Bradyarrythmias.ppt

8/9/2019 Bradyarrythmias.ppt

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Bradyarrythmias


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Bradyarrythmias

Bradycardia is defned as anyrhythm disorder with a heart rateless than 60 beats per minute. This

could also be called asymptomaticbradycardia.

Bradycardia can be a normal non-emergent rhythm. For instance, welltrained athletes may have a normalheart rate that is less than 60 bpm.


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The major !" rhythms classifed asbradycardia include#

$%inus Bradycardia

&First-degree '( bloc)

*%econd-degree '( bloc)Type + enc)enbach/obit +

Type ++ /obit ++

1Third-degree '( bloc) complete bloc)


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2st3egree '( Bloc)

45 interval 700ms

+8 accompanied by wide 95%, re8er to cardiology,high ris) o8 progression to 7ndand :rddeg bloc)

;therwise, benign i8 asymptomatic


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7nd3egree '( Bloc) /obittype +


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enc)ebach, /obit type +

>sually asymptomatic, but with accompanyingbradycardia can cause angina, syncope esp inelderlywill need pacing i8 s?s

'lso can be caused by drugs that slow conduction


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7nddegree bloc) Type ++ sually below '( node and accompanied by BBB or8ascicular bloc)

;8ten causes presyncope e?ercise worsens s?s

"enerally need pacing, possibly urgently i8 symptomatic


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:rd 3egree '( Bloc)

!omplete '( disassociation, C5 is a ventricular rate ill o8ten cause diiness, syncope, angina, heart 8ailure !an degenerate to (tach and (fb ill need pacing, urgent re8erral


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%ymptomatic bradycardia however is

defned as a heart rate less than 60 bpmthat elicits signs and symptoms.

%ymptomatic bradycardia e?ists when

the 8ollowing : criteria are present#

2= The heart rate is slow

7= The patient has symptoms := The symptoms are due to the slow

heart rate.


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Symptoms of bradycardia

' heart rhythm thatDs too slow cancause insuEcient blood ow to thebrain with symptoms such as#

Fatigue 3iiness

Gightheadedness

Fainting or near-8ainting spells +n e?treme cases, cardiac arrest may

occur.


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Causes of bradycardia

4roblems with the sinoatrial


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Functional or relative bradycardia

occurs when a patient may have aheart rate within normal sinus range,but the heart rate is insuEcient 8or

the patients condition. 'n e?amplewould be a patient with an heart rateo8 H0 bpm when they aree?periencing septic shoc).


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Bradycardia Pharmacology There are : medications that are used in the

Bradycardia '!G% 'lgorithm. They areatropine, dopamine


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2010 AHA pdate# Forsymptomatic bradycardia or unstable

bradycardia +( in8usion chronotropicagents


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Bradycardia Algorithm

The decision point 8or '!G%

intervention in the bradycardiaalgorithm is determination o8 adeKuateper8usion. For the patient with

adeKuate per8usion, you shouldobserve and monitor.

+8 the patient has poor per8usion,preparation 8or transcutaneous pacing

should be initiated, and an assessmento8 contributing causes


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!ranscutaneous pacing "!CP#

4reparation 8or T!4 should be ta)ingplace as atropine is being given. +8atropine 8ails to alleviate symptomatic

bradycardia, T!4 should be initiated.+deally the patient should receivesedation prior to pacing, but i8 thepatient is deteriorating rapidly, it maybe necessary to start T!4 prior tosedation.


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REMEMBER

For the patient with symptomaticbradycardia with signs of poorperfusion, transcutaneous pacing is

the treatment o8 choice.


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A; 95%N

A;

!+5!>G'T+;A


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Than) Oou

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Bradyarrythmias.ppt