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IMPRESSION: The finding of sinus bradycardia with 1st-degree AV block + marked sinus arrhythmia + the change in PR interval from beat #5-to-beat #6 — suggests a form of vagotonic block ( See My Comment in the October 9, 2020 post in Dr. Smith's ECG Blog ). Initial high sensitivity troponin I returned at 6ng/L (normal 0.20
Looking first at the long-lead II rhythm strip — there is significant bradycardia , with a heart R ate just under 40/minute. But the point to emphasize — is that it should only take seconds to recognize that there is bradycardia from significant AV block. = Would you approve her for a nonemergent surgical procedure?
The rhythm is uncertain ( ie, We only see 4 beats — because the same 4 beats are repeated in limb and chest leads — but in lead II there appears to be sinus bradycardia and arrhythmia plus a P wave with a PR interval too short to conduct preceding beat #1 — therefore need for a longer period of monitoring ).
IF the Patient is Younger and Athletic: The mechanism of AFib in younger, athletic individuals is often heavily influenced by increased vagal tone ( Rao and Shipon — ACC, 2019 — and — Calvo et al — Br J Sports Med, 2012 ). Baseline bradycardia in endurance athletes limits the use of ß-blockers. 25, 2022 ).
Athlete’s bradycardia due to increased parasympathetic tone and decreased sympathetic tone is a well-known observation. Though sinus bradycardia is usual, other abnormalities like sinus arrhythmia, sinus arrest, wandering atrial pacemaker and coronary sinus rhythm have been described. 2012 Jun;98(12):947-55.
Prior to Mizusawa's study, it was thought that the incidence of syncope, arrhythmia, or SCD in this cohort was low [7]. In light of the risk of arrhythmia events observed in the Mizusawa trial, a formal EP study might be reasonable to obtain in those with fever induced asymptomatic Brugada ECG changes to help risk stratify these patients.
Bradycardia. Electrocardiol 45:433-442, 2012 ). Finally — a detailed family history ( for early sudden death ) + a careful personal history ( for syncope/presyncope; malignant arrhythmia ) is in order. Acute febrile illness. Variations in autonomic tone. Hypothermia. Electrolyte imbalance ( hypokalemia; hyperkalemia ).
J Electrocardiology 45 (2012):433-442. Regardless of further evaluation, she should avoid bradycardia, AV nodal blockers, Na channel blockers, and fevers. --If Conclusion of this paper: Fever is a great risk factor for arrhythmia events in Brugada Syndrome patients. Bayes de Luna, A et al.
This ECG shows a sinus bradycardia with a normal conduction pattern (normal PR, normal QRS, and normal QTc), normal axis, normal R-wave progression, normal voltages. Hypothermia can also produce bradycardia and J waves, with a pseudo-STEMI pattern. ECG met STEMI criteria and was labeled STEMI by computer interpretation.
2012 Apr 4;4(6):483.) We don’t need to think deep, to realize, modalities which take on this arrhythmia head-on has a minuscule role at the population level. 2012 Oct 6;5(3):647. Al Chekakie MO, Akar JG. Epicardial Fat and Atrial Fibrillation: A Review. J Atr Fibrillation. Circ Arrhythm Electrophysiol. 2010 Jun;3(3):230-6.
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