Bradyarrhythmia

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Contents 1 More Specific Terms 2 Introduction 3 Etiology 4 Management 5 More General Terms 6 Additional Terms 7 References

More Specific Terms

• asystole
• atrioventricular (AV) block
• sinoatrial exit block
• sinus bradycardia
• ventricular escape rhythm

Introduction

• A disturbances in cardiac rhythm that result in an abnormally slow heart rate, usually under 60/min.

Etiology

• decreased sinus node automaticity
• sinus node exit block
• atrioventricular block
• pharmaceutical agents

• cholinesterase inhibitors ( sinus bradycardia)
• beta-blockers ( AV nodal block)
• diltiazem, verapamil ( AV nodal block)
• digoxin ( AV nodal block)

Management

• assess, Airway, Breathing, Circulation ( ABCs)
• administer oxygen
• establish IV access
• 12 lead ECG
• asymptomatic

• type II second degree AV block or type 3 heart block

• transvenous pacer
• transcutaneous pacemaker until transvenous pacemaker can be inserted

• 1st degree or type 1 second degree AV block

• observe [3]

• symptomatic (related to bradycardia)

• atropine 0.5 mg IV push every 3-5 min up to 3 mg
• transcutaneous pacemaker
• a & b unsuccessful/unavailable

• dopamine 5-20 ug/kg/min ( IIb intervention)
• epinephrine 2-20 ug/min ( IIb intervention)
• isoproterenol 2-10 ug/min (not indicated in cardiac arrest)

• permanent pacemaker

More General Terms

• cardiac arrhythmia

Additional Terms

• cardiac pacemaker

References

1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 177, 179
2. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
3. Goldberger JJ et al. Significance of asymptomatic bradycardia for subsequent pacemaker implantation and mortality in patients >60 years of age. Am J Cardiol 2011 Sep 15; 108:857. PMID: [1]
4. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010

bradyarrhythmia (bradycardia)