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In usual syncope, there could be a fall in blood pressure, bradycardia, and there are various types, which will be described. The most common is mixed type, in which, in the tilted position, the person develops both bradycardia and hypotension and usually there is a syncope. Various types of responses can occur to head up tilt test.
It is mentioned that square root sign can also occur in right right ventricular cardiomyopathy and severe bradycardia [1]. Reference Doshi S, Ramakrishnan S, Gupta SK. Invasive hemodynamics of constrictive pericarditis. Indian Heart J. 2015 Mar-Apr;67(2):175-82. doi: 10.1016/j.ihj.2015.04.011. 2015.04.011.
Polymorphic VT is managed by intravenous magnesium and measures to increase heart rate like pacing as it occurs most often in the setting of bradycardia and QT interval prolongation. Those at risk of recurrent VT with previous myocardial infarction and left ventricular dysfunction also need an implantable defibrillator.
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.
And, after the shock, if there is bradycardia, it can be covered by these two pacing electrodes, one at the tip, and one proximal to it. This a representative image, showing the implanted defibrillator, and two shock coils, one in the superior vena cava and another in the right ventricle. These are high voltage, defibrillator shock coils.
Use of drugs producing bradycardia like beta blockers in stages III and IV may precipitate low output state. In stage IV, this restrictive filling pattern remains fixed even during Valsalva maneuver. Initial stages (I to III) are considered reversible with treatment. Stage IV is considered as advanced.
But subcutaneous ICD cannot provide bradycardia and antitachycardia pacing as a transvenous ICD. Subcutaneous implantable cardioverter defibrillator was an innovation meant to reduce the lead related problems of conventional transvenous ICDs.
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