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Sinus bradycardia (Pathophysiology (Types (Sick sinus syndrome
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Sinus bradycardia
Pathophysiology
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Mechanism
Reduced output from SAN to
atria and AVN, reduced rate
Types
Sick sinus syndrome
Intermittent SAN failure to initiate impulses
Can progress to ectopics, tachyarrhythmias or cardiac arrest,
AF, VTEs etc,
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Diagnosis
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Investigations
Bloods
FBC, CRP, E+E, LFT,
clotting, glucose, lipids
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Bedside
Obs
ECG (sinus brady, dropped p waves if sick sinus)
History
DH
Meds (B-blockers), allergies
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PMH
Previous MI, other cardiac disease
SH
Living arrangements, occupation,
leisure (athlete etc), smoking, alcohol, drugs
PC/HPC
SOB, syncope, other symptoms
Management
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Definitive
Conservative
Information, advice, support
Identify and treat cause
Monitoring if asymptomatic
Medical
Pacing
Indication: symptomatic patients,
no response to atropine
MOA: wire connecting SAN and
ventricles to re-establish rhythm
Anticoagulants
Indication: sick sinus syndrome
E.g. NOAC, warfarin
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