ACLS: Bradycardia: Difference between revisions

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##Lyme dz
##Lyme dz
##Syphilis
##Syphilis
 
#[[Sick Sinus Syndrome]]
==Sick Sinus Syndrome==
#Collection of bradyarrhythmias with or without tachycardia<ref>Semelka, M et Al. Sick Sinus Syndrome: A Review. Am Fam Physician. 2013 May 15;87(10):691-696. http://www.aafp.org/afp/2013/0515/p691.html</ref>
##50% have alternating bradycardia and tachycardia
##Causes include:
###Intrinsic: degenerative fibrosis, infiltrative disease process, ion channel dysfunction, SA node remodeling
###Extrinsic: pharmacologic, metabolic/electrolyte disturbance, autonomic, OSA
##Clinical manifestations related to end-organ hypoperfusion
###Syncope/pre-syncope (50%)
##Dx - ECG identification, inpatient telemetry, outpatient Holter monitoring, event monitoring, loop monitoring
###ECG frequently negative for findings early in disease course
##Tx - remove extrinsic factors and/or pacemakers
###Pacemakers do not reduce mortality, only decrease symptoms
##Complications
###(50%) Tachy-brady syndrome with atrial fibrillation or atrial flutter
###(50%) AV block


==Treatment==
==Treatment==
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#'''[[Transcutaneous Pacing]]'''
#'''[[Transcutaneous Pacing]]'''
#'''[[Transvenous Pacing]]'''
#'''[[Transvenous Pacing]]'''


===Antidotes for toxicologic causes===
===Antidotes for toxicologic causes===

Revision as of 06:29, 24 August 2014

This page is for bradycardia with a pulse; for bradycardia without a pulse see Adult Pulseless Arrest (i.e. PEA)

Background

  • Only intervene if pt is symptomatic (hypotension, AMS, chest pain, pulm edema)

Categories

  1. Sinus node dysfunction
    1. Sinus bradycardia
    2. Sinus arrest
    3. Tachy-brady syndrome (sick sinus)
    4. Chronotropic incompetence
  2. AV node dysfunction
    1. 1st degree AV block
    2. 2nd degree AV block Mobitz I/Wenckebach
    3. 2nd degree AV block Mobitz II
    4. 3rd degree AV block (complete heart block)

Differential

  1. Ischemia/Infarction
    1. Inferior MI (involving RCA)
  2. Neurocardiogenic/reflex-mediated
    1. Increased ICP
    2. Vasovagal reflex
    3. Hypersensitive carotid sinus syndrome
    4. Intra-abdominal hemorrhage (i.e. ruptured ectopic)
  3. Metabolic/endocrine/environmental
    1. Hyperkalemia
    2. Hypothermia (Osborn waves on ECG)
    3. Hypothyrodism
  4. Toxicologic
    1. B-blocker
    2. Ca-channel blocker
    3. Digoxin toxicity
    4. Opioids
    5. Organophosphates
  5. Infectious/Postinfectious
    1. Chagas dz
    2. Lyme dz
    3. Syphilis
  6. Sick Sinus Syndrome

Treatment

  1. Atropine
    1. Can be used as temporizing measure (while awaiting pacing and/or chronotropes)
    2. Use cautiously in pts w/ ongoing ischemia (tachycardia may worsen ischemia)
    3. 0.5mg q3-5min (max 3 mg or 6 doses)
      1. may not work in 2nd/3rd deg HB, heart transplant
  2. Chronotropes
    1. Dopamine 2-10mcg/kg/min
    2. Epinephrine 2-10mcg/min
  3. Transcutaneous Pacing
  4. Transvenous Pacing

Antidotes for toxicologic causes

See Also

References

  1. Semelka, M et al. Sick Sinus Syndrome: A Review. Am Fam Physician. 2013 May 15;87(10):691-696.http://www.aafp.org/afp/2013/0515/p691.html#afp20130515p691-t2.
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