Sinus bradycardia medical therapy

Sinus bradycardia Microchapters
Home
Patient Information
Overview
Pathophysiology
Causes
Differentiating Sinus bradycardia from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Treatment
Medical Therapy
Primary Prevention
Case Studies
Case #1
Sinus bradycardia medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Sinus bradycardia medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
Guidance
FDA on Sinus bradycardia medical therapy
on Sinus bradycardia medical therapy
Sinus bradycardia medical therapy in the news
Blogs on Sinus bradycardia medical therapy
Directions to Hospitals Treating Sinus bradycardia
Risk calculators and risk factors for Sinus bradycardia medical therapy

WikiDoc Resources for Sinus bradycardia medical therapy
Articles
Most recent articles on Sinus bradycardia medical therapy Most cited articles on Sinus bradycardia medical therapy Review articles on Sinus bradycardia medical therapy Articles on Sinus bradycardia medical therapy in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Sinus bradycardia medical therapy Images of Sinus bradycardia medical therapy Photos of Sinus bradycardia medical therapy Podcasts & MP3s on Sinus bradycardia medical therapy Videos on Sinus bradycardia medical therapy
Evidence Based Medicine
Cochrane Collaboration on Sinus bradycardia medical therapy Bandolier on Sinus bradycardia medical therapy TRIP on Sinus bradycardia medical therapy
Clinical Trials
Ongoing Trials on Sinus bradycardia medical therapy at Clinical Trials.gov Trial results on Sinus bradycardia medical therapy Clinical Trials on Sinus bradycardia medical therapy at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Sinus bradycardia medical therapy NICE Guidance on Sinus bradycardia medical therapy NHS PRODIGY Guidance FDA on Sinus bradycardia medical therapy CDC on Sinus bradycardia medical therapy
Books
Books on Sinus bradycardia medical therapy
News
Sinus bradycardia medical therapy in the news Be alerted to news on Sinus bradycardia medical therapy News trends on Sinus bradycardia medical therapy
Commentary
Blogs on Sinus bradycardia medical therapy
Definitions
Definitions of Sinus bradycardia medical therapy
Patient Resources / Community
Patient resources on Sinus bradycardia medical therapy Discussion groups on Sinus bradycardia medical therapy Patient Handouts on Sinus bradycardia medical therapy Directions to Hospitals Treating Sinus bradycardia medical therapy Risk calculators and risk factors for Sinus bradycardia medical therapy
Healthcare Provider Resources
Symptoms of Sinus bradycardia medical therapy Causes & Risk Factors for Sinus bradycardia medical therapy Diagnostic studies for Sinus bradycardia medical therapy Treatment of Sinus bradycardia medical therapy
Continuing Medical Education (CME)
CME Programs on Sinus bradycardia medical therapy
International
Sinus bradycardia medical therapy en Espanol Sinus bradycardia medical therapy en Francais
Business
Sinus bradycardia medical therapy in the Marketplace Patents on Sinus bradycardia medical therapy
Experimental / Informatics
List of terms related to Sinus bradycardia medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Medical Therapy

Acute Management

• If a patient is symptomatic, intravenous access should be established.
• Atropine can be administered down an endotracheal tube or can be administered intravenously. The dose is 0.5-1 mg IV or ET q 3-5 min up to 3 mg total (0.04 mg/kg). The pediatric dosing is 0.02 mg/kg/dose IV, minimum of 0.1 mg. Isoproteronol (Isoprel) has been used in the past, but carries risks.
• Transcutaneous pacing can be undertaken while a temporary wire is being placed.
• Offending or exacerbating agents such as beta-blockers, calcium channel blockers or digitalis should be discontinued and underlying causes treated.
• Sleep apnea is a common cause and should be treated with weight loss and BiPAP.
• Continuous monitoring in the hospital is recommended.

Chronic Management

Asymptomatic sinus bradycardia requires no treatment. Patients with sick sinus syndrome generally require a pacemaker.

Contraindicated medications

Sinus bradycardia is considered an absolute contraindication to the use of the following medications:

• Amiodarone
• Betaxolol
• Bisoprolol
• Brimonidine tartrate and Timolol maleate
• Carteolol
• Esmolol
• Nadolol
• levobunolol hydrochloride
• Penbutolol
• Sotalol

ACC/AHA/HRS Guideline Recommendations for Pacemaker Implantation (DO NOT EDIT)

Recommendations for Permanent Pacing in Sinus Node Dysfunction (SND)

“

Class I 1. Permanent pacemaker implantation is indicated for SND with documented symptomatic bradycardia, including frequent sinus pauses that produce symptoms.(Level of Evidence: C) 2. Permanent pacemaker implantation is indicated for symptomatic chronotropic incompetence. (Level of Evidence: C) 3. Permanent pacemaker implantation is indicated for symptomatic sinus bradycardia that results from required drug therapy for medical conditions. (Level of Evidence: C) Class IIa 1. Permanent pacemaker implantation is reasonable for SND with heart rate less than 40 bpm when a clear association between significant symptoms consistent with bradycardia and the actual presence of bradycardia has not been documented. (Level of Evidence:C) 2. Permanent pacemaker implantation is reasonable for syncope of unexplained origin when clinically significant abnormalities of sinus node function are discovered or provoked in electrophysiological studies. (Level of Evidence: C) Class IIb 1. Permanent pacemaker implantation may be considered in minimally symptomatic patients with chronic heart rate less than 40 bpm while awake. (Level of Evidence: C) Class III 1. Permanent pacemaker implantation is not indicated for SND in asymptomatic patients. (Level of Evidence:C) 2. Permanent pacemaker implantation is not indicated for SND in patients for whom the symptoms suggestive of bradycardia have been clearly documented to occur in the absence of bradycardia. (Level of Evidence:C) 3. Permanent pacemaker implantation is not indicated for SND with symptomatic bradycardia due to nonessential drug therapy. (Level of Evidence: C)

”

References

Template:WikiDoc Sources