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Cardiovascular Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
A bradycardia results from a heart rate of less than 60 beats/min. It may be normal (e.g. physiological bradycardia in athletes). Pathological causes of sinus bradycardia are listed in Table 7.12.
Endocrinology
Published in Faye Hill, Sash Noor, Neel Sharma, Tiago Villanueva, Medical and Surgical Emergencies for Students and Junior Doctors, 2021
Faye Hill, Sash Noor, Neel Sharma
Patients should undergo measurement of T4, T3 (which are typically low) and thyroid-stimulating hormone measurement (which is classically elevated). Renal function helps to exclude hyponatraemia and acute renal failure in view of reduced perfusion. A full blood count will help to exclude infection and a serum glucose is beneficial in view of the risk of hypoglycaemia. An ECG will often demonstrate bradycardia.
Hypothyroidism
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
Look for: - Bradycardia.- Rough dry skin.- Slow relaxation of the ankle jerk.- Scar of previous thyroidectomy.- Carpal tunnel syndrome (see Case 83).- Deafness.
Comparison of perioperative outcomes and anesthetic-related complications of morbidly obese and super-obese parturients delivering by cesarean section
Published in Annals of Medicine, 2023
Patchareya Nivatpumin, Tripop Lertbunnaphong, Siritorn Maneewan, Nutha Vittayaprechapon
‘Difficult intubation’ was defined as three or more attempts at intubation. ‘Desaturation’ was defined as maternal oxygen saturation of <90% recorded for ≥5 min. ‘Hypotension’ was defined as systolic blood pressure (SBP) <20% of the SBP before the induction of anesthesia or use of a vasopressor agent. Episodes of hypotension were retrieved from the anesthetic records or counted by the number of boluses of any vasopressor. ‘Bradycardia’ was defined as a heart rate <50 beats per minute or when atropine was administered. ‘Postpartum hemorrhage’ was defined according to the American College of Obstetricians and Gynecologists criteria: bleeding exceeding 1,000 ml after delivery [16]. The intraoperative blood loss was determined by visual estimation by the attending anesthesiologist in the operating theatre. All patients received a uterotonic agent (intravenous oxytocin or carbetocin) after delivery; ‘uterine atony’ was defined as the need to use an additional agent (e.g. methylergonovine or prostaglandin). ‘Failure of regional anesthesia’ was defined as the need to convert to general anesthesia with an endotracheal tube. ‘Neonatal birth asphyxia’ was defined as a neonatal Apgar score <7 five minutes after delivery.
Derivation and internal validation of a clinical prediction score to predict major effect or death in acute metamfetamine toxicity
Published in Clinical Toxicology, 2023
Rex Pui Kin Lam, Chi Keung Chan, Man Li Tse, Eric Ho Yin Lau, Zonglin Dai, Matthew Sik Hon Tsui, Timothy Hudson Rainer
Unlike other early warning scores, we did not divide individual physiological parameters, such as pulse rate, into different risk bands, in which extreme values at both ends of the spectrum are generally given a higher score [12–16]. We are aware that some physiological parameters might not have a linear association with poor clinical outcomes. For instance, patients with severe bradycardia and tachycardia are both at risk of major effect or death. However, using the risk-band approach warrants the use of a scoring chart or software in score calculation, adding to the cognitive load of the users. We dichotomized physiological parameters for ease of use and weighed individual parameters with whole numbers to simplify the calculation. For parameters such as pulse rate, mean arterial pressure should be low if the bradycardia is severe enough to cause hemodynamic instability. Despite being a simpler scoring system based on dichotomized variables, the MASCOT score still performed well compared with existing early warning scores within the validation cohort, in which the pattern of drug use and occurrence of major effect or death were different from the derivation cohort. This indicates that model overfitting is less likely and the score is robust in different populations. Although the point estimate of the AUROC of the MASCOT score was lower than that of the MEWS, MEWS with GCS, and NEWS2, their 95% CIs overlapped considerably, making it difficult to confirm the superiority of one scoring system over the others.
A case of bradycardia during SARS CoV-2 infection in a 14-year-old child
Published in Infectious Diseases, 2021
Onder Kilicaslan, Didem Kizmaz Isancli, Omer Yilmaz Ulutas, Selma Oktay Ergin, Adem Karbuz
The epidemic caused by the SARS CoV-2 virus, also known as coronavirus disease 2019 (COVID-19), has rapidly turned into a global pandemic. Although respiratory distress was the most prominent symptom of COVID-19 initially, it has since been better understood to cause cardiac complications in patients regardless of cardiovascular disease history [4]. As the pandemic progressed, the adverse effects of arrhythmias caused by the virus and effective treatments became more apparent. A study conducted showed that the most commonly reported tachyarrhythmia was atrial fibrillation (21%), while the most common bradyarrhythmia was severe sinus bradycardia (8%), and complete heart block (8%) [5]. In another study, 17% of the patients admitted to hospital and 44% of the patients admitted to the intensive care unit had an arrhythmia [6]. Bradycardia was detected in our patient during initial examinations in the emergency department. ECG scans of the patient indicated that the bradyarrhythmia was sinus bradycardia. There were no signs of concomitant heart failure, blood pressure disorder, or discomfort. The patient had not previously used any arrhythmic drugs such as hydroxychloroquine or azithromycin.