This article presents complete information about the pathology of the blockade of the heart. Why it arises which blockades are how they show themselves and what treatment requires. Forecast for the disease.

Publication date of Articles: 07/01/2017

Date of renewal of the article: 05/29/2019

The blockade of the heart is the pathology of passing the wave of excitement from the atria to the ventricles. The degree of severity of the violation may be from the slowdown in the impulse until its complete stop.

Normally, the energy impulse, leading to a reduction in the heart, occurs in a sinus node located in the atria. Further, the excitement moves to the atrioventricular node at the entrance to the ventricles and on the nervous fibers of the Gis beam spreads to all myocardium. The consistent and rhythmic reduction of the chambers of the heart muscle is the key to normal blood flow in all organs.

In pathology, the pulse is blocked, and the ventricles are reduced less frequently than the atrium. And in severe cases, the stop of cardiac activity occurs.

In this article we will talk about.

• In addition to the atrioventricular blockade (av blockade), the violation may occur at the stage of transmission of excitation from the sinus node to the atrioventricular - such pathology is called the sinus node dysfunction. In a number of articles, it is mistakenly called the synoyatrial blockade.
• Rare types of violations of the pulse between the atrialists on clinical manifestations and in essence imitate the atrocial and ventricular, therefore not carried out by a separate unit.

Under the conditions of an atrioventricular blockade (av blockade), when there is insufficiency of the function of the ventricles, a violation of the blood supply to the internal organs appears. Particularly suffer from the brain and the heart itself, for which a high level of oxygen and nutrients is needed. Clinical manifestations of pathology are primarily associated with blood flow impaired in these bodies.

The impaired pulse may occur at any level:

• atrioventricular node (AV node),
• gis beam trunk,
• branch of the leg beam legs.

The lower the block level, the worse the course of the disease and its forecast.

Depending on the level and degree of violation, clinical manifestations can be completely absent or so pronounced that the patient cannot even fulfill household matters.

There are situations where there are no symptoms - then the blockades do not require treatment, and are subject to only observation in the dynamics. If there are manifestations of the disease, then therapy may include both conservative maintenance using only drugs and methods of temporary or constant form of electrical stimulation of the heart muscle. Depending on the specific situation, the complete cure may be as possible and impossible.

Therapists and arrists are engaged in the treatment of patients with the blockade of the heart. Encourse implantation is carried out endovascular cardiac surgeons.

Types of blood blockade

Having answered the question "What is a blockade of the heart," you need to disassemble what they are and how they are divided into medical practice.

The blockade of 1 degree is characterized by a slowdown in the passage of the pulse, but each reduction in the atria, although with a delay, corresponds to the reduction of ventricles. In most cases, the violation is localized at the level of the AV assembly, only a 20% lesion of conductive paths is detected at the level of Gis beam elements.

The blockade of 2 degrees characterizes the periodic loss of reduction of ventricles:

1. Type 1, or Mobitz 1 - there is a growing slowdown in the excitation, which ends with the fallout of the reduction of ventricles. Level level: 72% AV node, 9% Bunch of Gisa, 19% branch beam.
2. Type 2, or Mobitz 2 - a regular delay in conducting a constant loss of ventricular systole in a specific rhythm (each second or every third). Level level: 35% Gis beam trunk, 65% beam branch.

Blocade 3 degrees, or full av blockade - the pulse of excitation from the atrias to the ventricles does not pass at all, they are reduced separately from each other with different rhythm. Atrialia - more often than 60 cuts per minute, as the pulse comes from the sinus node, the ventricle - less often (rhythm can decrease to 20). With this blockade there is a significant violation of blood flow through the heart and internal organs. The level of the lesion: Av node suffers from 16-25%, at 14-20% - the trunk of the GIS beam, in 56-68% - the branch of the beam.

Also, heart blocks can be:

• physiological (5-10%) - the norm for people with the predominance of the influence of the parasympathetic nervous system, athletes,
• pathological, or organic, associated with damage to the conductive myocardial system (more than 90% of all blockads).

The article discusses only pathological changes in the conduct of excitation.

Causes of blockades

Acute blood blockade

Periodic and Permanent Heart Block

Characteristic symptoms

How to diagnose

What treatment is carried out

Patients with reversible causes of the occurrence of conductivity in the heart are a complete cure.

• medications,
• acute ischemia myocardial fibers without scar formation,
• reflex blockade.

In this case, if there are no serious violations by blood flow in organs, it is necessary to eliminate the main disease, and the violation of the excitation wave will be completely without treatment.

If the cause of the occurrence of an organic nature (there is pathology in the heart muscle) - there is no complete cure. In the absence of symptoms, observation is shown, since there is a risk of enhancing the degree of blockade. And if the patient has clinical manifestations - treatment and continuous observation is necessary.

Against the background of therapy, you can achieve good functional results with almost complete disability restoration for the blockade of the second degree type 1, less often - type 2.

In the case of the blockade of the third degree, 90% of patients already have, and the quality of life is improved only in part. The main purpose of treatment in this group is to reduce the risk of heart stop.

Total Patient Tactics with Heart Blocade:

Acute blood blockade

Heavy manifestations of acute violation of the insulation impulse by myocardium:

1. Acute cardiac failure.
2. Frequent pulse.
3. Violation of blood flow in myocardium.

Emergency treatment:

Paroxysmal or chronic blockade

First degree:

• observation in dynamics
• do not use drugs deteriorating the excitation impulse (listed in drug causes of blockade),
• in the event that there is insufficiency of the work of the left ventricle caused by cardiological pathology, the installation of an electric cardiac stimulator.

Second degree, type 1:

• observation in dynamics
• if the impaired pulse impairs the course of other cardiac pathology - drug therapy with cholinolithics or sympathomimetics.

Second degree, type 2:

• in the presence of clinical manifestations - temporary, and then, after preparation, constant electrostimulation of cardiac activity,
• in the absence of symptoms, the planned implantation of the extension is due to the high risk of the development of a full cardiac blockade.

Third degrees:

• if there are manifestations of blood flow and the lesion level below atrioventricular node - installation of the pacemaker,
• in the case of an asymptomatic flow, the implantation of the exh is shown at the rhythm of heart abbreviations less than 40 per minute and (or) periods of absence of ventricular reductions more than 3 seconds (asistolia).

Forecast

The complete cure of the heart blockade is possible only if it is associated with the causes that can be completely eliminated or cured. In violation of the electrical impulse, against the background of pathological changes in the heart - there is no cure from the disease.

Violations of small degrees have a favorable forecast in terms of preserving the working capacity and the ability to perform any physical exertion, but still require permanent observation by the doctor - the risk of increasing the degree of blockade always exists.

Excluding physiological types of blockade, any forms of violation of the reduction of the heart muscle are associated with existing cardiological diseases. The occurrence of the blockade in this case worsens their current.

For patients with blockade, but without a concomitant chronic form of circulating blood flow in myocardium, the risk of occurrence increases by 2 times, and the total mortality rate is 1.4 times.

Violation of the conductivity against the background of the existing ischemic myocardial disease increases the risk of death from cardiovascular complications by 2.3 times, and the total mortality increases 1.6 times.

An atrioventricular blockade of 2 degrees is the pathology of the SCC, the essence of which is to stop or slowing the passage of the pulse from the atria to the ventricles.

The course of the disease can be asymptomatic or accompanied by such clinical signs as dizziness, weakness, reduction of the pulse, loss of consciousness.

Treatment can be both conservative and operational (entry of the pacemaker).

Such pathology as an av blockade of 2 degrees appears as a result of the impact of the following reasons:

1. Improving the sensitivity of the wandering nerve. It may occur due to mechanical impact on the nerve, pain.

2. Reception of cardioactive drugs (beta-blockers, digoxin, preparations for recruiting arrhythmias, some antidepressants and a number of others). These means affect the AV node (indirectly or directly), causing the development of the blockade.

3. Inflammatory diseases:

• rheumatism, eagle;
• myocardits;
• endocarditis;
• lyme disease.

4. Infiltrative pathology:

• hemochromatosis;
• amyloidosis;
• malignant neoplasms (multiple myeloma and lymphoma);
• sarcoidosis.

5. Disorders of metabolism and endocrine pathologies:

• sclerodermia;
• hypercalemia;
• rheumatoid arthritis;
• hypermagniamia;
• dermatomyomy;
• hyperthyroidism;
• collagenoses (with damage to vessels);
• thyrotoxic paralysis;
• myxedema.

6. Other diseases:

• acute heart attack;
• heart tumors;
• injuries;
• muscle dystrophy;
• operational intervention in the heart with congenital vices;
• night obstructive apnea;
• some complications of CSS diseases;
• idiopathic age fibrosis of the heart skeleton.

Part of patients AV blockade 2 degrees can be inherited.

Views

Distinguish the following types of disease:

• AB blockade 2 types 1 (Other name - Mobitz 1);
• AV blockade of 2 types of type 2 (Other name - Mobitz 2);
• incomplete AV-blockade high degree.

Also av blockade may be:

• stainless blockade;
• transient av blockade of 2 degree (another name - transient blockade of 2 degree);
• intermittent blockade.

Symptoms

The clinical signs of the disease depends on the degree of damage to the assembly, the causes of the blockade, the presence of associated pathologies of the SCC and their localization.

The second degree of av blockade has more pronounced symptoms than an early form of the disease. Such a shortness of breath and weakness are added clinical signs, as:

• the deceleration of the heartbeat (the feeling of "heart felting");
• constant fatigue and reluctance to engage in the most elementary affairs;
• few pronounced headaches.

Diagnostics

The diagnosis is made based on the history of the history, examination of the patient and data ECG. Av blockade 2 degrees on ECG as follows:

Av blockade of the 2nd degree of Mobitz 1 is characterized by the fact that the PQ interval is lengthened, but even less with each cardiac cycle. In the end, this leads to the fact that the RR interval becomes all shorter and everything ends with the fallout of the QRS complex.

Av blockade 2 degrees of Mobitz 2 on the ECG looks like this:

• the PQ interval is always the same, the atrium is not carried out for a part of the impulses, the RR interval is constant;
• the launched blockade is characterized by the fact that each QRS accounts for more than one tooth P, QRs complexes with a second type of blockade wide.

Treatment

Before starting the treatment of AV blockade of 2 degrees, the doctor finds out the causes that caused the development of this pathology.

- If the cause of the disease was the reception of medicines, then you need to change their dosage or stop taking at all. This is usually enough to restore the rhythm of the heart.

- In other cases, conservative treatment is prescribed, aimed at eliminating the main pathology that caused the blockade. If these are accompanying heart diseases (including congenital), then the patient is prescribed an atropine and beta course - adrenomimetics.

- with heart attack, angina, IBS, myocarditis shows the introduction of izadrina intravenously.

- With an av blockade, the flow of glucagon, intravenously, the flow of which is complicated by cardiac insufficiency. If a stagnant form of the disease is observed, then the treatment regimen includes vasodilators and diuretics.

- If drug therapy is ineffective (for example, if diagnosed AV blockade 2 degrees of Mobitz 2) - treatment must be operational (the pacemaker is installed).

In the absence of treatment, av blockade may result in the development of cardiac asthma and even to death. This disease is especially dangerous for people who abuse alcohol for the elderly.

Forecast

With this disease, the forecast depends not so much on the degree of blockade as from its level. In addition, the forecast is influenced by the reason for the development of the blockade and the severity of concomitant pathologies of the heart.

Patients live with AV blockade of 2 degrees 1 type of full life, it is only necessary to constantly monitor the condition of the heart muscle.

It is much worse than the forecast if the distal departments of the conductive system are affected, as this increases the likelihood of the development of the full blockade of the heart.

To date, due to the fact that it became possible to install perfect and high-quality cardiimuulators, the forecast for this disease Improved significantly, and the chances of a favorable outcome increased significantly.

Frames of the cardiovascular system are most invisible for the patient. But until a certain point. Many diagnoses are postfactum, after opening the body. Some diseases do not give any symptoms at all, do not affect the anatomical state of the muscular organ.

The synoyatrial blockade is a violation of the movement of the electrical pulse from the natural rhythm driver (sinus node) to the underlying heart chambers (atrial and ventricles). Several heart structures are involved immediately, from here a generalized violation of his work.

The signal does not reach the ventricles, because they are reduced incorrectly (punishes occur).

With prolonged lesion, it develops: cameras that do not receive an external pulse begin to generate it independently. This can lead to a fatal outcome in the short term.

The treatment is carried out under the control of the cardiologist, better in the hospital before the detection of all nuances. Complete recovery presents some difficulties: more often, the synoatrial blockade acts by secondary pathology, flowing against the background of other diseases.

The correct pattern of therapy is the simultaneous impact on the cause and symptomatic component.

With the normal state of affairs, the muscular organ works autonomously and does not need third-party stimulation. Uninterrupted functioning is ensured by the presence of a special accumulation of active cell-cardiomyocyte cells - sinus node. It is located in the right atrium.

The task of this anatomical structure is to generate an electrical impulse that forces the remaining chambers to shrink.

With a synoyatrial (Ca) blockade, the generation is broken, or the propagation of the pulse into the underlying chambers of the heart. The result is the impossibility of proper stimulation of ventricles.

Since they do not receive the desired team, the full reduction is also not happening. The body seeks to compensate for this provision. Cameras begin to signal themselves, spontaneously excited.

But on the one hand, the intensity is not enough for high-quality blood release, with another ventricle cease to coordinate the actions.

Reduction turn out to be chaotic, disorderly. Fibrillation develops, which is highly likely leads to a heart stop.

Another point is the excessive activity of the sinus node itself. This is another compensatory mechanism. The organ begins to produce the impulse more often to at least somehow reach ventricles.

As a result, the patient with a launched synoinatrial blockade has two dangerous process in history: tachycardia as a result of excessive operation of a natural rhythm driver and fibrillation.

Do not notice these signs difficult, therefore the diagnosis is appointed relative to early stages. Although the position is not always described so critical. The patient can live with pathology for years, without even suspecting any problems.

Classification and degree

Typification is carried out by the severity of the state.

• Ca block 1 degree. It is the initial phase of the disease. Symptoms are missing, there is no change in well-being. The patient is active, engaged in everyday affairs.

It is possible to detect problems during sports, especially at a professional level. Excessive load leads to the acceleration of heart rhythm, violation of myocardial reductions, discomfort in chest.

Additionally, intensive shortness of breath and loss of consciousness in the type of surface frustration are discovered. After the rest, everything falls into place. An objective picture is made of minor fall arterial pressure and cardiac frequencies.

• Ca block 2 degree - This is an incomplete violation of the conductivity of the impulse. The contractility is still normal, the activity of the sinus node is normal or slightly reduced.

At this stage, strong tachycardia occurs, but the reverse process is also possible. Dyspnea, sleep disorders, insufficient portability of physical exertion. All this moments inherent pathology.

Depending on the Picture of the ECG, two types of the described state are distinguished:

SA blockage 2 degree 1 type - chaotic abbreviation transmission is found on the chart, usually two or more in a row, it is possible with an increase in the pulse time (Samoilov-Wishbach periods). Clinically, this form is especially dangerous, because more often causes a spontaneous stop of the heart without the possibility of urgent resuscitation by routine methods.

Ca block for 2 types of type 2 - Boots are missing symmetrically: there is an alternation of a normal reduction and passing it.

• Cinoauricular blockade of 3 degrees is considered a terminal stage. It takes from several months to its development, depending on the aggressiveness of the state and its root cause.

Electrocardiography shows weak contractions. In severe cases, the indicator degenerates almost into the straight line. There is a high risk of asystole or a heart stop. It may happen at any time.

The patient needs to urgently hospitalize. The synoatrial blockade of 3 degrees are extremely difficult. Requires radical measures. If lucky and deviations from other bodies have not yet arisen, transplantation will help, which in itself is difficult to feasible due to lack of donors.

In essence, the synoatrial blockade is a kind. It is similar to the defeat of the His beam legs and on manifestations, and according to the forecast.

But there is much more aggressive, gives more complications and carries a huge danger, since the violation concerns both ventricles at once, and at the SERDS suffer on 2-3 stages.

Causes

Development factors are always cardiac. On the one hand, it facilitates the diagnosis. On the other hand, it initially worsens the forecast.

• Poisoning phosphorus compounds. This is usually mineral fertilizers. Patients working in harmful chemical enterprises are especially risky. As soon as the dangerous factor is eliminated, the likelihood of restoring the normal health state is almost maximum.

Patients with acute intoxications should be immediately hospitalized for specific medical measures. The forecast in this case is relatively favorable.

• Congenital and acquired heart defects. What kind of big role does not play. It may be stenosis, a prolapse of mitral, aortic valves, violations of the anatomical development of the partition and other states.

The problem is that it is extremely difficult to detect them if every six months is not to access the cardiologist for the planned survey.

Finds random for the most part because pathological processes Detected already on irreversible stages. Some cases and are completely sacrificed postfactum when a person died.

The synocatrial blockade of this species is fixed in the framework of the main surgical treatment.

• Overdose drugs. Ironically, but funds designed to reduce blood pressure, eliminate arrhythmia, that is, medicines aimed at improving the heart can kill the patient in a matter of hours.

Amiodaron, "County", "Digoxin", Glycosides in general, beta blockers possess a special danger. Among third-party funds are psychotropic, including neuroleptics, antidepressants, tranquilizers.

Provocation of this effect is possible against the background of using oral contraceptives. All drugs must be appointed only by a specialist after careful diagnosis.

• Myocarditis. Inflammation of the heart muscle. It is an infective, less often autoimmune disease. Requires urgent medical care in the hospital.

Ambulatory so. dangerous state It is not treated, because on the background there are complications right up to heart attack or heart stop. Antibiotics in shock doses or immunosuppressants are used.

As a rule, the state is secondary. Develops as a complication cold illness, rheumatism and others. The synoyatrial blockade after transferred severe myocarditis itself does not pass.

• Vegeta dystonia. Strictly speaking, it does not apply to cardiac issues. However, the normal innervation of the cardiovascular system is disturbed. Hence the deviations in the conductivity of the electrical impulse.

It is a complex symptomatic complex. Manifested by many moments: from tachycardia, before dizziness, fainting, shortness of breath and others.

It is not considered an independent diagnosis, you need to seek the cause of this state. Usually it is about hormonal imbalance or pathologies of actually cerebral structures.

• Rheumatism. An autoimmune damage of cardiomyocyte cells. Protective body forces, designed to cover the body destroy their own fabrics. The reasons for such a deviation are not fully known. However, rheumatism pretty quickly destructs cardiac cells, causing coarse scarring and pronounced heart failure with a synoinatrial blockade.
• Moopathy. The growth of the muscular layer, also dilatation (expansion) of the heart chambers. Recovery does not seem possible due to an anatomical nature of deviation. Requires supporting therapy under the control of a specialist. Read more about cardiomyopathy and its types.

• Infarction and, as a result, scarring of affected areas (cardiosclerosis). Ends in a significant decrease in the conductivity of the natural pathways of the electrical pulse. Treatment is required urgently. There is always a risk of fatal outcome.

In fully healthy people, the synoatrial blockade is also possible. Spontaneous, transit, transient sala blocks are a consequence of an increase in the activity of the wandering nerve.

Such states can be dangerous, but they only last a few minutes, the maximum of half an hour. Patients with a missing cardiac history and neurologists are observed in an objective picture without organic deviations.

Attention:

The probability that the first attack will be the only one, but it is not great. Most likely, we are talking about impaired brain or endocrine system.

In the absence of data for pathology and functional disorders, they generally indicate the idiopathic form of the synoatrial blockade. This is a relatively rare option. Usually, diagnostic problems do not occur due to the evidence of the main process.

Symptoms stage 1

At an early stage, there are no manifestations at all or they are scarce. The clinical picture is folded from two signs:

• Pronounced shortness of breath. But only after intensive exercise. The average person is not so active to notice the deviation from the norm. In part, it is possible to suspect the problems according to the results of specialized tests (cycle ergometry), but they prescribe such a study only by testimony.
• Tachycardia. Acceleration of the heart rate due to excessive generation of an electrical impulse, against the background of the incomplete conductivity of the signal to the ventricles. The compensatory mechanism is activated. But he is initially flawed, it is not able to influence the position of things.
  Both features are detected only after severe exercise. An ordinary person does not notice the problem, because the diagnosis of 1 stage is almost no possible.

Symptoms on 2-3 stages

2-3 phases are accompanied by a number of rough changes in the state:

• Pain in chest. Goes or burning. Unlike the same angina, episodes are so small that the patient does not have time to pay attention to them. The discomfort is described as a instant unpleasant feeling that immediately disappears. Duration - from a pair of seconds to several minutes.
• Dyspnea. Against the background of minimal physical activity or alone. It is extremely difficult, the patient is not able to work, perform daily responsibilities. Even a campaign to the store becomes akin to achievement. Correquency is difficult. Usually such patients give a group of disability.
• Severity in the chest. The feeling seemed to have sewn a huge stone.
• Tachycardia, and reverse process. Increase and decrease the frequency of heart rate. One other can be replaced. In parallel, other arrhythmias arise. Fibrillation of ventricles. The number of movements reaches 300-400, but they are visible only on electrocardiography.
• Cyanosis of the nasolabial triangle.
• Increased sweating at night especially.
• Pallor skin.
• Funny, can be repeated for the same day.
• Headache.
• Vertigo, inability to navigate in space.
• Weakness, drowsiness. Long drop in labor activity.
• Apathy, reluctance to do something.

The synoyatrial blockade of 2 degrees is accompanied by all the manifestations described, but the treatment still has prospects.

Diagnostics

It is conducted under the control of the cardiologist. A group of methods is assigned:

• Oral survey patient and collection of anamnesis. The way to objectize complaints, formalize the symptoms and make a clinical picture.
• Fractional pressure measurement, heart rate.
• Daily monitoring using a special tonometer. Allows you to evaluate both CSS and AD for 24 hours in natural conditions for a patient.
• Electrocardiography. Study of functional indicators. Used as the main measure.
• Echocardiography. Ultrasonic tissue visualization method. Vices are diagnosed in this way.
• Blood test is common, hormones and biochemical.
• MRI by testimony.

As part of the expanded examination, the neurologist is attracted. It is also possible to appoint advice from a specialist working with the deviations of a hormonal background.

Symptoms on ECG

There are no changes in the first stage. It is impossible to detect problems. Either the features are so nonspecified that they do not give ideas about the nature of the process.

2 degree detects the most pronounced changes to the ECG:

• Skipping several pulses in a row. Objectively manifests itself in the complete absence of PQRST complexes on the graph. This is 1 type.

For the 2nd typical alternate dropping out of abbreviations. There is no and so on. The occurrence of defective movements may appear as minor waves.

• P-P elongation.
• Acceleration or slowdown in the intensity of the muscular organ.

SA blocade on ECG has traits of tachycardia, or bradycardia and uneven contractual activities.

The third stage is accompanied by a violation of functional activity. The schedule degenerates almost into the straight line.

Paths of treatment

The main method of state correction is operational. The implantation of the pacemaker, which will lead the rhythm artificially.

Medical impact is a temporary measure and an incomplete effect.

In the period of sharp attacks against the background of vegetative, nervous dysfunction assigned:

• Nitroglycerine.
• Atropine or amizil.

It is impossible to abuse drugs, they provoke hazardous forms of arrhythmias during excessive use.

In the long run, vitamin and mineral complexes are prescribed with enough magnesium and potassium, cardioprotectors (mildronat).

Attention:

Antiarrhythmic use is categorically not recommended, probably aggravating the state.

Forecast

Relatively favorable against the background of systematic drug treatment.

If the pacemaker is implanted and the operation has passed successfully, the survival rate increases to 90-95% in perspective of 10 years or more.

The absence of therapy is associated with almost 100% of the probability of death in a short period of time.

The pathological process is not always able to cure a surgically. Some patients with pronounced heart defects, severe concomitant states, senile age, the operation can be contraindicated.

However, it is impossible to neglect the chance. First, try to stabilize the patient, then still consider radical interference. Otherwise there is no chance of recovery.

Possible complications

Among the consequences:

• Asian and heart stop. The most likely outcome without treatment.
• Heart attack.
• Stroke. Acute circulatory breakdown in cerebral structures.
• Vascular dementia as a result of insufficient nutrition of the brain.

The prevention of dangerous moments is one of the tasks of therapy.

Finally

Sinoatrial (synoyauricular) blockade - a complex process: the essence of it in the violation of the movement of the electrical impulse from the natural driver of the rhythm to the ventricles and atria.

It is the path to the fall of the contractile ability of myocardium, the spontaneous formation of abnormal foci, the chaotic work of the muscular organ.

Treatment urgent, delay reduce the chances of recovery. Forecast with operational intervention favorable.

The synoatrial blockade (synoyauricular, sa-blockada) is considered one of the variants of the syndrome (SU). This type of arrhythmia can be diagnosed at any age, it is slightly registered with male people, in the overall population it is relatively rare.

In a healthy heart, the electric charge is generated in a sinus unit, which is located in the thicker of the right atrium. From there it extends to the atrocaded gastric node and to the legs of the beam of Gis. Due to the consistent passage of the pulse according to the conductive heart fibers, the correct reduction in its cameras is achieved. If an obstacle arises on some of the sites, then the reduction will be disturbed, then we are talking about the blockade.

With a synodatrial blockade, reproduction of either the proliferation of the pulse to the underlying departments of the conductive system from the main, sinus, node, therefore, the abbreviation and atrial, and ventricles are disturbed. At a certain point, the heart "misses" the impulse you need and is not reduced at all.

Different degrees of sinoatrial blockade require a different therapeutic approach. This violation may not be manifested at all, but may be caused by fainting and even the death of the patient. In some cases, the synoyatrial blockade is constant, in others it is transient. In the absence of a clinic, it can be limited to observation, blockade 2-3 degrees requires appropriate treatment.

Causes of synoatrial blockade

Among the main mechanisms of the synoyouricular blockade are damage to the node itself, a violation of the spread of the pulse on the heart muscle, a change in the tone of the wandering nerve.

In some cases, the impulse is not formed at all, in others - it is, but too weak to cause reduction of cardiomyocytes. In patients with organic myocardium injuries, the pulse meets a mechanical obstacle on its path and cannot go further on conductive fibers. Insufficient sensitivity of cardiomyocytes to an electrical pulse is possible.

Factors leading to a synoyouricular blockade, consider:

1. Cardiovascular form of rheumatism;
2. Secondary damage to the tissues of the heart during leukes and other neoplasms, injuries;
3. (, post-infarction scar);
4. Vagotonia;
5. Intoxication by drugs with exceeding a permissible dose or individual intolerance -, verapamil, amiodarone, quinidine;
6. Phosphoric substance poisoning.

SU work influences the activity of the wandering nerve, Therefore, when it is activated, a violation of the impulse generation and the appearance of SA-blockade is possible. Usually, in this case, they are talking about the transient sa-blockade, which itself appears and also passes. Such a phenomenon is possible from practically healthy people, without anatomical changes in the heart. In isolated cases, idiopathic synoyouricular blockade is diagnosed, when the exact cause of pathology cannot be found out.

Children also have a violation of the synoatrial node. Usually, such arrhythmia is found after 7 years of age, and frequent cause It becomes, that is, the blockade is rather transient, against the background of increasing the tone of the wandering nerve. Among the organic changes in myocardium, which can cause this type of blockade in a child - myocarditis, in which other types can be found along with the Ca blockade.

Varieties (types and degrees) of the synoatrial blockade

Depending on the severity of arrhythmia, several its degrees are distinguished:

• SA-block 1 degree (incomplete) when changes are minimal.
• Ca-block 2 degrees (incomplete).
• Ca-block 3 degrees (complete) - the most severe there is a reduction in both ventricles and atrial.

With a blockade of a sinus node 1 degree node functions, And all impulses cause a reduction in the myocardial atrial, but it happens less frequently than normal. The pulse along the node is slower, so the heart is reduced less often. On the ECG such degree of blockade is impossible to fix, but they are indirectly talking about more rare, which is supposed to reduce the heart.

With a synoyatrial blockade of 2 degrees, the impulse is no longer always formed, The result of which becomes the periodic absence of a reduction in the atria and ventricles of the heart. She, in turn, happens two types:

• SA-block 2 types of type 1 - gradually slows down the electrical signal over a sinus node, as a result of which the next reduction in the heart does not occur. Periods of increasing the time of the pulse are called the periods of Samoilova-Vestcabach;
• Ca-block 2 degrees of type 2 - drops down all the departments of the heart through a certain number of normal abbreviations, that is, without a periodic slowdown in the progress of the pulse on the SA-node;

Xinoauricular blockade of 3 degrees - full, When there is no regular reduction in the heart due to the lack of impulse from the sinus node.

The first two degrees of the blockade are called incomplete, as the sinus node, albeit abnormally, but continues to function. The third degree is complete when impulses do not come to atria.

ECG features at sa-blockade

Electrocardiography - the main way to detect the blockade of the heart, through which the non-coordinated activity of the sinus node is detected.

Ca-block 1 degree does not have characteristic ECG signs, It can be suspected by bradycardia, which often accompanies such a blockade, or shortening the PQ interval (a sign of a non-permanent).

Reliably the presence of sa-blockade on ECG can be said since the second degree of violation, in which it does not complete heart abbreviation, including atrium and ventricles.

At the ECG at 2 degrees are recorded:

1. Lengthening between the abnormalities of the atrial (P-p), and during the fallout of one of the next abbreviations, this interval will be two or more normal;
2. A gradual decrease in the rr after pause;
3. The absence of one of the next PQRST complexes;
4. During long intervals, absence of pulses may arise abbreviations generated from other rhythm sources (atrio-ventricular node, the legs of the Gis beam);
5. If there is not one, but at once a few abbreviations, the duration of the pause will be equal to several rr, as if they occurred normally.

The complete blockade of the synoatrial node (3 degrees) is considered when the ECG is registered,that is, there are no signs of electrical activity of the heart and its reduction, is considered one of the most dangerous species Arrhythmias, when the probability of the death of the patient is high during an asistolia.

Manifestations and methods of diagnosis of SA-blockada

The symptoms of the synoyatrial blockade is determined by the degree of severity of disorders in the conductive heart fibers. With the first degree, the sign of the blockade is absent, as well as the patient's complaints. In bradycardia, the body "gets used to" to the rare pulse, so the majority of patients do not feel any concerns.

SA-blocks 2 and 3 degrees are accompanied by noise in the ears, dizziness, intelligible feelings in the chest, shortness of breath. Against the background of the rhythm, general weakness is possible. If the SA-blockade developed due to the structural change of the heart muscle (cardiosclerosis, inflammation), then it is possible to rise with the advent of edema, skin sinushes, shortness of breath, reduction of working capacity, liver increase.

The child has signs of salam blocks differ little from those in adults. Often, parents pay attention to the reduction of working capacity and quick fatigue, the formation of the nasolabial triangle, fainting in children. This serves as a reason to appeal to the cardiologist.

If the gap between the abbreviations of the heart is too long, paroxysms (MAC) may be manifested when the inflow of arterial blood to the brain can be sharply shortened. This phenomenon is accompanied by dizziness, loss of consciousness, noise, ringing in the ears, causal muscle contractions are possible, involuntary emptying bladder and the rectum as a result of a pronounced brain hypoxia.

fainting with MAC syndrome due to the blockade of the sinus node

It can be carried out within 72 hours. Long-term ECG monitoring is important in those patients who, when suspected the presence of arrhythmias in a conventional cardiogram, could not detect changes. During the study, a transient blockade can be recorded, the Episode of the SA-Blockade at night or during exercise.

Children also holds Halter monitoring. Diagnostically significant is the detection of pauses lasting for more than 3 seconds, and bradycardia is less than 40 shots per minute.

Indicative is a sample with atropine. The introduction of this substance to a healthy person will cause an increase in the frequency of heart abbreviations, and with sa-blockade, the pulse will first double, and then it will also rapidly decrease - the blockade will occur.

To eliminate other cardiac pathology or search for the causes of the blockade can be carried out, which will show the vice, structural changes of myocardium, the scarring zone, etc.

Treatment

Ca-block 1 degree does not require specific therapy. Usually, for the normalization of the rhythm, it is enough to treat the main disease that caused the blockade, to normalize the mode of the day and lifestyle, or cancel drugs that could disrupt the automatism of the sinus node.

Transient sa-blockade against the background of the increased activity of the wandering nerve is well treated with the appointment of atropine and its drugs - bellataminal, Amizil. The same drugs are used in pediatric practice during Vagotonia, which causes the transient blockade of the sinus node.

SA-block attacks can be treated with medication using atropine, platifillin, nitrates, nifedipinebut, as practice shows, the effect of conservative treatment Only temporary.

Patients with a blockade of a sinus node are prescribed metabolic therapy aimed at improving myocardial trophic - Riboxin, Mildronate, Cocarboxylase, Vitamin Mineral Complexes.

With fixed sala blockade it is impossible to take beta blockers, heart glycosides, cordaron, amiodaron, preparations of potassium, Because they can cause an even greater difficulty of automatism and aggravation of bradycardia.

If the SA-node blockade leads to pronounced changes in well-being, causes an increase in heart failure, often accompanied by fainting with a high risk of a heart stop, then the patient is offered to be implanted. The testimony may also become the attacks of Morgali-Adams - Stokes and bradycardia below 40 blows every minute.

With a suddenly occurring heavy blockade with the attacks of the Mrogan-Adams-Stokes, temporary cardiovulation is required, shown indirect massage Hearts and artificial lung ventilation introduced atropine, adrenaline. In other words, a patient with similar attacks may require full-fledged resuscitation activities.

If the exact causes of the development of the synoatrial blockade, it was not possible to establish, the effective measures for the prevention of this phenomenon do not exist. Patients who have already recorded changes to the ECG should be adjusted by drugs that prescribe a cardiologist to normalize the lifestyle, as well as to regularly visit the doctor and remove the ECG.

Children with arrhythmias often recommend to reduce the overall level of load, reduce classes in sports sections and circles. A visit to children's institutions is not contraindicated, although there are specialists who advise to limit the child and in this. If there is no risk for life, and the episodes of sa-blockade are rather single and transient, it makes no sense to isolate a child from school or hiking in kindergarten, but observation in the clinic and regular inspection is necessary.

Video: Lesson on synoatrial and other types of blockad

Pathological changes in conductivity between the sinus node and the atrium may cause hazardous complications: a complete synoyatrial blockade leads to a violation of heart and sudden death abbreviations. Weak synoyouricular conductivity impairment usually transit, cause cardiac cycles, and do not create a danger to life. But any pathological changes in conductivity in the field of sinus node (sa blockade) require full-fledged diagnostics and effective treatment. The main goal of therapy is the restoration of rhythm and the prevention of ischemia of vital organs.

Causes of the disease

Indimacy external manifestations Depends on the presence and quality of the pulse: the synoatic changes in conductivity arise against the background of the following factors:

1. the complete absence of a pulse in the node;
2. low impulse force;
3. restricting the conductivity between the node and the atrium.

The main factors causing violations of conductivity and episodes of the loss of the rhythm of the sinus node are the following states and diseases:

• heart pathology (, myocarditis, congenital vices, chronic heart failure, atherosclerosis);
• negative medicinal effect (the side effect of some cardiovascular drugs);
• toxic damage in poisoning or severe diseases (pronounced disadvantage of potassium and oxygen);
• tumors in the cardiovascular system;
• nervous vegetative reflex reactions;
• mechanical damage in injuries and operations.

Any kind of violation of the impulses in the heart requires complete diagnosis with the release of the severity and type of cardiac pathology, which will become the basis of high-quality treatment.

Options of pathology

3 degrees of gravity are possible:

1. Sinoauricular blockade of 1 degree - the absence of symptoms is extremely rarely detected using special research
2. Xinoauricular blockade of 2 degrees (1 type) - gradual increase in heart blockade with sudden episodes of complete pulse loss with typical manifestations on ECG
3. Ca blockade of 2 degrees (2 type) - non-medical loss of cardiac complexes with episodic and temporary full blockades hold
4. Ca blockade of 3 degrees (complete) - the complete lack of conducting pulses from the sinus node to the atria

With the help of electrocardiography, the doctor will be able to identify the pathological impairment impairment and distinguish the disease from other types of dangerous cardiac pathology.

Symptoms of Disease

With 1 degree of disturbed synoyatrial conductivity, no signs, except for moderate heartbeat, will not. The possible manifestations of the blockade of the sinus node 2 degree belong:

• blood impairment in the central nervous systemmanifested by episodes of loss of memory, dizziness and headaches;
• periodically emerging shortness of breath;
• swelling on cardiac type;
• a tendency to faint and loss of consciousness with a temporary stop of vital functions.

With 2-3 degrees, the risk of sudden death in patients with synoyauricular disorders is quite high, so it is necessary to diagnose in a timely manner and accurately, ensuring the necessary medical events.

Diagnostic research

In addition to the usual inspection, the doctor will definitely direct on the ECG. It is according to the results of an electrocardiographic study, it is possible to accurately identify the presence and severity of the synoatrial blockade. With 1 degree of ECG manifestations, the minimal - sinus bradycardia, which normally happens to many people and is not considered pathology (more about sinus bradycardia we wrote).

The first type of 2 degrees of the blockade on the cardiogram is expressed by periodic rhythmic loss of cardiac cycles (loss of P-P teeth or a whole complex PQRST). The second type is characterized by the neurotic and multiple loss of P-P teeth, PQRST complexes, when two or more heart cycles disappear, forming pathological state blood circulation.

Detection of typical clinical symptoms and manifestations on an electrocardiogram is a criterion for making the diagnosis and appointment of treatment, which is especially important when complete absence pulses and high risk of sudden death.

View of the cardiogram with Ca-Blocade 2 degrees (1 type)

Principles of treatment

The detection of sinus bradycardia does not require medical events: it is quite possible to periodically observe the doctor. With violation of the conductivity of 2 degrees it is necessary to carry out complex therapy:

• identification and treatment of heart diseases that create conditions for the blockade of the sinus node;
• removal of toxic factors and drugs that negatively affect cardiac conducting impulses;
• the use of symptomatic therapy;
• the use of electrocardialism (Surgical implantation of ex).

Indications for installing the pacemaker are:

• violation of cerebral blood flow;
• heart failure;
• reducing heart rate below 40 shots;
• high risk of sudden death.

At 2-3 degrees of the synoatrial blockade the best effect from treatment appears after surgical operation By installing a pacemaker, and drug therapy is able to provide only temporary improvement and relief of symptoms.

Dangerous complications

Against the background of bradycardia and rhythm disorders due to blocking pulses in a sinus unit, the formation of the following pathological conditions should be fear:

• stop or failure of the synoatrial node;
• acute heart failure with edema, shortness of breath and a drop of vascular pressure;
• pronounced violations of cerebral blood flow;
• sudden death.

Even if nothing bothers, with any embodiment, the blockade is categorically unacceptable to abandon periodic visits to the doctor and regular surveys with the ECG.

On time, the detected deterioration in the conductivity of the heart can be corrected using a pacemaker and drug therapy, and in the development of severe complications it is extremely difficult to restore the lost heart functions and return the former quality of human life.