STUDY - Technical - New Dacian's Medicine
bradycardia
(Classical / Allopathic Medicine)
Bradycardia refers to a heart rate of fewer than 60
beats/minute. It occurs normally in young adults, trained
athletes, elderly people, and during sleep. It's also a normal
response to vagal stimulation caused by coughing, vomiting, or
straining during defecation.
By itself,
bradycardia is a nonspecific sign. However, in conjunction
with such symptoms as chest pain, dizziness, syncope, and
shortness of breath, it can signal a life-threatening
disorder.
ALERT:
After detecting bradycardia:
- check for other symptoms, such as chest pain, dizziness, shortness of breath, syncope, prolonged exposure to cold, or head or neck trauma
- place the patient on a cardiac monitor, or obtain an echocardiogram
- initiate emergency measures, if appropriate.
If the patient's bradycardia is asymptomatic, perform a focused assessment.
After detecting bradycardia:
- check for other symptoms, such as chest pain, dizziness, shortness of breath, syncope, prolonged exposure to cold, or head or neck trauma
- place the patient on a cardiac monitor, or obtain an echocardiogram
- initiate emergency measures, if appropriate.
If the patient's bradycardia is asymptomatic, perform a focused assessment.
HISTORY:
Ask the patient if he or a family member has a history of a slow pulse rate because bradycardia may be an inherited condition.
Ask the patient if he has an underlying metabolic disorder such as hypothyroidism that can precipitate bradycardia.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient if he or a family member has a history of a slow pulse rate because bradycardia may be an inherited condition.
Ask the patient if he has an underlying metabolic disorder such as hypothyroidism that can precipitate bradycardia.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs.
Inspect the skin for pallor, diaphoresis, and clamminess.
Palpate the peripheral pulses. Note paradoxical pulse - an accentuated fall in systolic pressure during inspiration that suggests pericardial tamponade.
Auscultate for abnormal heart sounds, rate, and rhythm.
Look for indications of hemorrhage, including visible bleeding and palpable masses, bruising, and tenderness.
Assess the patient for abdominal rigidity and rebound tenderness; auscultate for abnormal bowel sounds.
Take the patient's vital signs.
Inspect the skin for pallor, diaphoresis, and clamminess.
Palpate the peripheral pulses. Note paradoxical pulse - an accentuated fall in systolic pressure during inspiration that suggests pericardial tamponade.
Auscultate for abnormal heart sounds, rate, and rhythm.
Look for indications of hemorrhage, including visible bleeding and palpable masses, bruising, and tenderness.
Assess the patient for abdominal rigidity and rebound tenderness; auscultate for abnormal bowel sounds.
SPECIAL
CONSIDERATIONS:
Suctioning can induce hypoxia and vagal stimulation, causing bradycardia. Continue to frequently monitor vital signs.
Suctioning can induce hypoxia and vagal stimulation, causing bradycardia. Continue to frequently monitor vital signs.
PEDIATRIC
POINTERS:
Fetal bradycardia (a heart rate of fewer than 120 beats/minute) may occur during prolonged labor or complications of delivery, such as compression of the umbilicus, partial abruptio placentae, and placenta previa.
Bradycardia rarely occurs in full-term infants or children. However, it can result from congenital heart defects, acute glomerulonephritis, and transient or complete heart block associated with cardiac catheterization or cardiac surgery.
Fetal bradycardia (a heart rate of fewer than 120 beats/minute) may occur during prolonged labor or complications of delivery, such as compression of the umbilicus, partial abruptio placentae, and placenta previa.
Bradycardia rarely occurs in full-term infants or children. However, it can result from congenital heart defects, acute glomerulonephritis, and transient or complete heart block associated with cardiac catheterization or cardiac surgery.
AGING ISSUES:
Sinus node dysfunction is the most common bradyarrhythmia encountered among elderly patients. It may present as fatigue, exercise intolerance, dizziness, or syncope. If the patient is asymptomatic, no intervention is necessary. Symptomatic patients, however, require careful scrutiny of their medications. Beta-adrenergic blockers, verapamil, diazepam, sympatholytic and antihypertensive medications, and some antiarrhythmics have been implicated; symptoms may clear when these drugs are discontinued. Pacing is usually indicated in patients with symptomatic bradycardia lacking a correctable cause.
Sinus node dysfunction is the most common bradyarrhythmia encountered among elderly patients. It may present as fatigue, exercise intolerance, dizziness, or syncope. If the patient is asymptomatic, no intervention is necessary. Symptomatic patients, however, require careful scrutiny of their medications. Beta-adrenergic blockers, verapamil, diazepam, sympatholytic and antihypertensive medications, and some antiarrhythmics have been implicated; symptoms may clear when these drugs are discontinued. Pacing is usually indicated in patients with symptomatic bradycardia lacking a correctable cause.
PATIENT
COUNSELING:
Instruct the patient on what to expect from diagnostic testing. If appropriate, prepare the patient for 24-hour Holter monitoring.
Instruct the patient on what to expect from diagnostic testing. If appropriate, prepare the patient for 24-hour Holter monitoring.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)