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.
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?
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.
(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.
(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.
2. long interval of no P-QRS-T wave group appears.
sinus arrest ate?
what patients should intake?
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:
sinus arrest precautions before treatment?
sinus arrest performance:
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
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.
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.
(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).
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.
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) does not pass under the transition zone of the atrioventricular contraction characteristics are:
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 block Ⅰ type 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.
(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.
(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.
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
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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