Bradycardia pathophysiology: Difference between revisions

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*[[Infection|Infectious]] agents associated with relative [[sinus bradycardia]] include [[Lyme disease]], [[Chagas disease]], [[legionella]], [[psittacosis]], [[Q fever]], [[typhoid fever]], [[typhus]], [[babesiosis]], [[malaria]], [[leptospirosis]], [[yellow fever]], [[dengue fever]], [[Viral hemorrhagic fever|viral hemorrhagic fevers]], [[trichinosis]], and [[Rocky Mountain spotted fever|Rocky Mountain Spotted fever]]. <ref name="pmid11284920">{{cite journal| author=Cunha BA| title=The diagnostic significance of relative bradycardia in infectious disease. | journal=Clin Microbiol Infect | year= 2000 | volume= 6 | issue= 12 | pages= 633-4 | pmid=11284920 | doi=10.1046/j.1469-0691.2000.0194f.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11284920  }} </ref><ref name="pmid15949188">{{cite journal| author=Puljiz I, Beus A, Kuzman I, Seiwerth S| title=Electrocardiographic changes and myocarditis in trichinellosis: a retrospective study of 154 patients. | journal=Ann Trop Med Parasitol | year= 2005 | volume= 99 | issue= 4 | pages= 403-11 | pmid=15949188 | doi=10.1179/136485905X36307 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15949188  }} </ref>
*[[Infection|Infectious]] agents associated with relative [[sinus bradycardia]] include [[Lyme disease]], [[Chagas disease]], [[legionella]], [[psittacosis]], [[Q fever]], [[typhoid fever]], [[typhus]], [[babesiosis]], [[malaria]], [[leptospirosis]], [[yellow fever]], [[dengue fever]], [[Viral hemorrhagic fever|viral hemorrhagic fevers]], [[trichinosis]], and [[Rocky Mountain spotted fever|Rocky Mountain Spotted fever]]. <ref name="pmid11284920">{{cite journal| author=Cunha BA| title=The diagnostic significance of relative bradycardia in infectious disease. | journal=Clin Microbiol Infect | year= 2000 | volume= 6 | issue= 12 | pages= 633-4 | pmid=11284920 | doi=10.1046/j.1469-0691.2000.0194f.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11284920  }} </ref><ref name="pmid15949188">{{cite journal| author=Puljiz I, Beus A, Kuzman I, Seiwerth S| title=Electrocardiographic changes and myocarditis in trichinellosis: a retrospective study of 154 patients. | journal=Ann Trop Med Parasitol | year= 2005 | volume= 99 | issue= 4 | pages= 403-11 | pmid=15949188 | doi=10.1179/136485905X36307 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15949188  }} </ref>


=== Microscopic Pathology ===
===Microscopic Pathology===


* On microscopic histopathological analysis,  a few patients with sinus bradycardia may show no nodal histopathology, yet some microscopic findings are associated with the condition which includes the following:
*On microscopic histopathological analysis,  a few patients with sinus bradycardia may show no nodal histopathology, yet some microscopic findings are associated with the condition which includes the following:<ref name="pmid17646576">{{cite journal| author=Nof E, Luria D, Brass D, Marek D, Lahat H, Reznik-Wolf H | display-authors=etal| title=Point mutation in the HCN4 cardiac ion channel pore affecting synthesis, trafficking, and functional expression is associated with familial asymptomatic sinus bradycardia. | journal=Circulation | year= 2007 | volume= 116 | issue= 5 | pages= 463-70 | pmid=17646576 | doi=10.1161/CIRCULATIONAHA.107.706887 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17646576  }}</ref>
** Nodal cell reduction  
**Nodal cell reduction
** Nodal cell and fibrosis
**Nodal cell and fibrosis
** Amyloidosis in the nodal region
**Amyloidosis in the nodal region
** Sinus node hypoplasia
**Sinus node hypoplasia


==References==
==References==

Revision as of 14:45, 22 September 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M.Umer Tariq [2] Ibtisam Ashraf, M.B.B.S.[3]

Overview

Bradycardia generally results from sinus node dysfunction and AV node dysfunction. However, other pathophysiologic conditions can also result in bradycardia such as acute Myocardial infarction, obstructive sleep apnea, exaggerated vagal activity, increased intracranial pressure, and infectious diseases such as Lyme disease, rocky mountain spotted fever, chagas disease, psittacosis, Q fever, and typhoid fever.

Pathophysiology

The underlying mechanism is not clinically relevant to the treatment.

There are generally two types of problems that result in bradycardia:

Disorders of the sinus node

Disorders of the atrioventricular node (AV node)

Sinus bradycardia can also be seen in these pathophysiologic settings:[3][4]

Acute Myocardial infarction

Obstructive sleep apnea

Exaggerated vagal activity

Increased intracranial pressure

Infectious causes

Microscopic Pathology

  • On microscopic histopathological analysis, a few patients with sinus bradycardia may show no nodal histopathology, yet some microscopic findings are associated with the condition which includes the following:[10]
    • Nodal cell reduction
    • Nodal cell and fibrosis
    • Amyloidosis in the nodal region
    • Sinus node hypoplasia

References

  1. Alpert MA, Flaker GC (1983). "Arrhythmias associated with sinus node dysfunction. Pathogenesis, recognition, and management". JAMA. 250 (16): 2160–6. PMID 6620520.
  2. Brodsky, Michael; Wu, Delon; Denes, Pablo; Kanakis, Charles; Rosen, Kenneth M. (1977). "Arrhythmias documented by 24 hour continuous electrocardiographic monitoring in 50 male medical students without apparent heart disease". The American Journal of Cardiology. 39 (3): 390–395. doi:10.1016/S0002-9149(77)80094-5. ISSN 0002-9149.
  3. "StatPearls". 2020. PMID 29630253.
  4. Nof, Eyal; Luria, David; Brass, Dovrat; Marek, Dina; Lahat, Hadas; Reznik-Wolf, Haya; Pras, Elon; Dascal, Nathan; Eldar, Michael; Glikson, Michael (2007). "Point Mutation in the HCN4 Cardiac Ion Channel Pore Affecting Synthesis, Trafficking, and Functional Expression Is Associated With Familial Asymptomatic Sinus Bradycardia". Circulation. 116 (5): 463–470. doi:10.1161/CIRCULATIONAHA.107.706887. ISSN 0009-7322.
  5. Davis WT, Montrief T, Koyfman A, Long B (August 2019). "Dysrhythmias and heart failure complicating acute myocardial infarction: An emergency medicine review". Am J Emerg Med. 37 (8): 1554–1561. doi:10.1016/j.ajem.2019.04.047. PMID 31060863.
  6. Caples SM, Rosen CL, Shen WK, Gami AS, Cotts W, Adams M; et al. (2007). "The scoring of cardiac events during sleep". J Clin Sleep Med. 3 (2): 147–54. PMID 17557424.
  7. Gilson GJ, Miller AC, Clevenger FW, Curet LB (1995). "Acute spinal cord injury and neurogenic shock in pregnancy". Obstet Gynecol Surv. 50 (7): 556–60. doi:10.1097/00006254-199507000-00022. PMID 7566833.
  8. Cunha BA (2000). "The diagnostic significance of relative bradycardia in infectious disease". Clin Microbiol Infect. 6 (12): 633–4. doi:10.1046/j.1469-0691.2000.0194f.x. PMID 11284920.
  9. Puljiz I, Beus A, Kuzman I, Seiwerth S (2005). "Electrocardiographic changes and myocarditis in trichinellosis: a retrospective study of 154 patients". Ann Trop Med Parasitol. 99 (4): 403–11. doi:10.1179/136485905X36307. PMID 15949188.
  10. Nof E, Luria D, Brass D, Marek D, Lahat H, Reznik-Wolf H; et al. (2007). "Point mutation in the HCN4 cardiac ion channel pore affecting synthesis, trafficking, and functional expression is associated with familial asymptomatic sinus bradycardia". Circulation. 116 (5): 463–70. doi:10.1161/CIRCULATIONAHA.107.706887. PMID 17646576.

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