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Electrocardiogram (ECG) and telemetry revealed junctional bradycardia with heart rate in 30s and sinus pauses (5-7 seconds). He was admitted for further workup of bradycardia. His home medications included metoprolol succinate 25mg daily which was held given bradycardia. Initial laboratory analysis was unremarkable.
Discontinue all negative chronotropic agents, since the risk of torsade is much higher with bradycardia or pauses. As described above by Dr. Smith Pacing in today's case is an effective intervention as doing so prevents the bradycardia and pauses that are likely to precipitate additional episodes of Torsades de Pointes. (
EMS reports intermittent sinus tachycardia and bradycardia secondary to some type of heart block during transport. She was discharged with plan for outpatient cardiac MRI for further evalution. Each event is associated with a prodrome of mild substernal CP, SOB, and “brain fog.” Troponins were all negative.
Reasons for not prescibing or discontinuing were: CKD 6, severe aortic stenosis 5, asthma 3, symptomatic bradycardia 5, hypotension 3, type1 diabetes 2, syncope 1, Raynauds 1, patient choice 8 and 6 patients died before all appropriate medications could be initiated. In 10 cases no clinical reason could be identified.It
Hopefully a repeat echocardiogram will be performed outpatient. Other Arrhythmias ( PACs, PVCs, AFib, Bradycardia and AV conduction disorders — potentially lethal VT/VFib ). Systolic function normal by visual assessment only, unable to visualize well for further characterization. 1900: RBBB and LAFB are almost fully resolved.
Written by Willy Frick A man in his 70s with a history of HFrEF and sick sinus syndrome s/p dual chamber pacemaker placement was admitted for overnight observation following outpatient placement of a mitral valve clip. This is supported by the PT note which described a palpably irregular pulse with pauses and marked bradycardia.
He visited an outpatient clinic for it and an echocardiogram and exercise stress test was normal. His first electrocardiogram ( ECG) is given below: --Sinus bradycardia. His medical history is unremarkable except a similar pain occurred 4-5 times in the previous 3 months with less intensity, short duration, unrelated to exertion.
There’s sinus bradycardia, first degree AV block, normal axis, delayed R wave progression, and normal voltages. Hyperacute T waves are deflating, suggesting reperfusion but there is still reciprocal change in I/aVL and ST depression in V2, and the bradycardia is worse. Below is the ECG. What do you think? See analysis below.
Written by Willy Frick A middle aged man presented for elective outpatient surgery. To Emphasize: For those in search of "the quick answer" — today's middle-aged man should not be approved for an outpatient elective surgical procedure without further evaluation. The following ECG was obtained in the preoperative area.
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