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Cardiovascular Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Sinus bradycardia does not usually need treatment, except in the acute setting of a vasovagal attack. Haemodynamically important sinus bradycardias are treated with IV atropine to inhibit vagal drive to the SA and AV nodes.
The patient with acute cardiovascular problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Sinus bradycardia is a regular heart beat that originates from the sinoatrial node, but at a rate lower than 60 beats per minute (please see Figure 6.24). Whilst in a healthy heart this may not cause problems with cardiac output, as there is a corresponding increase in stroke volume, in the diseased heart, sinus bradycardia may cause circulatory compromise. If the patient becomes symptomatic, feels dizzy, faints, experiences chest pain, has a low blood pressure or becomes breathless, treatment will be required. Supplemental oxygen to maintain saturations between an agreed target range of 94–98% (or 88–92%, if at risk of hypercapnia) should be commenced. IV access will be needed and atropine 500mcg IV may be prescribed, as this inhibits the effect of the parasympathetic vagus nerve and allows the sinus node to increase the heart rate. If the bradycardia is extreme, then a temporary pacemaker may be indicated. It is important that the medications the patient is taking are reviewed, as common cardiac drugs such as beta blockers, digoxin and calcium antagonists such as diltiazem can cause a reduction in heart rate.
Medicine
Published in Seema Khan, Get Through, 2020
For each patient below, choose the SINGLE most appropriate treatment from the list of options. Each option may be used once, more than once or not at all. A 60-year-old man presents with chest pain and shortness of breath. ECG shows sinus bradycardia of 45 beats/min.A 55-year-old woman is noted to have a slow heart rate. She is asymptomatic. ECG shows no relationship between atrial and ventricular rhythm. The ventricular rhythm is 40 beats/min. The QRS complex is wide.A 60-year-old man collapses in the street. The event is unwitnessed. He has no pulse.A 30-year-old man involved in a high-speed RTA is found unconscious at the scene. He is breathing spontaneously. In A&E, the ECG monitor now shows an irregular rhythm and no P, QRS, ST or T waves. The rate is rapid.A 50-year-old man presents to A&E with severe chest pain. He has a history of angina. The pain is not relieved with GTN. BP is 120/70 with a pulse rate of 100. ECG shows regular sinus rhythm.
Treatment over Objection (in Anorexia Nervosa): Capacity Is Not the Whole Story
Published in The American Journal of Bioethics, 2023
Dr. Garcia seems very worried about Ms. Johnson. Her temptation to place a nasogastric tube immediately and arrange for intensive residential treatment upon discharge is understandable. In an effort to establish important clinical facts that accurately reflect the risks and benefits of a particular course of action, the CEC should expect to approach Dr. Garcia with an attitude of curiosity, respectfully asking questions that enable the attending physician to reflect upon and reconsider her assumptions. Dr. Garcia notes that the patient’s bradycardia is “endangering her life.” Is the danger imminent, such that immediate refeeding is truly warranted? It may or may not be safe enough to trial working with the patient to establish an incremental approach to improved nutritional status. Dr. Garcia appears to be relying solely on the finding of bradycardia to assess the situation as life-threatening. While severe bradycardia may be imminently life-threatening, sinus bradycardia can be a physiologic adaptation to low weight status commonly seen in patients with AN, and may not pose an imminent risk (Pomeroy and Mitchell 2002). If Dr. Garcia does not consider inviting a psychiatrist or psychologist into the case, ideally a colleague with expertise in AN, the CEC should be willing to make the suggestion.
Veratrum parviflorum poisoning: identification of steroidal alkaloids in patient blood and breast milk
Published in Clinical Toxicology, 2022
Jared T. Seale, Joseph E. Carpenter, Matthew D. Eisenstat, Emily A. Kiernan, Brent W. Morgan, Daniel P. Nogee, Xinzhu Pu, Colin A. Therriault, Michael Yeh, Owen M. McDougal
Patient 8 is a 58-year-old female who also consumed false hellebore leaves boiled in water. She developed vomiting, lightheadedness, chest discomfort, generalized weakness, and a sensation of pressure with tingling in the right arm 1.5 h after the meal. She initially presented to an urgent care clinic where she was noted to be hypotensive, and transferred to an ED. Blood pressure on arrival was 80/50, with a heart rate of 46. She received atropine 0.5 mg IV with transient improvement of her heart rate to 80, and blood pressure of 130/70. Her heart rate decreased to the 40 s again in the ED and blood pressure was 80/50. She received another dose of atropine 0.5 mg IV and a 1 L IV fluid bolus. Labs showed no acute abnormalities, with undetectable digoxin. EKG revealed sinus bradycardia. She was started on a dopamine infusion at 15 mcg/min and admitted to the ICU. She remained hemodynamically stable with heart rate in the 60 s and 70 s with normal blood pressure overnight. The dopamine drip was weaned off over 24 h, with full resolution of all symptoms.
Adverse drug reactions associated with concurrent acute psychiatric treatment and Covid-19 drug therapy
Published in International Journal of Psychiatry in Clinical Practice, 2021
Ekin Sönmez Güngör, Murat Yalçın, Melike Yerebakan Tüzer, Didem Beşikçi Keleş, Tuba Öcek Baş, Mine Ergelen, Alper Bülbül, Betül Kırşavoğlu, Mustafa Güneş
In our ward, although only one of our patients who received hydroxychloroquine had mild sinus bradycardia and no other patient had QTc prolongation or any other significant ECG changes, elevated liver enzymes was observed in two patients. Patient #16 had no other conditions that may increase the risk of cardiac side effects of HCLQ, such as old age, alcohol use, electrolyte abnormalities, or pre-existing cardiac diseases. It is well known that in patients with bradycardia, drugs that prolong QTc duration may lead to torsades de pointes, which is why we immediately ceased HCLQ treatment. Though HCLQ is a proarrhythmic drug (Naksuk et al. 2020), whether sinus bradycardia itself was a side effect of HCLQ treatment remains uncertain, as it is not among the mainly reported cardiac side effects such as ventricular tachycardia, bundle branch block or atrioventricular block.