22 - Bradyarrhythmias

Summary

This chapter discusses the diagnosis, evaluation and management of bradyarrhythmias. Sinus bradycardia occurs in 15-20% of patients with acute myocardial infarction secondary to ischemia of the sinoatrial (SA) node. Syncope may result from primary dysrhythmia or from reduced cardiac output. A 12-lead electrocardiogram (ECG) is essential for the diagnosis of bradycardia and to differentiate between the different types of bradyarrhythmias. History should focus particularly on symptoms of ischemic heart disease, and on medications such as nodal blockers. As the bradycardia worsens, cardiac output decreases as well. This results in hypotension and hypoperfusion that need to be corrected using medications or a pacemaker. In addition, a decrease in cardiac output can result in pulmonary edema. Even with the development of pulmonary edema, the bradycardia is the first thing that needs to be addressed. Treatment of the cardiogenic pulmonary edema can be instituted afterward.