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Sinus arrest

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[Intro]

Overview: sinus arrest (sinus arrest), also known as sinus still (sinus standstill), sinus pause, sinus pause. sinus arrest refers to the sinus node within a certain time to stop payment of excitement.

under arrest cardiac pacemaker can be divided into: ① sinus arrest; ② atrial arrest; ③ transition zone of the arrest; ④ ventricular asystole; ⑦ wholeheartedly arrest. Clinically, the whole-hearted arrest (cardiac arrest), ventricular asystole, sinus arrest is the most important.

under arrest causes can be divided into: ① primary sinus arrest: nothing to do with tachyarrhythmia arrest. ② secondary sinus arrest: secondary to tachyarrhythmia after the arrest.

time under arrest can be divided into: ① short pause stroke; each array arrest does not exceed 2 ~ 4s; ② longer time of arrest: arrest over each array 4s, 8s up above; ③ permanent arrest: pacemaker permanent loss of self-discipline.

[Cause]

sinus arrest is caused by what the?

(a) causes

1. primary sinus arrest were more common, mainly sinoatrial end in itself damage, caused more by structural heart disease. Such as coronary heart disease, acute myocarditis, cardiomyopathy, sick sinus syndrome, died of cardiac arrest is the frequency of various diseases before death late performance.

2. secondary sinus arrest

(1) secondary to a variety of tachyarrhythmias after transient sinus arrest (2 ~ 4s): The most common supraventricular tachycardia by stimulating the vagus nerve as well as drug treatment or esophageal pacing speeding inhibited, supraventricular tachycardia is corrected and the occurrence of sudden sinus arrest, mostly for short-term occurrence.

(2) anti-arrhythmic drug overdose or poisoning can cause sinus arrest: such as digitalis, quinidine, reserpine, amiodarone, etc. Recently, a propafenone (propafenone), moricizine, flecainide, Antazoline, three adenosine monophosphate (ATP)-induced sinus arrest case reports.

(3) increased vagal tone or carotid sinus hypersensitivity. Induced inhibition of the sinus node sinus arrest: for example, eye pressure, carotid sinus massage and stimulate the throat, endotracheal intubation and so on. normal and sometimes may also occur.

(4) cardiac trauma or cardiac surgery when the injury sinus: surgery or surgery may be after sinus arrest. coronary angiography, also can lead to sinus arrest.

(5) hyperkalemia, hypokalemia can also cause sinus arrest.

(B) the pathogenesis

sinus node ischemia, inflammation, fibrosis, degeneration, etc. can be inhibition of pacemaker cells in sinoatrial node electrophysiological characteristics, making it temporary or permanent loss of self-discipline, self-regulatory strength is at this time of sinus node 0, sinus arrest.

[Sign]

sinus arrest early symptoms?

over a long period of sinus arrest occurred without escape, sinus arrest, such as a transient, very short duration, may be asymptomatic. When sinus arrest lasted longer than 8s, the patient may appear black mask, short disturbance of consciousness or syncope, severe adams-stokes syndrome can occur even death. Long sinus arrest not associated with escape, could cause death.

1. During normal sinus rhythm, the sudden appearance of a significant long interval.

2. long interval of no P-QRS-T wave group appears.

3. pp interval and long interval of normal sinus pp interval is not a factor.

4. In the long interval after the PP, there may be escape or escape rhythm, atrioventricular junctions to escape or escape of the more common heart rhythm, ventricular or atrial escape rare.

5. Whenever a single escape rhythm of the heart, the primary consideration should be given persistent sinus arrest possible.

[Aftertreat]

sinus arrest ate?

what patients should intake?

need to intake of high energy, high-protein substances, such as eggs, meat , fish and vitamins, etc., thus facilitating the rehabilitation of the disease.

[Prevent]

sinus arrest should be how to prevent?

suspend or interrupt the formation of sinus impulses, and the sinus due to atrial and ventricular activities and their corresponding activities suspended, called sinus arrest, also known as sinus still .

common cause of this disease are:

1, increased vagal tone or carotid sinus hypersensitivity.

2, acute myocardial infarction, sinus degeneration and fibrosis, cerebral vascular accident and other diseases.

3, digitalis, quinidine stare potassium, acetylcholine and other drugs.

[Treat]

sinus arrest precautions before treatment?

prevention:

(1) regular periodic instruments detect heart rate, attention indicators associated with changes in symptoms, timely medical treatment

(2) to be happy and avoid emotional injury; Diet, avoid meal; avoid alcohol and spicy things; work and rest, be careful against cold.

sinus arrest performance:

over a long period of sinus arrest occurred without escape may be the patient appeared amaurosis, short disturbance of consciousness or syncope, severe adams-stokes syndrome can occur even death.

sinus arrest Chinese medicine treatment methods

one: chronic treatment

chronic phase of treatment should be to control the development of valvular disease, enhance the body resistance, prevention of streptococcal infection, rheumatic activities to avoid aggravating heart valve damage.

principles of treatment] [: yang Xin-based.

[Recipe]: heart yin deficiency-oriented persons, yin and blood, uneasiness of mind, to Tian wang Bu Xin dan ("regimen secret profile")-based subtraction, dominated by qi and yin Deficiency, qi Yin, to shengmaisan ("within the trauma and confusion" theory)-based subtraction. Dominated by virtual blood, qi and blood Fumai to zhigancao soup ("Treatise on"), the main addition and subtraction, weak heart yang-based persons, solid warm sun, in order to save labor Tang yang li ("medical cases must read ") the main addition and subtraction.

II: acute treatment

(1) wind-heat outside attack: treatment principles: Xin liang Xie table

] [Recipe: yin qiao San ("Warm Febrile Diseases") addition and subtraction. With silver Flower, Forsythia, bamboo, Nepeta, Arctium, Dougu, Campanulaceae, licorice, reed rhizome.

analysis [Fang-yi]: Fang with silver Flower, forsythia King, a thoroughly evil Xinliang heat, detoxification of reactive aromatic provision of foul; Nepeta, Dougu help Jun drugs through the open fur and evil; cow son, campanulaceae xuanfei Liyan, licorice detoxification; bamboo clear focus on the heat; reed rhizome heat fluid.

[Modified]: if the head pain more worse, Ghassan leaves, chrysanthemum clearing leader. If the cough, phlegm, Gabay mother, Peucedanum, almond

[Huatanzhike]: If the throat pain and swelling, with achyranthes aspera, per reference detoxification liyan . Jorge toxicosis shaped significantly, with Leaves, dandelion and other detoxification.

sinus arrest western treatment

(a) treatment

1. sinus arrest for the treatment of major causes of treatment, active treatment-induced sinus arrest of the primary disease.

2. For occasional, transient sinus arrest (especially due to increased vagal tone) and asymptomatic, heart rate 50 beats / min or more often do not need symptomatic treatment.

3. for frequent, long duration of sinus arrest, dizziness or syncope episodes have obvious symptoms, try atropine, isoproterenol (breathing set) (the role of B1 receptors in the heart, improve self-regulation of sinus node against hyperkalemia on sinus node inhibition.), ephedrine and other drugs. Severe cases, intravenous injection of atropine 0.5 ~ 1mg or injection of anisodamine (654-2); or isoproterenol 1mg 5% glucose in 250 ~ 500ml per minute drops 1 ~ 3μg. Intravenous calcium, calcium helps to restore the excitability of the cell membrane, especially for the ecg P wave disappeared, qrs wave widened by a significant effect.

4. to have repeated syncope, - adams syndrome episodes and medical therapy, you should consider placement of artificial cardiac pacemaker. Such as unconditional, may be provided in vitro emergency intravenous temporary cardiac pacing, and then sent to the hospital placement of artificial cardiac pacemaker conditional.

5. for persistent or permanent sinus arrest or syncope repeatedly sent the author, should be early placement of artificial cardiac pacemakers.

(b) the prognosis

by the increased vagal tone and the influence of drugs caused by, the general prognosis is good. Caused by a variety of organic heart disease, lead to frequent episodes of syncope, can cause death, the need to install the artificial pacemaker.

[Examine]

sinus arrest should be how ?

ecg can confirm the diagnosis, has the following characteristics:

1. transient or persistent sinus arrest sinus results of one or more room impulse did not occur, so the length of the electrocardiogram, ranging from the emergence of a long interval, in this long interval within. There are no P-QRS-T wave, long pp interval is not an integer multiple of the basic sinus cycle. In the same ECG, may be one or more long pp interval, but they appear long pp interval length can be mutually inconsistent. Transient sinus arrest does not appear more than escape, sometimes there may be more for the atrioventricular junctions of escape. A longer period of sinus arrest is often accompanied by a transient escape rhythm. Atrioventricular junctions mostly escape rhythm.

2. persistent or permanent sinus arrest were not seen on the ecg sinus P wave, can be seen secondary to escape rhythm or bradycardia Yat rhythm, often accompanied by atrioventricular junctions escape rhythm. ventricular escape rhythm, atrial escape rhythm rare.

3. paroxysmal supraventricular tachycardia, atrial flutter, atrial fibrillation, sinus arrest caused by such as these can cause rapid heart rate, speed suppression, it can cause sinus arrest, sinus node function but only slightly reduced, so the prognosis is good, long pp interval often greater than 2s, fast - slow transition syndrome, also can be seen varying degrees of sinus arrest ( figure 1).

[Diff]

sinus arrest the diseases easily confused?

1. transient sinus arrest and severe and significant sinus arrhythmia identification is sometimes difficult to identify the two. Severe and significant sinus arrhythmia is less common, and its slow phase pp interval can be significantly extended, a few cases, two short pp interval is greater than the sum, similar to sinus arrest. However, when the sinus arrhythmia is a change in pp interval gradually. pp interval was gradually reduced and gradually extend the cycle, and the slow phase of the pp interval is not fast relative to integer multiples of pp interval, the performance of different lengths for the pp interval.

2. transient sinus arrest and not downstream of atrial contraction and atrioventricular not pass under the transition zone of contraction identification

(1) does not pass under the atrial contraction characteristics are:

① not downstream of the atrial contraction the P 'wave often overlap the previous stroke of the T wave, the T-wave morphology. Should be carefully identified, which is key to the diagnosis, or paper can be used to increase the voltage to speed the way to the P 'wave exposure.

② not downstream atrial contraction is not fully compensatory pause: generally less than two sinus pp interval of and.

③ under more than one pass without atrial contraction produces a long pp interval equal or approximately equal.

(2) does not pass under the transition zone of the atrioventricular contraction characteristics are:

① retrograde P & prime ; often overlap in the previous wave of cardiac T wave, t wave morphology changes can, and should take a close look.

② no atrioventricular junctions downstream of contraction caused by the long pp interval on the electrocardiogram should be equal to each other, or roughly equal.

3. short-term or longer of sinus arrest and sinoatrial block identification of sinoatrial block is generated by the sinus node impulse, some or All can not reach the atria, causing atrial and ventricular asystole. Transient sinoatrial block in acute myocardial infarction, acute myocarditis, hyperkalemia, digitalis or quinidine like drugs and the vagal tone is too high. Cause of chronic sinoatrial block often unknown, common in the elderly, the basic lesions may be idiopathic sinus node degeneration. Other common diseases as coronary heart disease and cardiomyopathy. sinoatrial block can be divided according to their degree of first-degree block, second degree and third degree. But only the second-degree sinoatrial block can be diagnosed from the electrocardiogram. ecg showed a long interval between P wave. Is the basic P-P interval in multiples. sinus arrest is not a multiple of such relationship, then be able to carry out differential diagnosis, some cases can be seen Wenckebach (Wenckebach) phenomenon. And second degree atrioventricular block of Wenckebach phenomenon is similar, but the performance of the pp interval instead of RR interval progressively shortened, until the long interval. sinoatrial block can occur after the end of the escape. Many cases, escape for a long interval before, suggesting that low pacemaker can also organic disorders.

(1) second degree sinoatrial blocktype is characterized by the long pp interval after the pp interval gradually shortened, and the sudden appearance of long pp interval, was "getting short-long conflict," the characteristics of the phenomenon appeared again and again.

(2) second type Ⅱ or sinoatrial block height is characterized by sinus P wave without the long period between the basic sinus pp interval of the whole multiple, easy-to-identify, but if the merger sinus arrhythmia, the diagnosis has been difficult.

4. persistent or permanent sinus arrest and three (complete) sinoatrial block identification

(1) persistent or permanent sinus arrest is rare or atrial escape rhythm atrial escape, but three may be associated with sinoatrial block or atrial escape rhythm atrial escape . The reason is that the pathological sinus node suppression factors also inhibit the atrial pacing.

(2) in long-lasting or permanent sinus arrest before the continuous ecg tracings or 24h Holter record permanent or persistent sinus arrest before a temporary of sinus arrest, then the persistent or permanent sinus arrest the possibility of large; second degree sinoatrial block if there is three sinoatrial block probability.

(3) intravenous injection of atropine, sinoatrial function without improvement to sinus arrest; has improved for three-degree sinoatrial block. If they can not distinguish, we might as diagnosed sinus arrest.

5. persistent or permanent sinus arrest and atrioventricular junctions escape rhythm and ventricular escape rhythm identification

(1) atrioventricular conduction with room room escape and transition zone of the ventricular escape rhythm were, in fact, no sinus arrest, but the excitement of the atrioventricular junctions caused by an atrial chamber series extended only sinus rhythm.

(2) retrograde block with room after room, see the sinus P wave has not yet appeared, it is likely that sinus arrest.

6. persistent or permanent sinus arrest and sinus sinus ventricular conduction differential diffuse ventricular conduction is complete atrial block, sinus excited along the beam room spread under the atrioventricular junctions and ventricular myocardium, resulting in qrs wave, but not by the loss of atrial conduction of conductive, so did not see any P wave. Contribute to the diagnosis of the main points are: ① hyperkalemia. ② The clinical causes leading to hyperkalemia. ③ qrs wave of large abnormal. ④ T waves towering as tent-like tip.

7. persistent or permanent sinus arrest sinus bradycardia with significant identification of significant sinus bradycardia and its frequency is lower than the same cases of atrial escape rhythm or atrioventricular conduction with room room transition zone or ventricular escape rhythm, then the sinus P waves appear as scheduled, and the atrioventricular junctions escape rhythm interfere with atrioventricular out of touch. Like on one or several other ecg sinus bradycardia was seen slightly more than the frequency of the frequency of escape rhythm, and presented as a simple sinus bradycardia or sinus bradycardia with escape rhythm formed out of line interference , would help the diagnosis of sinus bradycardia. However, from sinus bradycardia to sinus arrest possibilities also exist.

[Disease]

sinus arrest may be caused by the diseases?

sinus arrest-related diseases

atrial myocardial infarction acute myocardial infarction after myocardial infarction pericarditis, right ventricular myocardial infarction myocardial infarction

more chest symptoms

"multi-temperament" heart sounds "butterfly" shadow co2 retention pas staining large abnormal qrs wave QT interval prolongation t wave flat or inverted one hundred specific symptoms of valve thickening and valve leaflet thickening after satiation chest crackles gallop heart sounds allergic cough pathologic Q wave is not entirely atypical chest pain of the room block side rib pain, unstable angina stitch


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