BRADYCARDIA :

INTRODUCTION :
Having bradycardia means that your heart beats very so!y" #or most $eo$e% a heart rate
o& '( to )(( beats a minute !hie at rest is considered norma" I& your heart beats ess
than '( times a minute% your doctor may diagnose bradycardia" In a neonate% bradycardia
may be de&ined as a rate beo! )(( b$m"
But the good ne!s is that a so! heart rate is sometimes norma and can be a sign o&
being very &it" Heathy young aduts and athetes o&ten have heart rates o& ess than '(
beats a minute"
In other $eo$e% bradycardia is a sign o& a $robem !ith the heart *s eectrica system" It
means that the heart+s natura $acema,er is not !or,ing right or that the eectrica
$ath!ays o& the heart are disru$ted" In severe &orms o& bradycardia% the heart beats so
so!y that it does not $um$ enough bood to meet the body+s needs" This can be i&e-
threatening"
. TY/01 :
)" Atrioventricuar Noda
2" 3entricuar
." Atria :
4a5 Res$iratory 1inus Arrythmia
4b5 1ic, 1inus 1yndrome
4c5 1INU1 BRADYCARDIA :
De&inition : 1inus bradycardia is a rhythm in !hich &e!er than the norma number o&
im$uses arise &rom the sinoatria 41A5 node% more s$eci&icay ess than '( b$m"
Asym$tomatic 4Resting5 : 1inus bradycardia occurs in norma chidren and aduts%
$articuary during see$ and it may aso be seen in the absence o& heart disease in the
&oo!ing settings:
At rest% in 26 to .6 $ercent o& asym$tomatic individuas under 26 years o& age"
In !e-conditioned athetes : The heart musce o& athetes has become
conditioned to have a higher stro,e voume% so re7uires &e!er contractions to
circuate the same voume o& bood"
In some edery $atients"
As a mani&estation o& a rare &amiia syndrome in !hich asym$tomatic sinus
bradycardia resuts &rom a mutation in HCN8% !hich is one o& a &amiy o&
$acema,er ion channe genes"
1ym$tomatic 4Reative5 : 9ost $atients actuay become sym$tomatic unti their heart
rate dro$s to ess than 6( beats:minute% even &e! u$ to 8( beats:minute"
0TIO;O<Y :
1inus bradycardia may be physiological !ith a high resting vaga tone% e"g" in athetes or
the diving re&e="
The causes o& a pathological sinus bradycardia incude:
Drugs 4negative chronotro$es5:
Betaboc,ers"
Cacium -channe boc,ers"
Digo=in"
Amiodarone"
Conidine"
3era$ami"
Hy$o=ia"
/ain 4may aso cause tachycardia5"
Hy$othyroidism"
Hy$othermia"
Cushing+s re&e= 4systemic res$onse to raised intracrania $ressure% eading to
!idening $use $ressure% irreguar breathing and bradycardia5"
Acute myocardia in&arction"
1ic, sinus syndrome"
/ericardia tam$onade"
Adrena insu&&iciency"
1evere obstructive >aundice"
/eura or $eritonea stimuation"
Rarey in&ection 4e"g" ty$hoid may cause reative bradycardia5"
0/ID09IO;O<Y
It is im$ossibe to give meaning&u &igures on incidence and $revaence" In most young
$eo$e bradycardia is $hysioogica and re$resents athetic training" The incidence o&
$athoogica bradycardia rises !ith age as the underying causes become more &re7uent"
DIA<NO1I1 :
A diagnosis o& bradycardia is sim$e and is generay made on an 0C< or teemetry
monitor 4Hoter monitor% 28 hr-ambuatory monitoring5 !hen there is so!ing o& the heart
rhythm to beo! 6( b$m% even i& ony transient" The chaenge is determining the etioogy
o& the bradycardia and determining the site at !hich there is reduction in im$use
generation or $ro$agation" The $rimary use o& testing is to correate sym$toms !ith
bradycardia and:or to estabish a $otentiay dangerous condition as the cause o&
bradycardia% even though the $atient may be asym$tomatic
/resentation
1inus bradycardia is most o&ten asym$tomatic" Ho!ever% sym$toms may incude
the &oo!ing:
1ynco$e
Di??iness
;ightheadedness
Chest $ain
1hortness o& breath
0=ercise intoerance
/ertinent eements o& the history incude the &oo!ing:
/revious cardiac history 4eg% myocardia in&arction% congestive heart
&aiure% vavuar &aiure5
9edications
To=ic e=$osures
/rior inesses
0C< Characteristics
Rate: ;ess than '( beats $er minute"
Rhythm: Reguar"
/ !aves: U$right% consistent% and norma in mor$hoogy and duration"
/ -R Interva: Bet!een (")2-("2( seconds in duration"
@R1 Com$e=: ;ess than (")2 seconds in !idth% and consistent in mor$hoogy"
/rominent U Aaves 4common &inding% but not a!aysB5"
DI##0R0NTIA;1:
Hy$ogycemia
Hy$othermia
Hy$othyroidism and 9y=edema Coma
0C< 0=am$e :
Sinus bradycardia secondary to anorexia nervosa
1inus bradycardia 4.6 b$m5 in a )6-year od gir !ith anore=ia nervosa"
Note the $rominent U !aves in the $recordia eads% a common &inding in sinus
bradycardia"
U Wave
Norma U Aave
When Should Sinus Bradycardia Be Treated?
1inus bradycardia shoud be treated !henever it is $roducing a heart rate that is so!
enough to cause &atigue% ightheadedness% or synco$e"
A too o&ten% doctors &ai to recogni?e that an oder $atient !ho may have ony mid
sinus bradycardia !hie they are at rest might sti need to be treated" This is because in
some $eo$e% the chie& $robem caused by sinus node disease is not resting bradycardia%
but rather% an inabiity to increase the heart rate a$$ro$riatey during activity -- !hich can
cause e=treme &atigue during e=ertion" This condition is caed Cchronotropic
incompetence"C
Doctors can ma,e the diagnosis o& chronotro$ic incom$etence sim$y by observing the
$atient+s heart rate during e=ercise -- &or instance% during a stress test" Because
chronotro$ic incom$etence is a &airy common condition in the edery and is readiy
treatabe 4!ith a rate -res$onsive $acema,er5% it is im$ortant &or oder $eo$e !ho are
e=$eriencing &atigue !ith even mid e=ertion to ma,e sure their doctors do the $ro$er
evauation"
How Is Sinus Bradycardia Treated?
I& sinus bradycardia is $roducing sym$toms% it shoud be treated"
The &irst ste$ in treating sinus bradycardia is to determine !hether it has a reversibe
underying cause" I& the sinus bradycardia is due to increased vaga tone% drug thera$y% an
in&ectious disease% $ericarditis% myocarditis or hy$othyroidism% then addressing the
underying $robem is usuay the ony treatment that is necessary"
But i& the sinus bradycardia is caused by intrinsic sinus node disease% or by some other
medica $robem that cannot be easiy reversed% then treatment !i re7uire the $acement
o& a $acema,er"
1o i& you have sinus bradycardia% you !i need to !or, !ith your doctor to determine
!hy you have it% and !hether it is causing sym$toms" Ahie most $eo$e !ith sinus
bradycardia do not re7uire a $acema,er% i& you do have sym$toms &rom sinus
bradycardia% you can be con&ident that a $acema,er !i com$etey eiminate those
sym$toms"
Re&erences:
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