Bradycardia in children

Nowadays, we often hear about such a phenomenon as bradycardia in children. We are talking about a slow heartbeat. This is a pathology that is as dangerous as a rapid heartbeat.

A tendency to a slow heart rate is observed in children who are passive by nature, prone to a slow reaction, phlegmatic. The heart works mainly slowly in children with reduced body weight, with an insufficient level of physical development, with some heart diseases. Sometimes the heart rate decreases in children who have reduced immunity, are often ill. Some medications and physiotherapy procedures can act in a similar way. Patients with immunodeficiency, immune pathologies also have a tendency to a slow heart rate.

Is bradycardia dangerous in children?

If left untreated, this condition can be dangerous, since the heartbeat slows down, and accordingly, the speed of blood flow through the vessels decreases. This is accompanied by a slowdown in metabolic processes. In particular, organs and tissues do not receive proper nutrition, do not receive the necessary amount of oxygen. The processes of removing metabolic products from the body are also disrupted. Excessive amounts of carbon dioxide accumulate in cells and tissues, which entails a disruption of the main chemical and biochemical processes in cells.

When carbon dioxide accumulates excessively in cells, hypoxia (lack of oxygen) and hypercapnia (accordingly, an increase in the level of carbon dioxide) occur. This entails a violation of the basic functions of the blood, immunity, respiratory and cardiovascular systems. The activity of the brain, nervous system, and muscles is disrupted. Numerous signs of intoxication and metabolic disorders may occur.

Epidemiology

According to statistics, bradycardia occurs in every sixth child under 3 years of age, as a natural physiological reaction to accelerated growth and rapid weight gain. Bradycardia also occurs in every fourth teenager, since they also experience accelerated weight gain. It is also worth noting that bradycardia is observed in every second premature baby, since their heart experiences excessive stress and has not yet had time to fully adapt to the stress. This is also due to the structural immaturity of the heart and insufficient development of blood vessels. Also, in many premature babies, the heart still has an unclosed septum.

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Causes bradycardia in a child

There may be many reasons: structural, functional disorders of the cardiovascular system, other systems, as well as some anatomical and physiological features, for example, excessive body weight, prematurity, some metabolic disorders, changes in the hormonal system, biochemical cycle. The reason may be both reduced training of the body and excessive physical activity, especially in professional athletes.

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Risk factors

The risk group primarily includes children with a family history of abnormal functioning of the cardiovascular system. These may include various pathologies of the heart, circulatory system, a tendency to arrhythmia, tachycardia and bradycardia in grandparents, parents. The risk group also includes children whose mothers suffered from bradycardia during pregnancy, children with certain defects and malformations of intrauterine development, as well as children with abnormal and difficult labor, with prematurity.

The risk group also includes older children with various heart diseases, vascular pathologies, and other diseases. Children with a high risk of developing allergic reactions, with neuropsychiatric pathologies, and frequent stress are also at significant risk. The risk also increases in adolescents, especially if they have impaired function of the endocrine and exocrine glands.

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Pathogenesis

The pathogenesis is based on the disruption of the normal functioning of the heart muscle. This slows down the heart rhythm. So, as for the heart rhythm, there is a decrease in the frequency of contraction of the heart muscle, as a result of which blood is less often ejected from the ventricle of the heart into the aorta. Accordingly, the internal organs receive much less oxygen and nutrients. Also, by-products of metabolism, carbon dioxide, are removed from tissues and cells much more slowly. The basis is a violation of automatism, contractility of the heart muscle, as well as a decrease in the trophism of the heart itself and a disruption of the normal functioning of the coronary vessels.

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Symptoms bradycardia in a child

The main symptoms are a slow heart rhythm, in which the heart rate drops below the age norm. At the same time, such a decrease should be regular and stable. Sometimes such a condition is detected only during an objective examination and measuring the pulse / pressure. But the person does not feel any pathology.

But there are cases when the child becomes lethargic, apathetic. He has a slow reaction, loss of strength. Weakness is felt, the child seems to have reduced vitality. It is also worth noting that such a child is inactive, gets tired quickly, does not tolerate high or even moderate loads. Sometimes it happens that such a child wants to sleep almost always, it is difficult to wake him up in the morning, in the evening he also quickly switches off, there is a lack of strength, decreased concentration, insufficient thinking and a slow reaction.

The earliest signs that may be precursors of bradycardia are the child's lethargy, decreased vitality, and insufficient activity level. The child has almost no fun, becomes sad, tries to sit more, or even lie down. He ignores active games, moves little, and is often tearful.

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Bradycardia in a child from 1 to 12 years old

Slowing of the heartbeat can occur for various reasons. First of all, they are all related to the functional and structural features of the heart structure, its underdevelopment, immaturity, as well as a general disruption of metabolic processes in the body, a lack of vitamins or improper nutrition. They can also form due to a lack of nutrients, vitamins, microelements and macroelements in the body. Various diseases (mental, somatic), the presence of an infection in the body, especially fungal, disruption of heart activity due to genetic predisposition, exposure to external unfavorable factors - all these are reasons why bradycardia can develop.

In addition, bradycardia in children of this age may be a reaction to some diseases. Heart rate often decreases against the background of colds, infectious diseases, and may be a complication of viral diseases, tonsillitis. It may be a consequence of the persistence of herpes viruses, cytomegaloviruses, chlamydia, and rickettsia in the body. It may be a consequence of increased sensitivity of the body, as well as a sign of the presence of a parasitic infection in the body.

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Bradycardia in children of athletes

This is often noted due to the fact that the heart muscle adapts to increased loads. Often this is not a negative reaction, since it prevents overwork of the heart, as well as its excessive wear and tear, prevents hyperactivity and excessive training of the heart, in which the heart muscle acquires excessive consumption of nutrients and oxygen.

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Bradycardia in children under one year

In children of the first year of life, bradycardia is most often a sign of insufficient development of the heart muscle, immaturity of the circulatory system, excessive exposure to its loads. Also, the cause can be rapid weight gain and rapid growth, which entails increased load and disruption of adaptation processes in the body. At the same time, some children feel well, but some feel weak, loss of strength.

It is worth noting that this condition is often functional, i.e. not caused by structural changes, but caused only by dysfunction. Often this condition is transient and normalizes when the causes that caused it are eliminated. There are drugs that help normalize heart function, accelerate the maturation of the heart muscle and its adaptation to stress. But these drugs should be prescribed exclusively by a doctor after examination. Self-medication can be extremely dangerous.

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Bradycardia in a premature baby

Prematurity is dangerous because the child is born before the due date, when its intrauterine development and maturation is still ongoing. The organs are not yet ready for normal functioning outside the mother's body, they experience negative effects of the environment, excessive and sometimes extreme loads. The heart has not yet fully adapted to the activity. The heart muscle is immature, the circulatory system, the heart chambers are not yet fully developed. All this leads to the development of functional disorders, as well as to the fact that the heart works at a slow pace. Premature newborns may require cardiopulmonary resuscitation, constant medical supervision, taking medications that will reduce excessive loads, promote successful adaptation of the heart muscle, and normalize heart activity.

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Bradycardia in adolescents

It is difficult to determine the exact cause of bradycardia in adolescents. It is mainly due to age-related changes, decreased reactivity of the body, increased excitability, neuropsychic overstrain, stress, changes in hormonal levels, general restructuring of the body, as well as a violation of the body mass index (the relationship between height and weight). This is due to rapid growth of the body and slow weight gain. These are the main reasons.

In addition to the main reasons, teenagers also have their own specific reasons, for example, increased sensitivity of the body, including to mosquito bites, worms, and other invasive pathologies.

Bradycardia can also be a reaction to taking a medicine or food product. Kidney, pancreas, liver diseases, and some infectious diseases can also cause the disease. It often occurs in children with a tendency to obesity, corpulence. It often occurs as a reaction to hypothermia or excessive heat, increased workload, stress, and fatigue.

Stages

Usually, the development of bradycardia occurs in three stages. At the first stage, it is a functional disorder that does not cause significant disturbances, does not cause discomfort, and does not disrupt the normal life of the child.

The second stage is accompanied by shortness of breath, a noticeable slowdown in heart rate. The child feels weak, it is difficult for him to bear high loads, and fatigue is felt quite quickly.

At the third stage, increased sensitivity to normal loads, fatigue, and lethargy usually develop. Severe pathologies may develop, including cardiac pathology, loss of consciousness, heart disease, decreased intensity of metabolic processes, hypoxia, and hypercapnia.

Mild bradycardia in a child

This is the simplest form, the first stage of the development of the pathology, which is accompanied only by functional disorders and does not affect the structure of the heart. It is easily eliminated with the help of special stimulating drugs, supplements, and also by performing special exercises of adaptive physical culture. This form may not even be felt by the child. It is often detected only at the diagnostic stage, if the pulse and heart rate are specifically measured.

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Moderate bradycardia in a child

With moderate bradycardia, a slowdown in heart rate is already felt. The child feels lethargic and weak, becomes apathetic, hardly plays, feels a desire to sit, lie down, and reduce activity to a minimum. Usually, this is a reversible condition that is easily regulated with the help of special medications.

Severe bradycardia in children

This is a form in which bradycardia becomes quite noticeable and significantly reduces the quality of life. The child becomes lethargic, apathetic, sleepy, and lacks strength. A slow heartbeat is also noted, which is felt not only when counting the pulse, but also during everyday activities, when walking. The pathogenesis is primarily based on the adaptation of the circulatory system to new conditions or under the influence of stress. The condition worsens due to the fact that it is accompanied by a lack of oxygen, disruption of the processes of removing toxins and metabolites from the outside. It is worth noting that all this occurs against the background of a decrease in the body's defenses, a decrease in the mechanisms of immune defense, and hormonal changes.

This is a condition in which there is a sharp decrease in the contractile activity of the heart muscle, which entails a reduction in the heart rate and leads to a sharp drop in the pulse. At the same time, the child's health deteriorates sharply, he feels a loss of strength, there may be sharp dizziness, nausea, the appearance of circles, flies before the eyes. Loss of consciousness often occurs. Emergency care is required, as well as mandatory further hospitalization.

Forms

There is a wide variety of bradycardias, depending on the factor that is used as the basis for classification. Thus, when classifying depending on the age factor, we distinguish between bradycardia of a newborn child, bradycardia in children under one year, and bradycardia in adolescents. Depending on the functional state, we distinguish between bradycardia of a premature child, bradycardia of the period of school adaptation (occurs in children aged 6-7 who have gone to school for the first time and experience stress), and bradycardia of adolescence, which is associated with increased stress on the body, adaptation processes, hormonal changes, and age-related changes.

Sinus bradycardia in children

This refers to bradycardia, which is accompanied by a disturbance of the sinus rhythm of the heart, and is quite clearly visible on the electrocardiogram. Sinus bradycardia is caused by a disturbance of the conductivity of the heart, as well as a blockage of the impulse transmission within the atria. The main pathology should be sought in the atria. It is usually normalized by medications and special supplements.

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Arrhythmia with bradycardia in a child

A condition that is accompanied not only by a decrease in pulse and heart rate, but also by a disturbance in its rhythm. In this case, a malfunction occurs, which can be identified as an uneven heartbeat. At first, the heartbeat quickens, then it slows down somewhat. Against the background of a general slowdown in heartbeat, unevenness of the intervals between beats may also occur. An additional beat may appear, or individual beats may be dropped.

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Complications and consequences

The consequences may vary – from a common disturbance of the heart rhythm, development of stable arrhythmia to disturbance of the functional state of the heart, development of cardiomyopathy, heart failure. Bradycardia in children is also dangerous because it entails disturbance of metabolic processes, which can slow down their growth and normal development. The brain also suffers from a lack of nutrients and oxygen. Hypoxia and hypercapnia develop.

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Diagnostics bradycardia in a child

The basis of diagnostics is the identification of etiological and pathogenetic factors that underlie the development of the disease. It is important to make the correct diagnosis, on the basis of which further treatment will be selected. To make the correct diagnosis, you need to contact a cardiologist who will conduct an examination, if necessary, prescribe appropriate laboratory tests, instrumental studies.

The main method is an examination, during which the doctor listens to the heart tones, listens for wheezing, whistling, noises, determines the rhythm, strength, intensity of the heartbeat, the zone of cardiac dullness. This allows already at the stage of early examination to assume the presence or absence of pathology, make a preliminary diagnosis and select methods for further research to confirm this diagnosis.

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Tests

Laboratory tests are routinely prescribed for any diagnosis. Since blood is the main liquid medium of the body, all changes occurring in the body are reflected in its composition. Of course, blood testing is an important stage in studying the work of the heart, since the cardiovascular system is responsible for transporting blood throughout the body. The intensity of the heart's work largely depends on the composition, concentration, thickness, and viscosity of the blood.

Platelets are red blood cells that determine the function of blood coagulation, its viscosity, and basic properties. They are responsible for stopping bleeding. If there is a deficiency, bleeding may be suspected. The blood becomes more liquid, which may also lead to a decrease in pressure and an increase in heart rate. An excess of platelets indicates a tendency to thrombosis. The blood becomes thick. Blood viscosity increases, and accordingly, the load on the heart increases: the rhythm decreases, the pressure increases.

An increase in the number of leukocytes may indicate the development of an inflammatory process. A decrease in the number of leukocytes may indicate anemia, leukemia, oncological processes, immunodeficiency, insufficient activity or immaturity of the bone marrow.

Neutrophils are part of the phagocytic immune system, they ensure the normal condition of the mucous membranes. An increase in the number of neutrophils can indicate inflammation, a decrease indicates tension in the immune system, protracted inflammatory processes, the presence of a progressive infection, in which it is already detected in the blood.

Lymphocytes are also cells that indicate the state of the immune system. A decrease may indicate a disorder of the immune system, malfunctions in the functioning of the bone marrow. An increase may indicate the presence of a viral infection, stressed immunity.

An increased number of eosinophils and basophils may indicate an allergic reaction, parasitic infection, or the presence of protozoa in the body. An increase in eosinophils is also observed during blood transfusions, chronic sensitization of the body, pregnancy, after operations, organ and tissue transplants. This is a reaction to the presence of anything foreign in the body.

ESR – erythrocyte sedimentation rate indicates in which direction and with what intensity inflammatory and autoimmune processes are occurring in the body.

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Instrumental diagnostics

Instrumental methods cannot be avoided to examine the condition of the heart. The main method is to measure the pulse and pressure using a tonometer. To do this, the tonometer tourniquet is applied to the arm (to the brachial vein, artery), after which the vessel is compressed. The chamber is inflated, a phonendoscope is applied to the vessel to listen to heartbeats. When the chamber is deflated, the pulse and pressure are counted (the readings are displayed on the display).

The second method is an electrocardiogram, which records the heart rhythm. The doctor then deciphers it and makes a diagnosis. In rare cases, echocardiography is used, which allows identifying the causes of bradycardia, ultrasound of the heart, computer or magnetic resonance imaging.

Bradycardia on ECG in children

On the electrocardiogram, bradycardia is presented as an increase in the interval between the two upper teeth R - R, which occurs due to the interval T - P. A heart rate of less than 60 per 1 min is also recorded. The interval P - Q is of normal duration, or slightly exceeds the norm (up to 0.21 - 0.22 sec.).

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Differential diagnosis

It is aimed at differentiating the signs of bradycardia from the signs of other diseases that have similar signs. For this purpose, the electrocardiogram method, echocardiography, electrophysiological methods, and some functional tests are mainly used. The clinical picture of the pathology is taken into account.

Treatment bradycardia in a child

Read more about methods of treating bradycardia in children in this article.

Prevention

It is important to maintain an optimal physical regime, observe a work and rest regime, avoid overwork, nervous and mental strain, and stress. It is important to create a favorable psychological climate for the child and eliminate the impact of unfavorable social and mental factors. The child should be registered with a cardiologist, undergo preventive examinations in a timely manner, and undergo the necessary treatment. It is important to maintain normal body weight and avoid bad habits. Salty, smoked, and spicy foods should be excluded from the diet. Salt consumption should be reduced to a minimum - no more than 2-3 grams per day.

You should also increase the amount of products containing a large amount of potassium - tomatoes, potatoes, oranges. Potassium ensures the normal functioning of the heart muscle. It is necessary to periodically take vitamins, mineral complexes. Food should not contain a lot of fats, lipids. Preference should be given to food containing a large amount of carbohydrates.

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Forecast

If you follow all the doctor's recommendations, take medications, maintain an optimal level of physical activity, and perform all the necessary preventive measures, bradycardia in children can be successfully eliminated. If you do not follow the recommendations and are irresponsible about your health, the consequences can be unpredictable, even fatal.