Bradycardia: Difference between revisions
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===Causes in Alphabetical Order=== | ===Causes in Alphabetical Order=== | ||
* [[Aceclidine ]] | * [[Aceclidine ]] | ||
* [[Acepromazine ]] | * [[Acepromazine ]] | ||
* [[Acetylcholinesterase inhibitor ]] | * [[Acetylcholinesterase inhibitor ]] | ||
* [[Adenosine ]] | * [[Adenosine ]] | ||
* [[Amiodarone ]] | * [[Amiodarone ]] | ||
* [[Amodiaquine ]] | * [[Amodiaquine ]] | ||
* [[Anorexia Nervosa]] | |||
* [[Anorexia Nervosa ]] | * [[Anorexia Nervosa ]] | ||
* [[Apnea of prematurity ]] | * [[Apnea of prematurity ]] | ||
* [[Asphyxia neonatorum ]] | |||
* [[Atenolol ]] | * [[Atenolol ]] | ||
* [[Athlete ]] | |||
* [[Atrioventricular Block ]] | * [[Atrioventricular Block ]] | ||
* [[Autonomic neuropathy]] | * [[Autonomic neuropathy]] | ||
* [[Barbiturates ]] | * [[Barbiturates ]] | ||
* [[Beta-blockers ]] | * [[Beta-blockers ]] | ||
* [[Brucellosis ]] | * [[Brucellosis ]] | ||
* [[Bupivacaine ]] | * [[Bupivacaine ]] | ||
* [[Calcium channel blocker ]] | * [[Calcium channel blocker ]] | ||
* [[Carbamate]] | |||
* [[Cardiac arrhythmia ]] | * [[Cardiac arrhythmia ]] | ||
* [[Cardiac catheterization]] | |||
* [[Cardiac Dysrhythmias ]] | * [[Cardiac Dysrhythmias ]] | ||
* [[Cardiomegaly ]] | * [[Cardiomegaly ]] | ||
* [[Cardiomyopathy]] | |||
* [[Catecholaminergic polymorphic ventricular tachycardia ]] | * [[Catecholaminergic polymorphic ventricular tachycardia ]] | ||
* [[Cerebral hemorrhage]] | * [[Cerebral hemorrhage]] | ||
* [[Cerebral venous sinus thrombosis ]] | * [[Cerebral venous sinus thrombosis ]] | ||
* [[Chagas' disease]] | * [[Chagas' disease]] | ||
* [[Clomipramine ]] | * [[Clomipramine ]] | ||
* [[Clonidine]] | |||
* [[Colorado tick fever]] | * [[Colorado tick fever]] | ||
* [[Congenital Central Hypoventilation Syndrome]] | |||
* [[Congenital Long QT Syndrome]] | * [[Congenital Long QT Syndrome]] | ||
* [[Cushing reaction]] | * [[Cushing reaction]] | ||
* [[Cushing reflex ]] | * [[Cushing reflex ]] | ||
* [[Cushing triad ]] | * [[Cushing triad ]] | ||
* [[Cyclic antidepressant poisoning ]] | |||
* [[Detomidine ]] | * [[Detomidine ]] | ||
* [[Digitalis ]] | * [[Digitalis ]] | ||
* [[Diltiazem ]] | * [[Diltiazem ]] | ||
* [[Diphenhydramine ]] | * [[Diphenhydramine ]] | ||
* [[Distichiasis -- heart and vasculature anomalies - sinus bradycardia]] | |||
* [[Donepezil ]] | * [[Donepezil ]] | ||
* [[Doxepin ]] | * [[Doxepin ]] | ||
* [[Drowning ]] | * [[Drowning ]] | ||
* [[Emery-Dreifuss muscular dystrophy ]] | * [[Emery-Dreifuss muscular dystrophy ]] | ||
* [[Enema]] | * [[Enema]] | ||
* [[Fetal distress ]] | * [[Fetal distress ]] | ||
* [[Gamma-Hydroxybutyric acid ]] | * [[Gamma-Hydroxybutyric acid ]] | ||
* [[Gastric lavage]] | * [[Gastric lavage]] | ||
* [[Glyceryl trinitrate ]] | * [[Glyceryl trinitrate ]] | ||
* [[Grayanotoxin]] | * [[Grayanotoxin]] | ||
* [[Hantavirus pulmonary syndrome ]] | * [[Hantavirus pulmonary syndrome ]] | ||
* [[Hashimoto's Thyroiditis]] | |||
* [[Heat exhaustion]] | |||
* [[Hellebore ]] | * [[Hellebore ]] | ||
* [[Holt-Oram syndrome]] | * [[Holt-Oram syndrome]] | ||
* [[Hydrocodone ]] | * [[Hydrocodone ]] | ||
* [[Hydroxyethyl starch | |||
* [[Hydroxyethyl starch Speedball (drug) ]] | |||
* [[Hypercalcemia ]] | * [[Hypercalcemia ]] | ||
* [[Hyperkalemia ]] | * [[Hyperkalemia ]] | ||
* [[Hypokalemia ]] | * [[Hypokalemia ]] | ||
* [[Hypothermia]] | * [[Hypothermia]] | ||
* [[Hypothyroidism ]] | * [[Hypothyroidism ]] | ||
* [[Ibuprofen ]] | * [[Ibuprofen ]] | ||
* [[Increased intracranial pressure]] | |||
* [[Isosorbide dinitrate ]] | * [[Isosorbide dinitrate ]] | ||
* [[Ivabradine ]] | * [[Ivabradine ]] | ||
* [[Legionella pneumonia ]] | * [[Legionella pneumonia ]] | ||
* [[Levobetaxolol ]] | * [[Levobetaxolol ]] | ||
* [[Levobupivacaine ]] | * [[Levobupivacaine ]] | ||
* [[Lidocaine]] | * [[Lidocaine]] | ||
* [[Lithium ]] | * [[Lithium ]] | ||
* [[Malnutrition]] | |||
* [[Mammalian diving reflex ]] | * [[Mammalian diving reflex ]] | ||
* [[Medetomidine ]] | * [[Medetomidine ]] | ||
* [[Mefloquine]] | * [[Mefloquine]] | ||
* [[Mepivacaine ]] | * [[Mepivacaine ]] | ||
* [[Methacholine]] | * [[Methacholine]] | ||
* [[Methyldopa ]] | * [[Methyldopa ]] | ||
* [[Morphine ]] | * [[Morphine ]] | ||
* [[Moxonidine ]] | * [[Moxonidine ]] | ||
* [[Mycoplasma pneumonia ]] | * [[Mycoplasma pneumonia ]] | ||
* [[Nadolol]] | * [[Nadolol]] | ||
* [[Nalbuphine ]] | * [[Nalbuphine ]] | ||
* [[Nalmefene]] | * [[Nalmefene]] | ||
* [[Necrotizing enterocolitis ]] | |||
* [[Neonatal lupus erythematosus]] | * [[Neonatal lupus erythematosus]] | ||
* [[Neurocardiogenic Syncope]] | * [[Neurocardiogenic Syncope]] | ||
* [[Neurogenic shock ]] | * [[Neurogenic shock ]] | ||
* [[Obstructive jaundice]] | |||
* [[Oculocardiac reflex]] | * [[Oculocardiac reflex]] | ||
* [[Opioid]] | |||
* [[Opioid poisoning ]] | |||
* [[Oxymorphone]] | * [[Oxymorphone]] | ||
* [[Phenobarbital ]] | * [[Phenobarbital ]] | ||
* [[Phenylephrine]] | * [[Phenylephrine]] | ||
* [[Phenytoin ]] | * [[Phenytoin ]] | ||
* [[Pilocarpine ]] | * [[Pilocarpine ]] | ||
* [[Pneumothorax ]] | |||
* [[Propafenone ]] | * [[Propafenone ]] | ||
* [[Propranolol ]] | * [[Propranolol ]] | ||
* [[Pulseless ventricular tachycardia]] | * [[Pulseless ventricular tachycardia]] | ||
* [[Quinidine ]] | * [[Quinidine ]] | ||
* [[Radiocontrast toxicity]] | * [[Radiocontrast toxicity]] | ||
* [[Raised Intracranial pressure ]] | * [[Raised Intracranial pressure ]] | ||
* [[Rapid sequence induction]] | * [[Rapid sequence induction]] | ||
* [[Reserpine ]] | * [[Reserpine ]] | ||
* [[Right Bundle Branch Block ]] | * [[Right Bundle Branch Block ]] | ||
* [[Ropivacaine ]] | * [[Ropivacaine ]] | ||
* [[Second Degree AV Block ]] | * [[Second Degree AV Block ]] | ||
* [[Sedatives ]] | |||
* [[Septic shock]] | |||
* [[Sick sinus syndrome ]] | * [[Sick sinus syndrome ]] | ||
* [[Sinoatrial Block ]] | * [[Sinoatrial Block ]] | ||
* [[Skull fracture ]] | |||
* [[Sleep]] | |||
* [[ST Elevation Myocardial Infarction Complications ]] | * [[ST Elevation Myocardial Infarction Complications ]] | ||
* [[Subarachanoid hemorrhage ]] | * [[Subarachanoid hemorrhage ]] | ||
* [[Sulpiride ]] | * [[Sulpiride ]] | ||
* [[Suxamethonium chloride ]] | * [[Suxamethonium chloride ]] | ||
* [[Tacrine ]] | * [[Tacrine ]] | ||
* [[Theobromine poisoning]] | * [[Theobromine poisoning]] | ||
* [[Timolol]] | * [[Timolol]] | ||
* [[Trazodone ]] | * [[Trazodone ]] | ||
* [[Trypanosoma cruzi]] | * [[Trypanosoma cruzi]] | ||
* [[Tularaemia ]] | * [[Tularaemia ]] | ||
* [[Typhoid fever ]] | * [[Typhoid fever ]] | ||
* [[Uncaria tomentosa ]] | * [[Uncaria tomentosa ]] | ||
* [[Vagal episode ]] | * [[Vagal episode ]] | ||
* [[Vasa previa]] | * [[Vasa previa]] | ||
* [[Vasovagal syncope]] | * [[Vasovagal syncope]] | ||
* [[Vertebral subluxation]] | * [[Vertebral subluxation]] | ||
* [[Xylazine]] | * [[Xylazine]] | ||
Revision as of 03:55, 6 August 2012
| Bradycardia | |
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| ICD-10 | R00.1 |
| ICD-9 | 427.81, 659.7, 785.9, 779.81 |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: M.Umer Tariq [2]
Overview
Bradycardia is defined as a resting heart rate of under 60 beats per minute.
Pathophysiology
Pathologic bradycardias are caused by disorders of impulse generation (impaired automaticity at SA node), impulse conduction (heart block) or escape pacemakers and rhythms. Bradycardia can be underlain by several causes, which are best divided into cardiac and non-cardiac causes. Non-cardiac causes are usually secondary, and can involve recreational drug use, endocrine disorders (hypothyroid); electrolyte imbalance (hyperkalemia); autonomic reflexes; situational factors (prolonged bed rest); infections lyme disease, medications, and autoimmunity disorders. Cardiac causes include acute or chronic ischemic heart disease, vascular heart disease, valvular heart disease, or degenerative primary electrical disease (fibrosis and calcification of the sinus node and conduction system).
Natural History, Complications, Prognosis
Slower sinus rates are often very well tolerated. Asymptomatic resting bradycardias, particularly in trained athletes and young individuals are not pathological and doesn't not require treatment.
Causes
It is difficult and sometimes impossible to assign a mechanism to any particular bradycardia. However, the underlying mechanism is not clinically relevant to treatment, which is the same in both cases of sick sinus syndrome: a permanent pacemaker.
There are generally two types of problems that result in bradycardias:
Disorders of the sinus node
- Impaired automaticity - Sinus node dysfunction/sick sinus syndrome)
- Exit block - Impaired conduction of the impulse from the sinus node into the surrounding atrial tissue
Disorders of the atrioventricular node (AV node)
- Atrioventricular conduction disturbances (1o AV block, 2o type I AV block, 2o type II AV block, 3o AV block) may result from impaired conduction in the AV node, or anywhere below it, such as in the bundle of HIS.
Causes of Bradycardia By Organ System
Causes in Alphabetical Order
Epidemiology and Demographics
Bradycardia is more common in older patients.
Diagnosis
Evaluation of bradycardia includes assessment of the heart rhythm, symptoms, medications, and associated medical conditions (reversible and irreversible). Symptomatic bradycardias are treated by removal of the underlying causes, medications (atropine) or insertion of a temporary or permanent pacemaker. The term relative bradycardia is used to explain a heart rate that, while not technically below 60 beats per minute, is considered too slow for the individual's current medical condition.
Symptoms
- Presyncope
- Syncope
- Fatigue
- Angina
- Symptoms of congestive heart failure
Resting EKG
The heart rate is < 60 beats per minute.
24 Hour Ambulatory Electrocardiogram Monitoring
The diagnosis is usually made with the help of a 24-hour ambulatory electrocardiogram (ECG) or telemetry.
Treatment
Urgent Treatment
- Check drug list and remove drugs predisposing to bradycardia like beta blockers, calcium channel blocker, anti-arrhythmic drug.
- Drug treatment for bradycardia is typically not indicated for patients who are asymptomatic.
- In symptomatic patients, underlying electrolyte or acid-base disorders or hypoxia should be corrected first.
- IV atropine may provide temporary improvement in symptomatic patients, although its use should be balanced by an appreciation of the increase in myocardial oxygen demand this agent causes. Atropine 0.5-1 mg IV or ET q3-5min up to 3 mg total (0.04 mg/kg)
Indications For a Temporary Pacemaker
Advanced heart block such as complete heart block is an indication for a temporary pacemaker insertion.
Chronic Management
There are two main reasons for treating brandycardia:
- With bradycardia, the first is to address the associated symptoms, such as fatigue, limitations on how much an individual can physically exert, fainting (syncope), dizziness or lightheadedness, or other vague and non-specific symptoms.
- The other reason to treat bradycardia is if the person's ultimate outcome (prognosis) will be changed or impacted by the bradycardia.
Treatment in this vein depends on whether any symptoms are present, and what the underlying cause is. Primary or idiopathic bradycardia is treated symptomatically if it is significant, and the underlying cause is treated if the bradycardia is secondary.
See also
References
de:Bradykardie it:Bradicardia nl:Bradycardie nn:Bradykardi sk:Bradykardia sv:Bradykardi