Symptoms

Slow pulse - low pulse

Slow pulse - low pulse


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A slow or low pulse is usually present when an adult's heart rate in normal rest is below 60 beats per minute. A slowed pulse is therefore also called a slowed heartbeat or medically called bradycardia.

Behind this does not always have to be a pathological cause, instead a slow pulse can be quite normal in trained athletes or young people. However, bradycardia can also be signs of serious diseases such as structural heart disease, coronary artery disease, a reduced metabolism such as hypothermia and hypothyroidism or poisoning or drug overdoses and can be a real danger, especially for older people. Accordingly, if symptoms such as dizziness, severe physical weakness or circulatory weakness and fainting spells occur, a doctor should be consulted in order to clarify the causes of the symptoms and to be able to treat any bradycardia accordingly.

Definition and symptoms

A slow pulse is a cardiac arrhythmia (bradycardia) in which the heart rate at rest is less than 60 beats per minute. The heartbeat occurs completely “automatically” through the sinus node in the right atrium, which, as a heartbeat, triggers the electrical stimuli for the heartbeat itself and passes it on through the excitation conduction system of the heart muscle. However, the pulse - which can be felt on the inside of the wrist on the side of the thumb - generally remains constant, even an increase in frequency during exercise does not occur abruptly, but gradually and gradually flattens out again. In an adult, healthy person, the heart normally beats about 60 to 80 times per minute at rest, but this heartbeat rate can rise to up to 160 - 200 beats per minute, for example, during heavy physical exertion or under stress.

In contrast, a low pulse is quite normal during sleep, since the body's functions are reduced to the bare minimum. Young and physically well-trained people also frequently have a low pulse, sometimes only up to 40 beats per minute. However, this is not a health problem, but is the expression of a young, healthy or very well-trained heart, which is able to pump enough blood for the oxygen supply through the body even with a few beats. However, the prerequisite here is that the person concerned feels well and fit - because a slow pulse is also a sign of a serious cardiac arrhythmia or a disease such as an underactive thyroid or typhoid. It is important that a low pulse (heart rate) is clearly distinguished from a low blood pressure, because the blood pressure can be in the normal range or even too high despite a slow pulse.

If there is a slowed pulse, in most cases there are no typical symptoms, rather this is often recognized accidentally during examinations in connection with other complaints or as part of preventive examinations or health check-ups. However, if the heart rate becomes so slow that the brain can no longer be adequately supplied with blood, dizziness, severe fatigue and physical weakness occur, which can lead to circulatory collapse (syncope), and a slow pulse in older people can also be the cause for a sudden confusion.

Causes

A slow or low pulse rate does not always have to be caused by a pathological cause - because (performance) athletes generally have a lower resting heart rate and slowed heartbeat due to regular endurance training. A comparatively low pulse can also occur in young people, which, however - if the person concerned feels well - also means no danger, but rather speaks for a young, healthy heart, which can pump enough blood for the oxygen supply through the body with just a few beats . Electrolyte disturbances can also be the cause. However, a slow pulse can also be a sign of a serious illness - this is why an exact medical clarification of the symptoms is indispensable, especially in the case of dizziness or severe fatigue or physical weakness. In infections with typhoid fever and yellow fever there is also a relative bradycardia despite high fever and in the event of an arterial circulatory disorder, the pulse on the affected limb is often not palpable or not every beat is palpable even though the heart rate is normal (so-called pulse deficit).

Underactive thyroid (hypothyroidism)

A slow pulse can be caused, for example, by an underactive thyroid (medical: hypothyroidism). This is a widespread deficient supply of the body with the thyroid hormones triiodothyronine (T3) and thyroxine (T4) - especially among women. This undersupply can be congenital, but it is acquired much more frequently in the course of life through loss or destruction of the thyroid tissue, for example as a result of an autoimmune disease (Hashimoto's thyroiditis), thyroid surgery, radiation therapy to the thyroid gland or the use of certain medications (e.g. thyroid drugs) ).

In rare cases, hypothyroidism can also be caused by extreme iodine deficiency, which is a vital trace element as it is involved in growth, bone formation and brain development as part of the thyroid hormones. If there is a deficiency in thyroid hormones, this has a negative or slowing effect on metabolic processes and performance, which is manifested by symptoms such as severe fatigue, listlessness, depression, weight gain and a slow pulse and, as a result, an increased sensitivity to cold. Dry, brittle skin and brittle hair are also common.

Showcase disease

If the pulse on the leg or foot is very slow or barely palpable, the "peripheral arterial occlusive disease" (short: pAD) can also be the cause, which is also colloquially referred to as "smoking leg". This is a disorder of arterial blood flow in the legs (or arms), which is usually caused by a vessel narrowing (stenosis) or even a vascular occlusion (occlusion) of the legs and arms supplying arteries, which in turn occurs in is most often the result of arteriosclerosis (“hardening of the arteries”).

Due to the restricted blood circulation, the muscles of the extremities are no longer adequately supplied with oxygen, so that severe pain occurs especially during exercise and a longer walk without a break is often almost impossible. For this reason, sufferers are usually forced to take regular breaks, which is why the disease is also known as a "shop window disease". PAD is not a rare phenomenon, but occurs in around 20% of those over 65, with men being affected more often than women.

The dangerous thing about pAD is that atherosclerosis can affect all other vessels in the body in addition to the extremities, which means that diseases such as coronary artery disease (CAD) and circulatory disorders of the brain and even stroke can often occur in connection with the disease. The main cause of atherosclerosis is particularly favored by nicotine consumption, high blood pressure, high blood lipid levels and diabetes (diabetes), but there are also other risk factors such as age, predisposition, overweight (obesity), too little exercise and an unhealthy, high-fat diet.

The symptoms of this disease depend on the stage of the window disease the patient is in. While there are usually no complaints at first, the pain described in the affected leg occurs in the second stage, which means that only short distances can be covered at a time without the patient being forced to stop briefly.

In the third stage, the pain also occurs at rest, until in phase four there is tissue destruction (necrosis) due to the lack of oxygen, which in advanced cases can even lead to amputation. In addition to the pain, an extremely slow or missing pulse and a lack of healing of wounds or ulcers as a result of insufficient blood circulation are typical signs of PAD. In addition, in many cases the affected leg or arm becomes cold and pale from the location of the vascular change.

Hypothermia (hypothermia)

If there is a slowed pulse or a drop below the normal heart rate, this can also be caused by hypothermia in the body or tissue (hypothermia), which occurs after prolonged and severe exposure to cold. Hypothermia in certain parts of the body or parts of the body such as hands or feet can lead to frostbite (local hypothermia), with hypothermia affecting the entire body there is even the risk of serious damage to health or, in the worst case, death from freezing. This form of hypothermia is very common, especially in the event of accidents in the water (drowning, shipwreck, water sports, children bathing, etc.) or in the mountains (athletes or climbers who have been injured, buried by avalanches, etc.).

In addition, in caves (for example in water caves), unsuitable or inadequate clothing or a constantly low ambient temperature can lead to frostbite, as well as a long stay in a cold environment without suitable protective clothing.

It can be particularly dangerous if you fall asleep outdoors or sit on cold floors for a long time, or lie down, for example, after excessive alcohol consumption. Alcohol is an extreme risk factor in this context, because it widens the blood vessels in the skin, which means that the body emits more heat and hypothermia occurs even faster than usual.

In hypothermia, a distinction is made between three phases, depending on the existing body temperature and symptoms: The beginning here is the "defense stage" or "mild hypothermia", in which the body temperature drops to 34 degrees Celsius and the blood circulation deteriorates and the body tries to generate heat by trembling. In this phase, the person concerned is still clearly conscious, appears restless and excited. At first, breathing, blood pressure and the pulse rate become faster, it can lead to anxiety or body aches, and the skin often turns pale bluish and already feels cold.

This is followed by the exhaustion phase or the "moderate hypothermia", in which a core body temperature of 34 to 28 degrees Celsius prevails. At this stage, the person concerned no longer trembles, but looks sleepy and listless - but is still conscious. The sensation of pain decreases, the pulse slows and the blood pressure drops, and the hypothermia is also clearly visible externally due to rigid, "frozen" facial features and a blue-gray discoloration of the skin.

In the third, so-called "paralysis stage" (severe hypothermia), the core body temperature drops to below 28 degrees Celsius, the patient is passed out or comatose, and cardiac arrhythmias later lead to a respiratory and circulatory arrest. What is striking here are the wide, rigid pupils and the paralysis of the muscles, in addition there are pulmonary edema and a greatly reduced to extinguished pain reaction. At this stage (also called "apparent death phase") it is hardly possible to determine with certainty whether the patient is still alive or has already died, because breathing can be extremely shallow or no longer perceptible and the pulse extremely slow and irregular or no longer be palpable.

Typhus

The cause of a slow pulse or a slow heartbeat can also be the infectious disease typhoid (Greek typhos: "haze", "fog"), which is caused by the bacterium Salmonella Typhi (Salmonella enterica ssp. Enterica Serovar Typhi) and, if left untreated, a dangerous one Can take a course with possibly fatal end. Accordingly, in Germany, Austria and Switzerland, both the disease itself and suspected death and deaths from typhoid must be reported to the responsible authorities.

Typhoid (also called "typhoid fever", "enteric fever" or "tummy typhus") is widespread in some parts of the world - especially in Africa, Southeast Asia and Latin America - so that more than 20 million people fall ill every year and around 200,000 of them to die. In most cases, the pathogen is transmitted due to poor hygiene in food preparation and contaminated water (smear infection); the incubation period is usually one to three weeks.

If the disease breaks out, it usually runs in four consecutive stages: For example, unspecific symptoms such as headache, body aches, lassitude, constipation and mild fever usually appear at the beginning, which in the following second stage quickly reaches over 40 degrees after about a week Celsius rises. In addition, there are headaches and body aches, which, however, gradually increase, as well as abdominal pain and slow onset disorders of consciousness.

The high fever persists in most sufferers for more than one to three weeks, but does not lead to an acceleration of the heartbeat, as is often the case with fever. Instead, “typhoid fever” shows a relative bradycardia or a slow heartbeat in relation to the high fever. In this third phase, in most cases, the patients feel really sick and without energy, no longer have an appetite and are passive and indifferent. In addition to this, the disease is now also externally visible, because the affected person looks feverishly heated and pale, in addition there is in many cases a grayish tongue coating and a rash on the upper body and abdomen (roseols) as well as other symptoms such as constipation and an enlarged spleen.

In the fourth stage of the disease that follows, the fever drops again, especially in the morning, but the people affected are usually worst at this point in time, as they have lost a lot of fluid and weight due to the long high fever. Most of the time, the pain in the gastrointestinal area increases, in addition to the constipation, typhus-typical diarrhea now appears, which is highly contagious because the typhoid bacterium is in the pulpy stool. Complications such as an intestinal breakthrough, bone marrow inflammation or a blood clot (thrombosis, embolism) are most likely to occur in this phase of the disease. In most cases, this last typhoid stage is over after five weeks at the latest and the patient is much better - but there is a risk that the disease will return again in the first few weeks afterwards.

As typhoid fever is primarily transmitted through contaminated food and water, hygiene should be given greater precaution, especially in areas with a high risk of infection, for example by avoiding uncooked vegetables or raw fruit and not drinking water from the tap or from opened bottles .

In addition, there is the possibility of getting vaccinated against typhoid, which can be useful for people who are planning a backpacking trip in a particularly badly affected area. Vaccination is possible both as an oral swallow vaccination and in syringe form, is considered to be well tolerated and offers protection for at least 60 percent of those vaccinated for at least one year (swallowed vaccination) or up to three years (syringe form). Which typhoid vaccination is possible in individual cases and which side effects may occur should be clarified with a doctor if necessary.

Yellow fever

Another possible cause of a slow pulse is the so-called "yellow fever". It is a virus disease that - like the tropical disease malaria - is transmitted by mosquitoes. The female mosquitoes of the Aedes genus play a role here, which soak up the blood of an infected person and pass on the virus it contains on the next bite.

The yellow fever virus belongs to the family of the so-called "flaviviruses", which also cause dengue fever and early summer meningoencephalitis (TBE) and occurs in equatorial Africa as well as in Central and South America. In contrast, there have been no yellow fever cases in Europe since the 19th century, and Asia has never been affected by yellow fever - although one possible theory here is that a certain immunity from diseases of related viruses (e.g. dengue virus ) could exist.

If those affected are infected with the yellow fever virus, the incubation period usually lasts three to six days, during which the virus migrates into the target organs, the central nervous system, liver, kidney, joints, muscles and skin, and multiplies there. The disease can then be of varying severity - there is often a sudden fever, in parallel with headache, chills, back pain, as well as nausea and vomiting, and a slow pulse with less than 60 beats per minute.

In many cases, the symptoms improve after a few days - in about every tenth case, however, there is a second phase of illness, in which the temperature rises again, but at the same time the pulse drops to only 40 beats per minute. In addition to bleeding from mucous membranes and body openings, there is sometimes vomiting of blood - which is why the disease is also known as "black vomiting". Bleeding into the intestine is also possible, which leads to bloody diarrhea or black stools ("tar stool").

In the course of more severe courses, jaundice (Iketrus) or yellow eyes and a yellow skin due to the damaged liver can also occur, in some cases kidney failure also occurs, which means that the excretion of urine in the affected patients is only limited or even impossible does not work anymore. Since toxic substances remain in the blood due to the limited functionality of the kidneys and liver, blood poisoning (sepsis) threatens, which in turn can lead to brain damage and consequential damage such as speech disorders or tremors. The recovery phase often takes a long time in more severe cases, but usually leads to a complete healing without permanent damage. If there is a very severe form of yellow fever, this can also be fatal - but in more than half of the cases this also heals after a certain time.

Other causes of slow pulse

In addition to this, various medications such as beta blockers and calcium channel blockers such as verapamil or diltiazem can be used as triggers for a low pulse. The same applies to increased intracranial pressure, for example as a result of a brain tumor, a serious skull injury or a stroke. In sick sinus syndrome, the sinus node, the heart's clock, gets out of step and stops or only emits slow impulses. A pacemaker is needed here.

The so-called "coronary heart disease" (short: CHD) can be the cause of bradycardia, which is a circulatory disorder of the heart muscle, which results from constricted coronary arteries. The main symptom of CHD is angina pectoris (chest tightness), a seizure-like pain in the chest, which can also radiate in the shoulders and arms, upper abdomen and back, over the neck to the lower jaw. As the disease progresses, the risk of cardiac arrhythmia, gradual heart failure (heart failure), a heart attack and sudden cardiac death (second death) also increases.

Bradycardes atrial fibrillation

Atrial fibrillation can also be the cause of a slow pulse. This is one of the most common cardiac arrhythmias in adults, which occurs in every third affected person without a recognizable underlying disease and without a recognizable cause. With atrial fibrillation, the heart gets out of tune, so to speak, because the atria transmit fast, uncontrolled, "flickering" impulses to the heart chambers. The atrial fibrillation frequency is between 350 and 600 beats per minute, which means that the heart can no longer perform its vital pumping function undisturbed and the blood flow becomes irregular. As a result, the blood builds up in the atria of the heart, where it can clump and form blood clots. There is a serious danger here, because there is a risk that the clot will come loose, get into the brain via the bloodstream and clog blood vessels there - which can ultimately lead to a stroke.

Atrial fibrillation can occur as a tachycardic arrhythmia in which the ventricles beat too quickly (heart rate greater than 100) or as a bradycardic arrhythmia in which the ventricles beat too slowly (heart rate lower than 60). A distinction is also made between a seizure-like, transient (paroxysmal) or permanent (permanent) condition, with the risk of a stroke from a blood clot being particularly high, especially in the case of permanent atrial fibrillation.

In bradycardic atrial fibrillation (medical: bradyarrhythmia absoluta), the movements of the atria are only transmitted to the ventricles at a slow frequency, which results in a slow heart rhythm or a low pulse. This causes dizziness, fainting or loss of consciousness very often, but in very rare cases there are no complaints with bradycardiac atrial fibrillation.

This form of cardiac arrhythmia can be caused by various diseases, for example coronary heart disease (CHD), a heart valve defect, a cardiac muscle disease or disturbances in the electrolyte balance. In addition, some medications can cause bradycardial atrial fibrillation, including calcium antagonists (for example, for high blood pressure) or cardiac glycosides or digitalis (to strengthen the heart). However, digitalis should never be taken without consulting a doctor and should not be potentiated lower than D6 when used for homeopathic purposes.

Therapy for an underactive thyroid

If there is an underactive thyroid as the cause of the slowed pulse, medications are usually prescribed to compensate for the hormone deficiency (L-thyroxine, levothyroxine). If these are taken regularly and in consultation with the doctor in appropriate doses, those affected usually do not experience any restrictions, but can achieve the same level of performance as those not affected. Unfortunately, there is no direct prevention of hypothyroidism, since the causes can be very different and in most cases cannot be attributed to external causes. If the disease can only be attributed to a lack of iodine in rare cases, the iodine supply can generally be improved by increased consumption of sea salt, sea fish and algae products. You can also consult your doctor about taking additional iodine supplements.

Treatment of a shop window disease

If a peripheral arterial occlusive disease or "window disease" is the cause of a slowed pulse, the therapy aims first and foremost to consistently minimize the risk factors - this is the only way to get the disease under control permanently and other incidents to prevent. Accordingly, those affected should immediately quit smoking and, if necessary, reduce excess weight, in addition, sufficient exercise must be provided and general attention must be paid to a healthy, balanced diet. In addition, it is important to treat other existing diseases such as high blood pressure or diabetes mellitus as best as possible, since this can also be the cause of the peripheral arterial disease.

In the initial stage, appropriate gymnastic exercises and a physically coordinated “walking training” are also suitable to mobilize the patient to such an extent that he can gradually cover longer distances without a break. At the same time, "platelet aggregation inhibitors" (especially acetylsalicylic acid, abbreviated: ASA) are often prescribed to prevent platelets from clumping together with possible blood clots. If other measures (such as catheter measures) are not sufficient to remove the constriction, drugs in the advanced stages three and four can also be used to promote blood circulation (prostanoids) via the vein, which dilate the blood vessels and thereby, on the one hand, improve drainage enable the blood and also prevent clotting of the platelets.

In the case of pAD, the further treatment steps depend on the stage of the disease and the location of the vascular changes. There are various surgical options available, but they are no guarantee that the narrowing or closure will not be repeated. If there is a vascular occlusion or a narrowing of just a few millimeters, the site may be stretched using a balloon catheter (angioplasty). If stretching is not possible due to a rigid constriction, there is still the option to peel off the deposits (thrombus artery rectomy). In addition, a stent or stent can be used if necessary to counteract a new constriction.

However, if the vascular change extends over a larger area, in many cases a bypass operation is carried out on the vessels of the leg, in which either a vein or a Teflon tube is used, so to speak, as a "diversion" for the narrowed vessel. However, if the blood flow deteriorates so much in the course of PAD that necrosis occurs and the tissue dies, the only option left is amputation.

Especially in the later phases of PAD, patients should take care of their legs and feet in addition to therapeutic measures and medication, because even the smallest injuries can quickly develop into ulcers and increase the risk of tissue death under PAVK. In this context, for example, the cutting of the toenails should always be done very carefully and footwear should be worn at all times that fits perfectly, is not too tight and is also breathable. On the other hand, walking barefoot should be avoided, as small injuries to the skin can also quickly occur here.

Treatment for hypothermia

If there is hypothermia or frostbite, immediate and properly used first aid can be decisive for the success of further treatment. It is generally important to follow the so-called "rescue chain", which means first of all to pay attention to self-protection and protection of the accident site and to make the emergency call under 112.

Furthermore, care should be taken that the patient is carefully removed, ideally in a warm room, or at least in a windless area. The person concerned should lie flat and not be moved, if possible, and must be wrapped in blankets or an emergency blanket to maintain warmth - the gold-silver foil can only fulfill its function if it is not directly on the skin, in addition, only the fuselage should be covered at first in order to avoid a so-called "salvage death". This term describes the death of a supposedly saved person shortly after recovery, which can occur in hypothermia due to strong movements or too rapid warming. The reason: If a person is exposed to cold temperatures for a longer period of time, the body concentrates the warm blood in the vital organs and instead reduces the blood flow to the skin or in the more distant parts of the body such as fingers, toes, nose and ears. This gradually creates a difference between the temperature in the outer body shell and that inside the body (body core).

If the patient is straightened or arms and legs are raised and massaged, for example, the cooled blood flows from the remote extremities back to the center of the body or the heart, thereby lowering the core temperature further, which in the worst case can lead to life-threatening cardiac arrhythmias or cardiac arrest can.

Dementsprechend sollte bei der Ersthilfe immer äußerst behutsam und bedacht vorgegangen werden, indem abrupte Bewegungen und eine schnelle Aufwärmung des Patienten vermieden werden und bis zum Eintreffen des Rettungsdienstes eine kontinuierliche Betreuung und Überprüfung der Vitalfunktionen (Atmung, Körpertemperatur und Kreislauf) stattfindet.

Eine weitere übliche Erste-Hilfe-Maßnahme bei Unterkühlung ist in diesem Zusammenhang auch die „Hibler-Wärmepackung“ durch die – bis zum Eintreffen der Rettungskräfte – ein weiterer Wärmeverlust sowie die Wiedererwärmung des Körpers auf ca. 36°C erzielt werden kann. Hierfür wird, nachdem die nasse Kleidung entfernt wurde, der Rumpf des Betroffenen mit einem Handtuch bedeckt, welches zuvor in etwa 40°C warmen Wasser getränkt wurde. Danach wird der Patient in zusätzliche Decken, Kleidung oder eine Rettungsdecke eingewickelt, wobei auch hier unbedingt die Extremitäten frei bleiben müssen, um das Risiko für einen Bergungstod zu minimieren.

Handelt es sich nur um eine milde Unterkühlung, sollte nach dem vorsichtigen Entfernen der nassen Kleidung eine langsame Wiedererwärmung, beispielsweise durch eine Wärmflasche, ein Körnerkissen und warme Getränke erfolgen. Befindet sich der Unterkühlte jedoch bereits im Lähmungsstadium, so müssen bei Atemstillstand und Herz-Kreislauf-Stillstand sofort Maßnahmen zur Herz-Lungen-Wiederbelebung ergriffen werden – diese sollte allerdings so lange am Stück durchgeführt werden, bis sich der Körper wieder auf eine normale Körperkerntemperatur aufgewärmt hat. Dies gilt selbst dann, wenn der Patient durch die Starre bereits tot erscheint, denn bei Unterkühlungen gilt der Grundsatz: „Niemand ist tot, so lange er nicht warm und tot ist“. Um kein Risiko durch Bewegen des Betroffenen einzugehen, muss die Kleidung mit einer Schere entfernt werden, zudem dürfen Maßnahmen zur Wiedererwärmung nur ganz langsam und unter Aussparung der Extremitäten unternommen werden. Übernimmt der Rettungsdienst die Versorgung des Unterkühlten, wird die Herz-Lungen-Wiederbelebung gegebenenfalls fortgeführt und bei Bedarf Sauerstoff zugeführt.

Behandlung bei Typhus

Ist die Infektionskrankheit Typhus für den langsamen Puls verantwortlich, erfolgt die Behandlung normalerweise über Antibiotika, in schwereren Fällen werden auch hochdosierte Kortisonpräparate verschrieben. Neben der Medikation ist es bei einem Typhus besonders wichtig, dass der Patient viel trinkt, um eine Austrocknung zu verhindern, die gerade durch die heftigen Durchfälle schnell eintreten kann. Da sich das Typhus-Bakterium „Salmonella Typhi“ im Kot befindet, sollte der Durchfall besser nicht durch Medikamente gestoppt sondern ausgestanden werden, um den Erreger möglichst schnell aus dem Darm zu befördern.

Therapie bei Gelbfieber

Tritt ein langsamer Puls infolge eines Gelbfiebers auf, so sind die therapeutischen Maßnahmen derzeit noch relativ eingeschränkt, da es bislang noch kein Medikament gegen das Gelbfieber-Virus gibt. Dementsprechend steht bei der Behandlung die Linderung der Symptome im Zentrum (zum Beispiel Schmerzmittel, fiebersenkende Maßnahmen), wobei in vielen Fällen ohnehin nur leichte oder sogar gar keine Beschwerden auftreten. Nimmt die Krankheit jedoch einen schwereren Verlauf, ist häufig eine intensivmedizinische Versorgung nötig – hier ist es allerdings wichtig, dass die entsprechende Klinik entsprechend ausgestattet ist und über die notwendige Erfahrung in Hinblick auf Tropenkrankheiten verfügt.

Da es bislang keine entsprechenden Medikamente zur Behandlung von Gelbfieber gibt, kann nur versucht werden, einer Ansteckung so weit wie möglich vorzubeugen. Daher sollte bei einer geplanten Reise in eine riskante Region verstärkt auf den Mückenschutz geachtet werden, indem beispielsweise weite, helle Kleidung und feste Schuhe getragen werden und die Kleidung sowie Mückennetze mit Mückenschutzmitteln (Repellentien) imprägniert werden. Zudem sollte natürlich immer auf ausreichenden Hautschutz geachtet werden.

Neben diesen Maßnahmen besteht außerdem die Möglichkeit einer Schutzimpfung gegen das Gelbfieber, die beispielsweise vom Auswärtigen Amt bei einer Reise in ein Gelbfieber-Verbreitungsgebiet dringend angeraten wird – darüber hinaus verlangen viele Länder bei der Einreise den Nachweis einer Impfung, wenn man aus einem entsprechenden Gebiet kommt. Geimpft wird dabei meist mit einem Lebendimpfstoff aus abgeschwächten Gelbfieberviren, der sehr wirksam und normalerweise recht gut verträglich ist und nach zehn Tagen einen Impfschutz für etwa zehn Jahre bieten soll. Hier ist allerdings zu beachten, dass es durchaus zu Nebenwirkungen wie Rötungen, Schwellungen, leichten Schmerzen an der Impfstelle sowie Kopfschmerzen kommen kann, in selteneren Fällen tritt auch ein grippeähnliches Fieber auf, teilweise begleitet von starker Mattigkeit, Gelenkschmerzen, Gliederschmerzen sowie Übelkeit und Erbrechen, Bauchschmerzen oder Durchfall. Auch wenn diese Impfreaktionen meist recht milde verlaufen, sollten Kinder unter sechs Monaten nicht geimpft werden, ebenso wie schwangere oder stillende Frauen oder ältere Menschen bzw.

Personen mit einer Abwehrschwäche. Neben dem eignet sich der Impfstoff auch nicht bei Menschen mit einer Hühnereiweißallergie, da hier innerhalb von Minuten (teilweise aber auch erst nach Stunden) allergische Reaktionen mit Schleimhautschwellung im Rachen, Nesselsucht bzw. Nesselfieber oder Luftnot auftreten können, die im schweren Fall bis zu einem allergischen Schock gehen können.

Behandlung bei bradykardem Vorhofflimmern

Konnte mittels eines Elektrokardiogramms (EKG) ein langsames bzw. bradykardes Vorhofflimmern diagnostiziert werden, besteht eine Möglichkeit der Therapie in der Absetzung bzw. reduzierten Einnahme verursachender Medikamente (zum Beispiel Kalzium-Kanal-Blocker oder Betablocker). Können Medikamente als Auslöser ausgeschlossen werden, kommt eine Herzschrittmachertherapie in Betracht, welche dem Patienten wieder zu einem regelmäßigen Herzrhythmus verhelfen kann. Die Implantation des Herzschrittmachers erfolgt meist relativ schnell und unkompliziert, indem ein Bereich unterhalb des Schlüsselbeins lokal betäubt und sodann ein kleiner Hautschnitt vorgenommen wird.

Durch diese „sanfte“ Methode könne Patienten meist bereits am Tag nach der Implantation das Krankenhaus wieder verlassen, müssen aber in den ersten Tagen größere Bewegungen mit der Schulterseite, in der sich der Schrittmacher befindet, vermeiden, damit sich die Elektroden nicht verschieben. Neben der Schrittmachertherapie besteht zudem die Möglichkeit der medikamentösen Drosselung der Blutgerinnung, da es aufgrund der unregelmäßigen Herzvorhofbewegungen zu gefährlichen Blutgerinnseln (Thrombose) in den Vorhöfen kommen kann. Dementsprechend sollten sich Betroffene auch bei sonstiger Beschwerdefreiheit unbedingt behandeln lassen, um hier das Risiko für einen Schlaganfall zu reduzieren.

Naturopathy

Da ein langsamer Puls ganz unterschiedliche Ursachen haben und ebenso unterschiedliche Beschwerden verursachen kann, muss zunächst in jedem Fall schulmedizinisch abgeklärt werden, was hinter dem Symptom steckt. Konnte eine ernsthafte Erkrankung ausgeschlossen werden, so bietet der Bereich der Naturheilkunde vielfältige Möglichkeiten, die – je nach Ursache der Bradykardie – auf sanftem Wege helfen können, Beschwerden zu lindern.

Liegt die Ursache für einen langsamen Puls beispielsweise in einer Unterfunktion der Schilddrüse (Hypothyreose), so besteht die Therapie bei schwereren Formen normalerweise in der täglichen Gabe eines individuell eingestellten Schilddrüsenhormonpräparates, welches in den meisten Fällen ein Leben lang eingenommen werden muss. Bei einer leichteren Unterfunktion, aber auch parallel zur konventionellen Behandlung, können jedoch naturheilkundliche Behandlungsmethoden sehr erfolgreich zur Linderung von Beschwerden beitragen. Hierzu gehören unter anderem eine jodreiche Ernährung durch den regelmäßigen Verzehr von Seefisch, Meeresfrüchten, Algenprodukten und Meersalz bei einer durch Jodmangel verursachten Unterfunktion der Schilddrüse bzw. die Vermeidung eines übermäßigen Verzehrs jodhaltiger Lebensmittel bei einer Schilddrüsenunterfunktion in Folge der Autoimmunerkrankung Hashimoto-Thyreoiditis.

Auch im Bereich der Pflanzenheilkunde bzw. Phytotherapie werden bei einer Hypothyreose in erster Linie Heilpflanzen mit einem hohen natürlichen Jodgehalt eingesetzt, zum Einsatz kommen hier beispielsweise Efeu, Hirtentäschel, Meerträubel und Thymian, denen insgesamt eine anregende Wirkung auf die Schilddrüse nachgesagt wird. Auch die Homöopathie bietet bei einer Schilddrüsenunterfunktion eine Vielzahl von Mitteln: Hier eignen sich insbesondere Calcium Carbonicum (Austernschalenkalk), Graphites oder Pulsatilla – welches Präparat genau auf den jeweilige Patienten passt und dadurch auch heilend wirken kann, lässt sich jedoch nur durch eine ausführliche Anamnese mit einem homöopathisch praktizierenden Arzt oder Heilpraktiker entscheiden.

Auch Schüssler-Salze erfreuen sich immer größerer Popularität im alternativmedizinischen Bereich. Hier werden bei einer Unterfunktion der Schilddrüse häufig die Salze Nr. 7 (Magnesium phosphoricum) und Nr. 14 (Kalium bromatum) sowie bei Jodmangel das Salz Nr. 15 (Kalium jodatum) eingesetzt. Neben dem bietet auch die sogenannte „Baunscheidttherapie“ ein alternativmedizinisches Verfahren zur Behandlung einer Hypothyreose. Dabei handelt es sich um ein von Carl Baunscheidt (1809-1873) entwickeltes „ausleitendes Verfahren“, bei welchem mit Hilfe eines speziellen Nadelungsgeräts („Lebenswecker“) zunächst 1 bis 2 mm tief in die Haut gestochen und die entsprechende Stelle anschließend mit einem speziellen Baunscheidt-Öl eingerieben wird. Ziel dieser nicht schmerzhaften Behandlung ist vor allem eine vermehrte Durchblutung im behandelten Gebiet, wodurch unter anderem die inneren Organe entlastet und in ihrer Funktionalität positiv beeinflusst werden sollen.

Generell hat sich bei der alternativmedizinischen Behandlung bei einem langsamen, schwachen und unregelmäßigen Puls auch das pflanzliche Homöopathikum Digitalis purpurea bewährt, welches aus dem roten Fingerhut gewonnen wird, welcher in allen Pflanzenteilen hoch wirksame, giftige Inhaltsstoffe enthält.

Digitalis purpurea wirkt herzstärkend und nimmt dem Patienten das unangenehme Gefühl, dass das Herz plötzlich still steht, was meist mit großer Angstund körperlicher Erschöpfung einhergeht. Dabei wird das Homöopathikum meist in Form von Globuli eingesetzt, die man unter der Zunge zergehen lässt. Empfehlenswert ist es hier, drei Mal täglich 5 Tabletten in der Potenz D3 bis D6 einzunehmen – die genaue Dosis bzw. Potenz sollte jedoch in jedem Fall individuell mit einem Arzt, Apotheker oder Heilpraktiker abgesprochen werden, damit das Mittel optimal wirken kann. In diesem Zusammenhang ist es ebenso ratsam, auf Tee und Kaffee während der Behandlung zu verzichten und die Globuli außerhalb der Mahlzeiten einzunehmen.

Besteht eine allgemeine Herzschwäche (Herzinsuffizienz) mit Bradykardie haben sich zudem die Mittel Thevetia neriifolia in der Potenz D2 bis D4 oder auch Veratrum viride in der Potenz D3 bis D4 als wirksame Heilmittel gezeigt – auch hier sollte jedoch keine Selbstmedikation ohne vorherige Absprache mit einem Experten erfolgen, gerade weil die richtige Dosierung von Fall zu Fall ganz unterschiedlich ausfallen kann.

Auch in Hinblick auf die Ernährung können Betroffene einiges tun, um einem langsamen Puls entgegenzuwirken: Zu den bekanntesten Hausmittel zählen hier Haselnüsse, Kaffee und Knoblauch, zudem sollte stets darauf geachtet werden, ausreichend zu trinken – im besten Falle ungesüßter Tee und Mineralwasser.

Darüber hinaus sollte für ein starkes Herz generell auf eine gesunde und ausgewogene Ernährung mit viel frischem Obst und Gemüse geachtet werden. Dabei empfiehlt es sich, fettes Schweine- und Rindfleisch nur in Maßen zu verzehren und besser durch mageres Geflügelfleisch zu ersetzen. Zudem sollte Fisch einen festen Platz auf dem Speiseplan einnehmen, da dieser für seine positive und stärkende Wirkung auf Kreislauf und Stoffwechsel bekannt ist. Neben der Ernährung ist auch regelmäßige Bewegung hilfreich, um den Puls etwas zu beschleunigen, dabei ist bereits ein kleiner täglicher Spaziergang oder die Fahrt zur Arbeit mit dem Rad ein guter Anfang, um etwas für die eigene Herzgesundheit zu tun. (No)


Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Social Science Nina Reese, Barbara Schindewolf-Lensch

Swell:

  • T. Paul, W. Ruschewski, J. Janoušek: S2k Leitlinie Pädiatrische Kardiologie: Bradykarde Herzrhythmusstörungen im Kindes- und Jugendalter, Deutsche Gesellschaft für Pädiatrische Kardiologie, (Abruf 05.09.2019), AWMF
  • G. Fröhlig: Bradykarde Herzrhythmusstörungen, Lehnert H. et al. (eds) SpringerReference Innere Medizin, Springer Reference Medizin. Springer, Berlin, Heidelberg, (Abruf 05.09.2019), Springer
  • H. Bogossian, F. Hasan, C. W. Israel et al.: Herzschr Elektrophys (2019) 30: 2., (Abruf 05.09.2019), Springer
  • Jerome M. Hershman: Hypothyreose (Myxödem), MSD Manual, (Abruf 05.09.2019), MSD
  • Lynne Mccullough: Diagnosis and Treatment of Hypothermia, Am Fam Physician. 2004 Dec 15;70(12):2325-2332., (Abruf 05.09.2019), aafp
  • Robert Koch Institut: Gelbfieber, (Abruf 05.09.2019), rki
  • L. Brent Mitchell: Vorhofflimmern (AF), MSD Manual, (Abruf 05.09.2019), MSD

ICD-Codes für diese Krankheit:R00.1ICD-Codes sind international gültige Verschlüsselungen für medizinische Diagnosen. You can find yourself e.g. in doctor's letters or on disability certificates.


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