Brady arrhythmias (A)

Definition “Heart rhythms with a ventricular rate <60bpm”

Aetiology Cardiac: Fibrosis of conduction pathways, post-MI, Aortic valve disease,

Cardiomyopathy
Endocrine: Cushing’s triad, Hypothyroid, Electrolyte abnormalities
Drugs: Beta blockers, Amiodarone, CCB
Normal if fit

History Dizziness, fatigue, syncope, exercise intolerance, SOB,

Examination Raised ICP (Cushing’s triad), pallor, cold peripheries,

Investigations Bloods: Digoxin level, UE, FBC,

12 lead ECG

Heart block Impaired electrical conduction between the atria and ventricles
1st degree: PR>0.2 seconds, Asymptomatic, no management required
2nd degree Mobitz I: Progressive prolongation of PR interval till missed
QRS
2nd degree Mobitz II: Constant prolonged PR interval with a regularly
missed QRS
3rd degree: complete heart block with no association between P waves and
QRS complex

Bundle branch LBBB: MI, Aortic stenosis, cardiomyopathy, hyperkalaemia, digoxin toxicity
block
RBBB: Normal with age, RVH, PE, MI, ASD, Myocarditis
WiLLiaM and MaRRoW

Management ABCDE
Identify reversable causes Ie electrolyte abnormalities
If evidence of haemodynamic instability give atropine
If stable observe