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Bradicardia sinusale: cause, sintomi, terapia



Definizione

Quindi, bradicardia significa, "cuore lento". Il termine "sinusale" fa riferimento alla sede d'origine dell'aritmia,

Per bradicardia sinusale si intende la riduzione della frequenza cardiaca inferiore a 60 battiti al minuto. La bradicardia sinusale è una condizione fisiologica in molti soggetti giovani e negli atleti, dovuta a una predominanza dell’attività vagale sul nodo del seno atriale. In alcuni casi tuttavia può essere la spia iniziale di una malattia del seno, soprattutto quando si rileva in circostanze che di norma si associano ad un aumento della frequenza cardiaca (scompenso cardiaco,esercizi fisico, emozioni ecc…), o può verificarsi in alcune condizioni patologiche (infarto miocardico inferiore,ipotiroidismo).

Quanti battiti al minuto?

La frequenza cardiaca generalmente è compresa tra 60 e 100 pulsazioni al minuto. Si parla di tachicardia quando la frequenza cardiaca è superiore a 100 battiti al minuto.

 

Eziologia

  1. Bradicardia costituzionale, bradicardia  dello sportivo o del sonno. (Durante la notte, il cuore tende a rallentare in maniera naturale la propria frequenza di contrazione, perché sono inferiori le richieste di sangue da parte di alcuni organi e tessuti del corpo).
  2. Farmaci: digitale, reserpina, beta-bloccanti, amiodarone.
  3. Sindrome del seno carotideo: in alcuni soggetti la compressione anche lieve del seno carotideo (collo troppo stretto, flessione del collo) provoca una bradicardia sinusale marcata, che può andare fino all’arresto dell’automatismo sinusale con pausa ventricolare o sincopo.
  4. Sindrome di bradicardia-tachicardia.
  5. Cause diverse: ipertono vagale, ipertensione intracranica, convalescenza da malattie infettive, mixedema, cachessia.



Sintomi

La bradicardia sinusale nel soggetto giovane non richiede ricerche approfondite se è ben tollerata, se la frequenza aumenta sotto sforzo, se i complessi QRST dell’ECG sono regolarmente preceduti da un’onda P. La bradicardia nei soggetti anziani, soprattutto se accompagnata da malesseri o da sincopi richiede una registrazione continua dell’ECG per 24 ore (Holter), al fine di ricercare un’eventuale sindrome di bradicardia-tachicardia.

 

Terapia

Nessuna nelle forme clinicamente mute.

Sospensione dei farmaci bradicardizzanti e terapia della causa nelle forme secondarie. L’impianto di uno stimolatore cardiaco nella sindrome bradicardia-tachicardia.



 

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