Bradycardia in children

Nowadays one often hears about such phenomenon as bradycardia in children. It's about slow heartbeats. This is a pathology that is also dangerous, like a heart palpitations.

The propensity to a slowed rhythm of the heart is noted in children who are passive by nature, are prone to a slow reaction, are phlegmatic. Mostly the heart works slowly in children with a reduced body weight, with an insufficient level of physical development, with certain heart diseases. Sometimes heart rate decreases in children who have decreased immunity, often get sick. Similarly, some medicines may be used, as well as physiotherapy procedures. In patients with immunodeficiency, immune pathologies, there is also a tendency to slow heart rhythm.

Is bradycardia dangerous in children?

In the absence of treatment, such a condition can be dangerous, since heartbeat slows down, respectively, and the rate 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, they do not receive the necessary amount of oxygen. Also, the processes of excretion of metabolic products from the body are disturbed. In cells and tissues an excessive amount of carbon dioxide accumulates, which entails a violation of the basic chemical and biochemical processes in the cells.

With excessive accumulation of carbon dioxide in the cells, hypoxia (lack of oxygen) and hypercapnia (correspondingly, an increase in the level of carbon dioxide) occur. This entails a violation of the basic functions of blood, immunity, respiratory and cardiovascular system. Violated the activity of the brain, nervous system, muscles. There may be numerous signs of intoxication, a violation of metabolic processes.

Epidemiology

According to statistics, bradycardia occurs in every sixth child under the age of 3, as a natural physiological response to accelerated growth and rapid body weight gain. Also, bradycardia occurs in every fourth teenager, as they also have accelerated body mass gain. It is also worth noting that every second premature baby is marked with a bradycardia, as their heart is overexerted and has not yet fully adapted to the load. This is also due to structural immaturity of the heart and insufficient development of blood vessels. Also, many premature hearts still have an unclosed septum.

[1], [2], [3],

Causes of the bradycardia in the child

There can 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 can be both reduced fitness of the body, and excessive physical activity, especially among professional athletes.

[4]

Risk factors

The risk group includes, in the first place, children who have a disruption in the normal functioning of the cardiovascular system in a family history. It can be various pathologies of the heart, circulatory system, the tendency to arrhythmias, tachycardia and bradycardia in grandmothers, grandfathers, parents. Children who have suffered bradycardia during pregnancy, children who have some defects and defects of intrauterine development, as well as children with abnormal and severe course of delivery, with prematurity are also at risk.

In the risk group, children of older age with various heart diseases, with pathologies of blood vessels, with other diseases also fall. Children with a high risk of developing allergic reactions, with neuropsychological pathologies, frequent stresses are also at considerable risk. Increased risk in adolescents, in particular, if they are impaired function of the glands of internal and external secretion.

[5], [6],

Pathogenesis

At the heart of pathogenesis is the disruption of the normal functioning of the heart muscle. This slows down the rhythm of the heart. So, as for the rhythm of the heart, there is a decrease in the frequency of contraction of the heart muscle, as a result of which the 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 from the tissues and cells much more slowly are derived by-products of metabolism, carbon dioxide. 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 violation of the normal functioning of the coronary vessels.

[7]

Symptoms of the bradycardia in the child

The main symptoms are a slow heart rhythm, in which the frequency of cardiac contractions decreases below the age norm. In this case, such a reduction should be regular and sustainable. Sometimes this condition is detected only with an objective examination and measurement of pulse / pressure. But the person thus does not feel any pathology.

But there are cases in which the child becomes listless, apathetic. He has a slow reaction, a breakdown. Weakness is felt, the child seems with a reduced vitality. Also worth noting that such a child is inactive, quickly gets tired, does not tolerate high, and even moderate loads. Sometimes it happens that such a child wants to sleep almost always, it is difficult to wake up in the morning, in the evening it also quickly turns off, lack of strength, reduced concentration of attention, insufficiency of thinking and slow reaction.

The earliest signs, which may be harbingers of bradycardia, are child's lethargy, decreased vitality, insufficient level of activity. The child practically does not have fun, becomes sad, tries to sit more, or even lie down. He ignores active games, moves little, often becomes whiny.

[8], [9], [10]

Bradycardia in a child from 1 year to 12 years

Slowing of the heartbeat can occur for various reasons. First of all, they are related to the functional and structural features of the heart, with its underdevelopment, immaturity, as well as a general violation of metabolic processes in the body, with a lack of vitamin or malnutrition. Also can be formed with a lack of nutrients in the body, vitamin, microelements and macro elements. Various diseases (mental, somatic), the presence of infection in the body, in particular, fungal, a violation of heart activity due to genetic predisposition, the impact of external adverse factors - all these are the reasons for the development of a bradycardia.

In addition, in children at this age, bradycardia can be a reaction to certain diseases. Especially often heart rate decreases against the background of colds, infectious diseases, may be a complication of viral diseases, sore throats. It can be a consequence of persistence in the body of herpesviruses, cytomegaloviruses, chlamydia, rickettsia. It can be a consequence of increased sensitivity of the body, as well as a sign of the presence of parasitic infection in the body.

[11]

Bradycardia in children of athletes

This is often noted in connection with the fact that there is an adaptation of the heart muscle to increased stress. Often this is not a negative reaction, as it prevents fatigue of the heart, as well as excessive wear and tear, prevents hyperactivity, and excessive training of the heart, in which the cardiac muscle takes on excessive intake of nutrients and oxygen.

[12], [13]

Bradycardia in children under one year of age

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 stresses. Also, the reason may be a quick set of body weight, and rapid growth, which entails an increased load and a violation of adaptation processes in the body. At the same time, some children feel good, but some feel weak, a breakdown.

It is worth noting that often this state is functional, that is, it is not due to structural changes, but is caused only by a violation of the function. Often this condition is coming and normalized when the causes that caused it are eliminated. There are tools that allow to normalize the function of the heart, accelerate the maturation of the heart muscle and its adaptation to the load. But these funds should be prescribed exclusively by the doctor after the examination. Self-medication can be extremely dangerous.

[14], [15], [16]

Bradycardia in 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 are adversely affected by the environment, excessive, and sometimes extreme loads. Adaptation of the heart to the activity has not yet occurred to the full. The heart muscle is characterized by immaturity, circulatory circles, cardiac 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 in a slow rhythm. Newborn preterm infants may require cardiopulmonary resuscitation, constant monitoring of doctors, taking medications that will reduce excessive stress, promote successful adaptation of the heart muscle, and normalize heart activity.

[17], [18], [19], [20], [21], [22], [23]

Bradycardia in adolescents

Determine the exact cause of bradycardia in adolescents is difficult. This is mainly due to age-related changes, a decrease in the reactivity of the organism, an increased level of excitability, neuropsychiatric overstrain, stress, a change in the hormonal background, a general restructuring of the body, and a violation of the body mass index (the relationship between height and weight). This is due to the rapid growth of the body, and a slow set of body weight. These are the main reasons.

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

Also, a bradycardia can be a reaction to the taking of any medication, or food. Also, the cause of the disease can be kidney disease, pancreas, liver, and some infectious diseases. It often occurs in children with a tendency to obesity, obesity. Often occurs as a reaction to hypothermia, or excessive heat, increased stress, stress, fatigue.

Stages

Usually bradycardia develops in three stages. In the first stage, this is a functional disorder that does not cause significant disturbances, does not cause discomfort, and does not disrupt the normal functioning of the child.

The second stage is accompanied by shortness of breath, a palpable delay in the rhythm of the heart. The child feels weak, it is hard for him to endure high loads, he feels tired very quickly.

In the third stage, usually increases the sensitivity to normal loads, fatigue, lethargy. Severe pathologies can develop, including cardiac pathology, loss of consciousness, heart diseases, a decrease in the intensity of metabolic processes, hypoxia and hypercapnia.

Light bradycardia in a child

This is the simplest form, the first stage of development of pathology, which is accompanied only by functional disorders and does not affect the structure of the heart. Easily eliminated with the help of special stimulating drugs, supplements, and by performing special exercises of adaptive physical training. This form may not even be felt by the child. Often revealed only at the stage of diagnosis, if you purposefully measure the pulse and heart rate.

[24], [25]

Moderate bradycardia in the child

With moderate bradycardia, the heart rate slows down already. At the same time the child feels lethargic and weak, he becomes apathetic, practically does not play, feels the desire to sit, lie down, reduce activity to a minimum. Usually this is a reversible condition, which is easily regulated with the help of special medications.

Severe bradycardia in children

It is a form in which bradycardia becomes very noticeable, and significantly reduces the quality of life. The child becomes sluggish, apathetic, drowsy, there is a lack of strength. There is also a slow heart beat, which is felt not only in the calculation of the pulse, but also in everyday activities, when walking. The pathogenesis is based primarily on adapting 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, a violation of the processes of excretion of toxins and metabolites out. It is worth noting that all this occurs against the background of reducing the body's defenses, reducing the mechanisms of immune defense, hormonal adjustment.

This is a condition in which there is a sharp decrease in the contractile activity of the heart muscle, which leads to a reduction in the heart rate, and leads to a sharp drop in the pulse. At the same time, the child's state of health deteriorates sharply, he feels a breakdown, dizziness, nausea, the appearance of circles, flies before the eyes can occur. Often there is a loss of consciousness. It requires urgent care, as well as mandatory further hospitalization.

Forms

There is a great variety of bradycardia, depending on what factor is the basis of the classification. Thus, when classified according to the age factor, bradycardia of the newborn child, bradycardia in children under one year, bradycardia in adolescents are distinguished. Depending on the functional state, the bradycardia of the premature baby, the bradycardia of the period of school adaptation (occurs in children aged 6-7 years, who first went to school, experiencing stress at the same time), as well as the bradycardia of the adolescent period, which is associated with increased stress on the body, adaptive processes, hormonal changes, age rearrangements.

Sinus bradycardia in children

Implied bradycardia, which is accompanied by a violation of the sinus rhythm of the heart, and is fairly well traced on the electrocardiogram. Sinus bradycardia is caused by a violation of the conduction of the heart, as well as blocking the transfer of momentum within the atria. The main pathology should be sought in the atria. Usually it is normalized by medicinal preparations and special additives.

[26], [27], [28], [29], [30], [31]

Arrhythmia with bradycardia in a child

A condition that is accompanied not only by a decrease in heart rate and heart rate, but also by a violation of its rhythm. At the same time, a malfunction occurs, which can be identified as uneven heart beat. First, rapid heartbeat occurs, then it slows down somewhat. Against the background of a general slowed heartbeat, there may also be an uneven interval between beats. There may be an additional blow, or individual shots fall out.

[32], [33]

Complications and consequences

Consequences can be different - from the usual violation of the heart rhythm, the development of a stable arrhythmia before the violation of the functional state of the heart, the development of cardiomyopathies, heart failure. Bradycardia in children is dangerous and the fact that it entails a violation of metabolic processes, which can slow down their growth, normal development. Also, from the lack of nutrients and oxygen, the brain suffers. Developing hypoxia, hypercapnia.

[34], [35], [36], [37]

Diagnostics of the bradycardia in the child

The diagnosis is based on the identification of the etiological and pathogenetic factors that underlie the development of the disease. It is important to put the right 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, assign appropriate laboratory tests, instrumental studies.

As the main method is the examination, during which the doctor listens to the heart sounds, hears the presence of wheezing, whistles, noise, determines the rhythm, strength, intensity of the heart beat, the zone of cardiac dullness. This makes it possible to presume at the stage of early examination the presence or absence of pathology, to make a preliminary diagnosis and to choose methods of further investigation to confirm this diagnosis.

[38], [39], [40], [41], [42], [43]

Analyzes

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 on its composition. Of course, the study of blood is an important stage in the study of the work of the heart, since it is the transfer of blood through the body that is involved in the cardiovascular system. The intensity of the heart depends on the composition, concentration, density, viscosity of the blood.

Platelets are red blood platelets that determine the function of blood coagulation, its viscosity, basic properties. Responsible for stopping bleeding. If there is a shortage, you can suspect bleeding. The blood becomes more fluid, it can also lead to a decrease in blood pressure and an increase in heart rate. Excess platelets indicate a tendency to thrombosis. The blood becomes thick. Increases the viscosity of the blood, and, consequently, increases the load on the heart: the rhythm decreases, the pressure rises.

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 system of immunity, they provide a normal state of the mucous membranes. With an increase in the number of neutrophils, we can talk about the presence of inflammation, a decrease indicates the intensity of the immune system, protracted inflammatory processes, the presence of a progressive infection, in which it is found already in the blood.

Lymphocytes are also cells that indicate the state of the immune system. Decrease can indicate a violation of the immune system, malfunctions in the functioning of the stagnant brain. The increase can talk about the presence of a viral infection, the intensity of immunity.

The increased number of eosinophils and basophils can speak of the presence of an allergic reaction, parasitic infection, the presence in the body of protozoa microorganisms. The increase in eosinophils is also observed with blood transfusions, chronic sensitization of the body, pregnancy, the field of operations, transplantation of organs and tissues. This is a reaction to the presence in the body of all foreign.

ESR - the rate of erythrocyte sedimentation indicates in which direction, and with what intensity inflammatory and autoimmune processes occur in the body.

[44], [45]

Instrumental diagnostics

To study the condition of the heart, instrumental methods can not be avoided. The main method is to measure the pulse and pressure with a tonometer. To do this, a tourniquet is applied to the arm (on the brachial vein, artery), after which the vessel is pinched. The chamber is pumped, a phonendoscope is attached to the vessel to listen to heart beats. When the camera is lowered, the pulse and pressure are calculated (the indicators are reflected on the scoreboard).

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

Bradycardia on ECG in children

In the electrocardiogram, a bradycardia is represented as an increase in the interval between the two upper teeth R - R, which occurs at the expense of the interval T - P. Also, the heart rate is recorded less than 60 per 1 minute. Interval P - Q of normal duration, or slightly above the norm (up to 0.21 - 0.22 seconds).

[46], [47], [48], [49], [50]

Differential diagnosis

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

Treatment of the bradycardia in the child

Details about the treatment of bradycardia in children read in this article.

Prevention

It is important to observe the optimal motor regime, observe the regime of work and rest, avoid overwork, neuropsychic stress, stress. It is important to create a favorable psychological climate for the child, to exclude the impact of adverse social and mental factors. The child should be on a dispensary record with a cardiologist, have timely preventive examinations, and conduct the necessary treatment. It is important to maintain a normal body weight, avoid bad habits. From the diet should be excluded salty, smoked and spicy food. Consumption of salt 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 provides a normal functioning of the heart muscle. It is necessary to take vitamins and mineral complexes periodically. Food should not contain many fats, lipids. Advantage should be given to food containing a large number of carbohydrates.

[51], [52], [53], [54]

Forecast

If you follow all the recommendations of the doctor, take medication, maintain the optimal level of physical activity, 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, up to a lethal outcome.