Can't count pulses per minute
Introduction
Introduction Mostly arrhythmia. The heart's pulsation is very regular. When the heart beats too fast, too slow or intermittent beat disorder, it is called arrhythmia. Arrhythmia can be found by touching the pulsation of the radial artery with your hand, but you must rely on an electrocardiogram for detailed examination. In daily life, the normal person's heart rate is roughly between 50-100 beats per minute. When the heart beats more than 100 times per minute, it is called tachycardia. When the heart beats less than 60 beats per minute, it is called bradycardia.
Cause
Cause
Arrhythmia can be seen in a variety of organic heart disease, including coronary atherosclerotic heart disease (referred to as coronary heart disease), cardiomyopathy, myocarditis and rheumatic heart disease (referred to as rheumatic heart disease) is more common, especially in the occurrence of heart In the event of failure or acute myocardial infarction. Arrhythmias that occur in patients with basic health or autonomic dysfunction are not uncommon. Other causes include electrolyte or endocrine disorders, anesthesia, hypothermia, chest or heart surgery, drug effects, and central nervous system diseases. Some causes are unknown.
Examine
an examination
Related inspection
Electrocardiogram
First, the consultation
In addition to solving the general medical history, the focus should be on the following two aspects.
1. The situation at the onset of arrhythmia: For most patients, the onset of arrhythmia is often not seen by doctors, especially when arrhythmia occurs intermittently. Therefore, ask patients or insiders (including eyewitnesses) in detail. Diagnosis is very necessary. The consultation should not only understand the cause, frequency, frequency, and duration of the attack. In addition to the mitigation method or process, it is more important to ask about the patient's feeling of arrhythmia, blood pressure, heart rate (rate) and whether there is palpitations, dizziness, J black, syncope, convulsions, shortness of breath, difficulty breathing.
2, the diagnosis of the cause: Although most of the arrhythmia is common in patients with structural heart disease, but many cases occur in other systemic diseases, and even in "healthy" people, therefore, in addition to pay attention to the cardiovascular system symptoms at the time of the consultation In addition, you should also pay attention to the symptoms outside the cardiovascular system, paying particular attention to the endocrine system, respiratory system, blood system, infection, water and electrolyte balance and medication.
Second, physical examination
Physical examination of patients with arrhythmia should pay attention to three points:
1. Frequency and characteristics of arrhythmia: mainly through cardiac auscultation. Although most arrhythmias rely on electrocardiogram to determine the nature, some simple arrhythmias such as premature beats, atrial fibrillation, etc. can basically establish a diagnosis through auscultation.
2, evidence of organic heart disease: such as heart enlargement, organic heart murmur, cardiac insufficiency.
3, other system abnormal performance: such as pay attention to patients with thyroid enlargement, pulmonary hypertension, anemia, infection and other signs.
Third, special inspection
For the qualitative diagnosis of arrhythmia, ECG is undoubtedly the simplest and most reliable method, but it can only record the heart rate (rate) in a short period of time, which makes it difficult to diagnose the arrhythmia of intermittent seizures. Dynamic electrocardiogram compensates for the deficiency of conventional electrocardiogram in this respect. It can continuously record the change of heart rate (rate) within 24-48 h of patients, which is important for the qualitative and quantitative diagnosis of arrhythmia in patients, but there is also a certain dynamic electrocardiogram. Disadvantages, such as the price is more expensive, can not be displayed in real time, and the number of leads is less, it is not as accurate as conventional ECG positioning. ECG monitoring combines the advantages of electrocardiogram and dynamic electrocardiogram. It can be dynamically observed and displayed in real time. In particular, his alarm and automatic recording functions bring great convenience to clinical diagnosis. In recent years, clinical application of ventricular membrane potential, heart rate variability analysis, esophageal or intracardiac electrophysiological examination and other methods are mainly helpful in judging the risk of prognosis or arrhythmia and the mechanism of arrhythmia.
Diagnosis
Differential diagnosis
Unable to count the pulse rate per minute needs to be distinguished from the following symptoms:
Micro-pulse: The pulse is very thin and soft, and it seems to be like nothing.
Pulse acceleration: People of different ages have different pulse rates. The younger the age, the faster the pulse. If the rate exceeds the normal range, it is called pulse acceleration. The pulse is weak and can not be clearly touched: obstetric shock is divided into shock compensation period, shock inhibition period, and shock failure period. A weak pulse or even a clear failure is a symptom of the shock inhibition period.
