In the good old days of Soviet medicine, the general medical setting was good and expressed something like this: “Do not give conclusions to narrow specialists and data of intermediate examinations, don’t show ready-made test forms, refer to the attending physician for explanations.”
However, in the era of insurance medicine, morals softened, and in the hands of any mother, an ECG film with a handwritten conclusion of a functional diagnostician could easily be found.
And the conclusions, I must say, are different, for example – Sinus arrhythmia. Should my mother faint immediately or first run to a paid cardiologist, having such an ECG in her arms?
What is sinus arrhythmia?
In a greater percentage of cases, sinus arrhythmia is a condition that does not threaten the life and health of the child. In general, sinus rhythm is a normal heart beat, the frequency of which is imposed by the main pacemaker (sinus node), the intervals between such contractions are the same. With sinus arrhythmia, the intervals between the individual heartbeats become different. At the same time, the total frequency of heart beats per minute remains within the normal range, may be increased (tachyarrhythmia) or reduced (bradyarrhythmia).
Unlike adults, for whom the normal heart rate ranges from 60 to 90 beats per minute, a child’s heart beats at different ages in different ways.
There are several options for sinus arrhythmia.
What sinus arrhythmia is not dangerous?
Sinus arrhythmia in children associated with breathing is called respiratory arrhythmia. This condition does not lead to disturbances in the pumping of blood by the heart, therefore it is not dangerous for children’s health.
Its origin is explained by the fact that during inhalation the heart rate reflex increases, while during exhalation it decreases. A similar situation occurs if the child during the ECG is laid on a couch covered with cold oilcloth. At this time, the child instinctively holds the breath, and the heart rate is reduced by several beats.
If the child ran before the test and then entered the cold room, sinus artimia can also be recorded on the ECG. Nevertheless, the statement that sinus arrhythmia in children is the norm is incorrect.
What is the main cause of the respiratory arrhythmia?
The immaturity of the nervous system is to blame. The younger the child, the easier it is to have such episodes. The most susceptible to such rhythm disturbances:
- Infants with postnatal encephalopathy, intracranial hypertension syndrome (see increased intracranial pressure in newborns), premature babies.
- Rickets in children, which alters the excitability of the nervous system, also provokes sinus respiratory arrhythmia.
- Excessively full children during exertion may manifest marked sinus arrhythmia.
- The child during periods of rapid growth (6-7, 9-10 years), the vegetative system does not have time to quickly adapt to the new requirements of the grown body.
Therefore, these age intervals may also be accompanied by respiratory sinus arrhythmia. As the maturation of the autonomic nervous system occurs, the risks of sinus arrhythmia become less and less.
Non-respiratory sinus arthmia
This rhythm disturbance can be permanent or paroxysmal. The frequency of attacks can vary from a couple per year to several per day. At the same time, the main pacemaker continues to impose the correct rhythm on the heart, however, changes in the cardiac conduction system or its cells (cardiocytes) result in arrhythmias. Most often, such changes are transient, that is, they are not associated with heart disease, but with some other disease or pathological condition.
Causes of non-respiratory arrhythmias
In approximately thirty percent of cases, pathological sinus arrhythmia occurs in children. Its causes lie in various cardiac pathologies.
- Hereditary predisposition If the parents of the child were prone to sinus arrhythmia of non-respiratory origin, then such a predisposition can be transmitted to the child. Although a hundred percent mandatory dependence is not.
- Infectious diseases accompanied by intoxication, fever or dehydration. Since the conduction of a nerve impulse, on which the contraction of the heart muscle depends, is connected with the fluxes of potassium, sodium and chlorine ions through the membrane of cardiocytes, any factors that change the water-electrolyte composition of the blood and interstitial fluid can trigger rhythm disturbances.
- Neurocirculatory dystonia (vegetative dystonia). Violation of the ability of vessels (including those that feed the heart) to adequately change its lumen depending on the needs of tissues for oxygen can also cause arrhythmias.
- Myocarditis. At inflammation of the cardiac muscle of a bacterial (for example, diphtheria) or viral (cytomegalovirus) infection, not only sinus arrhythmia will be observed, but also other rhythm disturbances (atrial fibrillation, extrasystole, heart block). There is also a rise in temperature, pain in the area of the heart, deafness of heart tones, signs of heart failure in the form of edema, shortness of breath, liver enlargement and other symptoms.
- Chronic rheumatic heart disease. Rheumatism, “licking the joints, but biting the heart,” affects the heart valve apparatus and can cause myocarditis and endocarditis. The debut of the disease is associated with transferred angina, accompanied by a temperature reaction, inflammation of large joints that pass quickly, and cardiac lesions, including sinus arrhythmia.
- Severe arrhythmia in a child can develop against the background of congenital heart defects.
- Heart tumors are the most rare cause of rhythm disturbances.
How are sinus arrhythmia in children and sport?
Quite often, parents whose children are engaged in sports sections, if a child has sinus arrhythmia, are asked what are the prospects for playing sports and how much previous classes are responsible for the development of rhythm disorders.
It must be said that without a predisposition to pathologies of the heart rhythm, even when playing professional sports, arrhythmia of the heart does not develop in a child. In the same case, when there was every reason for the debut of the arrhythmia, any physical activity could provoke it.
In all cases, respiratory arrhythmia in children is not a contraindication for classes in sports sections. But the child should be regularly examined by a cardiologist and he should receive a control electrocardiographic examination. It is important not to miss the possible transition of sinus arrhythmia to more severe rhythm disturbances.
If the child is involved in professional sports, he should be monitored by a sports doctor with a mandatory ECG every three months and Holter monitoring. If respiratory sinus arrhythmia is detected, the issue of admission to the competition should be decided individually. When confirming the non-respiratory nature of arrhythmias, sports are limited.
What can be seen on the ECG?
Since the pacemaker is a sinus node, there is a P wave in front of each ventricular QRS complex. This means that the electrical stimulation leading to myocardial contraction first spreads to the atria and then to the ventricles, that is, in normal mode.
The PQ interval, reflecting the time from the atria to the ventricles, maintains its normal length. But the RR interval between the tops of the ventricular complexes is lengthened or shrunk, reflecting a decrease or increase in heart rate. An example of sinus arrhythmia is shown in the figure.
What does the child feel?
Usually, sinus arrhythmia, especially respiratory, does not cause negative sensations. A child may feel increased heart rate.
If a child complains of shortness of breath, pain in the heart, fatigue, weakness, dizziness, this is a reason to consult a doctor. Probably, in addition to sinus arrhythmia, there is a more serious pathology of the heart. The same should be done if the child has shortness of breath or swelling, cyanosis of the nasolabial triangle or fainting.
Mom can count the number of heartbeats by placing a hand on the area of the baby’s left nipple. Also, arrhythmia can be detected by the pulse (clasping the wrist so that four fingers are on the outer edge of its inner surface, and the big one is on the opposite side). If you take a pulse or heartbeat for a minute, you can tell if there are any gaps between the individual beats at the present time.
What to do?
If a sinus arrhythmia is recorded on the ECG, a cardiologist should be visited. The doctor will prescribe a control electrocardiographic examination, ultrasound of the heart, urinalysis, CBC, and its biochemical examination.
In the event that no other abnormalities are detected, except for sinus arrhythmia, the child will be monitored by a cardiologist with a control electrocardiographic examination every six months.
Treatment of isolated sinus arrhythmia is not carried out. The child is engaged in physical education in the general group. Also not contraindicated in sports. Some restrictions may apply to participation in competitions.
For non-respiratory arrhythmias, they treat the cardiac problems that led to it. After the main therapeutic measures (a course of antibacterial or anticancer therapy, correction of heart disease, relief of manifestations of heart failure with a course of cardiac glycosides and diuretics, antiarrhythmic drugs and courses of Elkar or Mildronate are prescribed as a regenerative therapy).
In any case, when there is sinus arrhythmia in children, treatment will be selected by a cardiologist, based on the underlying cause that led to cardiac arrhythmias.