Bradyarrhythmia Management
Download as PPTX, PDF12 likes7,100 views
This document discusses different types of bradyarrhythmias which are heart rates less than 60 beats per minute. The types include sinus bradycardia, sick sinus syndrome, and AV blocks of varying degrees. Causes include drugs, ischemia, structural issues, and electrolyte imbalances. Treatment depends on whether the bradycardia is stable or unstable. For stable patients, no treatment may be needed but unstable patients require treatment of the underlying cause if known and use of drugs like atropine, epinephrine, or isoproterenol to increase heart rate. Pacing may also be used through temporary or permanent pacemakers.
Bradyarrhythmia Management
- 2. <60 beats per minute
- 3. Types Sinus Brady -Drugs (digoxin, beta blockers, verapamil, diltiazem, amiodarone) -Athletes -IncreasedVagalTone
- 5. Sick Sinus (Sinus Node Dysfunction) -characterised by sinus bradycardia, sinus pauses and junctional or ventricular escape rhythms. -tachy-Brady syndrome
- 7. AV Block -First-degree block, which has a prolonged PR interval -Second-degree block, which has intermittent AV conduction, ie intermittent dropped beats. -Third-degree block (complete heart block), which is due to complete interruption of AV conduction
- 8. Diagnosis Clinical + ECG -syncope, fatigue, shortness of breath on exertion and dizziness. Severe bradycardia can cause haemodynamic consequences of hypotension, altered conscious state, poor perfusion, ischaemic chest pain and cardiac failure
- 9. Causes Ischaemia HTN Structural/Congenital- OSA Toxicological- Drugs Metabolic- Electrolyte disturbance (K+) Endocrine- Hypothyroid Environmental-VagalTone, Hypothermia
- 10. What to do? Stable -Patients with asymptomatic bradycardia usually need no treatment- Stable BP ability to perfuse Unstable -Severe Symptoms and haemodynamic compromise
- 11. Treat the cause if identified
- 12. Atropine Atropine is most effective in sinus node dysfunction or block at the level of the atrioventricular (AV) node. -Comptetitive antagonist of Ach at muscarinic receptors -Reduces vagal tone and therefore increases HR -600mcg boluses up to 3mg
- 13. Adrenaline Chronotope -non selective alpha and beta agonist -infusion at 2-10mcg/min- titrate to effect -Adrenaline is preferred if systolic blood pressure is very low (less than 80 mm Hg)
- 14. Isoprenaline Chronotrope -Selective B1 Agonist -Caution risk of Hypotension -May require higher doses in patients with B-Blockers -10 to 20 micrograms IV, repeated according to clinical response, followed by an infusion at 1 to 4 micrograms/minute
- 15. Transcutaneous Pacing bradycardia unresponsive to drug therapy 3rd degree heart block Mobitz type II second-degree heart block when haemodynamically unstable or operation planned overdrive pacing asystole
- 16. FurtherTherapy Temporary Pacing Wires/Transvenous Pacing -CentralVenous Access (right IJV) -Permanent Pacemaker
- 17. place pads in AP position (black on anterior chest, red on posterior chest) connect ECG leads set pacemaker to demand turn pacing rate to > 30bpm above patients intrinsic rhythm set mA to 70 Sedation (Midazolam+Fentanyl) start pacing and increase mA until pacing rate captured on monitor if pacing rate not captured at a current of 120-130mA -> resite electrodes and repeat the above. once pacing captured, set current at 5-10mA above threshold Mechanical Capture/ElectricalCapture