Bradycardia

Question 1

What counts as bradycardia?

Answer 1

Bradycardia is define as a heart rate of <60 beats per minute (Other sources state <50bpm).

Question 2

What can cause bradycardia?

Answer 2

• sinus/AV nodal disease
• drug induced e.g. beta blockers, calcium channel blockers
• electrolyte abnormalities
• metabolic causes such as hypothyroidism

Question 3

Clinical features

Answer 3

Patients may present with dizziness, syncope and tiredness

Question 4

Management according to ALS algorithim

When can you give a certain drug?

What drug is it?

What drugs can you give if that drug doesn’t work?

What other management option is there?

Answer 4

Initial assessment using DR ABCDE, ECG monitoring with any reversible causes should be identified and treated.

Give Atropine 500mcg (with repeat boluses up to 3mg) if there are:
- any adverse features (shock, syncope, myocardial ischaemia or heart failure)

• If any factors increasing the risk of asystole include Mobitz type II block, complete heart block + broad QRS, recent asystole and ventricular pause >3 seconds

If there is an inadequate response to atropine, alternative drugs include:

• isoprenaline
• adrenaline
• aminophylline
• dopamine
• glucagon (in beta blocker/ calcium channel blocker overdose)
• glycopyrrolate
• transvenous pacing by a specialist

Transcutaneous pacing can also be used as an interim measure whilst awaiting expert help for transvenous pacing/ permanent pacemaker insertion.

Question 5

Sick Sinus Syndrome

Describes

Clinical features

Answer 5

describes the clinical manifestations of sinus node dysfunction

Patients can present with:

• dizzy spells / syncope
• palpitations
• angina
• features of low output heart failure.

Question 6

Sick Sinus Syndrome

ECG features

Answer 6

sinus bradycardia

sinoatrial block

periods of sinus arrest

abnormally long pauses after a premature beat