Symptom >> Internal Medicine >> Cardiology

Standing heart rate difference

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction The difference in standing heart rate refers to the difference in heart rate per minute in the vertical position. After recording the supine position II lead electrocardiogram, it quickly rose in 5 seconds and continued to record the electrocardiogram. The R-R interval between the standing position and the lying position was measured, and the difference in heart rate per minute between the standing position and the lying position (the vertical difference) was calculated. Normally greater than 15 beats / min, if less than 15 beats / minute abnormal. Diabetes patients under 60 years of age, the vertical difference is less than 15 beats / min, combined with clinical considerations can be considered cardiovascular cardiovascular neurological damage. Diabetes is a common disease caused by the interaction of genetic and environmental factors. Clinically, hyperglycemia is the main indicator. Common symptoms include polydipsia, polyuria, polyphagia, and weight loss. Diabetes can cause multiple systemic damage.

Cause

Cause

The etiology and pathogenesis of diabetes is very complicated and has not yet been fully elucidated. The causes of different types of diabetes vary, and even the same type of diabetes has different causes.

Currently considered to be mainly related to the following factors:

1. Race and genetic factors

The prevalence of type 2 diabetes varies from country to country, from 6 to 8% in the US to 3.21% in China, and 30% and 50% in the Pacific island countries of Nauru and Native American Pima.

2. Lifestyle changes

Due to the rapid development of the national economy in developing countries (such as China), people's living standards continue to improve, often with excess nutrients, while physical activity is significantly reduced, making the original potential function of islet B cells overburdened, thereby inducing diabetes.

3. Obesity factors

Obesity is currently considered to be an important risk factor for diabetes. About 60% to 80% of adult diabetic patients are obese before onset. The prevalence of diabetes is related to the degree and type of obesity. Central type (or abdominal type) obesity is particularly closely related to the occurrence of diabetes. According to some data, as the age increases, physical activity gradually decreases, and the ratio of muscle to fat changes. From 25 to 75 years old, muscles have gradually decreased from 47% to 36%, and fat has increased from 20% to 36%. This is one of the main reasons for the significant increase in diabetes in the elderly, especially obese and fatty. .

4, spiritual factors

Stress, agitation, and various stress states can cause massive secretion of hormones that raise blood sugar (such as growth hormone, norepinephrine, glucagon, and adrenocortical hormone). The prevalence of diabetes in urban residents who suffer more mental stress is higher than that of rural residents, and the prevalence of mental activity is higher than that of physical activity.

5. Environmental factors

(1), viral infection

In 1864, Norwegian doctors reported a case of diabetes after mumps virus infection, suggesting that there is a link between viral infection and diabetes. In the past 100 years, reports of type 1 diabetes after viral infection have been commonplace. The related viruses include mumps virus, rubella virus, cytomegalovirus, and Coxsackie B virus.

(2), chemical intake

Alloxan, streptozotocin and rodenticide Vacor have toxic effects on islet B cells, which can cause impaired glucose tolerance or diabetes after being taken by humans and animals.

6, autoimmune

Type 1 diabetes: Islet cell antibodies (ICA), insulin autoantibodies (IAA), glutamate decarboxylase antibodies (GADA), and other autoantibodies are present in the patient's serum.

Type 1 diabetes and its relatives are often accompanied by other autoimmune diseases such as hyperthyroidism, Hashimoto's thyroiditis, primary adrenal insufficiency, pernicious anemia, myasthenia gravis, and rheumatoid arthritis.

A large number of lymphocytes infiltrate islets in the pathological sections of diabetic pancreas, which is direct evidence of cellular immunity in type 1 diabetes.

Examine

an examination

Related inspection

Heart sound map check ECG

The WHO has published a new standard for the diagnosis of diabetes, which was approved by the Chinese Medical Association Diabetes Association and officially implemented in China:

Those with diabetes symptoms (polyuria, polydipsia, polydipsia, weight loss) who meet one of the following three are diabetes:

1. Random (any time of the day) plasma blood glucose 11.1mmol / L.

2. Fasting plasma glucose 7.0mmol/L.

3. Oral glucose tolerance test (OGTT) two hours plasma glucose 11.1mmol / L.

Diagnostic instructions:

1. Asymptomatic diagnosis of diabetes should have two blood glucose measurements to achieve the above criteria.

2. In the case of acute infection, trauma, surgery or other stress, although significant hyperglycemia is measured, it is not immediately diagnosed as diabetes, and it needs to be retested after the stress condition is over.

3. The OGTT test should be performed in an ideal situation. If the OGTT is not suitable for some reason, or if the child has severe diabetes symptoms, high blood sugar, positive urine glucose, or positive urine ketone body, the OGTT test may not be performed.

What kind of diabetes is diagnosed?

Type 1.1 Diabetes: Islet beta cell destruction leads to absolute insulin deficiency and a strong genetic predisposition. Usually before the age of 18, most of them are weight loss, the incidence is more urgent, the symptoms of diabetes are obvious, and insulin treatment is needed to control the disease. Patients often have ketosis, urinary ketone body positive, blood insulin, C peptide levels are low, and even can not be measured, the body islet cell antibody often continues to be positive.

Adult occult autoimmune diabetes is a subtype of type 1 diabetes. It is characterized by adult onset, slow progression of the disease, early insulin-free, more obesity at the time of onset, lower blood insulin and C-peptide levels, and islet in vivo. Beta cell antibodies are often positive and have a susceptibility gene for type 1 diabetes.

Type 2.2 Diabetes: Insulin resistance is mainly associated with insufficient insulin secretion, or insufficient insulin secretion with or without insulin resistance. It accounts for more than 90% of all diabetic patients, and its etiology is thought to be caused by multiple genetic and environmental factors (mainly under-exercise and excess energy), ethnicity, family history, unhealthy lifestyle, and obesity (especially abdominal type). Obesity), dyslipidemia, senile and impaired glucose tolerance are risk factors. For these groups, blood glucose monitoring should be strengthened and early intervention if necessary.

3. Other special types of diabetes: including a series of relatively clear or secondary diabetes, caused by genetic defects, other endocrine diseases, drugs and chemicals, infections, etc.

4. Gestational Diabetes: Diabetes that occurs during pregnancy or is first discovered. Screening time is generally selected between 24 and 28 weeks of gestation. For patients with gestational diabetes, the glucose tolerance test should be repeated 6 weeks after birth or longer. Most patients may return to normal blood sugar, but their chances of developing diabetes after a certain period of time may increase significantly.

Diagnosing the presence or absence of complications Acute complications of diabetes include: diabetic ketoacidosis, diabetic hyperosmolar coma, lactic acidosis, hypoglycemia coma. Chronic complications of diabetes include macrovascular disease (such as coronary heart disease, hypertension, etc.), diabetic nephropathy, diabetic retinopathy, diabetic neuropathy, diabetic foot and the like.

Diagnosis

Differential diagnosis

First, the speed of heart rate: According to statistics, the adult heart rate per minute exceeds 100 times, called heart rate overspeed. Heart rate is divided into two types: physiological and pathological.

(1) Physiological heart rate tachycardia Physiological heart rate tachycardia is very common, many factors affect heart rate, such as body position changes, physical activity, food digestion, emotional anxiety, pregnancy, excitement, fear, agitation, drinking, smoking, drinking Tea, etc., can increase heart rate. In addition, age is also a factor in heart rate overspeed, and children's heart rate tends to be faster.

(2). Pathological heart rate tachycardia can be divided into sinus heart rate tachycardia and paroxysmal supraventricular tachycardia:

1. Sinus heart rate tachycardia: It is characterized by rapid heart rate and slowing down. Generally, the heart rate per minute will not exceed 140 times. Most patients have no organic heart disease. Patients with heart rate tachycardia generally have no obvious discomfort, sometimes have palpitation. Shortness of breath and other symptoms.

2. Paroxysmal supraventricular rate: The heart rate can reach 160 to 200 beats per minute, characterized by sudden onset and sudden stop. It can occur in patients with organic lesions in the heart, or in patients without organic heart disease. Suddenly, the patient suddenly felt palpitation and increased heart rate. It lasted for several minutes, hours to days, and suddenly returned to normal heart rate. At the time of the attack, the patient felt palpitations, chest tightness, discomfort in the anterior region and swelling of the head and neck, and a sense of jumping. People without heart disease generally have no major impact, but the attack time is long. When the heart rate is more than 200 beats per minute, the patient has black eyes, dizziness, fatigue, nausea and vomiting, and even sudden syncope and shock due to blood pressure drop. Heart rate tachycardia in patients with coronary heart disease can induce angina pectoris.

Second, the sinus fetal heart rate: Fetal heart rate in the fetal electronic monitoring sinusoidal Fetal Heart Rate (SFHR), many authors believe that the emergence of SFHR indicates that the fetus has a serious danger, is a sign of fetal death The perinatal mortality rate is as high as 50% to 75%. Diagnostic criteria for SFHR:

(1) The fetal heart rate baseline was stable at 120~160 times/min, and the law fluctuated regularly.

(2) The amplitude is 5~15 times/min.

(3) Frequency 2~5 cycles/mino

(4) Short-term variation is fixed or flat.

(5) The sinusoidal wave fluctuates above and below the baseline.

(6) There is no normal fetal heart rate variability or reaction.

(7) lasts for more than 10 minutes.

Third, the arrhythmia: is a pathological phenomenon caused by abnormal heart attack caused by heart disease. Respiratory sinus arrhythmia: Respiratory sinus arrhythmia is the most common form of sinus arrhythmia. It occurs mostly in children, youth and the elderly, and middle-aged people are less common. The mechanism of respiratory sinus arrhythmia is due to the changes in the tension of the vagus nerve and sympathetic nerve in the process of breathing, and the periodicity and regularity of the sinus node self-discipline. When inhaling, the sympathetic tone is increased, the heart rate is increased, the vagus nerve tension is increased during exhalation, and the heart rate is slowed down. The cycle of heart rate changes is exactly equal to one breathing cycle, and the heart rhythm changes to regularity when the breathing is stopped.