Symptomatic Bradycardia Flashcards
Definition
Slow heart rate resulting in symptoms associated w/ hypo-perfusion
Goal of Care
Attempt to treat the underlying cause, improve perfusion, transport to hospital
Overview
SB - refers to weakness, dloc, sb, hypotension or chest pain that is due to bradycardia <50bpm
bradycardia can be due to cardiac causes or secondary due to increased vagal tone (e.g. nausea) or hypoxia
treatment focuses on optimizing the pt’s hemodynamic status and attempting to address the cause
Guiding Priniciples
Hypoxia - managed by ensuring adequate oxygenation, ventilation and cerebral perfusion
Atropine - is the first line medication - less likely too work w/ 3rd degree blocks, unlikely to be harmful
External Pacing - or EPI infusion is often successful - pacing usually requires mild sedation and analgesia
EPI - should be titrated to a heart rate less than 70bpm, as faster rates may decrease myocardial perfusion w/o increasing cerebral perfusion
Causes
- Bradycardia may be secondary to hypoxia or shock
- 2nd degree heart block
- 3rd degree heart block
- Toxic exposures most classically B-blocker, calcium channel blocker, organophosphates or digitalis
- Electrolyte disorder such as hyperkalemia seen more often in those w/ renal failure and on dialysis
Intervention Guidelines - EMR/PCP
keep pt at rest
position pt
- If symptoms suggestive of hypotension - lay flat
- If no suggestion of hypotension - position of comfort
Supp O2 saturation in less tha 94% or increased work of breathing
Intervention Guidelines - ACP
Asymptomatic - no tx is req’d
Unstable - increase ventricular rate
- Atropine
- EPI
Transcutaneous pacing
- Procedural Sedation & Analgesia
- Ketamine
- Midazolam
- Morphine
Further Care
If no stabilized, admission for possible pacemaker
IV infusions of dopamine or EPI
Decrease medications which may be slowing heart rate
Correct electrolytes
If due to cardiotoxic drugs the treatment of specific toxidrome
