Bradycardia: Difference between revisions

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== Causes ==
== Causes ==


===Causes of Bradycardia By Organ System===
{|style="width:70%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |
[[Atrioventricular Block]],
[[Cardiac arrhythmia]],
[[Cardiac Dysrhythmias]],
[[Cardiomegaly]],
[[Right Bundle Branch Block]],
[[Second Degree AV Block]],
[[ST Elevation Myocardial Infarction Complications]],
[[Sinoatrial Block]],
[[Pulseless ventricular tachycardia]],
[[Sick sinus syndrome]],
[[Cardiomyopathy]],
[[Distichiasis - heart and vasculature anomalies - sinus bradycardia]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[Carbamate]],
[[Opioid poisoning]],
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"|
[[Aceclidine]],
[[Acepromazine]],
[[Acetylcholinesterase inhibitor]],
[[Adenosine]],
[[Amiodarone]],
[[Amodiaquine]],
[[Atenolol]],
[[Barbiturates]],
[[Beta-blockers]],
[[Bupivacaine]],
[[Calcium channel blocker]],
[[Clomipramine]],
[[Clonidine]],
[[Detomidine]],
[[Digitalis]],
[[Diltiazem]],
[[Diphenhydramine]],
[[Donepezil]],
[[Doxepin]],
[[Glyceryl trinitrate ]],
[[Hydrocodone]],
[[Ibuprofen]],
[[Isosorbide dinitrate]],
[[Ivabradine]],
[[Levobetaxolol]],
[[Levobupivacaine]],
[[Lidocaine]],
[[Lithium]],
[[Medetomidine]],
[[Mefloquine]],
[[Mepivacaine]],
[[Methacholine]],
[[Methoxamine]],
[[Methyldopa]],
[[Morphine]],
[[Moxonidine]],
[[Nadolol]],
[[Nalbuphine]],
[[Nalmefene]],
[[Opioid]],
[[Oxymorphone]],
[[Phenobarbital]],
[[Phenylephrine]],
[[Phenytoin]],
[[Pilocarpine]],
[[Propafenone]],
[[Propranolol]],
[[Quinidine]],
[[Reserpine]],
[[Ropivacaine]],
[[Sulpiride]],
[[Suxamethonium chloride]],
[[Tacrine]],
[[Timolol]],
[[Trazodone]],
[[Uncaria tomentosa]],
[[Xylazine]],
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Hypothyroidism]],
[[Hashimoto's Thyroiditis]],
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"|
[[Grayanotoxin]],
[[Hellebore]],
[[Hypothermia]],
[[Heat exhaustion]]
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Obstructive jaundice]], [[Necrotizing enterocolitis ]], [[Typhoid fever ]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"|
[[Congenital Long QT Syndrome]],
[[Catecholaminergic polymorphic ventricular tachycardia]], [[Emery-Dreifuss muscular dystrophy]], [[Congenital Central Hypoventilation Syndrome]],
[[Distichiasis - heart and vasculature anomalies - sinus bradycardia]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"|
[[Enema]],
[[Gastric lavage]],
[[PCI Complications: Radiocontrast toxicity]],
[[Rapid sequence induction]], [[Cardiac catheterization]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"|
[[Chagas' disease]],
[[Hantavirus pulmonary syndrome]],
[[Legionella pneumonia and Mycoplasma pneumonia]],
[[Tularaemia]],
[[Colorado tick fever]],
[[Brucellosis]],
[[Trypanosoma cruzi]],
[[Typhoid fever]],
[[Septic shock]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"|
[[Holt-Oram syndrome]],
[[Vertebral subluxation]],
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"|
[[Vasovagal syncope]],
[[Vagal episode]],
[[Neurogenic shock]],
[[Subarachanoid hemorrhage]],
[[Raised Intracranial pressure]],
[[Autonomic neuropathy]],
[[Cerebral hemorrhage]],
[[Cerebral venous sinus thrombosis]],
[[Cushing triad]],
[[Cushing reaction]],
[[Cushing reflex]],
[[Neurocardiogenic Syncope]],
[[Increased intracranial pressure]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"|
[[Hypercalcemia]],
[[Hyperkalemia]],
[[Hypokalemia]],
[[Anorexia Nervosa]],
[[Malnutrition]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"|
[[Fetal distress]],
[[Neonatal lupus erythematosus]],
[[Vasa previa]],
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| [[Oculocardiac reflex]], [[Distichiasis - heart and vasculature anomalies - sinus bradycardia]]
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"|
[[Gamma-Hydroxybutyric acid]],
[[Hydroxyethyl starch]]
[[Speedball (drug)]],
[[Theobromine poisoning]],
[[Sedatives ]]
[[Cyclic antidepressant poisoning ]]
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| [[Anorexia Nervosa]],
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Apnea of prematurity]], [[Asphyxia neonatorum ]], [[Pneumothorax ]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Skull fracture ]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"|
[[Drowning]],
[[Mammalian diving reflex]],
|-
|}


===Causes in Alphabetical Order===
===Causes in Alphabetical Order===

Revision as of 03:58, 27 August 2012

Bradycardia
ICD-10 R00.1
ICD-9 427.81, 659.7, 785.9, 779.81

Bradycardia Microchapters

Home

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Bradycardia from other Conditions

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

Echocardiography

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Bradycardia On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Bradycardia

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Bradycardia

CDC on Bradycardia

Bradycardia in the news

Blogs on Bradycardia

Directions to Hospitals Treating Bradycardia

Risk calculators and risk factors for Bradycardia

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: M.Umer Tariq [2]

Overview

Causes

Causes in Alphabetical Order

Epidemiology and Demographics

Bradycardia is more common in older patients.

Diagnosis

Evaluation of bradycardia includes assessment of the heart rhythm, symptoms, medications, and associated medical conditions (reversible and irreversible). Symptomatic bradycardias are treated by removal of the underlying causes, medications (atropine) or insertion of a temporary or permanent pacemaker. The term relative bradycardia is used to explain a heart rate that, while not technically below 60 beats per minute, is considered too slow for the individual's current medical condition.

Symptoms

Resting EKG

The heart rate is < 60 beats per minute.

24 Hour Ambulatory Electrocardiogram Monitoring

The diagnosis is usually made with the help of a 24-hour ambulatory electrocardiogram (ECG) or telemetry.

Treatment

Urgent Treatment

  • Check drug list and remove drugs predisposing to bradycardia like beta blockers, calcium channel blocker, anti-arrhythmic drug.
  • Drug treatment for bradycardia is typically not indicated for patients who are asymptomatic.
  • In symptomatic patients, underlying electrolyte or acid-base disorders or hypoxia should be corrected first.
  • IV atropine may provide temporary improvement in symptomatic patients, although its use should be balanced by an appreciation of the increase in myocardial oxygen demand this agent causes. Atropine 0.5-1 mg IV or ET q3-5min up to 3 mg total (0.04 mg/kg)

Indications For a Temporary Pacemaker

Advanced heart block such as complete heart block is an indication for a temporary pacemaker insertion.

Chronic Management

There are two main reasons for treating brandycardia:

  1. With bradycardia, the first is to address the associated symptoms, such as fatigue, limitations on how much an individual can physically exert, fainting (syncope), dizziness or lightheadedness, or other vague and non-specific symptoms.
  2. The other reason to treat bradycardia is if the person's ultimate outcome (prognosis) will be changed or impacted by the bradycardia.

Treatment in this vein depends on whether any symptoms are present, and what the underlying cause is. Primary or idiopathic bradycardia is treated symptomatically if it is significant, and the underlying cause is treated if the bradycardia is secondary.

See also

References

  1. ↑ Pagon RA, Bird TD, Dolan CR; et al. PMID 20301600. Missing or empty |title= (help)
  2. ↑ Goldstein S, Qazi QH, Fitzgerald J, Goldstein J, Friedman AP, Sawyer P (1985). "Distichiasis, congenital heart defects and mixed peripheral vascular anomalies". Am. J. Med. Genet. 20 (2): 283–94. doi:10.1002/ajmg.1320200212. PMID 3976722. Unknown parameter |month= ignored (help)

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