sinus arrest
Introduction
Introduction to sinus arrest Sinusarrest (sinusarrest), also known as sinusstandstill (sinusstandstill), sinus intermittent, sinus pause, etc., refers to the sinus node to stop giving excitement within a certain period of time. According to the cardiac pacemaker stop, it can be divided into sinus arrest, atrial arrest, junctional regional arrest, ventricular arrest, whole heart arrest, clinical cardiac arrest (cardiac arrest), ventricle Stopping and sinus arrest are the most important. According to the reasons of the arrest, it can be divided into two types: primary sinus arrest and secondary sinus arrest. According to the time of the stroke, it can be divided into three types: short pause, longer stop, and permanent stop. basic knowledge The proportion of illness: 0.0025% Susceptible people: no specific people Mode of infection: non-infectious Complications: syncope A-S syndrome
Cause
Cause of sinus arrest
Causes
Cardiac organic disease
Primary sinus arrest is more common, mainly due to damage to the sinus node itself, mostly caused by organic heart disease, such as coronary heart disease, acute myocarditis, cardiomyopathy, sick sinus syndrome, frequent death arrest It is the pre-dying performance of various diseases in the late stage. In addition, cardiac trauma or cardiac surgery can damage the sinus node, sinus arrest can occur during or after surgery, and coronary angiography can also lead to sinus arrest.
Sinus node pacemaker cells are inhibited
Inflammation, fibrosis, degeneration, etc. can inhibit the electrophysiological properties of sinus node pacemaker cells, causing their temporary or permanent loss of self-discipline. At this time, the sinus node self-discipline intensity is grade 0, and sinus arrest occurs. Beat.
Arrhythmia
Transient sinus arrest (2 to 4 s) secondary to various tachyarrhythmia: most common in supraventricular tachycardia, after stimulation of the vagus nerve and drug therapy or over-speed suppression of esophageal pacing, on the room The sinus arrest that occurs when the tachycardia is suddenly corrected is mostly transient.
Drug factor
Antiarrhythmic drug overdose or poisoning can cause sinus arrest: such as digitalis, quinidine, reserpine, amiodarone, etc., recently, propafenone (heart rhythm), moresizine, flecainide, Case report of anoxazoline and adenosine triphosphate (ATP)-induced sinus arrest.
other factors
Increased vagal tone or carotid sinus allergy, inhibition of sinus node function caused by sinus arrest: such as oppression of the eyeball, massage of the carotid sinus, stimulation of the pharynx, tracheal intubation, etc., normal people can sometimes occur. Hyperkalemia, hypokalemia can also cause sinus arrest.
Prevention
Sinus arrest prevention
Regularly use the instrument to detect heart rate, pay attention to changes in related indicators and symptoms, promptly seek medical treatment, and actively treat arrhythmia, coronary heart disease, myocarditis and other primary diseases. Correct electrolyte imbalance and rational use of related drugs.
Complication
Sinus arrest complications Complications syncope A-S syndrome
Sinus arrest If the treatment is not timely, the prolonged period of time is too long, and there is no serious escape, such as convulsions, syncope, black Mongolian, A-S syndrome, and even sudden death.
Symptom
Sinus arrest symptoms common symptoms sinus arrest stun consciousness disorder blackmont
If the sinus arrest is too long, if there is no escape, the sinus arrest is transient, the duration is short, and it can be asymptomatic. When the sinus arrest time lasts longer, more than 8s, the patient can appear. Black Mongolian, transient disturbance of consciousness or syncope, severe cases can occur Adams-Stokes syndrome and even death, long-term sinus arrest without associated with escape, can cause death.
1. In normal sinus rhythm, a sudden long interval suddenly appears.
2. There is no P-QRS-T wave group in the long interval.
3. The long intermittent PP interval is not multiplied with the normal sinus PP interval.
4. After a long PP interval, an escape or escape rhythm may occur, and the atrioventricular transitional escape or escape rhythm is more common, and ventricular or atrial escape is less common.
5. In the case of a single heart rhythm of escape rhythm, the possibility of persistent primary sinus arrest should be considered.
Examine
Sinus arrest
The electrocardiogram can confirm the diagnosis and has the following characteristics:
1. Transient or persistent sinus arrest The sinus node has no impulses one or more times, so there is a long interval of varying lengths on the ECG. During this long interval, there is no P-QRS-T wave. The long PP interval is not an integral multiple of the basic sinus rhythm cycle. On the same electrocardiogram, one or more long PP intervals may occur, but the lengths of long PP intervals appearing each other may be inconsistent, transient sinus stop There is no escape, and sometimes it can occur. Most of them are atrioventricular transitional escape. The longer-term sinus arrest is often accompanied by an escape rhythm. Most of them are atrioventricular transitional rhythm.
2. Persistent or permanent sinus arrest: no sinus P wave can be seen on the electrocardiogram, secondary escape rhythm or slow escape rhythm can be seen, often accompanied by atrioventricular junction escape Heart rhythm, ventricular escape rhythm, atrial escape rhythm is rare.
3. Paroxysmal supraventricular tachycardia, atrial flutter, atrial fibrillation and other sinus arrests due to these rapid heart rate can lead to overspeed inhibition, it can cause sinus arrest, but its sinus node function is only mild Lower, so the prognosis is good, long PP interval is often greater than 2s, during the transition of fast-slow syndrome, different degrees of sinus arrest can also be seen.
Diagnosis
Diagnosis of sinus arrest
1. Identification of transient sinus arrest and severe and significant sinus arrhythmia
Sometimes the two are difficult to identify, the severe and significant sinus arrhythmia is less common, and the slow phase PP interval can be significantly prolonged. In a few cases, it can be greater than the sum of two short PP intervals, similar to sinus arrest. However, the change of PP interval is gradual when sinus arrhythmia is irregular, the PP interval is gradually shortened and gradually extended, and the PP phase of slow phase is not an integral multiple of the fast phase PP interval, which is expressed as PP. The length of the period varies.
2. Identification of short-term sinus arrest and pre-atrial contraction in the atrioventricular contraction and non-transmission:
(1) The characteristics of pre-trial contraction that have not been transmitted are:
1 The P' wave of the pre-atrial contraction that has not been transmitted is often overlapped on the T wave of the previous heart beat, so that the T wave shape changes, which should be carefully found. This is the key to diagnosis, and the voltage or paper speed can be increased. The faster method makes the P' wave appear.
2 The compensatory interval of contraction before atrial contraction is incomplete: generally less than the sum of the two PP intervals of sinus rhythm.
The long PP intervals produced by more than 3 uncontained atrial contractions were equal or approximately equal.
(2) The characteristics of the premature contraction of the uncompleted compartmental transition zone are:
1 Retrograde P' wave often overlaps the T wave of the previous heart beat, which can change the T wave shape, so it should be carefully searched.
2 The long PP interval caused by the contraction of the premature contraction without the transfer of the compartment should be equal or roughly equal to each other on the electrocardiogram.
3. Identification of transient or longer sinus arrest and sinus conduction block
Sinus block refers to the impulse of sinus node, some or all of which can not reach the atria, causing atrial and ventricular arrest. Short-term sinus block is seen in acute myocardial infarction, acute myocarditis, hyperkalemia, digitalis or The role of quinidine drugs and vagal tone is too high, the cause of chronic sinus block is often unknown, more common in the elderly, the basic lesions may be idiopathic sinus node degeneration, other common diseases because of coronary heart disease and cardiomyopathy The sinus block can be divided into the first degree, the second degree and the third degree according to the degree of blockage, but only the second degree of sinus block can make a diagnosis from the electrocardiogram. The electrocardiogram shows a long interval between the P waves. Is a multiple of the basic PP interval. There is no such multiple relationship in sinus arrest. According to this, differential diagnosis can be made. In some cases, Wenckebach phenomenon can be seen, and Wen's in the second degree atrioventricular block. The phenomenon is similar, but the PP interval is not progressively shortened until the RR interval, until there is a long interval, the sinus block can be delayed, and in many cases, the interval before the escape is quite long, suggesting that the low position Beat point At the same time, organic energy barriers.
(1) The second-degree type I sinus block is characterized by a gradual shortening of the PP interval after the long PP interval, and a sudden appearance of a long PP interval, which is characterized by a "sudden and short length". appear.
(2) The second degree II or even high sinus conduction block is characterized by the long interval of sinusoidal P wave is an integral multiple of the basic sinus rhythm PP interval, easy to identify, but if combined with sinus arrhythmia, Then the diagnosis is difficult.
4. Identification of persistent or permanent sinus arrest and third degree (complete) sinus block
(1) Persistent or permanent sinus arrest rarely occurs in atrial escape or atrial escape rhythm, and third-degree sinus block may be associated with atrial escape or atrial escape rhythm, the reason It is a pathological factor that inhibits the sinus node and also inhibits atrial pacing.
(2) Persistent or permanent sinus with temporary sinus arrest before permanent or permanent sinus arrest recorded by continuous electrocardiogram or 24h ambulatory electrocardiogram before permanent or permanent sinus arrest The possibility of sexual arrest is large; if there is a second degree sinus block, the possibility of third-degree sinus block is large.
(3) After intravenous injection of atropine, the sinus conduction function did not improve to sinus arrest; there was improvement to third-degree sinus block, if the two could not be distinguished, it may be diagnosed as sinus arrest.
5. Identification of persistent or permanent sinus arrest and atrioventricular transitional rhythm and ventricular escape rhythm
(1) Atrioventricular junctional escape and ventricular escape rhythm with room conduction, there is actually no sinus arrest, but a series of sinus rhythms caused by ventricular conduction in the atrioventricular junction It's just a matter of delay.
(2) With the retrograde blockage of the room, there is still no sinus P wave, it is likely to be sinus arrest.
6. Persistent or permanent sinus arrest and sinus conduction
Sinus conduction is diffuse complete atrial block, sinus agitation is transmitted along the room bundle to the atrioventricular junction and ventricular muscles, producing QRS waves, but not through the loss of conductive atrial muscle conduction, so it is not seen Any P wave that contributes to this diagnosis is: 1 blood potassium is too high; 2 has a clinical cause of hyperkalemia; 3QRS wave wide deformity; 4T wave tip like a tent.
7. Identification of persistent or permanent sinus arrest and significant sinus bradycardia
When the frequency of obvious sinus bradycardia is lower than the atrial escape rhythm or the atrioventricular junction or ventricular escape rhythm with room conduction, the sinus P wave appears as scheduled, and the chamber is connected. Regional escape rhythm forms interfering atrioventricular dislocation, as the frequency of sinus bradycardia seen on one or several other electrocardiograms slightly exceeds the frequency of escape rhythm, but presents as simple sinus bradycardia or sinus Cardiac bradycardia and escape rhythm form an interfering disjoint, which contributes to the diagnosis of sinus bradycardia. However, the possibility of transition from sinus bradycardia to sinus arrest is also present.
