Breaking Down Bradycardia π°οΈ
Slow heart rate with potential big impact. Dive into this high-yield 𧡠from @GlassHealthHQ
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1/16
Slow heart rate with potential big impact. Dive into this high-yield 𧡠from @GlassHealthHQ
#MedTwitter #MedX #MedED #Cardiology #ACC2024
1/16
Context Team: @Joshua___Ross @kassisMD @MaxCollMD @AlexSpacht @Gurbanikaur.
Tweetorial Team: @ShivaniReddy_1 @AmierHaidar @clarencetsaiMD
Bradycardia AI Context Article with References:
glass.health
2/16
Tweetorial Team: @ShivaniReddy_1 @AmierHaidar @clarencetsaiMD
Bradycardia AI Context Article with References:
glass.health
2/16
Definition π
- The NIH defines sinus bradycardia as a heart rate < 60 bpm in adults other than well-trained athletes.
- However, the ACC/AHA Task Force on Clinical Practice Guidelines & the Heart Rhythm Society have defined it as a sinus rate of < 50 bpm.
3/16
- The NIH defines sinus bradycardia as a heart rate < 60 bpm in adults other than well-trained athletes.
- However, the ACC/AHA Task Force on Clinical Practice Guidelines & the Heart Rhythm Society have defined it as a sinus rate of < 50 bpm.
3/16
What are the causes of pathologic bradycardia?
- Sinus node dysfunction (SND) (aka sick sinus syndrome) or atrioventricular (AV) block.
- SND is the most common cause of bradycardia in the US, especially in patients over the age of 65. π΄ π΅
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- Sinus node dysfunction (SND) (aka sick sinus syndrome) or atrioventricular (AV) block.
- SND is the most common cause of bradycardia in the US, especially in patients over the age of 65. π΄ π΅
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Other causes:
- Ischemic β€οΈβπ₯
- Infectious (Chagas, Endocarditis, Lyme disease) π¦
- Infiltrative (sarcoidosis, amyloidosis)
- Rheumatological (Lupus)
- Procedural trauma (s/p cath or valve surgery)
- OSA
- Metabolic ( β¬οΈ or β¬οΈ K, hypothyroidism)
- Drugs (eg. opioids)
5/16
- Ischemic β€οΈβπ₯
- Infectious (Chagas, Endocarditis, Lyme disease) π¦
- Infiltrative (sarcoidosis, amyloidosis)
- Rheumatological (Lupus)
- Procedural trauma (s/p cath or valve surgery)
- OSA
- Metabolic ( β¬οΈ or β¬οΈ K, hypothyroidism)
- Drugs (eg. opioids)
5/16
Also, consider familial/inherited conduction disorders such as SCN5A gene mutation for cardiac sodium channel π§ and HCN4 gene mutation for cardiac pacemaker channel π
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How does it present?
Young healthy patients or athletes may be asymptomatic πββοΈ
Symptomatic presentation can include:
- Syncope or pre-syncope π°
- Fatigue π©
- Dizziness or lightheadedness π΅
- Chest pain β€οΈβπ©Ή
- Shortness of breath π«
- Altered mental status π§
7/16
Young healthy patients or athletes may be asymptomatic πββοΈ
Symptomatic presentation can include:
- Syncope or pre-syncope π°
- Fatigue π©
- Dizziness or lightheadedness π΅
- Chest pain β€οΈβπ©Ή
- Shortness of breath π«
- Altered mental status π§
7/16
ECG confirms sinus bradycardia in a symptomatic patient. Now what?
β‘οΈ If patient is hemodynamically unstable: give 1 mg atropine q3-5 minutes (x 3 for max dose of 3 mg) π
β€΅οΈ Refer to the AHA's Bradycardia ACLS algorithm for more information!
8/16
β‘οΈ If patient is hemodynamically unstable: give 1 mg atropine q3-5 minutes (x 3 for max dose of 3 mg) π
β€΅οΈ Refer to the AHA's Bradycardia ACLS algorithm for more information!
8/16
β Avoid atropine in patients who are s/p heart transplant or have high-degree AV block.
Use it with caution with those w/ active coronary ischemia, glaucoma, GI obstruction, and pyloric stenosis.
9/16
Use it with caution with those w/ active coronary ischemia, glaucoma, GI obstruction, and pyloric stenosis.
9/16
βThe patient does not respond to atropine? How should we proceed next?
π‘ Transcutaneous pacing! It provides temporary rate support until transvenous pacing or a permanent pacemaker can be placed.
10/16
π‘ Transcutaneous pacing! It provides temporary rate support until transvenous pacing or a permanent pacemaker can be placed.
10/16
π Other med options if atropine is ineffective & pacing is unavailable: dopamine (2-10 mcg/kg/min), epi (2-10 mcg/min), isoproterenol (20-60 mcg bolus + 1-20 mcg/min infusion), aminophylline (250 mg bolus; for pts w/ 2nd or 3rd degree AV block associated w/ inferior MI)
11/16
11/16
What if we have a patient who has drug-induced bradycardia?
π Ca-channel blocker overdose (OD): tx w/ 10% Ca gluconate or 10% Ca chloride
π Beta-blocker OD: tx w/ glucagon + insulin
π Digoxin OD: tx w/ digoxin antibody fragment
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π Ca-channel blocker overdose (OD): tx w/ 10% Ca gluconate or 10% Ca chloride
π Beta-blocker OD: tx w/ glucagon + insulin
π Digoxin OD: tx w/ digoxin antibody fragment
12/16
π For chronic management of patients w/ symptomatic bradycardia due to SND, high-degree AV block, or non-reversible causes of bradycardia, consider electrophysiology consult for pacemaker placement.
13/16
13/16
What are some complications of bradycardia? π©Ί
- β€οΈ Heart failure
- Worsening of ischemic heart disease
- Tachy-brady syndrome
- Cardiac arrest (asystole)
14/16
- β€οΈ Heart failure
- Worsening of ischemic heart disease
- Tachy-brady syndrome
- Cardiac arrest (asystole)
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ποΈ Summary:
ποΈ Bradycardia is defined as HR < 50-60 bpm
ποΈ SND or AV block are common causes
ποΈ Presentation is highly variable
ποΈ Atropine is first-line tx for hemodynamically unstable patients
ποΈ Consider PPM placement for chronic mgmt of symptomatic bradycardia
15/16
ποΈ Bradycardia is defined as HR < 50-60 bpm
ποΈ SND or AV block are common causes
ποΈ Presentation is highly variable
ποΈ Atropine is first-line tx for hemodynamically unstable patients
ποΈ Consider PPM placement for chronic mgmt of symptomatic bradycardia
15/16
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