Bradycardia resident survival guide: Difference between revisions
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==Don'ts== | ==Don'ts== | ||
*Do not delay pacing if rhythm is Mobitz type II second degree block or third-degree AV block | |||
*Avoid using atropine in hypothermic bradycardia and Mobitz type II/second degree AV block | |||
==References== | ==References== |
Revision as of 19:05, 16 September 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]: Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]
Definition
Sinus bradycardia is defined as a sinus rhythm with a rate below 60 beats per minute.
Causes
Life Threatening Causes
Life-threatening conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
- Amiodarone
- Amitriptyline
- Beta-blockers
- Cardiac glycosides
- Cardiomyopathy
- Carotid sinus hypersensitivity
- Clonidine
- Diltiazem
- Dronedarone
- Flecainide
- Heart transplant
- Hypertensive heart disease
- Hypothermia
- Hypothyroidism
- Ischemic heart disease
- Lithium
- Lyme disease
- Methyldopa
- Obstructive sleep apnea
- Pericarditis
- Phenothiazines
- Procainamide
- Propafenone
- Quinidine
- Reserpine
- Rheumatic fever
- Sepsis
- Trauma
- Vasovagal syncope
- Verapamil
- Viral myocarditis
Management
Figure 1: Management of patients with Bradycardia
Assess appropriateness for clinical condition Heart rate typically < 50/min if bradyarrhythima | |||||||||||||||||||
Identify and treat underlying cause
| |||||||||||||||||||
Persistent bradyarhythmia causing:
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Yes | No | ||||||||||||||||||
Atropine first dose 0.5 mg iv bolus, repeat every 3-5 minutes Maximum: 3 mg If atropine ineffective:Transcutaneous Pacing OR Dopamine infusion (2-10 mcg/kg/min) OR Epinephrine infusion (2-10 mcg/min) | Monitor and observe | ||||||||||||||||||
Algorithm based on the 2010 AHA guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.[1]
Do's
- Prepare for transcutaneous pacing if perfusion is poor
- If atropine is ineffective, pacing should begin
- The use of sodium bicarbonate should be considered for severe metabolic acidosis
- Atropine should be used with caution in the presence of myocardial ischemia because it increases oxygen demand and could worsen the ischemia
Don'ts
- Do not delay pacing if rhythm is Mobitz type II second degree block or third-degree AV block
- Avoid using atropine in hypothermic bradycardia and Mobitz type II/second degree AV block
References
- ↑ Neumar, RW.; Otto, CW.; Link, MS.; Kronick, SL.; Shuster, M.; Callaway, CW.; Kudenchuk, PJ.; Ornato, JP.; McNally, B. (2010). "Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S729–67. doi:10.1161/CIRCULATIONAHA.110.970988. PMID 20956224. Unknown parameter
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