In adults, when the rhythm controlled by sinus node exceeds 100 beats per minute, it is called sinus tachycardia. This is the most common tachycardia, and its occurrence is often related to sympathetic excitation and decreased vagal tension. It is not primary arrhythmia, which may be caused by many reasons. Physiologically, it can be caused by exercise, anxiety and emotional excitement, and it can also occur after the application of drugs such as adrenaline and isoproterenol. It is easy to occur in heart diseases such as fever, hypovolemia, anemia, hyperthyroidism, respiratory insufficiency, hypoxemia, hypokalemia and heart failure. The disease can be cured after controlling the primary disease or inducing factors, but it is easy to recur.
The cause of disease
Exercise and emotional stress in healthy people can lead to tachycardia. Alcohol, tea, coffee and drugs such as isoproterenol and atropine often cause sinus tachycardia. Common diseases in disease state include fever, hypotension, hypoxia, cardiac insufficiency, anemia, hyperthyroidism, myocarditis and so on. The etiology of sinus tachycardia is mostly functional, and it can also be seen in organic heart disease and extracardiac factors. Its production is mainly related to sympathetic nerve excitation and decreased vagus nerve tension.
1. Physiology: Physiological sinus tachycardia is very common. There are many factors that affect the heart rate, such as posture change, physical activity, food digestion, emotional anxiety, pregnancy, excitement, fear, excitement, drinking, smoking, drinking tea, etc., which can increase the heart rate. In addition, age is also a factor, and children's heart rate tends to be faster.
2. Pharmacology: such as sympathomimetic drugs such as ephedrine and adrenaline. Parasympathetic nerve blockers such as atropine, caffeine, thyroxine and amphetamine can cause tachycardia.
3. Pathology: Systemic diseases such as high fever, anemia, hypoxia, infection, hyperthyroidism, pain, acute rheumatic fever, beriberi and neurosis can all cause tachycardia.
4. Cardiovascular diseases: Acute blood loss, hypotension and shock, arteriovenous fistula, heart failure, myocarditis, cardiomyopathy, pericarditis, acute myocardial infarction and various organic heart diseases can all lead to sinus tachycardia.
clinical picture
1. Palpitation, sweating, dizziness, dizziness, fatigue or primary symptoms.
2. It can induce other arrhythmia or angina pectoris.
3. The heart rate is mostly 100 ~ 150 beats/min, with strong heart sounds or signs of primary heart disease.
Diagnostic basis
1. The heart rate exceeds 100 beats/min, mostly 100 ~ 150 beats/min, and the heart sounds are always strong. There may be manifestations of primary disease.
2. ECG: sinus rhythm: I, II, avF, ⅴ 4-6 leads, P wave upright;
Lead avR and P wave inversion;
The remaining lead P waves can be upright or inverted.
The morphology of P wave is normal, the P-R interval is more than 0.12s, and the frequency is more than 100 times/min.
treat cordially
Principles of treatment:
1. Eliminate the inducement and treat the primary disease.
2. Symptomatic treatment.
Medication principle:
1. After eliminating the cause or inducement, the symptoms of most patients can disappear.
2. If there is a clear primary disease, it should be actively treated.
3. When the symptoms are obvious, drugs such as beta blockers or sedatives can be given for symptomatic treatment. When the drug "A" fails first, choose "B" or "C".
Curative effect evaluation
1. cure: after treatment, symptoms disappeared and ECG returned to normal.
2. Improvement: After treatment, the symptoms were relieved and the heart rate slowed down, but it was still greater than 100 beats/min.
complication
The disease is often caused by other diseases, so its complications are related to the etiology. Common complications include acute pulmonary edema, heart failure, cardiogenic shock and other critical symptoms.
1, pulmonary edema
Pulmonary edema is the increase of lung water content caused by fluid exchange disorder between pulmonary blood vessels and tissues. The disease can seriously affect respiratory function, and it is a common cause of acute respiratory failure in clinic. The main clinical manifestations are extreme dyspnea, sitting breathing, cyanosis, hyperhidrosis, paroxysmal cough with a large amount of white or pink foam sputum, symmetrical moist rales in both lungs, butterfly-shaped fuzzy shadow on X-ray chest film, and shock or even death in the late stage. Early arterial blood gas analysis may include low O2, low CO2 partial pressure, severe O2 deficiency, CO2 retention and mixed acidosis.
2. Heart failure
Heart failure is divided into left heart failure and right heart failure The main manifestations of left heart failure are fatigue, fatigue and dyspnea. At first, it is fatigue dyspnea, and finally it becomes dyspnea at rest, so you can only sit up and breathe. Paroxysmal dyspnea is a typical manifestation of left heart failure, which is more common in sleep, characterized by chest tightness, shortness of breath, cough and wheezing. Particularly severe dyspnea can evolve into acute pulmonary edema with severe asthma, sitting breathing, extreme anxiety, coughing up foam-containing mucus sputum (typically pink foam-like sputum), cyanosis and other lung depression symptoms. The main manifestations of right heart failure are edema of lower limbs, jugular vein dilatation, loss of appetite, nausea and vomiting, oliguria, nocturia, separation of drinking water and urination, etc.
3. Cardiogenic shock
Cardiogenic shock refers to the syndrome of severe acute peripheral circulation failure due to the extreme decline of cardiac function, which leads to a significant decrease in cardiac output. Clinically, the main manifestations are severe basic heart disease and systemic failure, including persistent hypotension, oliguria, disturbance of consciousness and peripheral cyanosis. And acute pulmonary edema and hemodynamic changes, namely arterial pressure.
Sinus tachycardia is called sinus tachycardia when the sinus rhythm is 100 ~ 150 beats/min. Sinus tachycardia is not a separate disease. First of all, we should try to avoid inducing factors, such as drinking strong tea, drinking alcohol, using drugs that excite the heart and speed up the heart rate. Keep a happy mood and prevent excessive excitement and anxiety. If you have cardiopulmonary diseases or other systemic diseases, you should actively treat them. When recurrent attacks and symptoms obviously affect daily life and work, you should see a doctor in time and find out the reasons as soon as possible to facilitate prevention and treatment.