Coronary sinus rhythm

Heart disease is a symptom of multiple diseases and can lead to other serious diseases. For example, arrhythmias, especially coronary sinus arrhythmias. Because the heart is composed of a complex structure, when the parts that make up the heart are infected by bacteria, the disease may lead to arrhythmia. If a person has an irregular lifestyle and often stays up late, he will have problems with insufficient blood circulation. So what should he do about his coronary sinus rhythm?

1. Anatomy of the cardiac conduction system. The cardiac conduction system is composed of special myocardium responsible for the formation and conduction of normal cardiac impulses, including the sinoatrial node, nodal terminal node, atrioventricular node, His bundle, left and right bundle branches and Purkinje fiber network.

Cardiology - Arrhythmia (II)

The sinoatrial node is the pacemaker of the heart's normal sinus rhythm. It is located at the junction of the entrance of the superior vena cava and the posterior wall of the right atrium. It is 10-20 mm long and 2-3 mm wide. It is mainly composed of P (pacemaker) cells and T (transitional) cells.

2. Classification of Arrhythmias

Arrhythmia refers to abnormalities in the frequency rhythm of cardiac impulses, conduction velocity, or activation order.

1. Abnormal impulse formation

⑴ Abnormal sinus rhythm: ① Sinus tachycardia. ② Sinus bradycardia, ③ Sinus arrhythmia, ④ Sinus arrest.

⑵ Ectopic arrhythmia: ① atrial escape beat and atrial escape heart rate, ② junctional escape beat and junctional escape rhythm. ③Ventricular escape beats and ventricular escape rhythm.

④ Aortic ectopic rhythm: premature contraction (atrial, atrioventricular junctional, ventricular) ⑤ Paroxysmal tachycardia: atrial, atrioventricular junctional, atrioventricular reentry, ventricular. ⑥Atrial flutter, atrial fibrillation. ⑦Ventricular flutter, ventricular fibrillation.

2. Impulse conduction abnormalities

⑴ Physiological: interference and interference atrioventricular dissociation.

⑵Pathological: ①Heart block: sinoatrial block, intra-atrial block, atrioventricular block (first-degree, second-degree and third-degree atrioventricular block) bundle branch or fascicular block (left and right bundle branch and left and right fascicular block) or intraventricular block.

② Reentrant rhythm: paroxysmal tachycardia (common atrioventricular nodal reentry, atrioventricular reentry and intraventricular reentry)

③Atrioventricular node conduction pathway: abnormal preexcitation syndrome.

3. Mechanism of arrhythmia

The mechanisms of arrhythmia include abnormalities in impulse formation and impulse conduction.

3. Electrocardiogram

It is the most important non-invasive examination technology for diagnosing arrhythmias. A 12-lead ECG should be recorded, and an ECG with a clear P wave lead should be recorded in long strips for analysis. Usually lead v1 or lead II is selected. Systematic analysis should include: Are the atrial and ventricular rhythms regular? What are the frequencies of each? Is the PR interval constant? Are the P wave and QRS wave morphology normal? The relationship between P wave and QRS wave, etc.

4. Long-term ECG recording

The dynamic electrocardiogram examination uses a small and portable recorder to continuously record the patient's electrocardiogram for 24 hours. The patient's daily work and activities are not restricted. This examination must understand whether the occurrence of symptoms such as palpitations and syncope is related to arrhythmias, clarify the relationship between arrhythmias or myocardial ischemia and daily activities, as well as the diurnal distribution characteristics, to assist in evaluating the efficacy of antiarrhythmic drugs, the efficacy of pacemakers or implantable cardioverter defibrillators, and whether functional disorders occur.

If the patient's arrhythmia attacks are intermittent and infrequent, it is sometimes difficult to detect with a dynamic electrocardiogram. At this time, an event recorder can be used to record the occurrence of arrhythmia and the electrocardiograms before and after it, and the real-time recorded electrocardiogram can be transmitted to the hospital by direct playback or via telephone or the Internet. The implantable loop electrocardiogram recorder is implanted under the patient's skin and can start automatically to detect and record arrhythmias. Its battery life is up to 36 months. It can be used for patients with infrequent attacks and syncope that may be caused by arrhythmias for unknown reasons. The disadvantage is that it requires a small incision surgery and is expensive.