Name
BRADYCARDIA
DESCRIPTION
DETAIL
CAUSES : - IDIOPATHIC - ATHLETES - SECONDARY TO PHARMACOLOGICAL PRODUCTS - HYPOTHYROIDISM - ADVANCED LIVER DISEASE - HYPOTHERMIA - TYPHOID FEVER - BRUCELLOSIS - VASOVAGAL SYNCOPE - SEVERE HYPOXIA - HYPERCAPNIA - ACIDEMIA - AC HYPERTENSION - AC M.I. - ELDERLY - AMYLOIDOSIS & OTHER CONDITIONS ASSOCIATED WITH ATRIAL MYOCARDIAL INFILTRATION - DURING CONVALESCENCE AFTER INFLUENZA OR PROLONGE FEVER - SICK SINUS SYNDROME - AV BLOCK - COMPLETE HEART BLOCK - RAISED INTRACRANIAL PRESSURE - ANOREXIA NERVOSA - AORTIC STENOSIS - AC NEPHRITIS CAUSING HYPERTENSIONOTHER TESTS : * INVASIVE INTRACARDIAL ECG RECORDING * CONTINUOUS - LOOP EVENT RECORDING * CAROTID SINUS PRESSURE - SINUS PAUSE IN EXCESS OF 5 SEC MAY OCCUR ( THIS MAY BE NORMAL IN ELDERLY ) * PHYSIOLOGIC OR PHARMACOLOGIC MANEUVERS THAT ARE VAGOMIMETIC ( VALSALVA MANEUVER OR PHENYLEPHERINE INDUCED HYPERTENSION), VAGOLYTIC ( ATROPINE ), SYMPATHOMIMETIC ( ISOPROTERENOL OR HYPOTENSION BY NITROPRUSSIDE ) , OR SYMPATHOLYTIC ( BETA-ADRENERGIC BLOCKING AGENTS ) CAN BE UTILISED, SINGLY OR IN COMBINATION.
TYPENOTES
ACLS 2005 Bradycardia Algorithm The following mnemonic directs AHA accepted actions after absolute (<60bpm) or relative (slower rate than expected) bradycardia with circulatory compromise due to the slow rate is discovered. Start the Secondary ABCDs and remember: *Pacing Always Ends Danger Mnemonic Intervention Note Pacing **TCP Immediately prepare for transcutaneous pacing (TCP) with serious circulatory compromise due to bradycardia (especially high-degree blocks) or if atopine failed to increase rate. Consider medications while pacing is readied. Always Atropine 1st-line drug, 0.5 mg IV/IO q3-5 min. (max. 3mg) Ends Epinephrine 2-10 Β΅g/min 2nd-line drugs to consider if atropine and/or TCP are ineffective. Use with extreme caution. Danger Dopamine 2-10 Β΅g/kg/min *Pacing does not "always end danger" in bradyarrhythmias. If the above measures do not improve circulatory stability the bradycardia may merely be an indication of a pathological process, think Differential Diagnosis! **Prepare for transvenous pacing (TVP), managed by an expert, if TCP fails.
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
COMPLETE BLOOD COUNT, ECG, HOLTER MONITORING