Fatal Heart Rate Regulation and Failure Prevention: Treatment of Bradycardia and Principles of Emergency Management of Heart Failure

Bradycardia generally refers to a heart rate below 60 beats per minute. Some physically fit individuals, or those with heart disease or obstructive jaundice, may experience bradycardia when taking certain medications. Generally, bradycardia is asymptomatic, but severe bradycardia can lead to fainting or acute cerebral ischemia. If the cause is unknown, a medical examination is necessary to determine the cause. Some middle-aged men with bradycardia who have normal hearts or no obvious palpitations or dizziness may not require treatment. For some middle-aged men with a more clearly identifiable cause, treatment should target the underlying cause. When the heart rate is slower than 45 beats per minute, atropine tablets, scopolamine (654-2), or isoproterenol tablets can be taken orally. Traditional Chinese medicine often uses methods that invigorate qi and dispel cold, which can often achieve certain therapeutic effects. Herbs used include ginseng, astragalus, polygonatum, cimicifuga, bupleurum, angelica, aconite, ephedra, asarum, dried ginger, and wolfberry. Patients with severe bradycardia or a history of syncope should have a permanent pacemaker implanted under the guidance of a doctor. Heart failure has acute and chronic forms. Acute heart failure presents with severe symptoms and a critical condition, often life-threatening if not treated promptly. Immediate oxygen administration is crucial; if available, oxygen can be dissolved in 20%–30% alcohol before inhalation. For comatose patients, a mask should be used for pressurized oxygen administration; hyperbaric oxygen therapy is even more ideal. In a typical home setting, the patient should first be placed in a sitting or semi-recumbent position with their feet dangling over the edge of the bed. If acute left ventricular failure is confirmed, and the patient is agitated, a small dose of morphine or pethidine should be administered first. Alternatively, fast-acting cardiotonic drugs such as strophanthidin K or digoxin can be used; vasodilators such as phentolamine, sodium nitroprusside, prazosin, and isosorbide dinitrate can be used; diuretics such as furosemide, ethacrynic acid, or hydrochlorothiazide can be used as emergency rescue measures. The treatment of chronic heart failure mainly focuses on reducing the burden on the heart and enhancing the working capacity of the myocardium. A good rest environment at home is essential, requiring a high-pillow or semi-recumbent position, and a reasonable diet to complement treatment. Effective treatment of the underlying cause of chronic heart failure is crucial; for those with rheumatic diseases, rheumatic activities should be controlled; excessively high blood pressure fluctuations require antihypertensive treatment; and those with hyperthyroidism and anemia should also receive appropriate treatment. Only in this way can the treatment effect of chronic heart failure be guaranteed. Specific treatment usually involves the use of cardiotonic drugs, diuretics, and vasodilators. Digitalis glycosides are generally administered orally in low doses, and among vasodilators, prazosin is often the first choice.