What is the first line medication for bradycardia?
What is a first line treatment for a patient with unstable bradycardia? Atropine. In the absence of reversible causes, atropine remains the first-line drug …
How to manage unstable bradycardia?
Atropine is the first line medication for the treatment of bradycardia. The administration of atropine typically causes an increase in heart rate. This increase in the heart rate occurs when atropine blocks the effects of the vagus nerve on the heart.
What are the treatment options for bradycardia with poor perfusion?
which signs and symptoms indicate a symptomatic bradycardia Pulmonary edema, shortness of breath, chest pain, hypotension What is the first-line treatment for unstable bradycardia
What is the goal of therapy for symptomatic bradycardia?
What is the first line treatment for bradycardia? Give atropine 1mg IV may repeat for a total does of 3mg IV If this is ineffective provide transcutaneous pacing and/or dopamine 5 to 20 mcg/kg per minute or epinephrine 2 to 10 mcg/min
How do you treat unstable bradycardia?
Atropine is useful for treating symptomatic sinus bradycardia and may be beneficial for any type of AV block at the nodal level. The recommended atropine dose for bradycardia is 0.5 mg IV every 3 to 5 minutes to a maximum total dose of 3 mg.Nov 28, 2005
What is the drug of choice for bradycardia?
Patients with imminent heart failure or unstable patients with bradycardia need immediate treatment. The drug of choice is usually atropine 0.5–1.0 mg given intravenously at intervals of 3 to 5 minutes, up to a dose of 0.04 mg/kg. Other emergency drugs that may be given include adrenaline (epinephrine) and dopamine.Feb 26, 2019
What is the best medication for irregular heartbeat?
Flecainide, sotalol (also a beta blocker) and amiodarone are also commonly prescribed for arrhythmias. They have the ability to terminate an arrhythmia and are usually given to prevent the abnormal rhythm from occurring or reduce its frequency or duration.
What is the best medication to lower heart rate?
Beta-blockers - can be used to slow down your heart rate, and improve blood flow through your body. You may take this drug if you have been diagnosed with irregular heartbeats, or high blood pressure. Some examples of this medication may include: Metoprolol (Lopressor®), propanolol (Inderal®), and atenolol (Tenormin®).
What is the difference between bradycardia and tachycardia?
Bradycardia is defined as a heart rate of less than 50 bpm 1 in adults (non-well-conditioned athletes). Generally severe bradycardia is more worrisome than tachycardia for the following reasons: 1.Cardiac output is dependent on heart rate and stroke volume.
What is hemodynamic instability?
By enlarge hemodynamic instability is defined as a myriad of hypotension and signs and symptoms of poor organ perfusion including altered mental status (AMS), ischemic chest pain and dyspnea from acute heart failure. However hemodynamic instability is not all-or-none rather it has a spectrum.
What is Torsade de Pointes?
3. Torsade de pointes is a pause-dependent arrhythmia, which is more likely to occur at slower heart rates. Moreover, bradycardia itself may prolong the QT interval. Leaving patients in a severely bradycardic state may increase their risk of torsade.
Does bradycardia cause hemodynamic instability?
Bradycardia can directly pull down cardiac output and cause hemodynamic instability 2. Theoretically slowing down the heart rate may cause a minimal increase in diastolic filling, thereby increasing the stroke volume. However, this compensatory factor is weak and extremely limited. 2.Progressive bradycardia is often a harbinger of death.
How does atropine work?
First, let’s look at atropine and how it works. Atropine increases the firing of the sinoatrial node (atria) and conduction through the atrioventricular node (AV) of the heart by blocking the action of the vagus nerve.
Does atropine increase heart rate?
The administration of atropine typically causes an increase in heart rate. This increase in the heart rate occurs when atropine blocks the effects of the vagus nerve on the heart. When the vagus nerve is blocked, the SA node increases its rate of electrical discharge and this, in turn, results in the increased HR.
Case
A 67 year old man is brought in by EMS after a syncopal episode at home. He has only partially regained consciousness, with a GCS of 12. His wife says that he has had a fast heart rate before and that he also has diabetes and high blood pressure. She isn’t sure what medications he is on. He has had flu like symptoms for a few days.
My approach
Just like every other time I step into the resuscitation room, my first thoughts are the ABCs. In bradycardic patients, immediate and effective management of airway and breathing is essential, because hypoxia is a potential cause of bradycardia.1,2 However, airway management in the setting of cardiogenic shock is fraught with difficulty.
Other FOAMed Resources
In case that is too much serious learning for you, you should definitely watch “Diagnosis Wenckebach” by the University of Alberta medical class of 2010:
Preface
Clinical Significance of Bradycardia
Etiology
Clinical Manifestation
Resuscitation
Transcutaneous Pacing
Transvenous Pacing
Case
My Approach
Notes
Other Foamed Resources
References
- Transvenous is much more effective than transcutaneous pacing with success rates of >95%. Transvenous pacing is indicated as following: 1. Unstable bradycardia which doesn’t respond to other medication and/or interventions. 2. High-degree AV blocks that leave the patient at ongoing risk of deterioration (e.g. Mobitz II, third-degree heart block wit...