Why Is It Called Sinus Bradycardia
The term sinus bradycardia breaks down based on the two words. Bradycardia comes from the Greek words bradys, meaning slow, and kardia, meaning heart. Sinus bradycardia means your heart is beating slowly but still using a sinus rhythm.
During sinus rhythm, every heartbeat you have starts in the sinoatrial node, a cluster of electrically active cells near the top of your heart. The SA node is your hearts natural pacemaker and generates the electrical current that makes your heart muscle squeeze. Sinus rhythm means your sinus node is setting the tempo for your heartbeat, which is normal and expected.
When Should I See My Healthcare Provider Or When Should I Seek Care
If you have sinus bradycardia without symptoms, you should still see a healthcare provider for an annual physical. These yearly visits are a key way to detect new problems before they become severe enough to cause symptoms.
If you have sinus bradycardia with symptoms, you should see your healthcare provider if your symptoms change noticeably or if your symptoms start to affect your daily life and routine.
When should I go to the hospital emergency room?
Because sinus bradycardia shares the following symptoms with other more serious heart conditions, you should go to the hospital if you experience:
- Dizziness, feeling lightheaded or fainting .
A note from Cleveland Clinic
Sinus bradycardia is a condition you may not even know you have, and for most people, it doesnt cause any symptoms. When it does cause symptoms, your healthcare provider can help you find out why its happening and if its a cause for concern. Fortunately, for people who do need treatment, this condition is often very treatable, and it shouldnt have a big impact on your daily life overall.
Causes Of The Sinus Bradycardia
The symptom, manifested as a decrease in the rhythm of contractions of the heart, does not necessarily indicate a disease. For example, when a person sleeps, the heart rate is lower than in a waking state. Therefore, sinus bradycardia is distinguished physiological and symptomatic . And in most cases, doctors can identify its causes.
So, the decrease in heart rate during hypothermia , as well as the sinus bradycardia that does not show itself in men and women of advanced age is a pathology, is the result of changes in the heart caused by aging.
Sinus bradycardia in athletes – physiological, with a high frequent wandering tone almost half of them simultaneously have sinus bradycardia and left ventricular hypertrophy, since with increasing volume and internal pressure, due to increased physical exertion, the heart rate decreases. For more details see – Sports heart
The sinus bradycardia in pregnancy, which occurs in the first half due to the characteristic vomiting of the early toxicosis, also belongs to the physiological one, and at later dates – when the uterus begins to exert mechanical pressure on the lower vena cava. But because of anemia, pregnant women have sinus tachycardia.
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Treatment For Cystic Bradycardia
Depending on the course of the disease, the most appropriate treatment tactics are selected. With excessive expression of the slow heartbeat , the question of implantation of the pacemaker is considered. This is necessary to prevent sudden cardiac arrest. Blinking requires a somewhat different treatment. In particular, doses of antiarrhythmic drugs that control the heart rate are selected. The most effective in terms of eliminating flicker beta-blockers, but their use is strictly based on medical indications.
Chest Pain Risk Factors
Before we delve into treatment for this specific case, lets consider our approach in general to any chest pain complaint. First of all, consider your patients cardiac risk factors. The HEART score is a clinical calculation that helps predict the risk of a major adverse cardiac event within 6 weeks. This is a great tool that will help to guide you in determining a disposition for your chest pain patients. The major risk factors considered in the HEART score are: hypertension, hyperlipidemia, smoking, diabetes, family history, previous CAD , BMI > 30. You can gather this information from reviewing the patients record/medication list or directly questioning the patient. Take time for a quick 30-60 second conversation.
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How Do Doctors Treat Bradycardia
Patients with imminent heart failure or unstable patients with bradycardia need immediate treatment. The drug of choice is usually atropine 0.51.0 mg given intravenously at intervals of 3 to 5 minutes, up to a dose of 0.04 mg/kg. Other emergency drugs that may be given include adrenaline and dopamine.
How Is Sinus Bradycardia Diagnosed
Your healthcare provider will take a medical history and give you a physical exam. You will need a test called an electrocardiogram . This gives a snapshot of your heart rhythm. This test alone is often enough to make the diagnosis. Continuous electrocardiogram, such as Holter or event monitoring, may be used to check the heart for a longer period.
Other tests to diagnose the condition may include:
- Blood tests to rule out hypothyroidism or other abnormalities
- Tests to diagnose sleep apnea
- Exercise stress testing, to check the heart rates response to exercise
- Electrophysiological testing, to check the heart rhythm in more detail
- Tests to study the autonomic nervous system
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Treatment Of Hyperkalaemia And Bradycardia
It is important to begin to determine the cause of hyperkalaemia, when a patient has a bradycardia on the background of this pathological condition. Next, those drugs that help improve your well-being are used. Some of them help remove potassium from the body . The action of others is aimed at stimulating the transfer of potassium from the intercellular fluid to the middle of cells .
Intrinsic Sinus Node Disease
In people with intrinsic sinus node disease, the heart rate can be slow both at rest and during exertion. People with symptomatic disease often have sinus node dysfunction , the most common cause of bradycardia requiring a pacemaker. As a result, however, their heart rate can fluctuate between bradycardia and tachycardia .
In addition to intrinsic sinus node disease, several other medical conditions can cause sinus bradycardia, including:
- Brain disorders, especially those associated with increased intracranial pressure or stroke
- Cardiac trauma due to injury or cardiac surgery
- Hypoxia , as often happens with obstructive sleep apnea
- Various types of infections, including Lyme disease, Chagas disease, and Rocky Mountain spotted fever
Sinus bradycardia treatment will often focus on resolving these underlying causes.
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What Tests Will Be Done To Diagnose This Condition
While a physical exam alone is enough to diagnose sinus bradycardia, its only possible with a specific type of test called an electrocardiogram . Thats because analyzing your hearts electrical activity is the only way to know that your heart rhythm is otherwise normal.
EKGs analyze your hearts electrical activity through several sensors called electrodes, which stick to the skin of your chest. These electrodes then display the electrical power of your heartbeat as a wave on a paper printout or a screen. Healthcare providers look at the wave for signs that your hearts electrical system isnt working properly. If your heartbeat is slow but otherwise normal, thats all a doctor needs to diagnose sinus bradycardia.
But if you have symptoms of sinus bradycardia, its important to know why. To answer that question, several other types of tests are possible.
- Electrolyte levels: These tests measure the levels of electrolytes in your blood, especially calcium and magnesium.
- Thyroid hormone levels: Hypothyroidism can cause sinus bradycardia.
- Troponin: Your heart muscles cells contain a specific type of troponin, a protein. Damage to those cells causes troponin to leak into your blood, indicating damage to your heart. Troponin is a key indicator that healthcare providers use to diagnose heart attacks.
- Toxicology screen. This test looks for toxic substances in your blood. This test can identify drugs that can cause sinus bradycardia, as well as other heart-damaging substances.
Treatment Of Pathological Bradycardia
The disease can be expressed in various forms, and each requires a special treatment tactic. In the mild expression of the clinic it is enough to drink hot tea or coffee, take a hot tub or exercise. A feeling of discomfort during pathological bradycardia is removed by special medications, which is prescribed by the doctor for outpatient treatment. If the heart rate is below 40 beats / min, then ambulance should be provided. In the following, as a rule, the variant of radical treatment is considered, that is implantation of the pacemaker.
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Determine If The Patient Is Symptomatic Or Asymptomatic
- Symptomatic, stable bradycardia: Most patients can be observed and will not require intervention.
- Patients with severe symptoms: Administer atropine.
- If second-degree AV block, Mobitz II, or third-degree AV block is present and the patient is symptomatic: Starttranscutaneous pacing or transvenous pacing.
- Perform a focused history and examination.
- Identify and treat the underlying cause .
- Consult cardiology and consider indications for permanent pacemaker .
How To Take Care Of Myself Or Manage Symptoms
Because sinus bradycardia requires an EKG to diagnose, its not something you should assume you have based on symptoms alone. The best course of action is to see your healthcare provider if you have sinus bradycardia symptoms. They can diagnose this condition and determine if its severe enough to need treatment.
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Bradycardia Causes + 9 Natural Ways To Improve Slow Heart Rate
If your heart beats less than 60 times each minute, you have bradycardia. This condition can also be referred to as sinus bradycardia. At rest, an adult heart typically beats between 60 and 100 times a minute anything lower may be a sign of an underlying medical condition. It can be a serious condition if your heart isnt pumping enough blood throughout the body.
There are, of course, exceptions. Young adults and premier athletes may have a resting heart rate of less than 60 beats a minute and this is generally not considered a health concern. Bradycardia symptoms can range from mild to severe, particularly when your brain, liver, kidneys and other organs arent getting enough oxygen.
Several conditions can cause bradycardia, including several potentially serious conditions, such as myocarditis, sleep apnea, lupus or certain medications. Bradycardia treatment depends on the underlying cause of the low resting heart rate but may also include the surgical placement of a pacemaker.
If you become suddenly faint, have difficulty breathing or experience chest pains, call 911 immediately.
Definition Of Sinus Bradycardia
Sinus bradycardia fulfills the criteria for sinus rhythm but the heart rate is slower than 50 beats per minute. ECG criteria follows:
- Regular rhythm with ventricular rate slower than 50 beats per minute.
- P-waves with constant morphology preceding every QRS complex.
- P-wave is positiv in limb lead II.
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Treatment Of Vaginal Bradycardia
The disease may occur with a poorly defined clinic and then no drugs are used. If the slowing of the rhythm is extremely pronounced, that is, the heart rate has dropped below 40 beats / min, then urgent measures should be taken. First of all an ambulance is called, then the patient is placed on a horizontal surface and raises his legs. If necessary, actions are performed on the return of consciousness or a cardiopulmonary resuscitation is performed. In the conditions of the hospital, preparations are introduced from the group of cholinolytics, which help to increase the heart rate and improve the well-being of the patient.
Treatment Of Ischemic Bradycardia
Drug treatment is performed in those cases where the following symptoms are observed: an abnormal condition, a reduced blood pressure, long or hard stopping attacks of a slowed heartbeat, a sharp intolerance to sick signs of the disease. If hemodynamic disturbances are absent, then the drugs are taken outpatient and, as a rule, in tabulated forms. In case of severe inflammation, intensive treatment is carried out in the hospital.
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Treatment Of Medication Bradycardia
If the medication is misused, the intestine must first be cleansed of excessive amounts of medication. Activated charcoal or any other sorbent is accepted for this purpose. In the absence of the preparation, it is possible to drink normal, pure water, boiled or non-carbonated. Next you need to look at the condition of the patient. At low clinical signs, home-based treatment may be performed under the supervision of a physician. In severe cases, an ambulance should be called, which will start detoxification therapy and deliver the patient to the intensive care unit.
Causes Of Sinus Bradycardia
The decrease in heart rate can happen during sleep and in people who exercise regularly, such as running and cycling athletes, for example, which is considered normal. It is also normal for it to happen after a large meal, during blood donation or when passing a nasogastric tube.
However, bradycardia can be caused by some cardiac or physiological conditions, the most common causes being:
- Sinus node disease
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Abnormal Causes Of Sinus Bradycardia
In all other situations, sinus bradycardia should be regarded as a pathological finding. There are numerous pathological conditions that cause sinus bradycardia. The most important causes are as follows:
- Myocardial ischemia/infarction Particularly ischemia or infarction located to the inferior wall of the left ventricle. This type of bradycardia is due to diminished automaticity in the sinoatrial node or conduction defects as a result of ischemia/infarction.
- Sinus Node Dysfunction Sinus node dysfunction implies that the cells of the sinoatrial node are defect and fail to generate electrical impulses.
- Side effects of drugs These drugs affect the pacemaker cells in the sinoatrial node. They may also induce conduction defects .
- Increased intracranial pressure .
- Hypothyroidism.
Treatment Of The Sinus Bradycardia
According to the experts of the European Society of Cardiology, for most people the treatment of sinus bradycardia is not required – if the patients do not have symptoms that are clearly associated with delayed heart beat, which adversely affects the general hemodynamics.
Than to treat and how to treat at presence of signs? It depends on the etiology of the lowered heart rate and the accompanying manifestations. If sinus bradycardia causes hypothyroidism, then hormone replacement therapy is indicated. Infectious myocarditis requires the use of antibiotics, with a deficiency of potassium and magnesium prescribe K and Mg tablets .
Treatment is necessary for dysfunction of the sinus-atrial node with severe clinical symptoms and with severe atrioventricular blockade, and this is exclusively surgical treatment by implantation of a permanent pacemaker.
In other cases – to increase the heart rate – drugs with a positive chronotropic effect, which give drugs blocking M-holinoretseptory, and drugs that stimulate -adrenoreceptors, can be prescribed. Among them: Atropine, Iazrin , Ipratropium bromide , Orciprenaline , Ephedrine, Epinephrine , Noradrenaline.
A sharp sinus bradycardia, fraught with a stop of breathing, followed by a cardiac arrest, requires emergency care – with the introduction of Atropine and cardiac stimulation.
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Case Presentation:
A 55 y/o male presents to the Emergency Department with 1 hour of chest pain. His initial EKG shows a sinus rhythm with a rate of 45 and no ST elevations or depressions.
What is your diagnostic approach and considerations in this patient?
You have a patient with sinus bradycardia complaining of chest pain. How can you refine your clinical gestault regarding your patient?
Sinus Bradycardia Ecg Review
Sinus bradycardia occurs on an ECG when there is a normal upright P wave in lead II sinus P wave preceding every QRS complex with a ventricular rate of less than 60 beats per minute.
The causes of sinus bradycardia include the following:
- AV blocking medications
- Heightened vagal tone
- Sick sinus syndrome
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Key Points About Sinus Bradycardia
Sinus bradycardia is a kind of slow heartbeat. It happens when the sinoatrial node fires less than 60 times per minute. In some cases, sinus bradycardia is normal, but other times it can mean an underlying problem.
- Sinus bradycardia can be caused by some health conditions. But in some people, its normal.
- Most people with sinus bradycardia dont have any symptoms. It is common in athletes and in the elderly.
- If you do have symptoms, your healthcare provider may remove or reduce any medicines that might be triggering it. Some people need a pacemaker.
- Follow all of your healthcare providers instructions carefully.
Diagnostics Of The Sinus Bradycardia
Diagnostics include pulse measurement, blood pressure, auscultation with a stethoscope, blood tests .
Anamnesis should contain information about all the patient’s diseases and medications taken.
The most important role is played by instrumental diagnostics using: electrocardiography with 12 leads , echocardiography, if necessary, ultrasound or chest MRI.
Sinus bradycardia on the ECG will be visible by decreasing the heart rate , by the presence of a sinus rhythm by a wider QRS-complex.
Pulses that appear inside or below the bundle of the His on the ECG will create a wide QRS complex with a heart rate of 20 to 40 beats / min.
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Treatment Of Sinus Bradycardia: General Aspects Of Management
Benign causes of sinus bradycardia do not require treatment. In all other situations it is necessary to find the underlying cause and direct treatments towards it. The most common causes are sinus node dysfunction, side effects of medications or acute myocardial ischemia/infarction. When the bradycardia causes hemodynamic symptoms it should be treated. Note that sinus bradycardia due to ischemia located to the inferior wall of the left ventricle is typically temporary and resolves within 12 weeks .
Benign causes of bradycardia need not be treated. When in doubt whether the bradycardia is physiological, it is useful to perform a Holter ECG . If drug side effects are believed to be the cause, it is fundamental to judge the risk of terminating drug therapy as compared with implementing an artificial pacemaker in order to be able to continue drug therapy. It is very common that patients with bradycardia have a strong indication for drugs that aggravate or even cause the bradycardia in such scenarios, it is generally considered to be evidence based to implement an artificial pacemaker that will allow for drug therapy to continue.
Sick sinus syndrome , which is a common cause of bradycardia, is also discussed separately.