Junctional Rhythm: An Overview

Introduction:

The heart is divided into four different chambers. Two upper divisions are called the right and left atrium, and two lower sections are called the right and left ventricles. The AV node, or the atrioventricular node, is a tiny structure present naturally within the heart. The chief function of the atrioventricular node is to connect the right atrium and the right ventricle electrically.

Due to the atrioventricular node, an impulse is generated that stimulates the heart pumping by giving signals to the heart chambers to begin contraction. In short, the atrioventricular node is the electrical station giving the green signal for the contraction of the heart's lower chambers. The His-bundle is a group of fibers present at the core center of the heart that carries electrical impulses throughout the heart.

When abnormal electrical signals are generated and released from the atrioventricular node or the His- bundle, the heart rhythm changes, leading to altered heart functioning; this abnormal heart rhythm can be captured through an electrocardiogram. This condition is referred to as junctional rhythm.

What Are the Causes of Junctional Rhythm?

A junctional rhythm is altered electrical activity of the heart, which has been documented equally in males and females, generally above the age of 65. Several conditions can lead to the development of a junctional rhythm. Additionally, certain medications may also predispose a patient to a junctional rhythm.

Below are some of the common causes of junctional rhythm.

• Second-degree blockage of the heart.

• Third-degree stoppage of the heart.

• Congenital heart disease.

• Myocardial infarction.

• Ischemic heart disorder.

• Rheumatic fever.

• Long-standing coronary artery disease.

• Congenital channelopathy.

• Lyme disease.

• Pericarditis.

• Amyloidosis.

• Anorexia nervosa.

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• Toxicity due to Digoxin.

• Carotid sinus hypersensitivity.

• Hyperkalemia.

• Benign intracranial hypertension.

• Sleep apnea.

• Hypothyroidism.

• Opioids and other recreational drugs.

• Fusion of isoproterenol.

• Antiarrhythmic agents of class 1 and class 4

• Neuromuscular disorders.

• Vasovagal simulation.

• Myocarditis.

• Collagen vascular disease.

• Sick sinus syndrome.

• Chest trauma.

• Beta-blockers and calcium channel blockers.

• Drugs include Ivabradine, Amitriptyline, Lithium, Cimetidine, Adenosine, Reserpine, and Clonidine.

• Radiotherapy.

What Are the Signs and Symptoms of Junctional Rhythm?

It should be noted that most patients with junctional rhythm do not show any classical signs of the disease. On the opposite side, symptomatic patients offer an array of clinical manifestations. Therefore, the deep-rooted cause of any symptom is the underlying condition that needs to be corrected.

Mentioned below are some of the signs and symptoms of junctional rhythm.

• Shortness of breath.

• Wheezing.

• Swelling in the lower limbs.

• Fever.

• Fatigue.

• Dizziness.

• Syncope.

• Palpitations.

• Swelling of the abdomen.

• Altered pulse rate.

• Pain in the joints.

• Abnormal heart murmurs or sounds.

• Feeling of heaviness in the chest.

• Tightness of the neck.

• Pounding feeling throughout the body.

• Lightheadedness.

• Intolerance to any physical activity.

• Generalized weakness.

• Bradycardia.

• A fluttering feeling in the heart.

• Excessive sweating.

• Constant headache.

How to Diagnose Junctional Rhythm?

A vigorous physical examination and medical history documentation are crucial for patients complaining of cardiovascular abnormalities. The signs and symptoms must also be considered since they may lead to the diagnosis of the underlying condition. Therefore, vital signs such as the patient's blood pressure, respiratory rate, temperature, and heart rate are observed. The patient's daily medications are also studied to rule out any predisposing factors.

Below are some of the diagnostic tools for junctional rhythm.

• Pulmonary function test.

• Echocardiography.

• Electrocardiography.

• Complete blood picture.

• Chest x-rays.

• Treadmill test.

• Thyroid function test.

• Electrophysiological study.

• His-bundle recording via electrode catheter.

• Nuclear imaging tests.

• Rhythm strip tests.

What Is the Treatment for Junctional Rhythm?

Generally, healthcare providers follow the wait-and-watch approach in case junctional rhythm is not the cause of significant health issues. Additionally, nicotine, alcohol, and caffeine are suggested to be avoided. Some specific therapy interventions have proven effective against junctional rhythm after years of research and study. The healthcare provider and team will decide the line of treatment most suitable for an individual patient since every case of junctional rhythm has its non-identical factors.

• Dive reflex.

• Valsalva maneuver.

• Carotid sinus massage.

• Eyeball Massage.

• Antiarrhythmic drugs.

• Electrical conversion.

• Intravenous phenytoin.

• Percutaneous radiofrequency ablation.

• Permanent pacemaker insertion.

What Are the Complications of Junctional Rhythm?

Any condition related to the heart, being in junctional rhythm, must be diagnosed as early as possible to avoid any risks to other vital organs or to involve the heart in any severe complication. Late diagnosis and delayed management strategies of junctional rhythm may lead to regular episodes of syncope. This occurs due to the blood pressure falling extremely low. Along with this, headache, dizziness, and lethargy are common complications. In extreme cases, the pulse rate may not be palpable, leading to a cardiac issue that can not be reversed. Patients may then end up in a line of treatment requiring surgical intervention, such as surgical insertion and placement of artificial pacemakers.

Conclusion:

Junctional rhythm is an abnormality in the rhythmic pattern of the heart. The cause for this abnormality depends on many factors, but the main issue is the underlying cardiovascular condition that needs to be immediately diagnosed and corrected. At times, the approach to management can be interdisciplinary depending on the signs and symptoms that the patient may present.

Constant monitoring of vital signs is crucial. The patient should not enter at the start of a cardiac emergency or any other compilation. Junctional rhythm is a reversible condition. Once correctly identified by the healthcare provider, patients should be educated about maintaining a healthy heart and living a smart heart lifestyle. The patient and their extended family members should be in a closed loop with their cardiologist to further improve and avoid junctional rhythm recurrence.