BRADYCARDIA

Ask the following questions:

1. Is there fever? If there is fever, one should look for yellow fever, diphtheria, cerebral abscess, or meningitis. Perhaps the fever is related to increased intracranial pressure from apoplexy.
2. Are there episodes of syncope? The addition of syncope should make one think of a sick sinus syndrome, complete heart block, vasovagal syncope, or carotid sinus syncope.
3. Is there a heart murmur present? Heart murmurs are found in complete heart block, but they are also a sign of aortic stenosis, which can cause bradycardia.
4. Is there a history of drug ingestion? Several drugs can induce bradycardia, the most notable being digitalis; propranolol, quinidine, and various cholinergic drugs also may induce bradycardia. Opium poisoning may cause bradycardia.
5. Is there nonpitting edema? Obviously, this is a sign of myxedema and should be looked for in any patient presenting with bradycardia.
6. Is there chest pain? An acute myocardial infarction may present with bradycardia, although it is more typical for tachycardia to be associated with this condition. Heart disease can cause a second- and third-degree block, which may result in bradycardia, but also various other types of arrhythmia that cause the slowing of the pulse.

DIAGNOSTIC WORKUP

If there is fever without any definite focal signs, a CBC, sedimentation rate, blood culture, chemistry panel, febrile agglutinins, and tests for other antibodies may be done. If there is fever with nuchal rigidity, a spinal tap should be done, preferably after a CT scan. An EKG will need to be done on all patients, and if this shows simple sinus bradycardia and there is no history of drug ingestion, a thyroid profile should be done. If there is chest pain, serial EKGs and cardiac enzymes should be done. If there is a heart murmur, echocardiography would be an important ancillary study. If the EKG shows various types of arrhythmia, a cardiologist should be consulted for further evaluation.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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