Cardiovascular Medicine Book

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Unstable BradycardiaAka: Sinus Arrest

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  1. Signs
    1. Bradycardia
      1. Absolute Bradycardia: under 60 bpm
      2. Relative Bradycardia: inappropriately normal rate
        1. Hypotensive patient should be tachycardic
    2. Cardiopulmonary decompensation
      1. Pediatric
        1. Poor perfusion
        2. Hypotension
        3. Respiratory distress
      2. Adult
        1. Chest Pain
        2. Shortness of Breath
        3. Decreased Level of Consciousness
        4. Hypotension and Shock
        5. Pulmonary congestion
        6. Congestive Heart Failure
        7. Acute Myocardial Infarction
  2. Precautions
    1. Avoid Lidocaine
      1. Lethal if Bradycardia is ventricular escape rhythm
  3. Management: Pediatric
    1. ABC Management
    2. Mnemonic: IV-O2-Monitor
      1. Obtain IV Access
      2. Oxygen Delivery
      3. Cardiopulmonary monitor
    3. Pediatric Vital Signs
    4. If signs of cardiorespiratory failure despite above
      1. Chest Compressions for Heart Rate under 60
      2. Epinephrine every 3-5 minutes
        1. IV/IO Dose: 0.01 mg/kg (0.1 ml/kg of 1:10,000)
        2. ET Dose: 0.1 mg/kg (0.1 ml/kg of 1:1000)
      3. Atropine
        1. Dose: 0.02 mg/kg IV, IO, or ET
        2. Minimum Dose: 0.1 mg
        3. Maximum Dose: 0.5 mg child, 1.0 mg adolescent
      4. Consider transcutaneous pacing or esophageal pacing
      5. Observe for change in rhythm (e.g Asystole)
  4. Management: Adult
    1. ABC Management
    2. Mnemonic: IV-O2-Monitor
      1. Obtain IV Access
      2. Oxygen Delivery
      3. Cardiopulmonary monitor
    3. Vital Signs
    4. History and Exam
    5. Electrocardiogram
    6. Chest XRay
    7. IF signs of immediate failure present:
      1. Atropine
        1. Dose: 0.5-1.0 mg q3-5 min to max total 3 mg
        2. No response in denervated transplanted hearts
      2. Transcutaneous pacing
      3. Dopamine 5-20 mcg/kg/min
      4. Epinephrine 2-10 mcg/min
    8. Prepare for Transvenous Pacing if indicated:
      1. Type II second degree AV Heart Block
      2. Third degree AV Heart Block

Sinus arrest (C0178428)

Definition (NCI)A failure of impulse formation in the sinus node. Sinus arrest is indistinguishable from third degree sinoatrial exit block on the standard ECG.
ConceptsPathologic Function (T046)
EnglishARREST SINUS, SINUS ARREST, Sinus Arrest/Pause, Sinus Pause
Spanishparo sinusal
Parent ConceptsSupraventricular arrhythmia (C0428974), Sinus node dysfunction (C0428908)
SourcesCOSTAR, CST, MTH, NCI, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Severe sinus bradycardia (C0264890)

ConceptsDisease or Syndrome (T047)
ICD9427.81
EnglishSevere sinus bradycardia
Spanishbradicardia sinusal severa
Parent ConceptsSinus bradycardia (C0085610)
SourcesMTHICD9, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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