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Heartbeat sometimes fast sometimes slow, treatment dilemma, how can this do?

May 15,2023 | YILING

Dr. Sun recently met a patient whose heart rate was usually slow, but who sometimes had tachyarrhythmia and no antiarrhythmic medication was available.

The 69-year-old man, surnamed Wu, came to Doctor Sun's specialist clinic one month ago because of palpitation. Dr. Sun carried a dynamic electrocardiogram to him, indicating "sinus bradycardia, frequent premature ventricular beats." The lowest heart rate during the day is 45 beats per minute, and there are more than 2,000 premature ventricular beats in 24 hours.

Doctor Sun integrated all the data of Uncle Wu: old, male, no evidence of coronary heart disease, cardiac color ultrasound ruled out the abnormal heart structure, thyroid function is normal, belongs to the non-organic heart disease of premature ventricular beat. In theory, the risk of premature beats is small, and the frequency is small enough that patients can be left untreated if they have no symptoms.

"Doctor Sun, I always feel panic and tightness in my chest!" Uncle Wu said helplessly.

If the symptoms are obvious, they must be treated.

Obviously, the frequency of Wu's premature beats has not reached the indication of radiofrequency ablation. However, because of the presence of bradycardia, oral antiarrhythmic drugs are not suitable. Finally, Sun prescribed Shen Song Yangxin Capsule, a Chinese medicine, which greatly improved Wu's symptoms.

 

What is arrhythmia?

The normal heartbeat should be regular, with a frequency of 60 to 100 beats per minute, usually about 60 to 70 beats per minute. Whether the rhythm of the heartbeat is irregular, or the frequency of the heartbeat is too fast or too slow, the popular understanding is that the heartbeat is abnormal, and the scientific name is called arrhythmia.

 

What are the types of arrhythmia?

Abnormal heartbeat arrhythmias are divided into two major categories according to frequency, namely tachyarrhythmia and slow arrhythmia. Arrhythmias are classified into sinus arrhythmias, atrial arrhythmias, borderline arrhythmias and ventricular arrhythmias according to their origin. Wu's sinus bradycardia belongs to sinus arrhythmia, and premature ventricular beats belong to ventricular arrhythmia.

How is arrhythmia treated?

 

 

All tachyarrhythmias can be treated with antiarrhythmic drugs. For some patients with suitable conditions, radiofrequency ablation of arrhythmia can also be used to achieve the purpose of radical treatment. The advantage of drugs is non-invasive, the disadvantage is the need for long-term medication and drug adverse reactions. The advantage of radiofrequency ablation is that it can cure arrhythmia radically, but the disadvantage is that it is an expensive and invasive operation.

 

For chronic arrhythmia, there is no western medicine suitable for long-term use. Therefore, for asymptomatic bradycardia, treatment is usually not given, but regular follow-up review of dynamic electrocardiogram. For slow heartbeats that cause symptoms, a pacemaker is needed.

So for Uncle Wu this kind of situation, clinical embarrassment. If you take antiarrhythmic drugs, you are at risk of further slowing down the heart rate. However, premature beats only lasted for more than 2,000 24 hours, and radiofrequency ablation surgery was not possible.

Is Shensong Yangxin Capsule antiarrhythmic drug?

At present, in some domestic guidelines and expert consensus, Shensong Yangxin capsule is also classified as antiarrhythmic drugs. However, it does not cause bradycardia as a side effect, unlike the chemical antiarrhythmic drugs commonly used today.

Shensong Yangxin Capsule belongs to the category of traditional medicine, mainly composed of ginseng, ophiopogon ophiopogon, cornus officinalis and Danshen. It has the functions and effects of invigorating qi and nourishing Yin, promoting blood circulation and regulating collaterals, clearing the heart and calming the mind. It is mainly suitable for patients with coronary heart disease and premature ventricular beat. In recent years, Shensong Yangxin capsule has been reported in the treatment of atrial arrhythmia (atrial premature beat, atrial fibrillation, etc.), suggesting a certain effect.

Since it does not have the side effect of slowing down the heart rate, it is especially suitable for patients like Wu who have both fast and slow heartbeats. For patients with arrhythmia whose basal heart rate is not slow, it can also be combined with traditional antiarrhythmic drugs to achieve better efficacy.

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