Pages

Wednesday, April 26, 2017

Introduction To Bradycardia

Bradycardia is defined as heart rate of less than 60 beats per minute.

Clinical Presentation
  • Often patients do not have any symptoms and it is detected as an incidental finding on routine physical examination.
  • Some patients may present with faints or blackouts, drop attacks, dizziness, breathlessness or lack of energy.
  • Findings on examination are slow pulse rate; normal or low BP with or without an evedence of secondary heart failure.
  • Sometimes there may be symptoms and signs of any associated disease that may help in diagnosing the cause of bradycardia.
InvestigationsA patient presenting with bradycardia with or without any associated symptoms should have following basic investigations done:

ECG: Ambulatory ECG may help with diagnosis of intermittent bradycardia as in sick sinus syndrome.
Blood tests: Thyroid function tests, Complete blood count, ESR, Urea, creatinine, LFTs, and digoxin levels (if pt taking digoxin).

Types Of Bradycardia

1. Sinus Bradycardia
There is a constant bradycardia and ECG shows normal P waves and P-R interval is <0.2 sec. 

Causes of sinus bradycardia are:
  • Physiological e.g atheletes
  • Vasovagal attack
  • Drugs e.g b -blockers, digoxin
  • Inferior wall MI
  • Sick sinus syndrome
  • Hypothyroidism
  • Hypothermia
  • Increased intracranial pressure
  • Jaundice
If patient is symptomatic management is hospital admission and cardiology referral.

2. AV node block (Heart block)Causes are
  • Ischemic heart disease
  • Drugs e.g digoxin, verapamil
  • Myocarditis
  • Cardiomyopathy
  • Fibrosis
  • Lyme’s disease
Types of heart block
  1. 1st degree heart block: Fixed P-R interval >200ms on ECG.
  2. 2nd degree block: It has two types :
  3. Mobitz type I: There is progressive lengthening of P-R interval followed by a dropped beat.
  4. Mobitz type II: constant P-R interval with regular dropped beats.
  5. 3rd degree block: it is a complete block in which P-P intervals are constant and R-R intervals are constant but not related to each other.
Patients with heart block should be referred to a cardiologist even if asymptomatic.

3. Stokes-Adams attack
It is defined as cardiac arrest due to AV block. Patients present with sudden loss of consciousness due to cerebral anoxia. The patient becomes pale and pulseless but respiration continues. attacks usually lasts apprx. 30 sec though occasionally are fatal. On recovery the patient becomes flushed. patients should be referred to cardiologist if suspected.

4. Sick sinus syndromeDue to sinus node dysfunction causing bradycardia with or without asystole, sino-atrial block, atrial fibrillation or supraventricular tachycardia. It is common among elderly patients. If symptomatic patients will need a pace maker.

2 comments:


  1. I feel so excited today because it's just a year since I got my breakthrough from Herpes.I was diagnosed of HSV1 on the 12/4/2015 and latter i got affected with the HSV2. That was my 2nd outbreak after i lost my ex fiance that got me affected with the virus. I was so scared when he died and what i heard about the Herpes virus as he's deathly and such has no cure. I feel so pity and and a disgrace to my personality,in my career and my family to have been in with the deathly sickness, and that would makes my love ones siblings stay far from me. I was going to my regular church activities when i begin to hear testimonies of how people get cure online, i never gave it a thought till my cousin Stephanie who was affected with HIV told me, Lenny you need not to worry cos i met i man today online , i traditional herbal healer whom two of her friends confirmed he cure them with his herbal herbs that i should give it a try. I saw the interest in her and she did contact the herbal doctor again in my present, luckily for me he picked and show up himself, behold he was at about to attain to some patients that have came back with appreciation of how he cure them from Cancer, HIV, and off much too the herpes he cured an 18 years old daughter.
    I was so happy that day, i wanted to be there but the distance was a barrier to me. I told him how the virus had eaten me up and and a truly believe there's cure for herpes. He told me me with assurance that my case wont be different and he had been curing lots of people With his herbal medicine and most people due contact him from the States and preperd the medicine and made use of the DHL to reach him.
    Honestly speaking Dr. Akpu power his a great and gifted herbalist,His destined to herbs.
    He made me do away with the medical prescription,the acyclovir (Zovirax), famciclovir(Famvir), and valacyclovir (valtrex). you don't know him because you haven't meet this man try and contact him yourself Dr. Akpu in Africa is popularly known in his City,and you can request for his address yourself. I'm so happy now cos,I and my cousin had been confirmed negative till date..the Lord is good in my life. Dr. Akpu sent me his herbal medicine that heal me too, 🙏 🙏 Dr. Akpu for giving me another life.
    Contact Dr.akpu for all kids of sickness@
    Dr.akpupowerherbscenter@gmail.com

    ReplyDelete
  2. I'M Kelly FROM KENTUCKY.
    I wanna thank God for Using Dr. Odey Abang to restore my son's Happiness. He came from school crying that he was diagnosed of Herpes and his teacher and the Physician Therapist told him he could not get a cure rather living on drugs, he never talk to us about it anymore not knowing he plans committing suicide . I had to monitor him and explain to him that he should manage the prescribes ACYCLOVIR, , FAMCICLOVIR and the VALACYCLOVIR.
    4 months later, he told me about an Herbalist who he heard curing people from online and he sents through the DHL service. Not quite long,he brought his phone, had to speak with the Herbalist and explain how my son had really felt and desperate in need of the cures, he assured me with no site effects after taking the medicine and promise to do as he said, 5 days later, t medicine arrived, applied as instructed and within two weeks to finish,I had my son told me he was wondering why all this while,they have not approved the cures of which doctor ODEY told him he Cures.
    Rest assured, after the checkup, he tested negative and his smiles was being restored.
    supriesed Herpes could be Cured!!!☔💯
    If you're in trouble of health
    HIV/AIDS, DIABETES, Herpetites, KIDNEY PROBLEM, INFERTILITY, INFECTIONS, IRREGULAR MESTURATION, WEEK ERECTION, CANCER ETC
    ALL THIS ARE CURABLE WITH HERBAL REMEDIES BY FROM DR. ODEY ABANG
    Kindly contact him for more information on health and Safety solutions @
    odeyabangherbalhome@gmail.com

    ReplyDelete