BRADYARRHYTHMIAS

SINUS BRADYCARDIA:

 Heart rate < 60 beats/min

 Regular sinus rhythm (every P wave followed by QRS complex)
 Normal P wave and QRS complex
 Causes

Physiological (increased vagal tone) Pathological

 During sleep (dt reduce metabolic  Acute inferior wall myocardial

demand)
 Athletes (Increase stroke volume)
infarction (RCA supply SA node)
 Sinus node disease (sick sinus
syndrome)
 Hypothermia
 Hypothyroidism
 Raised intracranial pressure
 Drugs (digoxin, beta-blocker,
verapamil)

Kumar & Clark’s Clinical medicine, 9th Edition

Symptoms of Bradycardia

• Patient can be
asymptomatic.

• However if patient unable to

compensate the reduction in
cardiac output, he will
present with these sign and
symptoms :
 SICK SINUS SYNDROME

• Also known as Sinus Node Dysfunction (SND).

• Inability of the sinoatrial (SA) node to generate a heart rate

that meets the physiologic needs of an individual.
- dysfunction of the sinus node’s automaticity or abnormal conduction
or blockages of impulses coming out of the nodal region.

• Underlying pathology
- Fibrosis, degenerative changes, or ischaemia of the SA node.
- Medications (beta-blockers, non-dihydropyridine calcium channel
blockers, digoxin).
- Congenital and acquired heart disease (particularly after corrective
cardiac surgery).
 SICK SINUS SYNDROME

• Most common in older people. Symptoms

 Lightheadedness.
• Characterised by a variety of arrhythmias
 Dizziness.
– Sinus bradycardia.
 Fatigue.
– Sinus arrest (sinoatrial block).
– Paroxysmal atrial fibrillation.  Syncope.

– Paroxysmal atrial tachycardia.  Palpitations.

– AV block.  Patients with coexisting
cardiac pathology 
• Key to diagnosis increasing dyspnea on
– establish a correlation between the exertion or worsening
patient's symptoms & the underlying
rhythm at the time of the symptoms. chest discomfort.
 SICK SINUS SYNDROME

Figure 7.12 shows an ambulatory record from a patient with sick sinus syndrome, who
complained of attacks of dizziness which were due to sinus pauses of 3.3 s.
MANAGEMENT OF BRADYARRHYTHMIAS
 Temporary pacemarkers
1. Transvenous Pacing: by inserting a bipolar pacing
electrode via IJV, subclavian or femoral vein

 Indicated in:
 Haemodynamically unstable
 Symptomatic sinus bradycardia
 Transient AV block

 Complications include pneumothorax, brachial plexus

or subclavian artery injury and local infections

 Thus, ideally not be used more than 7 days

2. Trancutaneous Pacing : by placing two large adhesive gel pad electrodes over
the apex and upper right sternal edge or over anterior and posterior chest

 Is easy but cause discomfort as it induces forceful pectoral and intercostal

muscle contraction

 It is only be used until transvenous pacing can be started