Difference between revisions of "ACLS: Bradycardia"

(Text replacement - "Category:Cards" to "Category:Cardiology")
(Differential Diagnosis)
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==Differential Diagnosis==
 
==Differential Diagnosis==
*'''Ischemia/Infarction'''
+
{{Symptomatic bradycardia}}
**Inferior [[MI]] (involving RCA)
 
*'''Neurocardiogenic/reflex-mediated'''
 
**[[Increased ICP]]
 
**Vasovagal reflex
 
**Hypersensitive carotid sinus syndrome
 
**Intra-abdominal hemorrhage (i.e. ruptured [[ectopic]])
 
*'''Metabolic/endocrine/environmental'''
 
**[[Hyperkalemia]]
 
**[[Hypothermia]] (Osborn waves on ECG)
 
**[[Hypothyroidism]]
 
**[[Hypoglycemia]] (neonates)
 
*'''Toxicologic'''
 
**[[B-blocker]]
 
**[[Ca-channel blocker]]
 
**[[Digoxin toxicity]]
 
**[[Opioids]]
 
**[[Organophosphates]]
 
**[[Clonidine]]
 
*'''Infectious/Postinfectious'''
 
**[[Chagas disease]]
 
**[[Lyme disease]]
 
**[[Syphilis]]
 
*[[Sick Sinus Syndrome]]
 
  
 
==Management==
 
==Management==

Revision as of 19:24, 2 June 2016

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

Background

  • HR < 60
  • Intervention only necessary if pt is symptomatic (hypotension, AMS, chest pain, pulm edema)

Categories

  • Sinus node dysfunction
  • AV node dysfunction
    • 1st degree AV block
    • 2nd degree AV block Mobitz I/Wenckebach
    • 2nd degree AV block Mobitz II
    • 3rd degree AV block (complete heart block)

Differential Diagnosis

Symptomatic bradycardia

Management

  • Atropine
    • Can be used as temporizing measure (while awaiting pacing and/or chronotropes)
    • Use cautiously in patients with ongoing ischemia (tachycardia may worsen ischemia)
    • 0.5mg q3-5min (max 3mg or 6 doses)
      • May not work in 2nd/3rd degree heart block, heart transplant
      • Priority is to use external cardiac pacemaking[1]
      • Block is below AV node so atropine will accelerate sinus rate, leading to worsening of block and increased fatigue of AV nodal cells
  • Chronotropes
  • Transcutaneous Pacing
  • Transvenous Pacing

Antidotes for toxicologic causes

See Also

References

  1. Burns, E. AV block: 3rd degree (complete heart block). http://lifeinthefastlane.com/ecg-library/basics/complete-heart-block/