Symptom >> Internal Medicine >> Cardiology

Missed pulse

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Pulse leakage is the heart rate greater than the pulse rate. The rhythm of the pulse reflects the rhythm of the heart. Normal human pulse rules, the pulse of sinus arrhythmia can change with breathing. Increase when inhaling; slow down when exhaling. A variety of arrhythmia patients can affect the pulse, such as atrial fibrillation, the pulse is absolutely irregular. Atrial fibrillation (atrial fibrillation), this arrhythmia can have "three inconsistencies", that is, the heart sound intensity is inconsistent, the speed is inconsistent, and the pulse is inconsistent (pulse leakage). For the treatment, propranolol (propranolol), verapamil (vistadine), cardiotonic drugs such as cedilan can be used.

Cause

Cause

In general, the causes of arrhythmia are as follows:

1. Various organic heart disease

Such as congenital heart disease, coronary heart disease, valvular heart disease, myocarditis, pericarditis, cardiomyopathy, endocarditis, etc., because the heart's sinus node and conduction system are affected by the disease, it is prone to arrhythmia, so arrhythmia Almost seen in understanding various types of heart disease.

2. Neurological and endocrine system regulation disorders, water and electrolyte imbalance

The nervous and endocrine system of the heart regulates disorders, the imbalance of the heart's ion balance, etc.; other than the cardiac factors, hypoxemia-induced myocardial hypoxia, systemic and cardiac local acid-base balance regulation disorders, etc. The essentials of arrhythmia ions and metabolism, the formation of arrhythmia conditional factors, and thus often induce the occurrence of arrhythmia.

3. The impact of drugs

A variety of drugs can cause arrhythmias, such as non-potassium diuretics, digitalis drugs, adrenaline, norepinephrine, isoproterenol, dopamine, dobutamine, amrinone and milrinone. Of particular note are various antiarrhythmic drugs either by altering the ion channel, or by stabilizing the cell membrane, or by altering the refractory period of the heart, or acting on the cardiac receptor to prevent or terminate arrhythmia. However, antiarrhythmia does not have the effect of arrhythmia itself, and if it is not applied properly, it can also mediate arrhythmia and even death.

4. Systemic or other systemic diseases

Such as nervous system diseases, endocrine system diseases, metabolic diseases, trauma, surgery, cardiac catheterization, etc. can cause arrhythmia.

5. Normal physiological characteristics

Sinus tachycardia or premature contraction can occur in emotional excitement, fright, depression, drinking, and drinking espresso. Healthy older people are more prone to arrhythmias than younger people. Generally speaking, there will always be arrhythmia in a person's life.

Examine

an examination

Related inspection

Pulse pulse wave velocity

Atrial fibrillation graphically describes the high-frequency and irregular, uncoordinated motion of a single fiber in the atrial muscle, with a frequency of 400-600 beats/min. Early atrial fibrillation is mostly bursty, repetitive and unpredictable, just like the ups and downs of nature, coming and going, capricious. Late atrial fibrillation is mostly persistent and lifelong, often making the health worse. It can be said that only those with atrial fibrillation can truly understand the pain of the disease.

symptom

Heart palpitations, shortness of breath, anxiety, chest tightness, and conscious heartbeat irregularities. Symptoms are more pronounced when paroxysmal episodes or heart rate are faster, often accompanied by symptoms of heart failure. There may be atrial thrombosis, causing embolism. There may be atrial thrombosis, causing embolism.

Sign

The general heart rate is 100 to 60 beats per minute, and the heart rate is irregular. When the heart rate is slow, the heart rhythm can be regular; the heart sounds are different, sometimes the second heart sound disappears; there is a lack of pulse. There may be signs of the original heart disease.

diagnosis

The electrocardiogram P wave disappears with f wave, the frequency is 350-600 times/min, and the QRS wave spacing is absolutely irregular.

Diagnosis

Differential diagnosis

There are several types of arrhythmia:

First, arrhythmia with normal heart rate (heart rate between 60 and 100 beats / minute , irregular heart rhythm), can be seen in the following three cases.

First, the sinus arrhythmia, there are two types: 1. Respiratory sinus arrhythmia, after the patient's breath and activity, the heart rhythm can be neat, but the heart rate is increased when inhaling, slowing down when exhaling. 2. Non-respiratory sinus arrhythmia, the patient's heart rate is not related to breathing. Such patients do not have to be treated, or just need to remove the cause.

Second, atrial fibrillation (atrial fibrillation): This arrhythmia can have "three inconsistencies", that is, the heart sounds are inconsistent, the speed is inconsistent, and the pulse is inconsistent (pulse leakage). For the treatment, propranolol (propranolol), verapamil (vistadine), cardiotonic drugs such as cedilan can be used.

Third, pre-contraction (premature beat): the number of pre-contraction in normal people can be reduced or disappeared in the late stage; while the number of pre-contraction in patients with organic heart disease increases, the first heart sounds increase, the second heart sounds weaken, and the pulse Leaking. For treatment, propranolol, verapamil, phenytoin (dalentin), lidocaine, and amiodarone can be used.

Second, the heart rate is too slow arrhythmia (heart rate below 40 beats / min), there may be two neat and irregular heart rhythm.

There are two types of heart rate neatly:

First, sinus bradycardia: heart rate is less than 40 ~ 60 times / minute, the first heart sound intensity is equal, heart rate can be accelerated after the activity, the heart beat and the jugular vein beat. Atropine, ephedrine and isoproterenol can be used for treatment.

Second, complete atrioventricular block: heart rate less than 40 beats / minute, can have the first heart sounds vary in intensity, there are slap sounds, heart rate does not increase after the activity, jugular vein beat has nothing to do with heart rate. The treatment is the same as sinus bradycardia, and a pacemaker can be installed if necessary.

Heart rate is not neat, it can be divided into two types:

First, the sinus conduction block: suddenly stop one or several times in the neat heart beat, the interval between them is exactly one or several times the two normal heart sounds. Treatment of the same sinus bradycardia.

Second, atrioventricular block: Among them, I degree atrioventricular block can have the first heart sound weakened; II degree atrioventricular block can have heart sound loss and pulse leakage; III degree atrioventricular block is heart beat Very slow, mostly 30~40 times/minute, the first heart sounds vary in intensity, sometimes you can hear the loud first heart sound (ie "cannon sound", the lower ventricular contraction of the ventricle is lower The position is suddenly closed). Treatment of sinus bradycardia.

Third, the heart rate is too fast arrhythmia (heart rate more than 100 times / min or more), there are two kinds of heart rhythm and irregular.

The heart rhythm can be divided into the following three types:

First, sinus tachycardia: heart rate between 100~140 beats per minute, heart rate speeding up and slowing down gradually appear, sputum patients holding their breath or pressing carotid sinus, can slow heart rate. Propranolol, verapamil and reserpine drugs can be used therapeutically.

Second, atrial flutter: heart rate between 70 ~ 160 times per minute, less affected by exercise and body position, compression of the carotid sinus can slow heart rate, in a multiple proportional relationship, the proportion of the number is not uniform when the heart rate is not neat. For treatment, drugs such as verapamil, propranolol, amiodarone and cardiotonin can be used.

Third, paroxysmal supraventricular tachycardia: heart rate between 150 ~ 250 times per minute, heart rate increased or slowed more suddenly, the compression of the carotid sinus can suddenly return to normal (but may also be invalid). Excitatory vagus nerve therapy (such as compression of carotid sinus, oppression of the eye, stimulation of the pharynx and Valsalva method), and use of verapamil, propranolol, cardiotonin, neostigmine, and B can be used for treatment. Drugs such as amiodarone, quinidine and phenytoin.

The heart rate is not neat and can be divided into the following two types:

First, paroxysmal ventricular tachycardia: heart rate between 160 ~ 220 times per minute, heart rate is slightly irregular, the first heart sounds vary, the patient's breath holding or compression of the carotid sinus heart rate does not slow down, pulse The rate is roughly the same as the heart rate. Therapeutic drugs such as lidocaine, acetaminophenone, procainamide, diisopropylpyramine, olfactory benzylamine or electric shock can be used.

Second, atrial fibrillation: auscultation can find the aforementioned "three inconsistencies"; in addition, when the carotid sinus is compressed, the heart rate can be slowed down. Treatment of the same atrial flutter. For patients with arrhythmia, it is sometimes difficult to completely prevent arrhythmia, but appropriate measures can be taken to reduce the incidence. Atrial fibrillation graphically describes the high-frequency and irregular, uncoordinated motion of a single fiber in the atrial muscle, with a frequency of 400-600 beats/min. Early atrial fibrillation is mostly bursty, repetitive and unpredictable, just like the ups and downs of nature, coming and going, capricious. Late atrial fibrillation is mostly persistent and lifelong, often making the health worse. It can be said that only those with atrial fibrillation can truly understand the pain of the disease.

symptom

Sign

diagnosis