Overview of abnormal electrocardiogram
Electrocardiogram (ECG) refers to that the heart is continuously excited by the pacing point, atrium and ventricle in each cardiac cycle, and with the changes of ECG bioelectricity, various patterns of potential changes are drawn from the body surface by ECG recorder. Electrocardiogram (ECG) is an objective index of the occurrence, spread and recovery of cardiac excitement.
What are the causes of abnormal ECG?
When arrhythmia, ventricular atrial hypertrophy, myocardial infarction, myocardial ischemia and other diseases occur, ECG abnormalities will occur. ① Nonspecific abnormality of T wave.
② The minimum voltage value of left ventricular hypertrophy (left ventricular hypertrophy) may be normal variation; A roughly normal electrocardiogram is suggested in English as: left ventricular hypertrophy with abnormal repolarization.
4. The principle of life after old inferior and posterior myocardial infarction is to avoid heavy physical activity.
Avoid excessive mental stress, irregular life and long-term continuous work. During the whole recovery period, it is necessary to accept the supervision and guidance of doctors frequently; The amplitude and direction of T wave are often influenced by endocrine, metabolism and autonomic nervous system activities, except heart disease. For example, when the spirit is stimulated, the T-wave can be temporarily flattened or even inverted. In general, in the high R-wave coupling, T-wave should not be lower than110 of R-wave; Normal T wave forms are mostly obtuse, with long anterior branches and short posterior branches. TaVR inversion; tⅰ、ⅲ、V4~6 .
Erect; The vertical T wave should be larger than110 of the same lead R wave, but TV 1≤0.4mV and TV2 ~ 4 ≤ 1.5 MV. Anything different from this is a T wave change;
5. Low voltage means that the absolute values of Q, R and S waves in each lead of the six limb leads are below 0.5mV. If the absolute values of the voltages in all five leads are below 0.5mV and the other lead is 0.5mV_0.9mV, it is called low voltage tendency. The appearance of low voltage indicates myocardial disease or general obesity.
What are the tests for abnormal electrocardiogram?
1, atrial hypertrophy: divided into left and right atrial hypertrophy or bilateral atrial hypertrophy. The ECG shows abnormal P wave, which is more common in chronic pulmonary heart disease, rheumatic mitral stenosis or atrial muscle thickening and atrial cavity enlargement caused by various reasons.
2. Ventricular hypertrophy: divided into left and right ventricular hypertrophy or biventricular hypertrophy. Electrocardiogram shows QRS wave abnormality, which is more common in rheumatic heart disease, chronic pulmonary heart disease, congenital heart disease, hypertension or ventricular muscle thickening and ventricular cavity enlargement caused by various reasons.
3. Myocardial ischemia: ECG shows abnormal ST segment and T wave, referred to as ST-T change, which is seen in chronic coronary insufficiency and angina pectoris.
4. Myocardial infarction: It can be divided into acute stage and senile stage. The electrocardiogram of acute myocardial infarction is characterized by obvious changes in QRS wave and ST-T, while the ST-T of old myocardial infarction mostly returns to normal, leaving only necrotic Q wave.
5. Arrhythmia: The rhythm of normal people is sinus rhythm, with a balanced rhythm, and the frequency is 60 ~ 100 times per minute. If the origin of cardiac excitement is in sinus node or abnormal conduction system, arrhythmia will occur.
6. Sinus arrhythmia: Sinus tachycardia occurs when the sinus heart rate exceeds 100 times per minute, which is common in exercise or mental stress, fever, hyperthyroidism, anemia, myocarditis, etc. Sinus bradycardia occurs when the sinus heart rate is lower than 60 beats per minute, which is common in hypothyroidism, intracranial hypertension, elderly people and some drug reactions. The electrocardiogram of sinus arrhythmia shows abnormal P-R interval, which has little clinical significance.
7. Premature beat: referred to as premature beat, it refers to the heartbeat that occurs before the normal cardiac cycle, and then there is often a long interval called compensatory interval, which is divided into atrial phase, junctional phase and ventricular phase. Electrocardiogram showed changes of P wave, QRS wave and ST-T, with complete or incomplete compensation interval. Occasional premature beats can be seen in normal people, but frequent ventricular premature beats or the formation of two laws and three laws are more common in many heart diseases.
8. Ectopic tachycardia: It can be divided into paroxysmal and non-paroxysmal, and can also be divided into supraventricular or ventricular tachycardia. The former has normal ECG morphology except for its fast frequency and irregular rhythm, while the latter has large QRS wave malformation, which is more common in organic heart disease, and non-organic heart disease can also occur.
9, flutter and fibrillation: divided into atrium and ventricle. Atrial flutter and atrial fibrillation are ectopic rhythms with a frequency of 250 ~ 600 beats per minute. P wave disappears and is replaced by abnormal "F" wave, which is more common in senile heart degenerative changes, hypertension, coronary heart disease, cor pulmonale, hyperthyroidism and so on. Ventricular flutter and fibrillation belong to malignant arrhythmia, and the patient's life is in danger, so it is necessary to race against time to rescue him.
Differential diagnosis of abnormal electrocardiogram;
1. Acute myocardial infarction: QRS and ST-T wave changes appear on ECG, which may lead to myocardial necrosis due to coronary artery blockage supplying myocardial blood flow, and may also affect life due to arrhythmia, heart rupture and heart failure. Emergency intensive care and observation are needed, especially when they arrive at the hospital in the golden period, and appropriate drugs and medical treatment are given at an early stage, such as thrombolytic drugs, emergency cardiac catheterization coronary angiography, coronary catheter dilatation and stent implantation in narrow coronary arteries.
2. Old myocardial infarction: there was myocardial necrosis in the past, which may be small in scope or the clinical symptoms are not obvious, especially in the elderly or severe diabetic patients with painless myocardial infarction, so that they did not feel the symptoms of myocardial infarction, and the history of myocardial infarction was unknown, which usually suggested that there was something wrong with the coronary artery, and other necessary further examinations and necessary treatments should be carried out by cardiologists.
3. Myocardial hypoxia: ECG changes caused by myocardial blood flow or perfusion may be caused by coronary artery stenosis, severe anemia, aortic valve stenosis, myocardial hypertrophy, hyperthyroidism or other problems such as drugs. Cardiologists should quickly assess the cause, and further check exercise electrocardiogram, myocardial perfusion photography, echocardiography and cardiac catheterization if necessary. To determine whether there is myocardial hypoxia caused by coronary artery disease and other reasons, and further treatment as needed. Subjects should quit smoking, exercise moderately, reduce greasy food, lose weight, control blood pressure and blood sugar, etc. So as to reduce the risk factors of coronary atherosclerosis and stenosis.
4. Nonspecific ST-T changes: those who have ST or T wave changes on ECG but fail to meet the standard of myocardial hypoxia may be caused by coronary heart disease, drugs, metabolic diseases and other cardiopulmonary diseases. It may also be temporary and has no clinical significance. It will be normal if you check it again. It is suggested that cardiologists evaluate and analyze the patient's medical history, clinical symptoms and risk factors, and make further examination if necessary. Especially those with clinical symptoms, they should go to the hospital for examination immediately, but if there is no special clinical significance, they should also avoid excessive anxiety or receive too many invasive examinations.
5. Arrhythmia: The normal ECG is affected by physical deformity, cardiac conduction axis, chest circumference, lung disease, obesity and other factors. Generally, it beats regularly at a speed of 60 ~ 100 times per minute. The so-called arrhythmia refers to irregular heartbeat or speed change, or the starting point of starting heartbeat is not stimulated by normal sinus node. It may be a normal physiological phenomenon, or it may be affected by systemic physical diseases, drugs, endocrine and nervous system, and it is necessary for cardiologists to decide the treatment plan according to individual conditions.
6. Sinus bradycardia: The heart rate at the beginning of sinus node is lower than 60 beats per minute, which may be a normal physiological phenomenon, especially for athletes or general sports people. It is normal for young people to have a heartbeat below 60 beats per minute at rest. In addition, some drug addicts, especially hypertensive patients, take β -receptor antagonists, antihypertensive drugs, anti-Parkinson drugs, digitalis cardiotonic drugs, antidepressants, morphine and so on. , will slow down the heart rate. And hypothyroidism, the body
Low body temperature and high brain pressure can also happen. However, myocardial hypoxia, myocardial infarction, myocarditis or sinus node degeneration in the elderly can also cause bradycardia. Therefore, asymptomatic healthy physical examinees, who have simple sinus bradycardia and no other complicated ECG abnormalities, and have no clinical symptoms such as dizziness, fainting and temporary loss of consciousness, especially young healthy people, may be physiological phenomena, so just observe. If you have clinical symptoms or other ECG abnormalities, you should consult a cardiologist.
7. Sinus tachycardia: the heart rate at the beginning of sinus node is greater than 100 per minute. When a healthy person is in tension, fear, stress or exercise, his heart rate may exceed 100. In addition, drug abuse, smoking, drinking coffee and other stimuli will also accelerate his heart rate, and there will be fever, physical illness, lack of body fluids and so on. Therefore, the general physical examination can be observed if there are no clinical symptoms. However, if there is a suspected disease, you should consult a doctor for further evaluation and examination.
8. Sinus arrhythmia: Under normal circumstances, the information released by sinus node is slightly different. When this difference is greater than 0. 1.6, it is called sinus arrhythmia. Normal young people or children are common normal phenomena, but they can be influenced by drugs, such as B- antagonists, foxglove and morphine. If this arrhythmia does not change with breathing, we should pay attention to whether there is any change in heart rate caused by acute physical disease, heart disease or brain disease, especially abnormal brain pressure.
9. Atrial premature beats: When the initial pulse of heartbeat is sent from the atrium outside the sinus node instead of the original sinus node, it may appear in normal healthy people, especially when drinking, coffee, nicotine, anxiety and fatigue are the most common. However, if there are clinical symptoms and the frequency increases, we should pay attention to whether there are atrial hypertrophy, myocardial hypoxia or infarction, pulmonary embolism, hypoxemia (such as smoking) and chronic lung diseases, and should go to the hospital for examination.
10. Sinus node conduction obstruction: P wave appears on ECG without rs wave, indicating that pulse cannot be conducted, which may be caused by athletes, vagus nerve excitation, sinus hypersensitivity of head artery, coronary heart disease, acute myocarditis, myocardial lesion, excessive foxglove or quinine, hyperkalemia, hypercapnia, hypoxemia and hypothermia. The elderly should pay attention to whether there is a sinus node of unknown cause. Especially for the elderly health examinees, if sinus node conduction obstruction is complicated with bradycardia, and there are symptoms of brain hypoxia such as dizziness, dizziness, fall, temporary loss of consciousness, special attention should be paid to severe sick sinus node syndrome. Cardiologists should conduct electrophysiological examination of cardiac catheters and install rhythm regulators if necessary. For most asymptomatic health examinees, if there are no special risk factors of coronary heart disease or cardiopulmonary disease, observation and follow-up are the most ideal suggestions without anxiety.
1 1. Multi-source atrial tachycardia: This kind of ECG abnormality is not common in general adult labor health examination, and usually appears in the elderly with serious diseases, especially in patients with chronic obstructive pulmonary disease. If the subject smokes and has obvious cough, expectoration and dyspnea, he is advised to quit smoking immediately and receive medication. In addition, people with digitalis poisoning, congestive heart failure, coronary heart disease, hypertensive heart disease, hypokalemia and pulmonary embolism may also have this disease.
12. Ectopic atrial rhythm: it occasionally appears in healthy people, but it usually suggests heart disease, especially in patients with heart failure. Therefore, when the subjects have abnormal ECG and symptoms, it is suggested that the cardiology department conduct a detailed investigation.
13. Atrial fibrillation and atrial flutter: This kind of abnormal heart rhythm usually has palpitation symptoms, which are rare in general workers or healthy people, and generally suggests heart disease, especially in the elderly. There are often atrial fibrillation or flutter heart disease, such as atrial enlargement, wind-induced heart valve disease, especially mitral stenosis, coronary artery disease, myocardial infarction, hypertensive heart disease, myocardial lesion, quinine overdose, WPW syndrome and so on. However, occasional paroxysmal atrial fibrillation or flutter disease occurs in pulmonary embolism, serious lung disease, especially when chronic obstructive pulmonary disease worsens. Occasionally, ordinary people without heart and lung diseases will have unexplained atrial fibrillation due to alcohol stimulation, or paroxysmal atrial fibrillation due to excessive coffee, smoking, hyperactivity, excitement or physical fatigue. Therefore, if there is such a change in ECG, cardiologists should make a detailed investigation as soon as possible, check the cause and make necessary treatment.
14. counterclockwise rotation of the heart: the space of the heart in the chest cavity is more backward than that of normal people, which generally has little clinical significance.
15. Left axis or right axis: When axis deflection occurs on ECG, you should consult a cardiologist for necessary examinations, including echocardiography, exercise electrocardiogram and cardiac catheterization, and make a detailed differential diagnosis.
16. atrioventricular block: it is a phenomenon of delayed conduction of cardiac conduction potential from atrium to ventricle through atrioventricular node. When the physiological vagus nerve is strong, first-degree obstruction can occur, often accompanied by sinus bradycardia. Atrioventricular block can also be caused by inferior myocardial infarction with atrioventricular node ischemia, anterior myocardial infarction with ventricular septal necrosis, atrioventricular node degeneration fibrosis or calcification, metabolic diseases or tumor infiltration invading atrioventricular node, myocarditis, rheumatic heart disease, B- antagonist, foxglove and other drugs. Generally, first-degree obstruction does not affect cardiac function. Please ask a cardiologist to identify and analyze the potential causes and eliminate them. There are two types of secondary atrioventricular conduction obstruction. The first kind is usually caused by drugs, especially foxglove, B- antagonist, type I arrhythmia drugs, verapamil and diltiazem in calcium blockers, which occasionally occur when the vagus nerve system is too strong, and also occur in myocardial hypoxia, degenerative conduction system diseases, myocardial pathological changes, myocarditis, hypoxemia and recent heart surgery. So we need to watch closely and find out the reason. The second-degree atrioventricular block must be caused by pathological diseases and will not occur under physiological conditions. It should be monitored by ECG monitor immediately and in cardiac intensive care unit, and actively find out the causes, especially the type II atrioventricular block complicated by myocardial infarction. Pay close attention and use a pacemaker immediately if necessary.
In addition, invasive diseases invade the cardiac potential conduction system, hypertension, cardiomyopathy, acute myocarditis, syphilitic heart disease, siderosis, congestive heart failure, heart surgery and so on. Type ⅱ atrioventricular conduction obstruction may also occur. Third-degree atrioventricular node conduction obstruction and atrial-ventricular potential separation mainly occur in acute myocardial infarction with large anterior wall necrosis. If you find this abnormal ECG, you should consider installing a pacemaker. In addition, some third-degree atrioventricular node conduction obstruction caused by pathological changes, degenerative infiltration, fibrosis or calcification, degenerative infiltration or calcification diseases, myocardial diseases and other factors need professional differential diagnosis and treatment by cardiologists, and some cases need emergency intensive care.
17. Obstruction of right bundle branch conduction: The conduction bundle to the right heart has pathological changes, such as myocardial infarction or hypoxia, myocarditis, invasive heart disease (tumor or amyloidosis), increased pressure load on the right ventricle caused by degenerative sclerosis or acute pulmonary embolism, atrial septal defect, chronic fluid load on the right ventricle, hypertensive heart disease and other heart or lung diseases. However, in some young people, there may be no heart disease and incomplete conduction obstruction of the right bundle branch. Therefore, health examination workers, especially young people, can be evaluated by cardiologists first, and then observed and followed up. However, some patients with symptoms, elderly people, potential risk factors, hypertension, chronic obstructive pulmonary disease and coronary heart disease should be identified by cardiologists, and their living habits and behaviors should be improved, blood pressure and blood sugar should be controlled, and other necessary drug treatments should be carried out.
18. Left bundle branch conduction obstruction: Except for a few people, this kind of conduction obstruction is mostly complicated with heart diseases, especially coronary artery diseases and various left ventricular hypertrophy diseases caused by increased pressure load or increased body fluid load, primary sclerosis, degenerative conduction system diseases, myocarditis, various invasive heart diseases, etc. Therefore, if the subjects find left bundle branch conduction obstruction in ECG, especially new cases not found in previous examinations, voices, heart murmurs or other people suspected of myocardial hypoxia and heart failure, they should be examined by echocardiography, exercise electrocardiogram and cardiac catheter. Evaluate and identify the cause and severity of heart disease and the necessary treatment in cardiology. If there is no obvious underlying disease, regular follow-up is recommended. However, it is necessary to quit smoking, lose weight, eat less high-fat foods, control blood pressure, blood sugar and blood lipids, and reduce risk factors affecting heart health.
19. Ventricular premature beats: This abnormal ECG is caused by ventricular ectopic potential. Ventricular premature beats will see abnormal QRS wave changes on ECG, which are generally divided into: 0 degree, ventricular premature beats; Level 1, occasionally alone, less than 30 per hour; The frequent occurrence of the second degree is greater than once per minute; Third degree polymorphic ventricular premature beats (R-ON-T phenomenon). In healthy people or people with mitral valve prolapse, the most common ECG abnormality is ventricular premature beats; In addition, mental stress, anxiety, nervousness, exercise, aging, alcohol, coffee, tobacco, plant-like nerve stimulants, antiarrhythmic drugs, anesthetics and so on. , will increase the incidence of ventricular premature beats; In addition, hypoxemia, hypokalemia, hypomagnesemia, myocardial hypoxic infarction, myocarditis, cardiomyopathy, mitral valve prolapse, other heart valve diseases and congestive heart failure will occur. Therefore, in general healthy asymptomatic young people, if there is no doubt about the special cause, simple ventricular premature beats only need to follow up and improve their living habits. However, if there are potential causes, symptoms or arrhythmia, or other ECG lesions, or high-density premature ventricular contractions, the causes and treatment should be examined in detail, especially when the R-ON-T phenomenon is in danger of developing into ventricular tachycardia or atrial fibrillation, it should be closely monitored and controlled.
20. Atrium enlargement or hypertrophy: If the right atrium enlargement may be caused by tricuspid valve or pulmonary valve countercurrent or stenosis, pulmonary embolism, pulmonary hypertension or chronic lung disease may cause pulmonary heart disease. If the physical examiner smokes for a long time, has chronic cough, has difficulty breathing and has hypertrophy of the right atrium in electrocardiogram, he should quit smoking as soon as possible. As for left atrial hypertrophy, the most obvious reason is mitral stenosis or regurgitation. Others include aortic valve disease, left ventricular hypertrophy and chronic left ventricular failure. Patients with chronic high cardiac pressure may cause left ventricular hypertrophy, and then left atrial hypertrophy. If hypertension is complicated with abnormal ECG, blood pressure should be strictly controlled.
2 1. Ventricular enlargement or hypertrophy: the contraction force of the heart during contraction pumps blood into blood vessels and circulates it to the whole body or lungs. If the long-term systolic pressure load increases, it will cause ventricular wall muscle hypertrophy; During diastole, the ventricular cavity receives blood from the atrium. If there is too much blood in the ventricular cavity, the body fluid load will increase, which will lead to heart dilatation. The manifestation of ventricular hypertrophy recorded by ECG is that the electric wave on ECG becomes larger, but the increase of QPS wave potential on ECG does not necessarily mean ventricular hypertrophy. It may be that young people are thinner and the heart is close to the chest wall and records higher potential. Therefore, those who have doubts about ventricular hypertrophy suggest further echocardiography to determine the cause and cardiac function. As for asymptomatic young people, besides controlling blood pressure, we should pay special attention to whether there is congenital cardiac hypertrophy, because this disease is prone to arrhythmia, sudden attack and sudden death during exercise. The causes of left ventricular hypertrophy or enlargement may be aortic stenosis, aortic valve disease, ventricular septal defect, mitral regurgitation, arterial catheter and other diseases. Among the causes of left ventricular hypertrophy in ECG of asymptomatic workers, hypertension and thin chest wall are the most common, and most of them only need to be tracked. However, if you have chest tightness, chest pain, dyspnea, wheezing and heart murmur, you should be further examined and treated by a cardiologist. Of course, we should quit smoking and control high blood pressure. Right ventricular hypertrophy is rarely found in labor health examination, which may be caused by tricuspid insufficiency, atrial septal defect or ventricular septal defect, pulmonary valve disease, pulmonary embolism, pulmonary hypertension and so on. Special attention should be paid to some chronic lung diseases, such as smoking, pneumoconiosis or chronic obstructive pulmonary disease caused by other reasons, which leads to an increase in the pressure load from the right ventricle to the pulmonary artery, resulting in the right ventricular wall muscle hyperplasia with rSs characteristics on the V 1 chest lead of the electrocardiogram. For example, if the electrocardiogram only shows ventricular hypertrophy or enlargement, but there are no symptoms of functional failure or abnormal lung function, It may be physiological or physical factors that lead to the high cardiac potential recorded on ECG, but it may also be a potential disease, so you don't need to be too anxious at first, but you should also discuss the problem with cardiologists appropriately, or use echocardiography and other related tests to confirm whether there is atrial hypertrophy (measure the thickness of myocardium) or enlargement (measure the size of cardiac cavity), and evaluate the heart.
1, atrial hypertrophy: divided into left and right atrial hypertrophy or bilateral atrial hypertrophy. The ECG shows abnormal P wave, which is more common in chronic pulmonary heart disease, rheumatic mitral stenosis or atrial muscle thickening and atrial cavity enlargement caused by various reasons.
2. Ventricular hypertrophy: divided into left and right ventricular hypertrophy or biventricular hypertrophy. Electrocardiogram shows QRS wave abnormality, which is more common in rheumatic heart disease, chronic pulmonary heart disease, congenital heart disease, hypertension or ventricular muscle thickening and ventricular cavity enlargement caused by various reasons.
3. Myocardial ischemia: ECG shows abnormal ST segment and T wave, referred to as ST-T change, which is seen in chronic coronary insufficiency and angina pectoris.
4. Myocardial infarction: It can be divided into acute stage and senile stage. The electrocardiogram of acute myocardial infarction is characterized by obvious changes in QRS wave and ST-T, while the ST-T of old myocardial infarction mostly returns to normal, leaving only necrotic Q wave.
5. Arrhythmia: The rhythm of normal people is sinus rhythm, with a balanced rhythm, and the frequency is 60 ~ 100 times per minute. If the origin of cardiac excitement is in sinus node or abnormal conduction system, arrhythmia will occur.
6. Sinus arrhythmia: Sinus tachycardia occurs when the sinus heart rate exceeds 100 times per minute, which is common in exercise or mental stress, fever, hyperthyroidism, anemia, myocarditis, etc. Sinus bradycardia occurs when the sinus heart rate is lower than 60 beats per minute, which is common in hypothyroidism, intracranial hypertension, elderly people and some drug reactions. The electrocardiogram of sinus arrhythmia shows abnormal P-R interval, which has little clinical significance.
7. Premature beat: referred to as premature beat, it refers to the heartbeat that occurs before the normal cardiac cycle, and then there is often a long interval called compensatory interval, which is divided into atrial phase, junctional phase and ventricular phase. Electrocardiogram showed changes of P wave, QRS wave and ST-T, with complete or incomplete compensation interval. Occasional premature beats can be seen in normal people, but frequent ventricular premature beats or the formation of two laws and three laws are more common in many heart diseases.
8. Ectopic tachycardia: It can be divided into paroxysmal and non-paroxysmal, and can also be divided into supraventricular or ventricular tachycardia. The former has normal ECG morphology except for its fast frequency and irregular rhythm, while the latter has large QRS wave malformation, which is more common in organic heart disease, and non-organic heart disease can also occur.
9, flutter and fibrillation: divided into atrium and ventricle. Atrial flutter and atrial fibrillation are ectopic rhythms with a frequency of 250 ~ 600 beats per minute. P wave disappears and is replaced by abnormal "F" wave, which is more common in senile heart degenerative changes, hypertension, coronary heart disease, cor pulmonale, hyperthyroidism and so on. Ventricular flutter and fibrillation belong to malignant arrhythmia, and the patient's life is in danger, so it is necessary to race against time to rescue him.
How to prevent and treat abnormal ECG?
Sinus arrhythmia is the most common arrhythmia, which is caused by irregular signals from sinus node. But this kind of "arrhythmia" mostly belongs to "respiratory sinus arrhythmia", which is a normal physiological phenomenon. Its characteristic is that it changes with the change of breathing. When inhaling, the heart rate can be accelerated by several jumps, and when exhaling, it can be slowed down by several jumps. Its fast and slow cycle is exactly equal to a breathing cycle, and when you hold your breath, your heart rate becomes regular. This kind of "sinus arrhythmia" which changes with breathing is completely normal, so there is no need to worry or treat it.
Therefore, people diagnosed with sinus arrhythmia can pay attention to whether the acceleration and deceleration of their heart rate are related to breathing. As long as there are no other symptoms, you don't need treatment and you can engage in normal study and life.
In addition, mental stress and other factors may also cause "sinus arrhythmia", which does not need treatment.