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Sinus bradycardia


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Sinus bradycardia

  1. 1. Sinus Bradycardia
  2. 2. Sinus Bradycardia• Sinus rate below 60 beats/minute• Regular rhythm• Occurs normally during sleep – Decreased metabolic demands• Occurs normally in a person with a well- conditioned heart – Athlete • Well-conditioned hearts can maintain a normal stroke volume with less-than-normal effort
  3. 3. Sinus Bradycardia• How it happens – Normal response to a reduced demand for blood flow • Vagal simulation increases and sympathetic stimulation decreases – Automaticity in the SA node diminishes
  4. 4. Sinus Bradycardia• A tolerable condition? – Most adults can tolerate a sinus bradycardia of 45- 59 beats/minute – Less tolerant of a rate below 45 beats/minute
  5. 5. Sinus Bradycardia• Causes – Non-cardiac disorders – Conditions producing excess vagal stimulation or decreased sympathetic stimulation – Cardiac diseases – Certain drugs
  6. 6. Sinus Bradycardia• No symptoms? No problem• Symptoms? PROBLEM – Prompt attention is critical – Can lead to more serious problems • Hypotension and dizziness • Ventricular tachycardia and ventricular fibrillation
  7. 7. Symptomatic Bradycardia• If a patient can’t tolerate bradycardia, he may develop these signs and symptoms: – Hypotension – Cool, clammy skin – Altered mental status – Dizziness – Blurred vision – Crackles, dyspnea – Chest pain – Syncope
  8. 8. Symptomatic Bradycardia• When to call for help and what to do until help arrives – Look at the patient and ask how they are doing – Call for help if heart rate is too slow and/or symptomatic • Compare it their normal heart rate and rhythm – Stay with the patient – If the patient is not breathing and does not respond • Call code • ABCs/CPR
  9. 9. Sinus Bradycardia• Atrial & ventricular rhythms are regular, as are their rates, except that they’re both under 60 beats/minute
  10. 10. Sinus Bradycardia• Normal – P wave preceding each QRS complex – PR interval – QRS complex – T wave – QT interval
  11. 11. Sinus Bradycardia• P wave – rounded, smooth, and upright in lead II, signaling that a sinus impulse has reached the atria
  12. 12. Sinus Bradycardia• PR interval• Normal indicating that the impulse is following normal conduction pathways – 0.12-0.20 seconds
  13. 13. Sinus Bradycardia• QRS complex• Normal duration representing normal ventricular impulse conduction and recovery – Less than 0.12 seconds
  14. 14. Sinus Bradycardia• T wave – Upright in lead II, confirming that normal repolarization has taken place
  15. 15. Sinus Bradycardia• QT interval – Within normal limits • 0.36 to 0.44 seconds