The Clinical Problem Solvers Episode 388: Schema Episode – Bradycardia
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Apr 3, 2025 Delve into the intriguing world of bradycardia management with a focus on a 72-year-old woman's case. Discover the nuances of distinguishing true from pseudobradycardia and the critical role of ACLS algorithms. Listen as hosts analyze an EKG displaying bradycardia and explore the implications of complete heart block. Learn how to navigate EKG readouts to identify key features and block classifications. Plus, unravel the complexities of cardiac sarcoidosis through advanced imaging techniques and collaborative patient care.
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Assessing Bradycardia
- First, assess the patient's stability by checking for hypotension, altered mental status, chest pain, or heart failure signs.
- Consider the rhythm and determine if it's true bradycardia or a fake out caused by non-perfusing beats.
Pseudobradycardia
- Pseudobradycardia occurs when a pulse oximeter fails to detect non-perfusing heartbeats.
- Non-perfusing beats arise from decreased ventricular filling due to rapid or premature heartbeats (e.g., AFib, PACs, PVCs).
Sinus Bradycardia Approach
- Use the V-LIDE schema to assess sinus bradycardia, considering vagal tone, lights/electrolytes, infiltration/ischemia, endocrine causes, and medications.
- Check for a chronotropic response and symptoms, and consider mimics like tachybrady syndrome and dysautonomia.