presentation on bradycardia, that i presented, i have collected information from various books, internet and other presentation.

2. TELL ME AND I FORGET. TEACH ME AND I
REMEMBER. INVOLVE ME AND I
LEARNED.
•BENJAMIN FRANKLIN

5. CIRCULATION

6. CARDIAC PHYSIOLOGY& PARAMETER
VOLUME
SV=ENDDIASTOLIC VOLUME-ENDSYSTOLIC
VOLUME
CARDIAC OUTPUT=HRXSV
AFTERLOAD AND PRELOAD
EF=STROKE VOLUME/END DIASRTOLIC
VOLUME
TROPISM
INOTROPIC (CONCRACTILITY)
CHRONOTROPIC (CHANGE HEART RATE)
DROMOTROPIC (CONDUCTION VELOCITY)
BATHMOTROPIC (EXCITABULITY)
LUSITROPIC ( RELAXATION)
CONDUCTION SYSTEM

7. Cardiac action potential
Atrial action potential
Ventricular action potential
Effective refractory period
Pacemaker potential
CHAMBER
PRESSURE CVP, RVP,PULMONARY ARTERY PRESSURE,
LEFT ATRIAL PRESSURE, LT. VENTRICULAR PRESSURE, AORTIC
PRESSURE
BLOOD PRESSURE
PULSE PRESSURE=SBP-DBP
ATREIAL BP=SYSTOLIC (90-140),DIASTOLIC (60-90)
MEAN ARTERIAL PRESSURE=SBP+(2XDBP)/3 (70-105mmHg)
Right atrial pressure (2-6mmHG)

8. RIGHT VENTRICULAR PRSEEURE
(RVP)
SYSTOLIC (SRVP):15-
25mmHG
DIASTOLIC (DRVP);0-8mmHg
PULMONARY ARTERY PRESSURE
SYSTOLIC (PASP):15-25mmHg
DIASTOLIC (PADP):8-15mmHg

9. ROLES OF AUTONOMIC NURVOUS SYSTEMS
SYMPATHETIC
PARASYMPATHETIC
ADRENERGIC
RECEPTOR
CATECHOLAMINES
EPINEPHRINE/
NOREPINEPHRINE
ACETYLCHOLINE
INCREASED HEART
RATE, BP,CO,
VASOCONSTRICTION,
DECREASED
HR,CO,BP,VASODILATION
REST AND DIGEST
FLIGHT OR FIGHT

10. PHYSIOLOGICAL TACHYCARDIA AND BRADYCARDIA..WHY??

11. human heart electrical system

14. INTRODUCTION
Heart rate, or heart pulse, is the speed of
the heartbeat measured by the number of
heartbeats per unit of time (bpm).
 The heart rate can vary according to the
body's physical needs, including the need
to absorb oxygen and excrete carbon
dioxide.
 Activities that can provoke change
include physical exercises, sleep, anxiety,
stress, illness, ingesting, and drugs.
 The normal resting adult human heart rate
ranges from 60–100 bpm.

15. CONT’
•Bradycardia is a slow heart rate, defined
as below 60 bpm
• Tachycardia is a fast heart rate, defined
as above 100 bpm at rest.[
•When the heart is not beating in a
regular pattern, this is referred to as
an arrhythmia, These abnormalities of
heart rate sometimes, but not always,
indicate disease.

16. BRADYCARDIA
 Bradycardia: A slow heart rate, usually
defined as less than 60 beats per
minute.
 Relative bradycardia is used in explaining a
heart rate that, although not actually
below 60 BPM, is still considered too slow
for the individual's current medical
condition.
 Absolute bradycardia A waking heart rate
below 40 BPM is considered absolute
bradycardia.

17. BRADYCARDIA IN HEALTHY
 During sleep, a slow heartbeat with
rates around 40–50 BPM is common,
and is considered normal
 Highly trained athletes ( athletic
heart syndrome) know as atheletic
bradycardia or atheletic associated
cardiomegaly.

18. CLASSIFICATION
1.Atrial
 respiratory sinus arrhythmia
 sinus bradycardia
 Sick sinus syndrome
2.Atrioventricular nodal
 An atrioventricular nodal bradycardia or
AV junction rhythm is usually caused by
the absence of the electrical impulse from
the sinus node.
3.Ventricular: A ventricular bradycardia,
also known as ventricular escape rhythm
or idioventricular rhythm.

19. Causes
General causes:
1º: Abnormal pacemaker/conduction
system (congenital or postsurgical
Injury)
infectious: Sepsis
Aging.
Heart diseases ( myocarditis,
cardiomyopathy, heart block,
Sick sinus syndrome,Mi)
Drugs( beta blocker, calcium
channel blocker, digoxin, opioid
drugs, antiarrthymias drugs)

20.  2º: Hs & Ts:
 – Hypoxia – Heart block
– H+ ions (acidosis) – Hypothermia –
Hyperkalemia, -hypoglycemia-hypothyroidism-
hypovolemia
-Trauma (head)
-Toxins
-Tension pnemothorax
-Temponate
-Thrombosis

21. SIGNS AND SYMPTOMS
 Near-fainting or
fainting (syncope)
 Dizziness
 Weakness
 Fatigue
 Shortness of
breath
 Chest pains
 Low BP
 cyanosis
 Confusion or
memory problems
 Easily tiring
during physical
activity
 Low heart rate

22. History & examination
R/O
Risk factors
use of known causative
medications
age over 70 years
recent myocardial infarction
Surgery

23. cont’
Hypothyroidism
electrolyte disorders
infections
exposure to toxins
infiltrative diseases
sleep apnoea

24. Key diagnostic factors
 presence of risk factors (common)
 pulse rate below 50 bpm (common)
 dizziness/lightheadedness (common)
 syncope (common)
 fatigue (common)
 exercise intolerance (common)
 shortness of breath (common)
 cannon a-waves in jugular venous
pulse (common)
 jugular venous distension (common)

25. Epidemiology
Impossible to give meaningful figures on
incidence and prevalence.
In most young people bradycardia is
physiological.
The incidence of pathological bradycardia
rises with age as the underlying causes
become more frequent.

26. DIAGNOSIS AND TEST
 Electrocardiogram (ECG or EKG)
 Echocardiogram
Blood tests:
CBC
Urine Examination
LFT,
Blood glucose.

27. Cont’
 Electrolytes
 Creatinine
 Cardiac enzymes (troponin),CK-Mb
 ABG
 Chest X-ray

28. MANAGEMENT
Stable patients:
 12 lead EKG
Consult cardiology
Unstable patients:
 CABs
ACLS -Bradycardia Algorithm
Address reversible causes
(Hs & Ts)

29. AHA ACLS Adult
Bradycardia Algorithm
Bradyarrhythmia typically seen when the HR <50/min
Is bradyarrhythmia causing the symptoms?
The priority should be identify and treat underlying cause
Maintain patent airway: assist breathing if necessary.
Apply oxygen ( if hypoxemic; Monitor pulse oxymetry
Apply cardiac monitor; monitor blood pressure.
I/V access
12 lead ECG. If available; do not delay treatment

30. Is the beadyarrhythmia
causing:
Hypotension?
Altered mental status?
Signs of suck?
Ischemic chest pain?
Acute heart failure?
Yes
No
Monitor and
observe
Give atropine
If atropine in affective;
Transcutaneous pacing (OR)
Dopamine infusion (OR)
Epinephrine infusion
Consider
Expert consultation
Transcutaneous pacing
Doses/details
Atropine IV dose;
First 0.5mg bolus
Repeat every 3-5minutes;
maximum 3mg
Dopamine IV infusion
2-10mcg/kg/minute
Epinephrine IV infusion
2-10mcg/minute

31. Drug calculation
Dopamine
• Preparation : 200mg in 45 NS
• 1ml=4mg=4000mcg
• Dose: 5mcg – 20mcg/kg/min
• E.g. Body wt= 50kgs
• 5mcg x 50 x 60=15000
• 15000/4000= 3.75ml/hr
• (OR)
• Desired dose*body wt in kg*0.015=dose in ml

32. Epinephrine/Adrenaline
•Preparation: 2mg in 49ml D5
•Strength: 1ml=0.04mg=40mcg
•Dose: 0.2mcg-1.3mcg/kg/min
E.g.
0.2 x 50 x 60=600mcg
600/40=15m/hr

33. NURSING INTERVENTION
 According to patient condition, do
planning, assessment, write nursing
diagnosis and provide care.
General nursing intervention
If ineffective air
way/unconscious; lateral recumbent or
three-quarters prone position of
the body (lateral sim’s position)
Suctioning,
place air way

34. Cont’
Monitor with pulse oxymeter
Glasgow coma scale
Catheterization
IV access
Close monitoring of vital signs (BP,
pulse, temperature, RR)
Notify the concern physician
Reassurance to patient /attendant

35. cont’
ECG
Put patient on monitor
Medication as per physician advised
Informed emergency laboratory, X-ray,
people if necessary.
Assess the side affect of drugs.