Medical history (history of illness) represents an important component in the diagnosis of sinus bradycardia. Family history Do you have relatives who suffer from cardiac arrhythmias? Social history Current medical history/systemic history (somatic and psychological complaints). When did bradycardia (= heart rate below 60 beats per minute) first occur? When did this occur for the … Sinus Bradycardia: Medical History
Endocrine, nutritional, and metabolic diseases (E00-E90). Amyloidosis – extracellular (“outside the cell”) deposits of amyloids (degradation-resistant proteins) that can lead to cardiomyopathy (heart muscle disease), neuropathy (peripheral nervous system disease), and hepatomegaly (liver enlargement), among others. Hashimoto’s thyroiditis – autoimmune disease that leads to chronic inflammation of the thyroid gland. Hyperkalemia (excess potassium) Hypercapnia – … Sinus Bradycardia: Or something else? Differential Diagnosis
1st order Insertion of a pacemaker Indications: Bradyarrhythmia (very slow heartbeat with a rate below 50 beats per minute with no discernible rhythm). Heart failure (cardiac insufficiency) with bradycardic arrhythmias. Bradycardic arrhythmias after myocardial infarction (heart attack). More see below pacemakers
The following symptoms and complaints may occur together with sinus bradycardia: Leading symptom Bradycardia (heart rate below 60 beats per minute). Associated symptom Fatigue Dizziness Syncope (momentary loss of consciousness) Note: symptoms of bradycardia usually do not begin until 40 beats per minute.
Therapy for sinus bradycardia depends on the cause. General measures Review of permanent medication because of possible effect on the existing disease: dose reduction or discontinuation of the medication if it is not indispensable or cannot be replaced. For more information, see “Drug therapy“. Vaccinations The following vaccinations are advised: Flu vaccination Pneumococcal vaccination Regular … Sinus Bradycardia: Therapy
The following are the most important diseases or complications that may be contributed to by sinus bradycardia: Cardiovascular System (I00-I99) Sudden cardiac death (PHT). Jumping to a different heart rhythm Psyche – nervous system (F00-F99; G00-G99) Anxiety Prognostic factors In clinically heart-healthy individuals, an asymptomatic resting heart rate below 50/min appears to affect prognosis only … Sinus Bradycardia: Follow-up
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; furthermore: Inspection (viewing). Skin and mucous membranes and throat Auscultation (listening) of the heart
2nd order laboratory parameters – depending on the results of the medical history, physical examination, etc. – for differential diagnostic clarification Small blood count Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate). Electrolytes – potassium, magnesium Thyroid parameters – TSH Highly sensitive cardiac troponin T (hs-cTnT) or troponin I (hs-cTnI) – to … Sinus Bradycardia: Lab Test
Therapeutic target Restoration of a normal heart rate Therapy recommendations Asymptomatic sinus bradycardia does not require drug therapy! In the case of bradycardia, drug therapy is given only in an emergency: Atropine (parasympatholytics) in symptomatic but hemodynamically still compensated bradycardia of suprahisic origin (sinus bradycardia, AV block II° Wenckebach type). Epinephrine (agent of last choice) … Sinus Bradycardia: Drug Therapy
Obligatory medical device diagnostics. Electrocardiogram (ECG; recording of the electrical activity of the heart muscle). [Sinus bradycardia: regular rhythm and inconspicuous P waves that are transitioned one-to-one. Sinus arrest: completely absent atrial actions. Atrial fibrillation (VHF): Variable picture with more or less delineable atrial actions, often flicker waves expressing completely uncoordinated atrial excitation (no P … Sinus Bradycardia: Diagnostic Tests
