What is bradycardia??

Bradycardia 

Bradycardia has a heart rate of <60 beats / min, which may not affect the hemodynamic status of some patients.  A clinically significant heart rate is insufficient for the patient's current condition and life may not be helpful.  Bradycardia can be caused by problems in the synothelial node, problems in the conduction pathways of the heart, metabolic problems, or heart attacks / heart damage diseases.  There are different types of bradycardia. Sinus bradycardia, sick sinus syndrome, tachycardia-bradycardia syndrome, hypersensitive carotid sinus syndrome, sinus stagnation / arrest, serological en definition. No rhythm disturbances with heart rate <60 beats / min (BPM) Hemodynamic status of some patients  Can not affect.  Clinically significant bradycardia heart rate is insufficient for current patient status and may not be able to sustain life.  As a classification type of sinus bradycardia resulting in an increase in sympathetic tone or stimulation of the vagina, it may also be a physiological response in young, healthy individuals, especially trained athletes.  Pathophysiological causes include: Cardiovascular disease [ischemic / hypertensive heart disease, acute myocardial infarction (MI), cardiomyopathy) surgery (eyes, congenital heart disease, transplant) infection / inflammation (meningitis), L medications (antirritic agent, cardiac  Glycosides, agents) antihypertensive, antipsychotic agents) electrolyte imbalance (hyperchemia) hereditary disease (Frederick ataxia, X-  A variety of sinus node abnormalities in the types of arrhythmias in the sinus node and surrounding tissue, a nd muscle development, familial disorder sick node node dysfunction (SND), formerly known as sick sinus syndrome (SSS)  Include, persistent spontaneous sinus bradycardia that is not caused by medications and is not suitable for physical conditions, sinus arrest, or block  .  Production, a combination of cyanudelente and atrivascular.  Paroxysm: Period of regular or irregular frequencies, faster and less atrial and ventricular.  It covers sinotral node dysfunction with relevant clinical signs (lighthouse, syncope, palate), common causes include degenerative fibrosis of the sinus node, tachycardia-bradycardia syndrome, a type of diseased lymph node dysfunction (NDS)  Decreased alternating heart rate with increased heart rate.  Hypersensitive carotid sinus syndrome, also known as carotid sinus hypersensitivity, is due to sensitization of the carotid sinus syncope bradycardia afferent or efferent organ due to stimulation of the vagina and sympathetic extraction. This can be the result of a block / stop sinus or a  Sinotral Node Block (SA).  Sinus arrest failure is characterized by the absence of impulse generation by the cyanoatral node (SA), may be benign or pathological.  Aetiological agents include acute myocardial infarction (MI), excessive vagal tone, fibrotic degenerative changes, medications (ie quinidine, prionamide, digital).  The SinoArtial (SA) node output block is characterized by a failure of atrial depolarization due to an impulse block outside the SinoArtial (SA) node.  Sub-types include a second-degree SinoArTIAL (SA) output block (SA) (Weinkebuch), a second 2-degree SinoArtial (SA) output block, and a third-degree sinotrial (SA) output block.  Etiologic agents include acute myocarditis, myocardial infarction (MI), excessive vagal stimulation, medications (ie quinidine, cousin, digital) from block to atrioventricular (AV (heart block)), this may be due to structural AB delayed impulses. Or  Atria are obstructed by ventricles due to conduction. Common causes include myocardial infarction (MI) and history of myocarditis  Haas is involved. The risk of estrol is indicated by the following: Recent CEES MOBITZ TYPE II ATRIOVENTRICULARARULLE (AV) COMPLETE block heart block (third degree) with wide QRS> 3 seconds Ventricular arrest classification of atroventricular (AV) block First degree  Interval of block ATRIOV Fixed PR MOBITZ II before and after the block with a wide QRS complex, the block is in its bundle or bundle branches, disease  While often symptomatic, the third-grade block may advance the third-degree block to the atrioventricular. (AV) Pressure-blocking for the atrioventricular (AV). The R-R interval is longer than the P-P interval, the atrioventricular (  AV) The node may be in its bundle or bundle branches. It may be congenital or may be acquired as a result of acute ischemia, medications, or other pathological diseases.  The issuer.  The evaluation stated that the cause of the following are symptoms of bradycardia and signs of poor perfusion and clinical instability, low blood pressure (CHF) heart failure alters the mental state pain in chest seizures, 12-lead ECG tuning  Laboratory test (ECG) electrocardiogram ambulatory ECG monitoring (Holter or external loops) may be considered when signs and symptoms are intermittent or paroxysmal.  Suggest bradiarasis, particularly atrioventricular block (AV).  Electrophysiological studies (EPS) are used to confirm whether syncope is secondary to the bradyarrhythmic system, particularly in patients with a history of branch block, sinus bradycardia, myocardial infarction (MI).  Invasive electrophysiological studies (EPS) can be used to assess impulse conduction from the atrium to the ventricle while the patient is at rest, using it to identify patients at risk of sudden cardiac death to eliminate tachycardia.  Is also done.  And evaluation of effectiveness.  Echocardiography Traunthoracic echocardiography (TTE) is identified with new patients with second-line mobicvic type II atrioventricular (AV) block, high-quality atrioventricular block, or coronary artery disease.  Such as cardiomyopathy, congenital anomalies, tumors, valvular heart disease) occur with bradycardia or conductive disorders.  Other studies such as advanced imaging, such as cardiac computed tomography (CT), cardiac magnetic resonance imaging (MRI), or nuclear imaging, may be performed in selected patients with sinus node dysfunction when structural disease is suspected and diagnostic in others.  Modalities.  It is not defined.  Exercise testing may be considered in patients experiencing syncup during or after exercise.  It should not be used as a diagnostic test only to measure the heart rate range during exercise.  The table test in the vertical for vasodecepant or cardioinhibitory response can be used to identify patients with syncope.  ECG sinus bradycardia is interpreted when the rate of discharge from the sinus node is <60 beats per minute, with normal P waves preceding each lead, a negative P wave in the QRS complex AVR and indicating the origin of sinus nodes.  is.  Unless vertical P wave I, II and AVL management of sinus bradycardia therapy principles with inadequate cardiac output and / or life-threatening arrhythmia is necessary.  Observations and monitoring are recommended for hemodynamically stable patients.  Second-line therapy and transcutaneous stimulation can only be considered if the patient with acute symptomatic bradycardia does not respond to atropine.  Pharmacotherapy Atropine's first-line agent It is used for symptomatic sinus bradycardia, hypersensitive carotid sinus syndrome, and atrioventricular (AV) blocks.  Choleralergic-mediated decrease in heart rate is reversed by increasing its parasympathetic effect on the myocardium.  Signs and symptoms improves the use of heart rate in patients with acute myocardial infarction with myocardial infarction or acute coronary ischemia, which are not effective in patients who have had a heart transplant.  Temporal measures of pending transcutaneous stimulation create transcutaneous stimulation.  .  The second-line agent considers a temporary measure in patients with an unsatisfactory response to atropine and, at the same time, pending the insertion of a pacemaker, epinephrine infusion of epinephrine may be used in patients with symptomatic bradycardia,  Specifically related to hypotension, the use of strong alpha and beta adrenergic agonists dopamine symptomatic Bradyca  Can be Dia patients, particularly associated with hypotension, where Attropin may fail after may be inappropriate or culture.  Dopamine infusion may be administered in addition to epinephrine, or may only be administered.  Both alpha and beta adrenergic agonists are glucagon actions, consider whether a calcium inhibitor or beta-blocker is a possible cause of bradycardia.  Inhibitor.  Isoproterenol (isoprenylene) can be considered for transient heart block, but should be used with extreme caution, not with increased heart rate in acute MI patients or in patients with acute symptomatic beta bradyuria with atrioventricular-nodal conduction.  Other agents: aminophylline, theophylline, glycoprolate, terbutaline device-based therapy. This indication is determined by the severity of bradycardia.  Symptomatic sinus bradycardia, recommended for patients with atrioventricular (AV) block, may be at risk of being hemodynamically unstable for hypersensitive carotid sinus syndrome Essol patients and for those with an irresponsible atrophine.  Atrioventricular (AV) block or block temporary pacing emergency intervention is used during the interval before permanent pacemaker implantation or resolution of bradycardia, transcutaneous pacing, non-invasive intervention applied for symptomatic bradycardia.  Recommended for patients who do not respond to atropine therapy or are hemodynamically unstable, especially those with high-grade atrioventricular (AV) block.  Hemodynamic stability and electrocardiogram (ECG) results should be monitored during stimulation.  Intermittent Pacing Aggressive intervention involving the insertion of a temporal pacemaker gains venous access to the thoracic region, the most common insertion site being the internal jugular vein and the subclavian vein.  If atropine therapy and transcutaneous stimulation fail, it is only used for use in patients with a high level of atrioventricular (AV) block, with residual rhythms and life-threatening bradycardia required as a backup.  Must be done for.  If bradycardia is excluded due to extracorporeal causes, 1-degree acinetic atrioventricular block, 2-degree asymmetric MOBITZ I with asymmetric conduction block, or arioventricular (AV) block is expected to resolve.  .  Pacing mode: Single-chamber pacemakers are considered for patients who require a single-wire ventricular blinder, dual-chamber pacing is beneficial for patients with a history of stroke, embolism, atrial fibrillation, capacity.  Low exercise rate and pacem dual-chamber pacemakers are preferred for patients with sinus node disease, atrioventricular (AV) block is acquired when the desired rate of frequency reduces the risk of stroke, pacemaker syndrome, and general improvement.  Quality of life.  Kleinman Me, Brennan EE, Goldberger ZD, et al.  Part 5: Adult Basic Life Support and CPR Quality: Illumination for CPR and Emergency Cardiovascular Care from the 2015 American Heart Association Update.  circulation.  November 2015;  132 (18) (Suppl 2): ​​S414 – S435.  DOI: 10.1161 / CIR.0000000000000259 Accessed on June 6, 2016.  Adam V, Crown LA.  Diagnosis and treatment of sick sinus syndrome.  I am a famous doctor.  2003 APR;  67 (8): 1725–1732.  http://www.aafp.org/.  Accessed on March 10, 2017.  American Heart Association.  2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.  Part 7.3.3.  Management of symptomatic bradycardia and tachycardia.  circulation.  2005;  112: iv-67-iv-77.  DOI: 10.1161 / circulaha 105.18551 Brignol M, Auricchio A, Baron-Esquius G, et al.  2013 ESC Guidelines on Cardiac Pacing and Cardiac Resin Synchronization Therapy: European Society of Cardiology (ESC) Working Group on Cardiac Pacing and Resin Synchronization Therapy.  Revival.