Sinus bradyarrhythmia in a child or teenager. What is it, playing sports

What is sinus bradyarrhythmia in children?

Sinus bradyarrhythmia is a congenital or acquired heart disease in which the beat frequency decreases to a critical level. As a result, the patient’s blood circulation slows down, internal organs and systems receive less oxygen and nutrients, and suffer from hypoxia. Pathology can occur at any age, but the most dangerous consequences are observed in children.

Sinus bradyarrhythmia in a child is diagnosed if the number of beats per minute does not exceed 60 times. The development of the disease is not always accompanied by visible symptoms and disorders.

It occurs more often in premature babies, with some forms of cerebral palsy. The reason lies in the dysfunction of the sinus node, better known as the pacemaker. There are moderate and severe forms of the disease.

Moderate

Moderate bradyarrhythmia in rare cases is a congenital anomaly of the body. Sometimes this feature appears in children who are actively involved in sports. But any form is dangerous to health and can disrupt the formation of organs and brain development. Unpleasant symptoms often appear when air is exhaled from the lungs.

Sinus bradyarrhythmia in a child is when the number of beats per minute is less than normal

Often, a moderate form of the disease appears with constant hypothermia and is formed as a protective reaction to low temperatures. On inspiration, the pulse is restored to normal levels, so diagnosis is difficult and requires a combination of different techniques.

Expressed

When the heart rate drops below 40–45 beats per minute, a diagnosis of severe bradyarrhythmia is made.

The following signs indicate it:

• frequent burning in the heart area;
• the child looks weak, sick, drowsy;
• The baby gets tired quickly with light loads.

The form of the disease is dangerous due to sudden attacks with loss of consciousness and memory. They worsen children’s general well-being, school performance, and limit communication with peers.

Which sport is not suitable

Parents should take into account that if a reduction in heart rate in a child is caused by a congenital heart defect, then he should avoid exhausting physical activity.

In general, sports that involve static loads are contraindicated for people with heart disease. They are characterized by prolonged tension of various muscle groups, while no action is performed. As a result, a tense, immobilized muscle compresses the vessels, the heart receives additional stress, and it has to push blood through the narrowed vessels.

In addition to static loads, it is advisable for children with bradycardia to be wary of explosive loads. The fact is that during such exercises, adrenaline is released into the blood. This helps increase blood pressure and blood sugar levels. As a result, the heart requires more oxygen. With bradycardia, when the body is already suffering from a lack of oxygen, this situation can result in not very good consequences.

Currently, there is a classification by J. Mitchell, which includes sports undesirable for people with heart pathologies. According to Mitchell's findings, a high risk of loss of consciousness is possible during activities:

• diving;
• horse riding;
• cycling
• gymnastics;
• karate;
• skiing;
• judo;
• bodybuilding.

But you shouldn’t be too critical of the listed sports. Everything is very individual and largely depends on the training program, the emotional state of the child, as well as the degree of bradycardia. Only a consultation with a cardiologist will help you finally determine what the risks are when playing a particular sport.

Why does the disease develop in children and adolescents?

In newborn babies, the heart beats at a frequency of 120–140 beats per minute. As you grow and mature, your heart rate decreases to a stable rate of 65–75 times. If the level drops below 60 beats, an examination is necessary to exclude dangerous pathologies. They develop as a result of inflammatory or congenital anomalies of the sinus node, increased tone of the vagus nerve.

Among the causes of sinus bradyarrhythmia in preschool age:

• complications after suffering from pneumonia, tonsillitis, otitis media;
• constant hypothermia;
• intracranial pressure;

• predisposition to cardiovascular pathologies;
• metabolic disorders and thyroid dysfunction;
• oncology.

In adolescents, the cause of sinus bradyarrhythmia is often associated with improper formation of hormonal levels. In rare cases, the child’s body reacts to taking energy drinks, illegal drugs, or poor eating habits (bulimia or anorexia in girls 13–15 years old).

Signs of illness

Sinus bradyarrhythmia in a child is sometimes asymptomatic and is detected by chance during a comprehensive diagnosis of other diseases. The main signs depend on the age, developmental characteristics of children, and the stage of the disease. Depending on the cause, the problem may be physiological, organic, neurogenic, drug-related or toxic.

Your child may have the following symptoms:

• increased sweating at rest;
• feeling of lack of air;
• loss or confusion of consciousness;
• heaviness in the chest;
• poor appetite;
• low concentration, deterioration in school performance;
• discharge on the face of the nasolabial triangle.

Tingling or burning in the heart with bradyarrhythmia always occurs when exhaling. If you hold your breath for a few seconds, the discomfort disappears.

Physiological

For natural reasons, a slowdown in heart rate is observed during a night's rest or daytime sleep, after waking up. At rest, the pulse drops to 65–60 beats, the changes are practically not felt by the child. During physical activity or active play, the indicator rises to a normal and comfortable level.

Among the dangerous physiological causes of the disease is the appearance of benign or malignant tumors in the heart area, on the myocardial muscle. The child complains of shortness of breath and tingling in the chest, has pale skin, and may lag behind peers in development in terms of weight and height.

Organic

Bradyarrhythmia can form due to improper development of the sinus node in the heart. The number of beats per minute decreases to 45–50 units, and deformation and necrosis of myocardial tissue begins.

The problem occurs against the background of serious diseases:

• vascular ischemia;
• cardiosclerosis;
• cardiomyopathy.

In a young child, sinus bradyarrhythmia of the organic type develops with inflammation of the pericardium of the heart. This is a dangerous complication after a sore throat or otitis media, in which characteristic symptoms are observed: constant low-grade fever, muscle weakness, low activity in play and study, joint pain.

Neurogenic

Sinus bradyarrhythmia in a child can be a consequence of pathologies of the nervous system: intracranial pressure, childhood neuroses, vegetative-vascular dystonia.

In addition to pain in the heart area, young patients feel:

• dizziness;

• low blood pressure;
• attacks of panic or irritability.

The problem requires an integrated approach to treatment, the help of an endocrinologist, cardiologist and neurologist.

Medicinal

In childhood, bradyarrhythmia of this type develops extremely rarely. It occurs in children with asthma, kidney pathologies or severe lung diseases, who constantly take potent drugs to maintain vital functions. Damage to the sinus node of the heart can occur as a side effect after undergoing chemotherapy for oncology.

Toxic

Increasingly, doctors are observing babies who have sinus bradyarrhythmia after toxic poisoning. The reason is associated with living in a disadvantaged area, constant contact with toxic substances in the house, kindergarten, and school. Damage to the heart is caused by pathogenic bacteria and viruses in typhoid fever, hepatitis A or B.

In everyday practice, a doctor often has to deal with the phenomenon of bradycardia in children. Bradycardia is a rare heartbeat or a slow heart rate below normal for age.

The criteria for bradycardia in children of different age groups have significant differences. So, for example, for an 8-year-old child, bradycardia is considered to be a decrease in heart rate (HR) of less than 66–74 beats per minute, and for a 2-month-old child, a heart rate of less than 119–144 will be considered bradycardia. In an adult (over 18 years of age), bradycardia is a decrease in heart rate below 59 beats per minute. The older the child, the slower the frequency of his rhythm becomes. A baby is born with a heart rate of 140–160 beats per minute, and by the age of 8–11 years, its rhythm slows down to 75–95 beats per minute. This is due to the fact that as the child grows, the volume of blood circulating in the body increases, the size of the heart increases, the ability of the heart muscles to contract decreases, the vessels become less elastic, and the length of the vessels in the body increases; the susceptibility of the cardiovascular system to vasoactive substances circulating in the blood changes. For example, a newborn baby’s heart weighs only 15–25 g; it can push only 3–4 ml of blood. The heart of a healthy adult weighs about 200–250 g. Such a heart can push out from 70 to 90 ml of blood with one contraction. Therefore, normally, the heart rate in children will be higher than in adults, and will depend on age, height, weight, physical activity, sleep or wakefulness. Accordingly, with a physiologically high heart rate in a child, bradycardia values ​​will be in a certain range for each age group.

The prevalence of bradycardia in practically healthy children without obvious heart pathology is quite high. Most often, changes are detected by chance during preventive examinations, clinical examinations, and during examinations after illnesses (mainly of an infectious nature). At the same time, children with bradycardia most often do not make complaints about poor health, tolerate physical activity well, and lead a normal lifestyle. But, unfortunately, bradycardia may not always be asymptomatic and harmless.

The reasons for bradycardia in children can be different. More often, bradycardia in a healthy child is a normal reaction of the body to accelerated growth and rapid/or slow weight gain (this is especially typical for young children - up to 3 years old, as well as during adolescence). If a child regularly attends a sports section, and physical activity is common for him, then such a small athlete will most likely have bradycardia. Also, a slowing of the heart rate without clinical manifestations occurs in children with underweight, with retarded physical development, in children who are often ill, after suffering from colds and infectious diseases, in premature infants.

What happens in the body during bradycardia?

When heart rate decreases, the speed of blood movement through the vessels also slows down. This leads to a decrease in the supply of oxygen and the removal of carbon dioxide in organs and tissues of all systems. The organs most vulnerable to hypoxia are affected first: the brain and heart. Therefore, with bradycardia, a child may experience dizziness, headaches, weakness, increased fatigue (cannot tolerate even moderate physical activity), the child wants to sleep all the time, concentration decreases, appetite decreases, and fainting may occur. If your child faints, you should consult a doctor immediately. For the most part, such loss of consciousness is not dangerous, but there are a number of clinical conditions that still require immediate treatment.

Therefore, a child with bradycardia should be monitored by a cardiologist, undergo timely preventive examinations and, if necessary, receive treatment. The doctor determines the risks and dangers of bradycardia for each small patient individually, based on complaints, life history, physical fitness, clinical manifestations, finding out whether the child is taking any medications that slow down the heartbeat, and whether there are any concomitant diseases that can lead to bradycardia ( kidney disease, heart disease, thyroid gland, pancreas disease, obesity, diabetes, neurosis...). And one of the most important points is assessing the dynamics of heart rate using the ECG (what bradycardia is - moderate/severe, regular/irregular, is it stable). There may be other more serious rhythm disturbances, accompanied by a rare pulse - atrioventricular block of the 2nd and 3rd degree, sinoatrial block of the 2nd and 3rd degree, sick sinus syndrome. In such conditions, it may be necessary to install an artificial pacemaker (pacemaker). Having received all the information about the child’s condition, the doctor, if necessary, will prescribe an additional examination (usually an ECG for rhythm, an ECG with stress (physical, drug), Holter ECG monitoring, echocardiography, blood tests - CBC, determination of blood viscosity, electrolyte composition , study of hormonal status, etc.).

Parents of children observed with bradycardia should properly organize the optimal motor mode for the child (on the recommendation of a cardiologist), monitor the fullness of sleep, and avoid overwork. It is important to maintain normal body weight and eat right. Avoid salty, smoked, spicy and fatty foods, as well as fizzy drinks. Increase the amount of foods containing elements and vitamins “necessary” for the heart - bananas, oranges, persimmons, lettuce, spinach, pumpkin, potatoes, dried apricots, dairy products, fish, porridge (millet, rolled oats, buckwheat).

Results: Most often, bradycardia in children is temporary and as they grow older, it can disappear without a trace. In children, this condition is quite easy to correct if necessary. But the decision about what to do with bradycardia and whether it needs to be treated is made only by a cardiologist.

Is it normal for a child who plays sports to develop the disease?

At the initial stage of bradyarrhythmia, the child leads an active lifestyle. But excessive sports activities in preschool age can provoke disturbances in the development of certain parts of the heart. This causes the appearance of painful symptoms during the transition period.

With regular sports activities in children, in 90% of cases the physiological type of the disease is diagnosed.

With a constant load, the heart gets used to working at an increased pace for several hours a day, so at rest the pulse drops to 60 beats per minute: this is how the body “forces” the myocardial muscles to rest between heavy workouts. This condition does not cause concern among doctors, does not entail dangerous complications, and is detected in 50% of professional athletes, football players, and cyclists.

Medical indications

Among the main symptoms of bradycardia in children are:

• pale skin;
• fast fatiguability;
• shortness of breath;
• dizziness that occurs in attacks;
• pain in the chest area;
• fainting and semi-fainting states.

To prevent bradycardia and reduce symptoms, doctors advise following a special diet:

1. Drink as much fluid as possible. Ideally, one and a half to two liters per day.
2. Eat a lot of vegetables. It’s good if carrots, parsley, and cabbage predominate in the diet.
3. Give preference to lean meat.
4. From fruits, choose apples, bananas and citrus fruits that are good for your heart.
5. Eat fermented milk products.
6. Don't give up seafood.

In addition to diet, hardening and moderate physical activity are useful.

When choosing a sport for a child with cardiac bradycardia, its degree should be taken into account. To do this, you need to do an ECG, which will help you understand what kind of bradycardia is taking place: sinus or heterotopic.

Be sure to consult a cardiologist. It will help you decide on the type of load that will be optimal for a particular type and diagnosis.

How dangerous is the disease?

More severe complications occur with severe forms of the disease. The child’s body constantly experiences a lack of oxygen, the blood supply to soft tissues deteriorates, and the elimination of toxins and decay products slows down. This leads to the death of heart tissue and nerve fibers, and concomitant diseases of the kidneys, liver, and thyroid gland develop.

Among the dangerous complications:

• fainting;
• brain hypoxia;
• heart failure;
• thrombosis;
• increased risk of ischemic stroke;
• tachycardia.

In the absence of treatment or ignoring the recommendations of doctors, the child develops cardiopathy or angina pectoris, requiring surgical intervention.

Is treatment necessary?

Moderate sinus bradycardia in a child does not always require drug treatment. After diagnosis and identification of the cause, most children continue to play sports, attend school and clubs without restrictions. Doctors recommend annual ultrasound examinations to monitor the condition of the myocardium and sinus node.

In severe cases, treatment with special medications, physiotherapy, and vitamin complexes is required. The task of doctors is to prevent the development of complications that can lead to disability. If the situation worsens as you get older, corrective surgery is performed or a pacemaker is installed.

Diagnostic measures

Measuring your pulse daily can help detect irregular heart rhythms. If a decrease is observed for more than 7–10 days, it is better to consult a pediatrician or cardiologist for advice.

For a comprehensive examination, the following diagnostic methods are recommended:

• Taking an anamnesis, interviewing parents (doctors are interested in the presence of a genetic predisposition to diseases of the cardiovascular system).
• Daily monitoring of rhythm and blood pressure using a special device (Holter technique).

• Electrocardiogram.
• Ultrasound of the heart or echocardiography.
• MRI of the chest in severe forms of the disease.
• Analysis of thyroid hormones.
• Doppler of the arteries and vessels of the brain in the neurogenic form.

A clinical blood test helps identify hidden inflammation, shows anemia and other disorders. Diagnosis is carried out without hospitalizing the child to the hospital.

Methods for treating bradyarrhythmia

Only after a comprehensive examination does the doctor select a treatment method. For moderate forms of the disease in children and adolescents, a special diet and correction of the daily routine are recommended. A vitamin complex with magnesium, potassium and Omega-3 amino acids strengthens the heart muscle and immunity, helping the child cope with the stress of school and section.

If the heart rate is 40–50 beats, a therapeutic course in a hospital is recommended. The child is given special medications to eliminate hormonal imbalance or infectious inflammation due to pericarditis. In the organic or toxic form, treatment of the underlying cause is required.

Drug therapy

If the heart rate is slow, drugs are administered to normalize the heartbeat.

These are special cholinergic protectors that stimulate myocardial function without sudden surges in blood pressure:

• Metacin. Taken intravenously or subcutaneously 2–3 times a day, 0.5–1 mg. For a child, the daily dose should not exceed 6 mg.

• Atropine. When the heart rate decreases to 20–25 beats, the medicine is administered at a dose of 300 mcg every 6 hours. During an attack of bradyarrhythmia, a one-time dosage of 10 mcg per 1 kg of baby’s weight is used.
• Amiodarone. Improves coronary blood flow, used in the form of tablets or injections. For children, the dose is up to 10 mg per day. Course duration is up to 2 months.

To stimulate signal conduction from the sinus node, it is recommended to take beta-agonists:

• Ephedrine (Norepinephrine, Adrenaline);
• Izadrina;
• Alupenta (Eufillina).

For neurological problems that provoke attacks of bradyarrhythmia, doctors select sedative medications. When treating children, preference is given to herbal remedies with minimal risk of complications: Glycine, Pantogam, Citral.

Surgery

If drug therapy does not help stabilize the heart rhythm, surgery is performed. A common method is radiofrequency cardiac ablation, or RFA.

With its help, the cardiac surgeon cauterizes the area of ​​the muscle that causes the signal to slow down or removes excessive tissue growth on the wall of the sinus node. As a result, the incorrect path of impulses is interrupted, the frequency enters the normal range of 65–75 beats.

Before the operation, the child in the hospital undergoes a comprehensive examination for blood clotting time, viral hepatitis, and receives consultation with an otolaryngologist.

The cauterization procedure is as follows:

• Anesthetic and sedative drugs are injected into the femoral artery for anesthesia.
• Through a vein, the doctor passes a thin probe from sensors directly to the inflamed area of ​​the heart.
• Using a visual intravascular sensor, the surgeon determines the point of impact.
• After cauterization, a change in heart rhythm is observed for 10–15 minutes, after which the probe is removed and the patient is sent for rehabilitation.

The operation has minimal complications: there are no painful incisions, healing and recovery time is reduced. Already on the first day the baby can get up, move and eat. On days 3–5 he is discharged for home treatment.

A more traumatic method is to install a pacemaker. The miniature device becomes an artificial pacemaker, replacing the function lost by the heart. The device is permanently implanted into the child and is adjusted individually.

The procedure for installing a pacemaker is carried out by experienced cardiac surgeons and includes the following steps:

• Electrodes are inserted into the device through a puncture in the vein. They will pass through large vessels directly to the device.

• A subcutaneous pocket no larger than 5 cm in size is formed in the armpit, into which the pacemaker is placed.
• The connection occurs through the lateral vein of the arm.
• The electrodes are additionally attached to the endocardium using reliable hooks.
• Additionally, the device is tested and the results are recorded in a computer program.

The operation to install a pacemaker lasts at least 3 hours. The child receives antibiotics for 3–5 days to prevent rejection of the implanted device. Complete rehabilitation takes no more than 10 days.

Recipes for folk remedies

At the initial stage of the disease, drug treatment and traditional methods can be combined. Some plants contain beneficial substances that stimulate the functioning of the heart muscle and saturate tissues with mineral compounds and phytoncides. The most accessible recipes at home:

With an integrated approach, sinus bradyarrhythmia is treatable. Many children “outgrow” the disease by the age of 16–18 and get rid of shortness of breath and muscle weakness. Modern methods make it possible to completely relieve a child from the consequences of the disease and reduce the risk of dangerous complications, disability or death by 90%.

Article design: Vladimir the Great

Causes of bradycardia in adolescents when playing sports

A number of conditions can cause sinus bradycardia. In some cases the cause is unknown. When sinus bradycardia causes problems and obvious symptoms, it is called pathophysiological sinus bradycardia. Reasons for this type include:

• Problems with the SA node (sick sinus syndrome).
• Inflammatory heart diseases such as pericarditis or myocarditis.
• Heart diseases existing at birth (congenital).
• Increased pressure inside the head. For example, with a brain injury.
• Obstructive sleep apnea.
• Medicines that affect the SA node and heart rate, such as beta blockers or calcium channel blockers.
• Hypothyroidism.
• Some rare genetic diseases such as myotonic dystrophy.

How is sinus bradycardia diagnosed in adolescent athletes?

The diagnosis is made based on the medical history and a thorough physical examination of the young athlete. You will need a test called an electrocardiogram (ECG). This gives a picture of the heart rate. This test alone is often enough to make a diagnosis. A continuous electrocardiogram, such as Holter monitoring, can be used to check the heart over a longer period.

Other tests to diagnose the condition may include:

• Blood tests to rule out hypothyroidism or other abnormalities.
• Tests to diagnose sleep apnea.
• Perform stress testing to check your heart rate response to exercise.
• Tests to check in more detail your heart's electrical activity and (electrophysiological study) heart rhythm.
• Tests to study the autonomic nervous system (the nervous system that automatically controls various body functions).