ABNORMALITIES OF PULSE

RATE

By: Luiza Mae Sagabaen Castro

American Heart Association (AHA) . . .
Normal pulse for healthy adults 60 to 100 beats/min.
The pulse rate may fluctuate and increase with exercise, illness, injury,
and emotions.
Females ages 12 and older - faster heart rates than males.
Athletes (such as runners) who do a lot of cardiovascular conditioning,
may have heart rates near 40 to 60 beats/min.
 PULSE RATE BY AGE RANGE
Approximate Age Range Pulse rate (beats per minute)
Newborn 100 - 160
0 - 5 mos. 90 – 150
6 – 12 mos. 80 – 140
1 – 3 years 80 – 130
3 – 5 years 80 – 120
6 – 10 years 70 – 110
11 – 14 years 60 – 105
15 years or older 60 - 100
BRADYCARDIA - pulse rate below 60 beats/ min (slow heart rate)
Sinus bradycardia is a feature of poisoning with some agents. Most patients will
tolerate heart rates as low as 45 beats/minute without compromise to cardiac output.

Symptomatic bradycardia associated with hypotension and poor cardiac output

Repeat doses may be necessary, but for longer-acting agents this may cause
atropine poisoning.
Dobutamine or Isoprenaline
Pathophysiology
Bradycardia, shown on the right, is a
slower heart rhythm that may occur
because the sinus node in the heart
may be discharging electrical impulses
at a slower than normal rate. A heart
with a normal heart rhythm is shown
on the left. Bradycardia may also be
due to other causes.
Clinical features
Near-fainting or fainting (syncope)
Dizziness or lightheadedness
Fatigue
Shortness of breath
Chest pains
Confusion or memory problems
Easily tiring during physical activity
 Causes
Heart tissue damage related to aging
Damage to heart tissues from heart disease or heart attack
Heart disorder present at birth (congenital heart defect)
Infection of heart tissue (myocarditis)
A complication of heart surgery
Underactive thyroid gland (hypothyroidism)
Imbalance of chemicals in the blood, such as potassium or calcium
Repeated disruption of breathing during sleep (obstructive sleep apnea)
Inflammatory disease, such as rheumatic fever or lupus
Medications, including some drugs for other heart rhythm disorders, high blood pressure
and psychosis
Toxicological and Non-toxicological
investigations
Pharmacologic Management
Atropine
o Competitive antagonist of acetylcholine at muscarinic receptors
o Increased HR (by reducing vagal tone)
o 400 mcg up to 3mg
o Useful in vagally mediated bradycardia or possibly very high blocks

Adrenaline
o Non selective Alpha and Beta agonist
o Increased BP and HR
o 2 – 10 mcg/min
Pharmacologic Management
Isoprenaline
o Selective, potent Beta agonist (B1)
o Risk of hypotension (No alpha effect and B2 agonist)
o (+) inotrope, (+) chronotrope
o 1 – 4 mcg/min

Dopamine
o 2 – 10 mcg/kg/min
 Non-pharmacologic Management
Prevent heart disease
Treat or eliminate risk factors that may lead to heart disease. Take the following steps:
Exercise and eat a healthy diet.
Maintain a healthy weight.
Keep blood pressure and cholesterol under control
Don't smoke
If you drink, do so in moderation.
Don't use recreational drugs.
Manage stress.
Go to scheduled checkups.
TACHYCARDIA - pulse rate over 100 beats/ min (fast heart
rate)

Rapid heart rate, sinus tachycardia, and atrial or ventricular arrythmia

is regular in poisoned patient.
In overdose patient, extreme sinus tachycardia associated with
agitation of sympathomimetic recreational drugs such as Cocaine is
often regular.
In extreme tachycardia, beta-blocker due to atrial arrhythmia, cardiac
acting calcium antagonist or adenosine can be given.
Esmolol - used in order to avoid aggravating toxicity and assess
response prior to using longer-acting agents.
 Pathophysiology
• Tachycardia is the medical term for a heart rate
over 100 beats per minute. There are many heart
rhythm disorders (arrhythmias) that can cause
tachycardia.

• Sometimes, it's normal for you to have a fast

heartbeat. For instance, it's normal for your heart
rate to rise during exercise or as a response to
stress, trauma or illness. But in tachycardia, the
heart beats faster than normal due to conditions
unrelated to normal physiological stress.
Clinical features
 Dizziness
Lightheadedness
Shortness of breath
Chest pain
Heart palpitations
Unconscious/ fainting (syncope)  cardiac arrest

In some cases, tachycardia may cause no symptoms or complications. But if left untreated,
tachycardia can disrupt normal heart function and lead to serious complications, including:
Heart failure
Stroke
Sudden cardiac arrest or death
 Causes:
Anemia
Drinking too many caffeinated beverages
Drinking too much alcohol
Exercise
Fever
High or low blood pressure
Imbalance of electrolytes, mineral-related substances necessary for conducting electrical impulses
Medication side effects
Overactive thyroid (hyperthyroidism)
Smoking
Sudden stress, such as fright
Use of stimulant drugs, such as cocaine or methamphetamine
Toxicological and Non-toxicological
investigations
 Pharmacologic Management
 Fever - Acetaminophen (Tylenol), Ibuprofen (Advil, Motrin)
Hyperthyroidism - Methimazole (Tapazole)
Cardiac arrhythmias - Digitalis (Lanoxin)

Anti-arrhythmic medications:
Beta-blockers - stop the action of the hormone adrenaline, slow down heart rate, first line tx
–
Ex. Bisoprolol (Zebeta®), Metoprolol (Lopressor®), Propanolol (Inderal®), Atenolol (Tenormin®)
Calcium channel blockers- effective in atrial tachycardia reduce the strength and rate of the
heart's contraction and are used in treating abnormal heart rhythms
Ex. Verapamil (Verelan, Calan), Diltiazem ( Cardizem, Tiazac)
 Amiodarone - used to treat and prevent an irregular heartbeat. It slows down nerve activity
in the heart and relaxes an overactive heart (Cordarone, Pacerone)
Non-pharmacologic Management
Prevent heart disease
Treat or eliminate risk factors that may lead to heart disease. Take the following steps:
Exercise and eat a healthy diet.
Maintain a healthy weight.
Keep blood pressure and cholesterol under control
Stop smoking
Drink moderately
Don't use recreational drugs.
Use OTC medications with caution.
Limit caffeine
Control stress.
Go to scheduled checkups.
References:
https://www.hopkinsmedicine.org/health/conditions-and-diseases/vita
l-signs-body-temperature-pulse-rate-respiration-rate-blood-pressure
https://www.medicinenet.com/what_is_a_good_heart_rate_for_my_a
ge/article.htm
https://www.mayoclinic.org/diseases-conditions/bradycardia/symptom
s-causes/syc-20355474#:~:text=Bradycardia%2C%20shown%20on%20t
he%20right,be%20due%20to%20other%20causes
.
https://www.slideshare.net/jameswheeler001/treatment-of-bradycardi
a
https://www.mayoclinic.org/diseases-conditions/tachycardia/symptom
s-causes/syc-20355127
https://www.racgp.org.au/afpbackissues/2007/200707/200707kistler.p
df
https://www.drugs.com/health-guide/tachycardia.html