Sinus Arrhythmia

One very common clinical finding I come across during a physical examination is a phenomenon called Sinus Arrhythmia (SA), also called Respiratory Sinus Arrhythmia (RSA) (but as RSA is already used as an acronym for Responsible Service of Alcohol and for Rivest, Shamir and Adleman, I won't use it here)- This is a finding in which the heart rate speeds up during inhalation and slows down during exhalation.

Recent research has suggested this is a normal physiological response, and indeed, it is more commonly found in children and in the very fit. The slowing down of the heart rate during exhalation is due to the nervous system switching into a momentary state of parasympathetic (3 S's - Sleep, Sandwiches, Sex) dominance, as opposed to the commonly known sympathetic (Fight or Flight) dominance.

There may be any number of reasons why this occurs, and research is still continuing, but as SA is something I try to reduce whenever I find it, I'd like to put forward some of my ideas on why it is so common (and why I treat patients to reduce it when it is present). The Chinese Medical model considers most arrythmias (and many other cardiac problems) to be the result of either obstruction or deficiencies in the energy that supplies the heart and the 'Upper Heater'- Metaphorically, the upper chest is considered to be the uppermost of a system that the Chinese term the San Jiao (3 Energisers/Burning Spaces or 3 Heaters) and the San Jiao is considered to exist in the 'Cou Li', the spaces between organs, the interstices. The Upper Heater is somewhat analogous to the mediastinum, the pleura and the linings of the airways in the lungs, along with the 'bag' of the pericardium.

The nervous system functions that regulate the heart rate are very easily modulated by acupuncture treatment. Commonly, retaining one needle in a point called Lung 9 (Taiyuan) for a period of twenty minutes or so is enough to reduce the severity of SA, and generally only a few repetitions are needed to eliminate it completely. Taiyuan is considered to be a point that boosts the energy of the Lung channel (acupuncture meridian) and of the Lung organ itself, as well as removing obstructions from anywhere in the Upper Heater. Other points can be added to assist with this regulatory function, depending on the patient's constitution and presentation.

I surmise that the 'problem' here (not that SA is anything to be really concerned about in and of itself) is that many of us are walking around in a permanent, slight state of sympathetic nervous system over-excitation and dominance. When the parasympathetic nervous system kicks in during exhalation, the difference between sympathetic and parasympathetic dominance is very pronounced and noticeable, often even to the point where the pulse speeds up a lot during inhalation, then seems almost to stop for a couple of beats' worth of time, before starting again.

Interestingly, it is fairly common to see patients (myself included) who display a quite pronounced SA when stressed or exhausted, but none at all when rested or when they feel energised.

To check for yourself, simply find a pulse anywhere on your body (usually the carotid artery in the neck is easily found) and feel the rate for a few breaths. Once a 'normal' rate has been established, take a deep breath and let it out. If you feel that the heart rate speeds up during inhalation and then slows down during exhalation, you have most likely found a Sinus Arrhythmia (which is nothing to worry about- take a few more breaths...).

If you do find this phenomenon occurs for you or for someone you know, consider how you feel generally. If you feel perfect, full of energy and free from any nagging complaints (and you are quite or super-fit) then your SA becomes simply an indicator of being in fine health, with a nice sensitivity to your blood chemistry. If you feel otherwise, then maybe it is time to consider adding some light cardiovascular exercise and possibly some acupuncture treatment to your maintenance schedule. It is our job as healthcare providers to set up conditions so that your body does the best possible job of maintaining itself in perfect balance.