the myocardium and it is precisely this that causes the human heart to beat at one frequency or another.
The principle of its operation is reminiscent of electrical wiring - there is an initiator of an electrical impulse (the sinus node itself) and there are elements that conduct impulses from it. If “problems” occur at one of the stages of the impulse, arrhythmias develop.
In the case of sinus bradycardia, the frequency of impulses emanating from the sinus node itself decreases to less than 60 beats per minute.
Sinus bradycardia can be either physiological (normal)
, and
pathological
, that is, associated with any diseases or health conditions.
Nosological classification (ICD-10)
- G90.9 Autonomic nervous system disorder, unspecified
- K29.6.1* Hyperacid gastritis
- K31.3 Pylorospasm, not elsewhere classified
- K80.5 Bile duct stones without cholangitis or cholecystitis
- K81.1 Chronic cholecystitis
- K82.8.0* Dyskinesia of the gallbladder and biliary tract
- N23 Renal colic, unspecified
- R10.4 Other and unspecified abdominal pain
- R45.1 Restlessness and agitation
Contraindications and side effects
In some cases, taking the drug is excluded:
- individual intolerance to any component of the drug;
- allergic reactions;
- angle-closure glaucoma;
- prostate in a hypertrophied form, in which problems with urination are observed;
- myocarditis;
- cardiosclerosis;
- vascular atherosclerosis in an advanced stage;
- endocarditis.
With long-term use, dosage violation and in case of individual intolerance, the following side effects are possible:
- gastralgia;
- myasthenia gravis;
- feeling of nausea;
- arrhythmia;
- headaches;
- vomit;
- allergic reactions;
- increased drowsiness.
Pharmacodynamics
Belladonna leaf has an anticholinergic and antispasmodic effect. Interferes with the stimulating effect of acetylcholine; reduces the secretion of salivary, gastric, bronchial, lacrimal, sweat glands, pancreas. Reduces the tone of the muscles of the gastrointestinal tract, bile ducts and gallbladder; causes tachycardia, improves AV conduction. Dilates the pupils, impedes the outflow of intraocular fluid, increases intraocular pressure, and causes paralysis of accommodation.
Lily of the valley tincture has a cardiotonic effect.
Valerian rhizome with roots has a sedative and antispasmodic effect. Facilitates the onset of natural sleep. The sedative effect occurs slowly, but is quite stable.
Menthol is a local irritant, has a venotonic, analgesic, reflex coronary dilation and antianginal effect.
special instructions
The drug should be taken with caution by drivers and operators of moving machinery. Drops may reduce concentration and attention. Therapy is carried out with caution in children (up to 12 years) and the elderly. To enhance the therapeutic effect, Zelenin drops are sometimes combined with hawthorn-based drugs (must be agreed with your doctor).
During pregnancy and breastfeeding, the drug is used with caution and only in consultation with a doctor. Drops can only be used in cases where the expected benefits are higher than the potential risks.
Instructions for use and dosage
So, how to take the drug? You must first read the instructions carefully. And also be sure to coordinate all the details with your doctor. Drops should be taken 3 times a day, half an hour before meals. The dosage is as follows:
- For adults – 20-30 drops;
- For teenagers over 12 years old, the number of drops should be equal to their age.
The drug is not prescribed to children under 12 years of age, since there is no accurate data on the effect of the drug on the body and no research has been conducted.
You need to take the drops with a small amount of water; half a glass is enough for one dose. The duration of the course is adjusted by the doctor and depends on the individual characteristics of the body, the tolerability of the components, and the effect of the medication in each specific case.
Composition and pharmacological action
The product has shown its effectiveness in the fight against heart pathologies, due to its unique natural composition, which includes:
- Belladonna leaves - reduce the level of secretion of the pancreas and salivary gland, improve the conductivity of electrical impulses in the muscles, reduce the appearance of spasms;
- Lily of the valley leaves are a cardiotonic product, significantly increase the speed and frequency of contraction of the heart muscle, help get rid of bradycardia;
- Valerian officinalis roots have a sedative effect, help improve sleep and reduce excitability. The result is not immediately noticeable, which allows you to avoid negative consequences for the body. Valerian dilates coronary vessels, affects the myocardial muscle, restores the conductive function of the heart;
- Menthol is an auxiliary component that improves organ reflexes, including helping muscles contract. It is a local irritant, tones the veins, relieves pain, and has an active effect on the heart.
It is the natural composition that ensures the high effectiveness of the product and the almost complete absence of side effects.
Sinus bradycardia in pathological conditions
1. Diseases of the cardiovascular system:
- hypertonic disease
- coronary heart disease (angina pectoris, myocardial infarction)
- heart injury
- inflammatory heart diseases (myocarditis, pericarditis)
- infiltrative heart diseases (amyloidosis)
- cardiomyopathy
- congenital diseases of the cardiac conduction system
- congenital heart defects
In the case of severe hypertension and hypertrophic cardiomyopathy, when a pronounced increase in the muscle mass of the heart develops, the normal nutrition of the nerve fibers of the conduction system of the heart is disrupted.
Approximately according to the same scenario, bradycardia develops in inflammatory and infiltrative heart diseases.
When the myocardial mass increases due to inflammation (myocarditis) or deposition of specific pathological substances such as amyloid deposition. And the nerve fibers are mechanically compressed by edematous and dense pathological tissue.
With angina, especially in the elderly, there is severe calcification (that is, calcium deposits) and atherosclerosis (that is, plaque deposits) of the coronary arteries. This complicates the delivery of blood, including to small vessels passing through the thickness of the myocardium and feeding the conduction system of the heart.
During myocardial infarction, an ischemic zone develops, which also often affects elements of the conduction system of the heart and leads to the development of bradycardia. As a rule, as the infarction area heals, bradycardia goes away.
2. Neuromuscular diseases (myotonia, ataxia)
3. Connective tissue diseases (systemic lupus erythematosus)
4. Heart surgeries (valve replacement, radiofrequency ablation)
In the presence of neuromuscular diseases, the heart itself is healthy, but initially the normal conduction of impulses along the nerve fibers suffers.
In systemic lupus erythematosus, the damaging effect is due to an autoimmune, that is, self-damaging mechanism, with the development of small foci of inflammation in the heart muscle.
small foci of inflammation in the heart muscle. Any operations on the heart, especially on the valves, can result in bradycardia, since the conduction system of the heart is located quite close to the valvular apparatus of the heart.
When performing ablation, that is, “burning out” the focus of arrhythmia with laser or cryotherapy, a zone of damage similar to a heart attack may appear, followed by the formation of a scar. If such a scar is located close to the elements of the conduction system of the heart, then bradycardia eventually develops.
5. Toxic factors: food botulinum toxin, carbon monoxide, narcotic substances
In this case, toxins paralyze the conduction of impulses through the conduction system and this leads to bradycardia.
6. Infectious diseases: diphtheria, Lyme borreliosis
The mechanism of the damaging effect of the infectious agent in such patients combines the development of a focus of inflammation in the heart muscle and the paralytic effect of the microbial toxin. Or the formation of small foci of sclerosis at the site of former inflammation (similar to scars during myocardial infarction).
7. Medicines:
A) pulse-lowering drugs:
- beta-blockers (bisoprolol, metoprolol, anaprilin, carvedilol, nebivolol)
- cardiac glycosides (digoxin)
- calcium antagonists (verapamil, diltiazem)
B) antiarrhythmic drugs (propafenone, cordarone, sotahexal)
B) centrally acting antihypertensive drugs (clonidine, moxonidine)
D) narcotic drugs and anesthetics (morphine, thiopental, propofol)
D) antidepressants (amitriptyline)
In the case of drug exposure, bradycardia is transient, that is, it disappears when the drug is discontinued and is associated with a reversible suppression of the behavior of the impulse along the conduction system of the heart.
8. Disorders of water-salt metabolism:
- excess potassium (hyperkalemia) after taking veroshpiron, potassium preparations (panangin, asparkam), angiotensin-converting enzyme inhibitors (enalapril, perindopril, etc.), sartans (losartan, telmisartan, etc.)
Excess potassium paralyzes the normal exchange of ions in the heart cell, and its functioning is disrupted. The impulse through the conductive system is lost.
9. Endocrine diseases:
-hypothyroidism (low thyroid function)
Thyroid hormones are the “gasoline” on which our “engine”, the heart, moves. They “set the pace” of the work of the whole organism, including metabolism (or rather, its speed), as well as the heart rate. In case of hypothyroidism, bradycardia develops. Hypothyroidism is characterized by mucous protein swelling of the tissues, which can lead to purely mechanical swelling of the heart tissues and compression of the elements of the conduction system of the heart.
10. Pathology of the central nervous system:
- intracerebral hematomas
- hydrocephalus and intracranial hypertension syndrome
In this case, the central mechanism of bradycardia is activated when the vasomotor center, which is responsible for the heart rate, is compressed.
11. Hypothermia
When hypothermia occurs, metabolism is catastrophically slowed down.
All systems, including the cardiovascular system, operate in a mode of reduced activity, which can manifest as bradycardia. SINUS BRADYCARDIA IN CHILDREN AND ADOLESCENTS
has the same causes as in ADULTS. They are listed above. As you get older, sinus bradycardia can transform into a normal heart rate or tachycardia. After all, the child’s body is very plastic and easily changes under the influence of various factors.
AMONG WOMEN
, especially during pregnancy, sinus bradycardia may develop, but not always. This is not a pathology and in no way interferes with delivery either naturally or surgically. This bradycardia is transient (temporary) in nature and disappears after childbirth.
A special group consists of patients with SINUS BRADYCARDIA IN THE ELDERLY. The leading causes of bradycardia in this age group are coronary heart disease and drug factors (taking pulse-lowering drugs). Kidney pathology makes a large “contribution” to the development of bradycardia in the elderly.
With age, the entire body ages, including the kidneys. Their function of removing toxins is reduced and medications taken even in standard doses can accumulate in the body, causing overdose and side effects.
In the elderly, an increase in blood potassium levels due to kidney pathology causes a decrease in heart rate. Or a consequence of taking medications (veroshpiron, ACE inhibitors). A combination of these factors also affects the pulse.
With age, the nutrition of the conduction system of the heart also deteriorates due to atherosclerosis of the coronary arteries, and this also leads to bradycardia.
CLINICALLY, sinus bradycardia is manifested by weakness, dizziness, sometimes fainting, or the patient himself discovers a rare pulse
Physiological sinus bradycardia - causes:
1. Sleep
In sleep, the whole body rests, including the heart. It, of course, does not stop completely, but it slows down and this is important for proper rest of the whole body and the heart itself. After all, the heart is an organ that works around the clock. With different activity, depending on the time of day.
The night is called the “kingdom of the vagus”, since it is at night that less adrenaline is produced, and the hormone norepinephrine mainly works and is characterized by a pulse-suppressing effect. This is an adaptive (protective mechanism) given to us by nature and it allows the “eternal worker” - the heart - to rest.
2. Clamping of large vascular-nerve bundles
(on the shoulder, hip) with a long-term non-physiological position (sitting at an angle, prolonged awkward position of the arm)
And in the event of a damaging effect, a reflex decrease in heart rate occurs. This goes away without a trace when the influence of the provoking factor ceases. For example, compression of the neurovascular bundle by a hematoma, mechanical compression in a forced position (working at an angle, sitting at an angle).
3. Systematic exercise (compensatory or adaptive bradycardia)
Any sport is an adrenaline rush. To protect the body from excessive exposure to this hormone, norepinephrine (anti-adrenal hormone) begins to be produced compensatoryly over time.
This is accompanied by a number of signs, including the formation of a rare pulse - bradycardia. In this case, the heart is ready for sports stress, works smoothly and economically, and wears out less. The last position is relative, big sport always means heart problems.
The fact is that all large vessels in the body (femoral, brachial artery) are intertwined with small thin branches of the autonomic (peripheral) nervous system.
4. Excessive tone of the parasympathetic nervous system (so-called vagotonia)
In some people, norepinephrine dominates in the body from birth and this condition is called vagotonia.
A person has a central and peripheral nervous system. The peripheral nervous system is a “braid” of all internal organs and blood vessels. And normally, two nerves approach each vessel and internal organ - adrenal and noradrenal.
If the adrenal system dominates, then this is usually manifested by an increased pulse (tachycardia), excessive sweating, and excessive excitability. If the norepinephrine system prevails, the patient has a rare pulse and is prone to sweating and chilliness. Often suffers from pathology of the gastrointestinal tract (typical signs of vagotonia).
5. Eating too much food.
The mechanism of development of bradycardia in this case is similar to all the positions listed above.
6. Carotid sinus syndrome
– reflex bradycardia due to compression of the carotid artery and the so-called carotid sinus located next to it. This reflex is used for tachyarrhythmias, when massage of the area where the carotid artery is located reflexively reduces the pulse.
