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Discontinue all negative chronotropic agents, since the risk of torsade is much higher with bradycardia or pauses. Because she has cardiomyopathy and ventricular dysrhythmias, the pacer included an Implanted Cardioverter-Defibrillator (ICD) Echo 6 days later after CRT: Normal estimated left ventricular ejection fraction. The plan: 1.
Soon afterward, the patient’s symptoms return along with lightheadedness, bradycardia, and hypotension. The patient has also developed sinus bradycardia, which may result from right coronary artery ischemia to the SA node. The Queen of Hearts agrees: Around this time his initial high sensitivity troponin I resulted at 231 ng/L.
A formal echocardiogram was completed the next day and again showed a normal ejection fraction without any focal wall motion abnormalities to suggest CAD. Cardiology was consulted and they agreed that the EKG had an atypical morphology for STEMI and did not activate the cath lab.
There are 2 main options: Overdrive pacing could be considered and in the right clinical situation, this is often effective for reducing ventricular arrhythmias ( especially in the case of preventing pause induced or bradycardia-induced arrhythmias in association with QTc prolongation ). Try a different kind of antiarrhythmic.
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