Bradycardia: symptoms, degrees, consequences

The lower limit of normal heart rate varies widely for different age groups of patients. For adults of working age, 60 beats per minute is considered normal. However, if it is found that a person's heart beats more slowly (bradycardia), this does not necessarily mean pathology. A slightly slower rate at which the heart muscle contracts may be a normal variant in adolescents or in people who are constantly and seriously involved in sports. For example, in people over half a century old, the heart beats at a rate of 65 beats per minute and faster, so a slow heartbeat in the elderly is recorded with a more frequent pulse. The heart muscle contracts even faster in children, especially small ones. [ 1 ]

In this article, we will look at the symptoms and types of bradycardia and try to understand in which cases and why slow heart rate can be dangerous. However, in most patients, a decrease in cardiac output occurs due to pathological reasons that cause a violation of cardiac conduction or the automaticity of the sinus node, its weakness.

Patients rarely pay attention to the first signs of bradycardia. In the initial stages, it is almost not clinically manifested. Rare dizziness and slightly increased fatigue are attributed to fatigue, weather changes, and pressure fluctuations. A slight slowdown in heart rate is usually an accidental finding during an electrocardiogram for a completely different reason.

The pronounced symptoms - weakness, frequent dizziness, constant fatigue, shortness of breath, pre-syncope, episodes of confusion, speech and visual disorders, fainting correspond to a significant decrease in cardiac output (less than forty per minute). They appear as a result of oxygen starvation of cerebral structures, and this condition requires treatment.

Psychosomatics

Researchers of mental causes of various diseases quite unanimously note: heart problems arise in people who forget about themselves, do not love themselves enough and devote all their strength to serving other people, helping them and solving other people's problems. Such a life position leads to the development of arrhythmia. A person, forgetting about himself, begins to live in someone else's rhythm, adapting to someone else's needs. Tachycardia or bradycardia indicates an urgent need to change the attitude towards oneself - to restore contact with one's heart, the need to learn to love and respect oneself. [ 2 ]

O.G. Torsunov explains the decrease in myocardial contractility and the occurrence of cardiac conduction disorders by passivity and pessimistic moods. Mistrust and the mental stress associated with it lead to weakness of the sinus node. At the same time, sentimental, unfounded gullibility also leads to pathological cardiac conduction due to the increased vulnerability of the nervous tissue of the heart muscle.

Bundle branch block, which leads to heart rhythm disturbances, often occurs in people who constantly work in a tough rhythm – executives, businessmen.

A slow heart rate somatizes the unwillingness to grow, to age, to mature, the attempt to slow down time in order to postpone the growing up of children, the death of a loved one who is seriously ill.

Symptoms

The occurrence of negative symptoms with a reduced pulse rate indicate that it is caused by pathological reasons. These may be heart diseases - an inflammatory process or degenerative changes in the myocardium, atherosclerosis of the coronary arteries, hypertrophic cardiomyopathy, myocardial infarction and its consequences in the form of cicatricial changes. Any person will think about the presence of cardiac pathologies first of all, feeling pain in the heart with bradycardia. However, discomfort in the chest, taken for heart disease, can have a completely different origin. Hormonal disorders associated with dysfunction of the thyroid gland, dysfunction of the adrenal glands, can cause endocrine bradycardia and cardiac discomfort. Heart pain with vegetative-vascular dystonia, neuroses with disorders of vegetative functions have a neurotic origin. Pain in the epigastrium can radiate behind the sternum due to spasmodic contractions of the stomach walls. They can occur with ulcer disease, which also leads to a slow heart rate. The presence of nausea, heartburn, belching can indicate the gastric origin of such pain. Renal, hepatic, intestinal colic, esophageal-diaphragmatic hernia can manifest themselves in this way.

Weakness with bradycardia is a completely natural symptom. When the heart rate decreases, the "main engine" of our body does not pull. Weakness appears, the severity of which corresponds to the degree of slowness of the pulse. Severe weakness requires emergency measures and may indicate a pre-infarction or pre-stroke condition.

Dizziness with bradycardia can be a symptom of instability of arterial pressure, oxygen starvation of brain tissue. As a result of a prolonged decrease in the volume of blood pumped per minute, all organs and tissues suffer from hypoxia, but first of all it affects the work of the brain.

This symptom may worsen over time with periodic fainting and convulsive states. Cerebral hypoxia leads to the development of cerebral insufficiency, which manifests itself in attention disorders, forgetfulness, episodic visual, speech and intellectual disorders.

Headache combined with a slow pulse may be symptoms of a pre-stroke condition, subarachnoid hemorrhage, neoplasms in the brain, or may be a consequence of unstable blood pressure or neurocirculatory disorders.

Patients with bradycardia often have respiratory disorders: shortness of breath, respiratory rhythm disturbances. Such symptoms may accompany any cardiac pathology, and also indicate the presence of primary pulmonary hypertension. Patients complain of coughing with bradycardia, a feeling of respiratory arrest. The most characteristic symptoms of pulmonary hypertension are progressive shortness of breath and rapid fatigue, in the initial stages such conditions occur under the influence of physical exertion. These disorders are associated with right ventricular heart failure and are caused by a decrease in cardiac output. The development of pathological changes is expressed by discomfort in the chest area, dizziness, reaching pre-syncope paroxysms. [ 3 ]

Features of bradycardia in different categories of the population

Slow heart rate is found in most cases in adult patients. This is just a symptom that can indicate many diseases, both directly of the cardiovascular system and other organs.

Bradycardia in adults can be physiological and pathological. In young people who are prone to slow heart rate, bradycardia is often associated with respiratory arrhythmia caused by physiological reasons - instability of the tone of the sympathetic part of the autonomic nervous system, its insufficient activity. With age, activity often stabilizes, and with it - the heart rate. Among the risk factors for the occurrence of such a symptom as bradycardia, acquired causes, cardiac and extracardiac, begin to prevail, leading to abnormal automatism of the sinus node or conduction disorders.

Bradycardia in women of fertile age is often associated with hypothyroidism, intoxication, vegetative-vascular dystonia, stress. Heart diseases in women generally develop later than in men. They are protected by estrogens. An increased risk of developing cardiovascular pathologies is associated with taking hormonal contraceptives. Smoking and alcohol also have a detrimental effect on the cardiovascular system of the female body. Pathological pregnancy - late toxicosis, accompanied by hypertension can cause heart rhythm disturbances in the expectant mother, and even in the distant future, 10 years after childbirth.

Bradycardia during pregnancy manifests itself with the same symptoms as outside of it. Moderate bradycardia may not bother much, but if a woman constantly feels noise in the ears, dizziness, shortness of breath, then it is necessary to draw the attention of the doctor supervising the pregnancy to this. Increased fatigue and weakness should also not be ignored. Some women do not attach importance to such symptoms, believing that during pregnancy this is natural. However, if they are associated with bradycardia, then insufficient cardiac output leads to circulatory disorders, placental insufficiency, fetal hypoxia, premature termination of pregnancy. [ 4 ]

Bradycardia after childbirth also requires examination. Of course, it may go away over time, since childbirth is stress for the body and mild bradycardia may be physiological in nature, especially if the woman gained excess weight during pregnancy, was not very physically active, chronically lacks sleep, is overtired, carried and gave birth to twins or triplets. However, pregnancy complications, in particular, the already mentioned gestosis, unstable blood pressure, genetic predisposition to heart disease, recent colds and other causes may become active in the postpartum period, and bradycardia after childbirth will be the first symptom of a developing pathology.

Pathological bradycardia in men of working age is often associated with myocardial infarction and post-infarction complications, hypertension. The probability of developing a heart attack in men on average begins to increase ten years earlier than in women. Various intoxications, endogenous and exogenous, peptic ulcer are more typical for men. But men are not used to complaining about dizziness, tinnitus and pre-fainting condition. Therefore, they can trigger a pathological process.

Physiological bradycardia is not uncommon in athletes and men engaged in heavy physical labor. Among the male population, a low pulse at rest is observed in about a quarter of its representatives. Sinus bradycardia at rest with good health indicates a well-trained heart. And yet, pathologies in this part of the population cannot be ruled out without examination.

With age, the prevalence of heart rhythm disorders increases proportionally to the growth of cardiovascular pathologies, past illnesses and intoxications, and medications taken. Bradycardia in the elderly is not uncommon. Women with the onset of menopause are often forced to take estrogen-containing drugs to reduce the symptoms of menopause - hot flashes, anxiety, insomnia, the risk of osteoporosis. Hormone replacement therapy, especially long-term and intensive, increases the likelihood of developing heart disease and a decrease in heart rate. American cardiologist H. Glassberg does not advise getting carried away with HRT, especially for women with heart disease. She believes that it is better to combat age-related manifestations with the help of diet and special exercises.

Senile bradycardia in both sexes can be physiological and observed after sleep, stress and physical overexertion, but is more often a symptom of trouble. Elderly people with arrhythmia are recommended to undergo regular examinations: visit a cardiologist, do an electrocardiogram, monitor blood pressure. Constant weakness, dizziness, impaired coordination of movements, vision, paresthesia, pallor and discomfort in the chest can be symptoms of cardiac pathology. [ 5 ]

Bradycardia in children can be a variant of the age norm, or it can be pathological. In the first case, it usually does not manifest itself clinically. In the second case, in babies it is most often caused by congenital heart anomalies or cerebral disorders, previous infectious diseases, intoxications and other reasons. Children born as a result of difficult births, who have suffered hypoxia, are prone to heart rhythm disturbances. Noticeable symptoms of bradycardia in a child (fatigue, shortness of breath, poor appetite and, especially, fainting) indicate the presence of pathology and require mandatory examination. [ 6 ]

Stages

The complex of symptoms corresponding to the slowing of the pulse and, accordingly, the minute volume of blood circulation, can be expressed to varying degrees. Mild bradycardia does not manifest itself in any way, is detected by chance, its correction is usually not difficult. It is also called bradycardia of the 1st degree and is diagnosed when the heart rate differs from the lower limit of the age norm by no more than ten beats per minute. A slightly slow pulse has practically no effect on hemodynamics, however, if such work of the heart is caused by pathological reasons, then the process of slowing can progress. Therefore, accidentally detected bradycardia, even with good health, requires differentiation of the onset of painful changes in the body from physiological characteristics associated with the constitutional-hereditary type or good physical training.

Moderate bradycardia may also not affect blood circulation, so in most cases it does not have noticeable symptoms and is also an accidental finding. Bradycardia of the 2nd degree is diagnosed when the pulse rate differs from the lower limit of the age norm by no more than 20 beats per minute. People with a moderate slowdown in heart rate may notice that they get tired from physical activity, they have shortness of breath and dizziness, however, usually these symptoms do not cause much concern. Sometimes they note a vague discomfort in the chest area. However, if bradycardia of the second degree is detected, it is necessary to undergo an examination and find out its cause.

Severe bradycardia is manifested by noticeable symptoms - severe weakness, dizziness, shortness of breath, pre- and fainting states. All organs and tissues suffer from insufficient blood supply, but, first of all, brain activity is impaired. The patient may begin to have problems with memory and attention, with vision, and episodic confusion appears. Bradycardia of the 3rd degree is diagnosed in patients with a heart rate of less than 40 beats per minute. Severe bradycardia is manifested by attacks of loss of consciousness with convulsions (Morgagni-Adams-Stokes syndrome). The attack lasts from several seconds to several minutes and often passes on its own. When the heart function is restored, consciousness quickly returns to the victim and, in most cases, the attack is amnestic. In young patients without pathologies of the cerebral and coronary arteries, the attack can proceed without loss of consciousness - severe weakness and lethargy occur. In patients with atherosclerosis, it develops rapidly and lasts more than one minute; such an attack can be fatal. [ 7 ]

Depending on the provoking factor, acute and chronic forms of slow heartbeat are distinguished. Severe bradycardia occurs in vascular accidents (heart attack, stroke), acute poisoning, inflammation and infections. Chronic bradycardia develops in severe long-term diseases.

Complications and consequences

Physiological bradycardia does not pose a danger. But only until symptoms appear: weakness, shortness of breath, fainting, etc. A person who is healthy today can get sick tomorrow, and his physiological feature can turn into a pathology. [ 8 ]

What is dangerous about bradycardia? A long-term slow heart rate of pathological origin can be complicated by angina, atrial fibrillation, arterial hypertension, and chronic hemodynamic disorders. This affects the functioning of all body systems.

Complications of severe bradycardia include the development of such conditions with ambiguous prognostic implications as acute myocardial infarction or acute cerebrovascular accident, ventricular extrasystole. [ 9 ]

An attack of bradycardia, accompanied by a significant decrease in pulse rate, is fraught with the development of Morgagni-Adams-Stokes syndrome, asystole and sudden cardiac death. [ 10 ]

A slow heart rate should not be underestimated, although the prognosis in this case depends entirely on the nature and severity of the underlying disease and the degree of slowing of cardiac activity.