Bradyarrhythmia in the ER

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.