A 55 year old woman presents to your OPD with complaints of dizziness on getting up and weakness.
She has been having these symptoms from last 3 months .
She also complains of fatigue , shortness of breath & Chest pains.
She does not have any tinnitus and no recent history of fever , sore throat or any other illness.
On examination :
Her Blood pressure is 90/ 60 mmHg.
Temp : 37 C
Pulse 47 beats / minute
Chest Clear.
Normal neurological examination no cerebellar signs detected .
Rest of Respiratory ,Gastro Intestinal and Cardiovascular System examination are all normal.
No murmurs or added sound audile.
You perform an ECG which is given below
1. What are the findings in the ECG ?
2. What are the causes of this condition?
3. How will you manage this patient
4. What are the complications of this disease ?
Answers given in comments section.
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Discussion :
1. What are the findings in the ECG ?
This patient is having bradycardia with pulse of 47beats / minute .
2. What are the causes of this condition?
Bradycardia can be caused by:
Heart tissue damage related to aging
Damage to heart tissues from heart disease or heart attack
Heart disorder present at birth (congenital heart defect)
Infection of heart tissue (myocarditis)
A complication of heart surgery
Underactive thyroid gland (hypothyroidism)
Imbalance of chemicals in the blood, such as potassium or calcium
Repeated disruption of breathing during sleep (obstructive sleep apnea)
Inflammatory disease, such as rheumatic fever or lupus
Medications, including some drugs for other heart rhythm disorders, high blood pressure and psychosis.
3. How will you manage this patient :
Maintain patient Airway ,
If hypoxemic , oxygen should be given .
Iv access should be established and Cardiac monitor should be attached and BP monitoring should be done.
If patient has persistent bradycardia causing Hypotension , altered mental status , signs of shock or acute heart failure , Atropine should be given as 0.5 mg iv bolus repeated upto 3-5 minutes till maximum of 3 mg is given.
If atropine is ineffective , transcutaneous pacing or Dopamine infusion or Epinephrine infusion should be given. and an expert consultation with a view to pacemaker insertion should be sought in the long term management plan.
4. What are the complications of this disease ?
If bradycardia is left untreated , possible complications can include:
Frequent fainting spells
Inability of the heart to pump enough blood (heart failure)
Sudden cardiac arrest or sudden death.
Further Reading :
https://www.mayoclinic.org/diseases-conditions/bradycardia/symptoms-causes/syc-20355474
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