acute bradycardia

Question 1

What is the definition of bradycardia?

Answer 1

What is the definition of bradycardia?

Question 2

When is bradycardia considered a medical emergency?

Answer 2

When it presents with adverse features like shock, syncope, heart failure, or myocardial ischemia.

Question 3

What is the most common cause of pathological bradycardia?

Answer 3

Sick sinus syndrome, with an incidence of 1 in 600 people over the age of 65.

Question 4

Which population is more commonly affected by physiological bradycardia?

Answer 4

Younger populations, athletes, and during sleep.

Question 5

What are the three main categories of bradycardia classification?

Answer 5

1. Physiological: Seen in athletes, younger individuals, or during sleep.
2. Cardiac causes: Sick sinus syndrome, heart block, post-MI, or aortic valve disease.
3. Non-cardiac causes: Vasovagal response, hypothyroidism, hypothermia, raised ICP (Cushing’s triad), medications.

Question 6

What are the symptoms of bradycardia?

Answer 6

Lightheadedness, syncope, fatigue, and shortness of breath.

Question 7

What are the typical signs on examination?

Answer 7

No specific signs other than bradycardia.

Question 8

What bedside investigation is key in diagnosing bradycardia?

Answer 8

ECG: Helps determine the underlying cause, such as sick sinus syndrome or heart block.

Question 9

What imaging might be used to identify the cause of bradycardia?

Answer 9

Transthoracic echocardiography (TTE) to assess for post-MI complications or aortic valve disease.

Question 10

What is the first-line treatment for bradycardia with adverse features?

Answer 10

500 micrograms of IV atropine.

Question 11

What should be done if the initial dose of atropine is ineffective?

Answer 11

Repeat atropine (up to 3 mg total) or consider transcutaneous pacing, isoprenaline, adrenaline, or other drugs (e.g., aminophylline or glucagon in beta-blocker/calcium channel blocker overdose).

Question 12

What is the management if there are no adverse signs but a risk of asystole?
A:

Answer 12

500 micrograms IV atropine.
Alternatively, consider transcutaneous pacing, isoprenaline, or adrenaline.

Question 13

What is the management for bradycardia with no adverse signs and no risk of asystole?

Answer 13

observation

Question 14

What are the key buzzwords for bradycardia?

Answer 14

ECG with prolonged PR interval or pauses.
Atropine 500 mcg IV (first-line for emergencies).
Transcutaneous pacing.
Permanent pacemaker for long-term management.
Cushing’s triad (bradycardia, irregular breathing, hypertension).