Sinus arrhythmia in children
Introduction
Introduction to sinus arrhythmia in children Sinus arrhythmia (sinusarrhythmia) refers to the dysfunction of sinus node, which makes the heart rate appear faster and slower. The pulse accelerates when inhaling and slows down when exhaling. The difference between fast and slow is >0.12s, which is a child. Common physiological phenomena during the period. This phenomenon is more common in bradycardia, but it will disappear after fever, exercise or atropine. In a few cases, the arrhythmia is more obvious. It is suspected to be a second degree of atrioventricular block or premature beat. An electrocardiogram should be used to identify, and the rhythm of the wandering is more common in pediatrics. The pace of sinus node is in the sinus node or sinus. The relationship between the node and the atrioventricular node is variable, and the P wave morphology and the PR interval are periodically changed, often accompanied by sinus arrhythmia. Its clinical significance is the same as sinus arrhythmia. basic knowledge The proportion of illness: 0.004%-0.007% Susceptible people: children Mode of infection: non-infectious Complications: sinus arrhythmia in children
Cause
Causes of sinus arrhythmia in children
(1) Causes of the disease
Sinus arrhythmia is more common in healthy children, especially in children after 3 years old, infants and young children are rare, often appear in slow heart rate or sleep, and when the heart rate increases or exercise, the heart rhythm can be neat and tidy, drugs such as digitalis , morphine, beta blockers can cause arrhythmia, can also be seen in children with structural heart disease.
(two) pathogenesis
Classification and mechanism of arrhythmia: Arrhythmia can be divided into three main categories according to their causes:
1. Excited formation
Can be divided into two categories: sinus arrhythmia and ectopic rhythm, sinus arrhythmia including sinus tachycardia, sinus bradycardia, sinus arrhythmia, migratory rhythm and sinus rest, ectopic rhythm refers to excitement Ectopic pacemakers other than sinus node, such as decreased sinus node autonomy or blocked conduction, secondary pacing point excites, prevent cardiac arrest, called passive ectopic heart rhythm, occurs 1 or 2 times It is said that Yi beat, more than 3 times for escape rhythm, such as the increase in the self-discipline of the secondary pacemaker, the frequency of excitement exceeds the frequency of the sinus node, and the first step is to give excitement before the sinus node, called initiative. Ectopic rhythm, which occurs 1 or 2 times is called premature beat, 3 times or more is called tachycardia, its frequency is faster and regular is called flutter, more rapid and irregular called vibrato, ectopic rhythm According to the different pace points, it can be divided into atrial, borderline and ventricular.
2. Excitatory conduction disorder
The conduction disorder caused by the physiological refractory period is called disturbance, and it most often occurs in the atrioventricular junction area. If multiple consecutive agonists are involved in the atrioventricular junction, the interference is called interfering atrioventricular separation. The pathological block can be Occurred in the sinus node and atrium, in the atrium, junction area and ventricle, respectively, called sinus conduction block, intraventricular block, atrioventricular block and bundle branch block, when excited through the house Ventricular bypass causes some ventricles to excite first, known as pre-excitation syndrome, which is an abnormal conduction pathway.
3. Excitatory formation and conduction disorders coexist
Such as parallel heart rhythm, ectopic heart rhythm with external block, etc., sinus arrhythmia is the most common in children with arrhythmia, among which sinus tachycardia is the first, followed by sinus arrhythmia, only two of them account for arrhythmia 78.6% of the electrocardiogram, most of them are physiological phenomena. The electrocardiogram room of Beijing Children's Hospital detected 1039 arrhythmia from 11969 to 1974. There were 1196 cases of arrhythmia (excluding sinus tachycardia and sinus arrhythmia). The percentage of all kinds of arrhythmia, the highest incidence of premature beats (pre-systolic), the most ventricular, the second block of atrioventricular block, to more than once, the incidence of pediatric arrhythmia and adults, Mainly atrial fibrillation was significantly reduced compared with adults, accounting for only 0.6%. Adult atrial fibrillation was second only to ventricular premature contraction, ranking second.
Prevention
Prevention of sinus arrhythmia in children
It should be noted that certain digitalis such as digitalis, morphine, beta-blockers can cause arrhythmia, but also in organic heart disease, should actively prevent various heart diseases.
Complication
Sinus arrhythmia complications in children Complications sinus arrhythmia in children
Sinus arrhythmia is a common physiological phenomenon and generally has no complications.
Symptom
Symptoms of sinus arrhythmia in children Common symptoms Arrhythmias, tachycardia
Sinus arrhythmia is generally associated with clinical symptoms. It is often found during auscultation or electrocardiography that sinus arrhythmia can be related to the cycle of breathing, acceleration during inhalation, slowing of exhalation, and sinus arrhythmia without clinical significance.
Examine
Examination of sinus arrhythmia in children
Routine examination without abnormalities, routine chest X-ray and echocardiography, ECG features:
1. Respiratory sinus arrhythmia
(1) Sinus P wave.
(2) Arrhythmia is related to breathing, slowing down when exhaling, accelerating when inhaling, and turning the heart rhythm into a rule when holding your breath.
(3) On the same lead, the PP pitch differs by more than 0.12 s.
2. Non-respiratory sinus arrhythmia
(1) The performance is basically the same as that of respiratory sinus arrhythmia.
(2) Arrhythmia has nothing to do with the breathing cycle.
Diagnosis
Diagnosis and differentiation of sinus arrhythmia in children
According to clinical features and auxiliary examination results, the diagnosis of organic heart disease and other causes was confirmed.
Sinus block and sinus rest
(1) Changes in PP interval occurred suddenly, while sinus arrhythmia was irregular.
(2) The long PP interval of sinus block is a simple multiple of the basic sinus rhythm interval (second degree II).
(3) or the PP interval is progressively shortened, and the Wen's phenomenon (second degree I) occurs.
2. Atrial premature contraction
(1) Pre-atrial contraction P' wave and sinus P wave morphology are different.
(2) The basic heart rhythm can be even, and the pre-contraction is advanced in advance, and it is often accompanied by incomplete compensatory interval.
