sinus arrhythmia



Overview of Sinus Arrhythmia

Definition

The rhythm initiated by the sinus node is called sinus rhythm.

Under normal circumstances, sinus rhythm has a fixed rhythm, and the adult sinus heart rate (the frequency of the heartbeat) is 60 to 100 beats per minute.

A sinus rhythm that is too fast, too slow, or has an irregular rhythm is called a sinus arrhythmia.

Typing

They are categorized as follows, depending on the electrocardiogram and clinical manifestations.

Sinus tachycardia

Sinus rhythm with a normal rhythm but with a frequency of more than 100 beats/minute.

Sinus bradycardia

Sinus rhythm with a normal rhythm but with a frequency below 60 beats/min.

Sinus arrhythmia

Sinus rhythm with an irregular rhythm and a time difference of greater than or equal to 120 milliseconds between adjacent cardiac cycles (a cardiac cycle is a cycle in which the atria or ventricles contract and diastole 1 time each).

Includes respiratory sinus arrhythmia, nonrespiratory sinus arrhythmia, and ventricular chronotropic sinus arrhythmia.

Sinus Arrest

The inability of the sinus node to generate electrical impulses and the heart stops beating.

Sinus Block

A delay or block in the conduction of electrical impulses from the sinus node to the atria.

According to the severity of the delay or block, it can be categorized as first degree sinus block, second degree sinus block, or third degree sinus block.

Sick sinus node syndrome (sick sinus syndrome)

Multiple causes of sinus node dysfunction, causing a syndrome characterized by multiple arrhythmias.

Morbidity

Can occur at any age.

Physiologic sinus arrhythmias occur in children and young adults.

Pathological sinus arrhythmia occurs more often in people with heart disease, endocrine disease, anemia and other diseases.

Causes

Causes

The causes and triggers of sinus arrhythmia sometimes cannot be separated. Some of the following factors may sometimes be the causes and sometimes the triggers of sinus arrhythmia.

Physiological factors

Lifestyle factors

Sinus tachycardia can be caused by drinking strong tea, coffee, alcohol, spicy and stimulating foods (such as raw onion, garlic, ginger, etc.), and starvation, etc. It can gradually return to normal with digestion and metabolism of the diet and eating.

Sinus tachycardia can be caused by smoking, exercise, etc., and can gradually return to normal after stopping smoking or exercise.

Sinus bradycardia can occur during sleep and return to normal after waking up.

Psychological factors

Nervousness, anxiety, fear, etc. can cause sinus tachycardia, which can return to normal when these emotions disappear.

Environmental factors

Cold and heat can cause sinus tachycardia, which can be normalized by moving to a warm or cool environment.

Age factor

Sinus bradycardia can occur in young people.

Children may experience sinus arrhythmia that accelerates with inhalation and slows down with exhalation.

Occupational factors

Athletes or people who work out for long periods of time are relatively susceptible to sinus bradycardia.

Diseases

Diseases of the heart or coronary arteries: Coronary heart disease, congenital heart disease, myocarditis, cardiomyopathy, etc. can cause a variety of sinus arrhythmias.

Diseases outside the heart or coronary arteries: autoimmune diseases, hyperthyroidism or hypothyroidism, various causes of fever, hyperkalemia, hypokalemia, hypoglycemia, anemia, etc. can cause a variety of sinus arrhythmia.

Drugs

Beta-blockers, non-dihydropyridine calcium channel blockers, digitalis, acetylcholine, amiodarone, epinephrine and other drugs can cause sinus arrhythmia.

Symptoms

Sinus arrhythmia caused by physiologic factors, or disease- or drug-induced sinus arrhythmia may have no obvious symptoms when the condition is mild.

When disease or drug-induced sinus arrhythmia is severe, symptoms such as palpitations, chest tightness, dizziness and fainting may occur.

Common Symptoms

Palpitations: may be characterized by a rapid heartbeat, a feeling of a missed heartbeat, or a feeling of stopping the heart.

Chest discomfort: may manifest as chest pain, chest tightness, etc.

Dizziness.

Weakness: feeling weak.

Blackout: darkness before the eyes.

Loss of consciousness: syncope, persistent transient loss of consciousness that lasts for a few seconds and then wakes up on its own; coma, which lasts for a long time and is unresponsive to calls.

Convulsions: Muscle tremors throughout the body, often accompanied by loss of consciousness, may be one of the manifestations of cardiac arrest.

Cardiac arrest: manifested as respiratory and cardiac arrest, requiring immediate CPR and electric defibrillation.

Sudden death: Mostly caused by severe sinus arrest, the onset of which can lead to death within a short period of time.

Complications

Prolonged sinus arrhythmia can lead to ischemia of the brain, heart, kidneys and other organs, causing dysfunction and the following symptoms.

Cerebral ischemia: blackout, fainting, memory loss, irritability, etc.

Heart ischemia: chest pain, chest tightness, dyspnea, etc.

Kidney ischemia: oliguria, proteinuria, back pain, etc.

Consultation

Department of Medicine

Cardiovascular Medicine

Physical examination reveals sinus arrhythmia or symptoms such as palpitations, chest discomfort, dizziness and fatigue, etc. It is recommended to visit the Department of Cardiology promptly.

Emergency Department

If you experience loss of consciousness, convulsions, respiratory arrest, etc., it is recommended that you go to the Emergency Department or call the 120 emergency number immediately.

Preparation for medical treatment

Preparing for medical treatment: registration, preparation of documents, common problems

Tips for medical treatment

Electrocardiogram (ECG) or ambulatory electrocardiogram (EKG) may be required. Wear loose-fitting clothing and avoid jumpsuits.

Preparation Checklist

Symptom list

Pay particular attention to the time of onset of symptoms, special manifestations, etc.

Are there symptoms of palpitations, weakness, dizziness?

How long have the symptoms lasted? Are they frequent?

Is there a clear trigger for the onset of discomfort?

Is the chest tightness severe? When does it get worse? Any obvious triggers?

List of medical history

Any other medical conditions?

Have you had any tests? What are the results?

Have you had any treatment? What kind of treatment? What is the effect of the treatment?

Does anyone else in your family have similar symptoms?

Do you drink a lot of tea, coffee, or alcohol?

Have you been under a lot of anxiety and stress lately?

Do you smoke? How many cigarettes a day? How long have you been smoking?

Do you exercise regularly?

Checklist

Test results for the last 6 months, which you can bring with you to the doctor’s office.

Blood Tests

C-Reactive Protein

Myocardial Injury Markers

Blood biochemistry

Echocardiogram

Esophageal Electrocardiogram

Coronary Angiography

Electrocardiogram, 24-hour ambulatory electrocardiogram

Electrophysiology

Medication List

Medication use in the last 3 months, if available in boxes or packages, bring with you to the doctor’s office

Anti-M cholinergic receptor drugs: atropine, scopolamine, scopolamine

Heart rate raising drugs: dopamine, epinephrine, isoprenaline

Non-dihydropyridine calcium channel blockers: verapamil, diltiazem

Beta-blockers: propranolol, metoprolol, atenolol, bisoprolol, carvedilol

Diagnosis

Diagnosis is based on

Medical history

May have cardiac or coronary artery disease such as coronary artery disease, myocarditis, or cardiomyopathy.

May have a disease other than cardiac or coronary artery disease such as hyper- or hypothyroidism, hyperkalemia, or anemia.

May have recently taken medications such as beta-blockers, non-dihydropyridine calcium channel blockers, and digitalis.

May have recently been emotionally agitated or consumed strong tea or coffee.

Clinical manifestations

Symptoms

Symptoms such as palpitations, chest discomfort, dizziness, fatigue, blackouts and syncope.

Physical signs

Pulse: There may be an increase or decrease in pulse rate or an abnormal rhythm.

Cardiac examination: heart rate may increase or decrease, heart rhythm may be abnormal, and heart sounds may be enhanced or weakened.

Other findings: lower extremity edema may be present.

Laboratory Tests

Blood routine and C-reactive protein: to clarify the presence of inflammatory diseases, anemia, etc.

Blood biochemistry: including electrolytes, etc., can clarify the presence of sinus arrhythmia caused by electrolyte abnormalities.

Markers of myocardial injury: to clarify the presence of myocardial ischemia, etc., which can clarify the etiology.

Blood hormone level: check the level of thyroid hormone, adrenal hormone, etc. to clarify the cause.

Imaging tests

Echocardiography

Used to evaluate the structure and function of the heart.

Non-invasive, low cost, usually the preferred diagnostic method for myocardial and pericardial diseases.

Precautions: Expose the chest according to the doctor’s requirements before the examination, adjust the position according to the doctor’s requirements during the examination, and cooperate with the doctor’s examination.

Coronary Angiography

Can identify coronary artery disease and determine the severity of the disease.

Precautions

Before the examination, you should clearly inform the doctor of your past illnesses and medications, and stop using certain medications as requested by the doctor.

During the examination, lie down as requested by the doctor and avoid moving around. Inform the doctor promptly if you feel unwell.

Move around as requested by the doctor after the examination and avoid excessive movement of the puncture site, such as the wrist and thigh root.

Inform the doctor promptly if there is bleeding or increasing pain at the puncture site after the examination.

Electrocardiogram (routine surface ECG)

It is the most important diagnostic basis.

By checking the ECG signal, it confirms the presence of sinus arrhythmia and clarifies the type and severity of the arrhythmia.

24-hour ambulatory electrocardiogram (Holter examination)

Ambulatory electrocardiogram is mainly used to assess the number of occurrences of sinus arrhythmia and the time of occurrence, and can determine the cause and severity of sinus arrhythmia.

Precautions

After wearing the dynamic ECG machine, patients can maintain their usual daily activities without deliberately reducing the amount of exercise.

When moving around, the upper limbs should avoid exerting themselves or making large movements, so as to avoid the device slipping off.

Do not take a bath or swim during the examination to avoid liquid entering the instrument and affecting the results.

When the patient has discomfort symptoms during the whole examination, the patient and family members should record the beginning and ending time of the symptoms and the triggers, so as to provide more clues for the doctor’s diagnosis.

Esophageal ECG

Electrodes are inserted from the nasal cavity into the vicinity of the left atrium to evaluate the function of the sinus node through stimulation.

Electrophysiologic Examination

By recording electrical signals from different parts of the heart, the location and severity of lesions are clarified, providing information for diagnosis and formulation of treatment plans.

Differential Diagnosis

Sinus arrhythmia should be differentiated from arrhythmia caused by lesions in other parts of the heart other than the sinus node.

Similarities: chest discomfort, dizziness, blackouts, syncope, etc.

Differences: Arrhythmias caused by abnormal function of the atria, atrioventricular junction, ventricles, etc. can be differentiated by electrocardiogram.

Treatment

Treatment focuses on removing the cause of the disease, relieving symptoms, and reducing the risk of serious conditions. Treatment includes general therapy, medication, and implantation of a pacemaker if necessary.

General treatment

Rest

Take rest and avoid exertion.

Ensure adequate sleep and avoid late nights.

Ensure adequate nutrition.

Ensure that the diet is adequate in protein, vitamins, minerals and other nutrients.

Avoid foods high in salt, sugar and fat.

Improve lifestyle habits

Quit smoking.

Exercise in moderation and rest promptly when discomfort occurs during exercise.

Regulate heart rate

Sinus tachycardia can be improved by methods such as the Valsalva maneuver. It must be performed by a doctor or as directed by a doctor.

Inhale deeply, hold your breath, and then “exhale” while holding your breath.

Exhaling allows the gas in the windpipe and mouth to exert pressure on the throat.

Removing the cause of the disease

Active treatment of the primary disease, such as hyperthyroidism (hyperthyroidism) causing sinus tachycardia and hypothyroidism (hypothyroidism) causing sinus bradycardia, must be actively treated.

Sinus arrhythmia is often relieved when the primary disease is cured.

Regular checkups

Follow your doctor’s instructions for regular checkups.

Medication

Generally, no medication is needed, but in severe cases, medication should be used as directed by a doctor.

Beta-blockers

Can control heart rate and relieve tachycardia symptoms.

Used for sinus tachycardia combined with myocardial ischemia, and there is no contraindication such as bronchial asthma, acute heart failure, chronic obstructive pulmonary disease.

Commonly used propranolol, metoprolol, atenolol, bisoprolol, carvedilol and so on.

Anti-M cholinergic receptor drugs

Can improve heart function, increase heart rate, and relieve symptoms of bradycardia.

Can be used for sinus bradycardia, sinus arrest or atrioventricular block.

Prostatic hypertrophy is contraindicated.

Dopamine, Epinephrine, Isoprenaline

Can increase myocardial contractile function and increase heart rate.

Used in sinus bradycardia when treatment with anti-M cholinergic receptor agents is ineffective or contraindicated, or in atrioventricular block or cardiac arrest.

Non-dihydropyridine calcium channel blockers

Used for sinus tachycardia.

Can be used alone or in combination.

Verapamil and diltiazem are commonly used.

Aminophylline

Increases cardiac output and myocardial contractility, also relaxes bronchial smooth muscle, dilates bronchial tubes, and relieves wheezing symptoms.

Implantation of a pacemaker

Can be used to treat conditions such as sinus bradycardia and sinus block.

An instrument placed inside the heart to control the heart rhythm can have the effect of temporarily or permanently increasing the heart rate and reducing the risk of serious conditions.

Pacemakers are categorized into temporary pacemakers and permanent pacemakers.

Temporary Pacemakers

A temporary pacemaker is implanted into the heart through interventional therapy to maintain a normal heart rate and rhythm in the event of a serious condition.

When the cause of the condition is removed and the voluntary heart rate returns to normal, the temporary pacemaker is removed; if it does not return to normal, it may be replaced with a permanent pacemaker.

Permanent Pacemakers

Permanent pacemakers are used in the following situations:

Bradycardia presenting with severe symptoms.

Bradycardia caused by sinus node dysfunction with significant symptoms.

Epilepsy causing seizure-induced bradycardia that is not effectively treated with antiepileptic therapy.

Precautions for the use of pacemakers

Try to stay away from electronic products such as cell phones.

Stay away from magnetic cards, magnets, induction cookers, and other items with magnetic properties.

Avoid magnetic resonance imaging (MRI) examinations.

Seek medical attention when there are abnormalities in function.

Prognosis

Cure

Some physiologic causes of sinus bradycardia, sinus tachycardia, and sinus arrhythmia do not require treatment.

Physiologic sinus arrhythmias caused by exercise, diet, etc., may resolve spontaneously.

Sinus arrhythmia caused by sinus block and sick sinus node syndrome can return to normal with timely treatment.

Hazards

The symptoms of palpitations and chest tightness caused by sinus arrhythmia can have an impact on work and life.

After installing a pacemaker, there are restrictions on places of activity, household goods, and so on.

If it causes heart failure and severe cerebral ischemia, it will limit the intensity of activities or cause sequelae such as hemiplegia and speech disorder, which will reduce the quality of life.

If not treated in time, severe heart failure, cardiac arrest and even life-threatening may occur.

Daily

Daily Management

Dietary management

Ensure adequate protein, unsaturated fat, vitamins, minerals, dietary fiber, and water. Choose soy products, milk (low-fat or skimmed), lean meat, fish (may be 1 or 2 times a week), fresh fruits, fresh vegetables, nuts, etc.

Appropriate control of carbohydrate intake, can choose cereals, potatoes, etc. instead of refined rice, refined noodles.

Avoid high salt and high fat diets, keep the daily salt consumption within 6 grams, and avoid fried, pickled and barbecued foods.

Adults should drink 1,500 to 1,700 milliliters of water per day (or control the amount of water intake according to your doctor’s requirements).

Avoid raw, cold, hard and hot foods, chew slowly and avoid overeating.

Avoid irritating foods such as chili peppers, curry, mustard, coffee and strong tea.

If arrhythmia is caused by disease or medication, meals should be taken under the guidance of a doctor for the original disease. For example, if tachycardia is caused by hypokalemia, foods high in potassium should be consumed in moderation on a daily basis after the potassium deficiency has been corrected.

Abstain from alcohol.

Life management

Quit smoking and stay away from “second-hand smoke” (avoid passive smoking).

Ensure adequate sleep and avoid staying up late.

Exercise in moderation, such as brisk walking, jogging, tai chi, swimming, square dancing, cycling, etc., or follow the doctor’s instructions to choose exercise programs.

Exercise intensity should be gradual, avoid over-exercise.

If you feel uncomfortable during exercise, you should stop and rest immediately.

Emotion Management

Avoid bad emotions such as tension, anxiety, anger and depression.

Relieve stress by listening to soft music, chatting with friends and relatives, reading books, watching soothing movies and TV dramas.

Self-protection

If dizziness occurs, sit or lie down immediately to avoid falling.

Prevention

Actively treat physical illnesses.

Use medication appropriately: Use medication according to your doctor’s requirements. Seek medical advice if you feel unwell during the use of medication.

Reasonable diet to prevent heart disease.

Improve dietary structure and ensure adequate nutrition.

Avoid overeating and maintain appropriate body weight.

Avoid diets high in salt, fat and sugar, and try to avoid pickled, smoked, barbecued and fried foods.

Avoid stimulating foods such as chili peppers, coffee and strong tea.

Eat more foods rich in dietary fiber, such as whole grains, fresh fruits and vegetables, etc. Food types should be diversified and alternated.