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Abstract: The patient was found to have an abnormal ECG on physical examination. The ECG showed sinus rhythm, sinus bradycardia, and ST-T changes, and was recommended by the physical examination department to come to the cardiology clinic for further examination of dynamic ECG, serum ions, five items of metabolic function, and cardiac ultrasound. The patient’s nervousness and anxiety are relieved.
Basic information】Female, 60 years old
Disease Type】Sinus bradycardia
Hospital】Harbin First Hospital
Time】May 2022
Treatment plan】No obvious cardiac lesions after examination, no special treatment is needed, if necessary, oral heart treasure pill or Ningxinbao capsule
Treatment period】Outpatient follow-up for 3 days
Treatment effect] The patient’s sinus bradycardia was not substantial, no special medication was needed, and the patient’s nervousness and anxiety were relieved
I. Initial interview
The patient, accompanied by her daughter, came to the hospital with an ECG in her hand. The patient had not been diagnosed with any disease in the past and had no symptoms of discomfort during the day. The ECG showed sinus rhythm, sinus bradycardia, ST-T changes, heart rate of 50 beats/min, blood pressure of 125/80 mmHg, auscultatory rhythm, no pathological murmur was detected, heart rate was about 50 beats/min, other examinations brought by the patient from the physical examination department did not reveal any abnormality, and the preliminary diagnosis was sinus bradycardia.
II. Treatment history
According to the common causes of bradycardia, the patient was advised to further improve the relevant examinations. The patient was advised to perform 24-hour ambulatory electrocardiogram, serum ionization, A-alpha five, and cardiac ultrasound to help rule out the presence of hyperkalemia, hypothyroidism, cardiomyopathy, or valvular disease. The results of serum ionization, A-alpha, and cardiac ultrasound did not reveal any problems, and the patient’s heart rate was about 54 beats/min. 24-hour ambulatory ECG showed an overall sinus rhythm, with an average heart rate of 56 beats/min for 24 hours and sinus bradycardia for bradycardia. Patients are advised to monitor their heart rate regularly without treatment. If the heart rate slows down further, especially when chest tightness occurs, they can take Heartbelt Pills or Ningxinbao Capsules orally to increase the heart rate and improve myocardial ischemia.
III. Treatment effect
After detailed examination, it was confirmed that the patient’s sinus bradycardia was not pathological bradycardia, so no special medication was needed. He explained the test results to the patient and his family in detail, relieved the patient’s mental stress, and informed the patient that the sinus bradycardia detected in the current physical examination was not of substantial significance, and relieved the patient’s nervousness and anxiety. The patient was instructed to follow up with the outpatient for 3 days.
IV. Precautions
The patient felt very happy as a doctor after a detailed examination, which showed no significant cardiac abnormality and no need for special treatment. However, patients are advised to avoid taking drugs that can cause further slowing of the heartbeat on a regular basis, such as metoprolol succinate extended-release tablets, diltiazem hydrochloride tablets, bisoprolol fumarate tablets, digoxin tablets, etc. When the slow heartbeat leads to chest tightness, you can take drugs like Ningxinbao capsule or Xinbao pill orally to increase the heart rate, improve myocardial ischemia, relieve the symptoms, and further improve the coronary CT examination. During the day, you should also pay attention to low salt and low fat diet, eat more fresh fruits and vegetables, avoid straining and staying up late, take regular rest and rest, and do not eat smoked, pickled and fried foods. It is best to have a medical checkup every six months to a year, and pay attention to monitoring your heart rate and blood pressure at home.
V. Personal insight
In actual clinical practice, many patients find that their ECG abnormalities will become very anxious and nervous, in fact, there are some ECG changes may not necessarily have substantial significance, of course, for the elderly group or as far as possible to improve the relevant examination, to exclude organic pathology, so that also more at ease, such as sinus bradycardia, in fact, is a relatively common problem, some people may be heavy physical laborers If the patient has no previous illnesses or symptoms, no treatment is needed and the heart rate can be monitored regularly. For sinus bradycardia, it is important to rule out the presence of hyperkalemia and hypothyroidism, and to perform a 24-hour ambulatory electrocardiogram and cardiac ultrasound to better identify whether the sinus bradycardia is caused by heart disease.