SHM's Clinical Quick Talks-Approach to Bradycardia

Pdf Summary

Bradycardia refers to a resting heart rate below 60 beats per minute, while bradyarrhythmia indicates a slow heart rate due to an irregular heartbeat. Sinus bradycardia is often observed in healthy adults, particularly athletes and individuals during sleep.<br /><br /><strong>Initial Assessment</strong>:<br />1. <strong>Clinical Examination</strong>:<br />   - <strong>Vitals</strong>: Heart rate (HR), blood pressure (BP), oxygen saturation.<br />   - <strong>Symptoms</strong>: Dizziness, syncope, chest pain, dyspnea, fatigue.<br />   - <strong>History</strong>: Palpitations, chest trauma, recent tick bite, streptococcus pharyngitis.<br />   - <strong>Physical Signs</strong>: Pulmonary edema, altered mental status, shock signs.<br />   - <strong>Risk Factors</strong>: Age, cardiovascular and medication history, electrolyte imbalances.<br />2. <strong>Diagnostic Tests</strong>:<br />   - <strong>12-lead ECG</strong>: Evaluate rhythm, P-wave, PR interval, QRS complex width.<br />   - <strong>Labs</strong>: Glucose, electrolytes, calcium, magnesium, thyroid function, troponin, urine drug screen.<br />   - <strong>Monitoring</strong>: Continuous telemetry, frequent BP monitoring, maintain oxygen above 94%.<br /><br /><strong>Etiologies of Bradycardia</strong>:<br />1. <strong>Cardiac Causes</strong>: Sick sinus syndrome, ischemic heart disease, conduction system disease, genetic disorders.<br />2. <strong>Medications</strong>: Beta-blockers, digoxin, calcium channel blockers, amiodarone, clonidine.<br />3. <strong>Vagal Tone</strong>: Vasovagal syncope, athletes.<br />4. <strong>Metabolic Conditions</strong>: Hypothyroidism, hyperkalemia, hypoxia.<br />5. <strong>Infections</strong>: Endocarditis, myocarditis, Lyme disease.<br />6. <strong>Other Causes</strong>: Obstructive sleep apnea, hypothermia, increased intracranial pressure.<br /><br /><strong>Stability Assessment</strong>:<br />- <strong>Unstable Bradycardia</strong>: Signs include hypotension, shock, altered mental status, ischemic chest discomfort, acute heart failure. Requires immediate resuscitation (ACLS protocols).<br />- <strong>Stable Bradycardia</strong>: Hemodynamically stable with mild/no symptoms. Requires monitoring and assessment for reversible causes.<br /><br /><strong>Management</strong>:<br />- <strong>Unstable Bradycardia</strong>:<br />   - <strong>Medications</strong>: Atropine, dopamine, epinephrine; specific antidotes for drug toxicities.<br />   - <strong>Pacing</strong>: Transcutaneous pacing if unresponsive to medication, followed by transvenous pacing if necessary.<br />- <strong>Stable Bradycardia</strong>:<br />   - <strong>Observation</strong>: Serial ECGs, BP monitoring, correcting reversible causes including electrolyte imbalances and medication toxicity.<br />   - <strong>Specific Antidotes</strong>: Address specific drug toxicities with appropriate antidotes like glucagon or calcium gluconate.<br /><br /><strong>Clinical Pearls</strong>:<br />- Atropine should be avoided in high-grade AV block as it may exacerbate bradycardia.<br />- For symptomatic bradycardia, always have pacing pads ready.<br />- Aggressively manage hyperkalemia in patients with wide-complex bradycardia.

Asset Subtitle

Neel Patel, Sammar Rasheed

Meta Tag

Concept Bradycardia

Concept Bradyarrhythmia

Concept Sinus Bradycardia

Concept Electrocardiogram

Concept Complete Heart Block

Keywords

Bradycardia

Bradyarrhythmia

Sinus bradycardia

Clinical examination

Diagnostic tests

Cardiac causes

Medications

Metabolic conditions

Unstable bradycardia

Management

Bradycardia

Bradyarrhythmia

Sinus Bradycardia

Electrocardiogram

Complete Heart Block