Symptomatic Bradycardia

Question 1

A bradycardia is symptomatic if these 3 criteria are present

Answer 1

1. The heart rate is slow
2. The patient has symptoms
3. The symptoms are due to the slow heart rate

Question 2

Bradycardic symptoms include…

Answer 2

Chest discomfort or pain
Shortness of breath
Decreased level of consciousness
Fatigue
Light-headedness
Dizziness
Presyncope or syncope

Question 3

Bradycardic signs include…

Answer 3

Hypotension
Orthostatic hypotension
Diaphoresis
Pulmonary congestion
Frank congestive heart failure
Pulmonary edema
Frequent bradycardia-related PVCs or VT

Question 4

Primary decision point in bradycardia algorithm is…

Answer 4

Determination of adequate perfusion

Question 5

Ask: Is persistent bradycardia causing… (5)

Answer 5

Hypotension?
Acutely altered mental status?
Signs of shock?
Ischemic chest discomfort?
Acute heart failure?

If no to all, monitor an observe

Question 6

If persistent bradycardia is causing poor perfusion, the first drug of choice is… (dose, frequency, maximum)

Answer 6

Atropine

First dose: 0.5 mg bolus
Repeat every 3-5 minutes
Maximum 3 mg

Question 7

Drug choices other than Atropine include… (and dose)

Answer 7

Dopamine: 2-10 mcg/kg per minute
Epinephrine: 2-10 mcg per minute

Question 8

Do not rely on Atropine in…

Answer 8

Mobitz type II second- or third-degree AV block or in third-degree AV block with a new wide QRS complex

Question 9

Consider transcutaneous pacing…

Answer 9

…in unstable patients with high degree heart block when IV access is not available and when patients do not respond to atropine