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Y3M - Cardiology > Bradycardia > Flashcards

Bradycardia Flashcards

1
Q

What is bradycardia?

A

< 60 bpm.

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2
Q

Causes of sinus bradycardia.

A

Physical fitness

Vasovagal attacks

Sick sinus syndrome

Drugs like b-blockers, digoxin and amiodarone

Hypothyroidism

Hypothermia

Raised ICP

Cholestasis

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3
Q

How can bradycardia be assessed?

A

By QRS complex

Rhythm

P-waves

P following QRS

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4
Q

What is a narrow QRS bradycardia with regular rhythm and p waves.

The p-QRS is 1:1.

PR is normal

A

If there is a normal PR = sinus bradycardia

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5
Q

What is a narrow QRS bradycardia with regular rhythm and p waves.

The p-QRS is 1:1.

PR is prolonged.

A

First degree HB

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6
Q

What is a narrow QRS bradycardia with regular rhythm and p waves.

The p-QRS is 2:1

A

Wenkebach’s if there is a drop.

or

Fixed AV block.

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7
Q

What is a narrow QRS bradycardia with regular rhythm and p waves.

There is no relation between P and QRS waves.

A

Complete HB.

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8
Q

What is a narrow QRS bradycardia with regular rhythm and no p waves or buried in QRS/T?

A

Junctional rhythm. (This can also be tachycardic)

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9
Q

What is a narrow QRS bradycardia with irregular rhythm?

A

AF with slow VR.

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10
Q

What is a broad QRS bradycardia with irregular rhythm?

A

AF with slow BBB.

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11
Q

What is a broad QRS bradycardia with regular rhythm and no p waves?

A

AF with complete HB.

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12
Q

What is a broad QRS bradycardia with regular rhythm and p waves.

The p-QRS is 1:1.

PR is normal

A

Sinus brady with BBB

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13
Q

What is a broad QRS bradycardia with regular rhythm and p waves.

The p-QRS is 1:1.

PR prolonged.

A

1st degree HB with BBB

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14
Q

What is a broad QRS bradycardia with regular rhythm and p waves.

The p-QRS is 2:1

A

Fixed AV block

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15
Q

What is a broad QRS bradycardia with regular rhythm and p waves.

There is no relation between P and QRS.

A

Complete HB

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16
Q

Explain the assessment algorithm of bradycardia.

A
17
Q
A

First degree AV block

18
Q
A

2nd degree Mobitz Type 1.

This is Wenkebach AV block.

Each successive QRS, the P-R interval increses until there is a non-conducted P wave.

19
Q
A

2nd degree HB.

Mobitz Type II - Ratio of AV conduction varies from 2:1 block or 3:1 block.

20
Q
A

Complete AV block.

no relationship between P and QRS.

21
Q

Treatment of 1st degree AV block.

A

No treatment indicated.

If the patient is on digoxin check for toxicity.

If there are symptoms such as dizziness or syncope, consider cardiac monitoring.

22
Q

When might 2nd degree AV block type I (Wenkebach) occur?

A

Young fit patients with high vagal tone - can be seen during the night if monitored.

Inferior MI.

23
Q

Treatment of 2nd degree AV block Type I (Wenkebach)

A

No specific therapy is indicated because it rarely proceeds to complete heart block.

Cardiac monitoring should be done if syncope or dizziness.

24
Q

Treatment of 2nd degree AV block Type II.

A

Always requires pacemaker (in the absence of a recent acute coronary event or drugs have been excluded)

This is because it is likely to proceed to complete heart block.

25
Q

Causes of complete heart block.

A

IHD (esp inf MI)

Idopathic fibrois

Congenital

Aortic valve calcification

Cardiac surgery/trauma

Digoxin toxicity

Severe hyperkalaemia

26
Q

Treatment of complete heart block.

A

If haemodynamically unstable give atropine 600 micrograms to a max of 3 mg.
Isoprenaline at rate of 5 micrograms/min can be tried as well.

Urgent permanent pacemaker is indicated. Should be done within 24 hours in all patients without a likelihood of recovery (such as recent coronary event)

27
Q

Management of bradycardia (algorithm) Pt 1.

A

Give O2 if hypoxic, manual BP, ECG 12 leads and IV access.

Identify reversible causes.

Check for adverse signs;
Shock
Syncope
Heart failure
Myocardial ischaemia

28
Q

Management of bradycardia if no adverse signs.

A

Assess the risk of asystole;

Recent asystole
Mobitz type II
Complete HB with broad QRS
Ventricular pause >3s.

If there are no risk -> continue observation.

29
Q

Management of bradycardia in a stable patient with risk of asystole.

A

Repeat atropine 500 micrograms IV every 3-5 mins (max 3mg)

Transcutaneous pacing

Isoprenaline 5 micrograms/min IVI

Adrenaline 2-10 micrograms/min IVI

Alternatives;
Aminophylline, dopamine, glucagon

Seek expert help and arrange transvenous pacing.

30
Q

Management of bradycardia in an unstable patient.

A

Give atropine 500 micrograms IV.

If there is no satisfactory response;

Repeat atropine 500 micrograms IV every 3-5 mins (max 3mg)

Transcutaneous pacing

Isoprenaline 5 micrograms/min IVI

Adrenaline 2-10 micrograms/min IVI

Alternatives;
Aminophylline, dopamine, glucagon

Seek expert help and arrange transvenous pacing.

Y3M - Cardiology (34 decks)

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