Sinus arrhythmia in adolescents

Sinus arrhythmia in adolescents in cardiology is determined in violation of the frequency and rhythm of contractions of the heart muscle, which can be both physiological and pathological. In any case, it is necessary to consult a doctor with this symptom, since only the cardiologist can find out: where the violation of the heart rhythm is associated with the anatomical and physiological features of the cardiovascular system during the pubertal period, and where there is a pathological abnormality in the electroconductive system of the heart.

According to the International Classification of Diseases, disturbances in the work of the sinus-atrial node, which are manifested by an increase or decrease in the heart rate, have a code for the ICD 10 - 149.

[1], [2], [3], [4], [5]

Causes of sinus arrhythmia in adolescents

In the majority of cases, the causes of sinus arrhythmia in adolescents - when the heart rate (HR) for a short time falls out of normal physiological indicators - lie in the variability of the rhythm of the heart in the process of breathing. The so-called respiratory supraventricular tachyarrhythmia, common to many adults, appears with increased physical exertion, stress or increased excitement, high temperature indices during infectious diseases, and after taking certain medications. On the ECG, respiratory sinus arrhythmia in adolescents looks like a change in the RR interval: during inspiration it contracts (heart rate rises), and expands during expiration (heart rate decreases).

Such sinus arrhythmia does not require therapy. Moreover, since the excitation and inhibition of the vagus nerve (nervus vagus) alternating during respiration, which ensures parasympathetic innervation of the smooth muscles of the lungs and heart, fluctuations in heart rate are considered to be a physiological adaptive response of the organism. As noted by cardiologists, with auscultation, respiratory sinus arrhythmia is detected in 85-90% of adolescent patients.

In addition, the pubertal period is characterized by: hormonal changes that affect the work of the heart; various manifestations of autonomic dysfunction of somatoform etiology; propensity to neuroses. Therefore, if the complaints are identical and the supraventricular tachyarrhythmia is expressed on the ECG, the child can be diagnosed with neurogenic or neurocirculatory asthenia (dystonia) or cardioneurosis, which is basically the same, because it is a consequence of a violation of parasympathetic neuro-regulation of the cardiovascular system.

The pathogenesis of sinus arrhythmia in adolescents not associated with respiration is the violation of pulse generation by the main driver of the heart rhythm - the sinus-atrial (sinus or synotrial) node, which is a cluster of special cells (cardiomyocytes) in the myocardium of the upper right atrium. Due to the polarization of the membranes of these cells, electrical impulses are produced, causing rhythmic contractions of the cardiac muscle fibers. Violations of the functions of the synotrial node may be a signal for the presence of various infectious cardiological diseases (rheumatic carditis, myocarditis, endocarditis) or previously not manifested anomalies (for example, congenital Wolff-Parkinson-White syndrome, sinus node weakness or mitral valve prolapse) in the teenager.

To supraventricular tachyarrhythmia can lead to the presence of foci of chronic infection (tonsillitis, caries), iron deficiency anemia, as well as electrolyte imbalance - especially the deficiency in the body of a teenager potassium, calcium or magnesium. So, a lack of calcium happens with a decrease in the functions of the thyroid gland or chronic liver and kidney failure. With a tendency to diarrhea, adrenal diseases, anemia, excessive physical exertion and stress, the body loses potassium. And intestinal diseases, hypoglycemia, lack of B vitamins or prolonged treatment with antibiotics cause a significant decrease in the level of magnesium ions (without which the intake of calcium ions into the cells of the heart muscle is disrupted).

[6], [7], [8], [9], [10]

Symptoms of sinus arrhythmia in adolescents

Symptoms of sinus arrhythmia in adolescents are different for tachycardia (rapid heart rate) and bradycardia (lower heart rate).

The first signs of sinus arrhythmia in adolescents with tachycardia are manifested by sudden attacks of strong palpitation or irregular heartbeat, accompanied by general weakness, increased sweating and light dizziness. There may be complaints about a feeling of discomfort behind the sternum and cardialgia (pain in the heart).

It should be borne in mind that the intensity of the manifestation of symptoms is directly dependent on the degree of development of pathology, and there are often no obvious signs at all. But such symptoms as a teenager's fast fatigue, lethargy, bouts of breathing, blanching of the skin and syncopal (fainting) conditions, should not be overlooked by adult family members.

Severe sinus arrhythmia in adolescents occurs with severe neuroses, as well as infectious diseases of the myocardium, which can develop due to viral, bacterial or parasitic damage to internal organs. In such cases, the pulse of the teenager is rapid, but of weak filling, the skin is pale, blood pressure is low.

Nadzheludochkovaya tachyarrhythmia with mitral valve prolapse manifests not only tachycardia and a sense of lack of air during breathing, but also not dependent on physical exertion with aching or stitching pains in the heart. And in the syndrome of weakness of the sinus node, there is a sinus bradycardia (less than 55 beats per minute) with a sinking heart, dizziness, a cold sweat, a sensation of suffocation and short-term fainting.

The consequences of this pathology can be serious with organic lesions of the heart structures; for example, with supraventricular tachyarrhythmia associated with mitral valve prolapse, its insufficiency develops.

The most frequent complications are heart failure and hemodynamic disorders, that is, a slowdown in the total blood flow in the vascular system. This leads to an insufficient supply of oxygen to the brain cells, which negatively affects the health status of the teenager and their cognitive abilities.

Diagnosis of sinus arrhythmia in adolescents

The standard diagnostics in clinical practice begins with the collection of anamnesis, general examination with measurement of the pulse rate and auscultation.

Instrumental diagnostics include:

• electrocardiography (ECG);
• ECG according to Holter's method (monitoring of the electroconductive system of the heart during the day);
• echocardiography;
• phonocardiography;
• coronary angiography;
• X-ray and ultrasound of the chest in the heart.

Inadequate tests for sinus arrhythmia in adolescents - general and biochemical analyzes of blood and urine, as well as a laboratory study of the level of the hormone in the blood.

Given the polytheology of this symptom complex, differential diagnosis is very important. In serious cases, in order not to miss the organic pathology of the heart structures, cardiologists conduct CT or MRI of the chest in the heart area.

[11], [12], [13], [14]

Treatment of sinus arrhythmia in adolescents

As already noted above, in cases of physiologically induced fluctuations of the heart rate during breathing, the treatment of sinus arrhythmia in adolescents is limited to the appointment of light sedative agents of plant origin that contribute to the normalization of the heart rhythm: tinctures of motherwort or valerian (15-17 drops twice a day), tablets of Alora with an extract of passionflowers, Dormiplant with extracts of Valerian root and Melissa leaves, etc.

In the presence of the main, etiologically related disease, it is necessary to carry out its complex treatment with the appropriate specialist, to which the doctor who observes the patient will send. When a cardiologist does not see the positive dynamics of non-drug therapy - regulating the regimen, making adjustments to the diet, taking vitamin-mineral complexes - drugs can be used.

When supraventricular tachyarrhythmias in adults, the use of drugs blocking the β-receptors of epinephrine and norepinephrine is shown, but all of them have a restriction of use up to 18 years as a contraindication. This indication can be explained by the presence of huge lists of side effects in these medicines, including thrombocytopenia, increased blood sugar, diuresis and vision disorders, nausea, intestinal problems, fainting, insomnia, etc.

Among drugs with antiarrhythmic effect, the most commonly prescribed powder is Magnesium sulfate (1 g per 100 ml of water) and tablets Quinidine and Etatsizin. The last two antiarrhythmic drugs are contraindicated in pediatrics, but the age limit is unfortunately not specified in the instructions.

Medications that block the calcium channels of cardiomyocytes are used to relieve supraventricular tachyarrhythmia, and Amiodarone (other trade names - Cordarone, Aldaron, Sedacoron) or Verapamil hydrochloride (Verakard, Lekoptin, Kaveril) can be prescribed to teenage patients. Amiodarone take one tablet (0.2 g) once a day, while eating. This drug has contraindications (thyroid pathologies and potassium deficiency in the body) and side effects (in the form of gravity in the stomach, nausea, loss of appetite, lowering blood pressure, dizziness and depressive state).

Verapamil is allowed to be used in the treatment of sinus arrhythmia in adolescents from the age of 14 (40 mg twice a day, half an hour before a meal); over 14 years old - 40 mg three times a day. This medicine also has side effects: nausea and vomiting, diarrhea and frequent urination, decreased blood pressure, headache and dizziness, disturbed sleep and psyche.

With supraventricular tachyarrhythmia, Sparteine sulfate, Asparcum (Panangin), Tromcardinum can also be used - one tablet 2-3 times a day.

Cardiologists who do not have homeopathic specialization, homeopathy for sinus arrhythmia in adolescents is not used. To do this, you need to find a cardiologist-homeopath (or homeopath-cardiologist), who will prescribe the appropriate drug after the rapid diagnosis of Voll. These can include agents such as Spigelia, Heart tone, Cralonin, and others.

Operative treatment is required in case of a blockade of the sinus-atrial node threatening to stop the heart. Then a cardiac operation is performed to implant the pacemaker, which will replace the failed heart rate driver.

Alternative treatment of sinus arrhythmia in adolescents

The most well-known and proven means for maintaining the normal functioning of the heart muscle - honey with nuts and dried apricots - can be used as an alternative treatment for sinus arrhythmia in adolescents.

For its preparation, you need to peel two dozen walnuts and crush the kernel to the state of small crumbs. And then scald two lemons and, without peeling, very finely chop, draining the juice in a glass container. In the same way, you should prepare dried apricots (200 g). Finishing stage of preparation: mix thoroughly with 200 g of natural honey (you can use both liquid and sugar). And be sure to add lemon juice, which was collected during the cutting of lemons. The mixture is transferred to a jar with a lid and stored in the bottom of the refrigerator. Use a tablespoon no more than two times a day - in the morning and in the evening.

In addition, phytotherapists recommend the treatment of herbs sinus arrhythmia in adolescents. Used infusions of herb Leonurus, vinca small, sweet clover, melissa, hiccough, vulgaris vulgaris, icteric leucoid (250 ml of water - a tablespoon of dry raw materials). Such home remedies should be taken twice a day for 50-70 ml, infusion of icteric - 10-15 drops 2-3 times during the day.

Of course, can not do without broths of roots and rhizomes of valerian or hawthorn fruit. Their preparation can be simplified by filling the shredded raw material with boiling water in a small thermos bottle. After 5 hours the product is ready, after cooling it needs to be poured into a container with a tight lid, the shelf life in the refrigerator is 4-5 days (then a fresh portion is prepared). Dosage - on a teaspoon three times a day, before eating; duration of application - month.

[15], [16], [17]

Prophylaxis and prognosis of sinus arrhythmia in adolescents

Prevention of sinus arrhythmia in adolescents includes: a daily regimen (with an obligatory 8-hour night sleep), no stress, reasonable physical activity, regular and proper nutrition (that is, 4-5 times a day, with the exclusion of fatty, sweets and products with caffeine) .

Teenagers will benefit from enriching the diet with products containing potassium, calcium and manganese. Foods rich in potassium salts include baked potatoes, legumes, carrots, beets, bananas, oranges, avocados. Calcium is abundant in dairy products (especially cheese and cottage cheese), in almonds and sunflower seeds. And to get enough magnesium you need to eat buckwheat, oatmeal, barley and millet cereals, as well as all sorts of nuts.

It is clear that the prognosis of the disease is individual, since the pathogenesis of cardiac rhythm disturbances is different. However, with due attention to the health of adult offspring, it is possible to detect and treat the disease in time (if it is not genetically determined). And the creation of conditions for the normalization of health will help to ensure that sinus arrhythmia in adolescents does not become a serious cardiac pathology for life.