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Bradyarrhythmia in the ER

  • Carlos Jerjes-SánchezEmail author
  • Jose Gildardo Paredes-Vázquez
  • Mariana Vanoye Tamez
  • David Rodríguez
  • Raul del Toro-Mijares
  • Mauricio Vázquez Guajardo
Chapter

Abstract

Bradyarrhythmias have a broad clinical spectrum with life-threatening implications in several cases, demanding an accurate and prompt diagnosis and initial treatment. The initial approach in the emergency room is to determine the clinical stability of the patient and identify the primary cause of the arrhythmia. The electrocardiogram is the main diagnosis tool that brings specific characteristics, helping in recognition of different types of bradyarrhythmias. It is important to determine if the bradycardia is secondary to drug toxicity and must be treated with the specific antidote or withdrawal if possible. Bradyarrhythmia is classified into nodal sinus dysfunction and atrioventricular block, with subsequent subdivisions. Atropine is the standard gold therapy in unstable patients; if it is not effective, beta-agonist drugs can be used. Myocardial infarction, post-heart transplant, and spinal cord injury are clinical conditions that can be specifically treated with aminophylline. Pacing is the final treatment option in acute algorithm treatment, and transcutaneous pacing is the modality of choice in the initial approach to this therapy avoiding delay in the pacing treatment. Prognosis depends on the specific bradycardia causes. The reader will find practical elements for the early recognition of bradyarrhythmia and flowcharts for a fast-track evaluation that could improve patient care in the emergency room.

Keywords

Bradyarrhythmia Bradycardia Atropine Pacing Epinephrine Dopamine Emergency 

References

  1. 1.
    Brady WJ, Laughrey TS, Ghaemmaghami CA, Tintinalli JE, Stapczynski JS, Ma OJ, et al. Chapter 18 – Cardiac rhythm disturbances. In: Tintinalli’s emergency medicine: a comprehensive study guide. 8a ed. New York: McGraw-Hill Education; 2016. accessmedicine.mhmedical.com/content.aspx?aid=1139620333. Accessed 27 Nov 2018.Google Scholar
  2. 2.
    Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, et al. Part 1: executive summary: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132:S315–67.CrossRefGoogle Scholar
  3. 3.
    Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with Bradycardia and Cardiac Conduction Delay. J Am Coll Cardiol. 2018. https://linkinghub.elsevier.com/retrieve/pii/S073510971838985X. Accessed 27 Nov 2018
  4. 4.
    Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E. Braunwald’s heart disease. A textbook of cardiovascular medicine. 10th ed. Philadelphia: Elsevier/Saunders; 2015.Google Scholar
  5. 5.
    Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt O-A, et al. ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: The Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J. 2013;34:2281–329.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Instituto de Cardiología y Medicina Vascular, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnológico de MonterreySan Pedro Garza GarcíaMéxico
  2. 2.Centro de Investigación Biomédica del Hospital Zambrano Hellion, TecSalud, Escuela de Medicina, Tecnológico de MonterreySan Pedro Garza GarcíaMéxico
  3. 3.Escuela de Medicina y Ciencias de la Salud, Tecnológico de MonterreyMonterreyMéxico

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