article thumbnail

Ep 155 Treatment of Bradycardia and Bradydysrhythmias

ECG Cases

In Part 1 of our 2-part series on bradycardia and bradydysrhythmias we discussed a practical approach with electrophysiologist Paul Dorian and EM doc Tarlan Hedayati. How is the treatment of bradycardia different in the patient with hypothermia? Cardiac ischemia? In this, part 2, we discuss details of treatment. Myxedema coma?

article thumbnail

An Unusual Bradycardia

Dr. Smith's ECG Blog

Common explanations for unusual rhythms such as this one include: i ) Hyperkalemia ( or other severe electrolyte disorder ); ii ) Recent infarction/ischemia; iii ) Sleep apnea; iv ) Severe hypothyroidism; v ) Acute neurologic catastrophe (ie, stroke, bleed, trauma, tumor ); vi ) Some other toxicity.

article thumbnail

56 year old male had 5/10 chest pain for several hours, then presented to the ED in the middle of the night with 1/10 pain.

Dr. Smith's ECG Blog

No ischemia. Case continued Another ECG was recorded 3 hours later, still 1/10 pain: There is sinus bradycardia with RBBB. This is a conundrum, because it is clear that the patient is having an acute MI, the ECG is dynamic, but the pain is very mild and there is no ECG evidence of active transmural ischemia.

article thumbnail

A woman in her 50s with dyspnea and bradycardia

Dr. Smith's ECG Blog

Her vital signs were within normal limits except for bradycardia at 55 bpm. It is probably sinus bradycardia with very small/depressed P-waves and prolonged PR interval. P EARL # 4 In my opinion, it is not worth wasting time trying to figure out the specific rhythm diagnosis of a bradycardia when there is hyperkalemia.

article thumbnail

Extreme Bradycardia: a Case-Based Lesson in Pacing

Dr. Smith's ECG Blog

For instance, if there were inappropriate sinus bradycardia at less than 60 bpm, the atrial pacer would take over if it is programmed to wait 1 second before firing. The T-waves of both of these beats have, coincidentally , a superimposed P-wave Clinical course: The potassium was normal, there was no ischemia or drug toxicity.

article thumbnail

A 40-Something male with a "Seizure," Hypotension, and Bradycardia

Dr. Smith's ECG Blog

Both of these features make inferior + RV MI by far the most likely ( Pseudoanteroseptal MI is another name for this ) There is also sinus bradycardia and t he patient is in shock with hypotension. A narrow complex bradycardia without any P-waves is also likely to respond to atropine, as it may be a junctional rhythm.

article thumbnail

What is this ECG finding? Do you understand it before you hear the clinical context?

Dr. Smith's ECG Blog

Altered Mental Status, Bradycardia == MY Comment , by K EN G RAUER, MD ( 2/2 /2024 ): == Dr. Meyers began today’s case with the clinical challenge of asking you to identify the underlying cause of ECG #2. -- Read this ECG -- Osborn Waves and Hypothermia (this is the "Figure" above) What does LBBB look like in severe hypothermia?

Blog 137