|
|
| (29 intermediate revisions by 3 users not shown) |
| Line 1: |
Line 1: |
| __NOTOC__ | | __NOTOC__ |
| {{SI}} | | {{Junctional bradycardia}} |
| {{CMG}}
| |
|
| |
|
| {{SK}} Junctional escape; junctional escape rhythm
| | '''For patient information, click [[Junctional bradycardia (patient information)|here]]''' |
|
| |
|
| ==Overview==
| | {{CMG}}; {{AE}} {{M.P}} |
| Junctional bradycardia is a slow (40 to 60 beats per minute) narrow complex escape rhythm that originates in the [[atrioventricular node]] to compensate for slow or impaired conduction of pacemaker activity in the atrium.
| |
|
| |
|
| ==Pathophysiology==
| | {{SK}} Junctional escape; junctional escape rhythm |
| Normally, the [[atrioventricular node]] ([[AVN]]) can generate an escape rhythm of 40-60 beats per minute in case the [[sinoatrial node]] ([[SA node]]) or atrial pacemakers fail ([[sinus arrest]]) or slow ([[sinus bradycardia]]) or if there is [[complete heart block]]. This [[junctional escape rhythm]] generates a normal, narrow [[QRS complex]] rhythm at a rate below 60 beats per minute (junctional bradycardia) as the electrical impulses once they are generated are conducted with normal velocity down the usual pathways. [[Retrograde P waves]] (i.e. upside down) [[P waves]] due to retrograde or backward conduction may or may not be present.
| |
|
| |
|
| ==Causes== | | ==[[Junctional bradycardia overview|Overview]]== |
| ===Life Threatening Causes===
| |
| Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
| |
| *[[Acute coronary syndrome]]
| |
| *[[acute renal failure|Acute hyperkalemic renal failure]]
| |
| *[[Diabetic ketoacidosis]]
| |
| *[[Myocardial rupture]]
| |
| *[[NSTEMI]]
| |
| *[[organophosphate|Organophosphorus poisoning]]
| |
| *[[parathion|Parathion poisoning]]
| |
| *[[spider bite#spider venom|Poisonous spider bites]]
| |
| *[[brain damage|Severe brain injury]]
| |
| *[[STEMI]]
| |
|
| |
|
| ==Common Causes== | | ==[[Junctional bradycardia historical perspective|Historical Perspective]]== |
| *[[Acetylcholine]]
| |
| * [[Acute rheumatic fever]]
| |
| *[[Amiodarone]]
| |
| * [[Antiarrhythmic agents]]
| |
| * [[Beta-blockers]]
| |
| * [[Calcium channel blockers]]
| |
| * [[Digitalis toxicity]]
| |
| *[[Dilated cardiomyopathy]]
| |
| *[[Diltiazem]]
| |
| *[[Hyperkalemia]]
| |
| *[[Hypermagnesemia]]
| |
| *[[Hypertensive heart disease]]
| |
| * [[Ischemic heart disease]]
| |
| *[[Methylprednisolone]]
| |
| *[[Phenytoin]]
| |
| * [[Sick sinus syndrome]]
| |
| * [[Sinus arrest]]
| |
| * [[Sinus bradycardia]]
| |
| * [[STEMI]] particularly inferior MI involving the [[posterior descending artery]]
| |
|
| |
|
| ===Causes by Organ System=== | | ==[[Junctional bradycardia classification|Classification]]== |
| {|style="width:80%; height:100px" border="1"
| |
| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | | |
|
| |
|
| '''Cardiovascular'''
| | ==[[Junctional bradycardia pathophysiology|Pathophysiology]]== |
| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Acute coronary syndrome]], [[acute rheumatic fever]], [[Andersen cardiodysrhythmic periodic paralysis]], [[Brugada syndrome]], [[cardiac tumor#heart in lymphomas|cardiac lymphoma]], [[cardiac tumor]], [[congenital heart disease]], [[congestive heart failure]], [[dilated cardiomyopathy]], [[hypertensive heart disease]], [[hypertrophic cardiomyopathy]], [[ischemic heart disease]], [[Jervell and Lange-Nielsen syndrome]], [[long QT syndrome]], [[myocardial infarction]], [[myocardial rupture]], [[myocarditis]], [[NSTEMI]], [[pericarditis]], [[Romano-Ward syndrome]], [[sick sinus syndrome]], [[sinus arrest]], [[sinus bradycardia]], [[sinoatrial arrest|sinus node fibrosis]], [[STEMI]], [[tachycardia-bradycardia syndrome]], [[Timothy syndrome]], [[valvular heart disease]], [[reperfusion injury|coronary reperfusion therapy]]
| |
| |-
| |
| |bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
| |
| |bgcolor="Beige"| [[Berberine]], [[grayanotoxin]], [[organophosphate|organophosphorus poisoning]], [[parathion|parathion poisoning]], [[spider bite#spider venom|poisonous spider bites]], [[pyrethroid|pyrethroid poisoning]], [[Arizona bark scorpion|scorpion toxin]]
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Dental'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Dermatologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Drug Side Effect'''
| |
| |bgcolor="Beige"| [[Acetylcholine]], [[all-trans retinoic acid]], [[amiodarone]], [[antiarrhythmic drugs]], [[anthracyclines]], [[barbiturate]], [[beta-blockers]], [[bupivacaine]], [[calcium channel blockers]], [[carbamazepine]], [[cimetidine]], [[citalopram]], [[clonidine]], [[digitalis]], [[digoxin]], [[diltiazem]], [[diphenhydramine]], [[donepezil]], [[edrophonium]] [[neostigmine]], [[granisetron]], [[guanethidine]], [[halothane]], [[idarubicin]], [[isoprenaline|isoprenaline infusion]], [[lithium]], [[mepivacaine]], [[mesalamine]], [[methyldopa]], [[methylprednisolone]], [[nelfinavir]], [[nicorandil]], [[phenothiazine]], [[phenytoin]], [[procainamide]], [[propafenone]], [[propanolol]], [[propofol]], [[pyridostigmine]], [[remifentanil]], [[reserpine]], [[ropivacaine]], [[ropivacaine]], [[tacrine]], [[thiamylal]], [[timolol]], [[tricyclic antidepressants]], [[urapidil]], [[verapamil]], [[cholinesterase inhibitors]]
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Ear Nose Throat'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Endocrine'''
| |
| |bgcolor="Beige"| [[Diabetic ketoacidosis]], [[Hashimoto's thyroiditis]], [[pheochromocytoma]], [[hypothyroidism|profound hypothyroidism]]
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Environmental'''
| |
| |bgcolor="Beige"| [[Berberine]], [[hypothermia]], [[spider bite#spider venom|poisonous spider bites]], [[Arizona bark scorpion|scorpion toxin]]
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Gastroenterologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Genetic'''
| |
| |bgcolor="Beige"| [[Andersen cardiodysrhythmic periodic paralysis]], [[Brugada syndrome]], [[congenital heart disease]], [[Emery-Dreifuss muscular dystrophy]], [[Jervell and Lange-Nielsen syndrome]], [[Limb-girdle muscular dystrophy|limb-girdle muscular dystrophy type 1B (LGMD1B)]], [[muscular dystrophy]], [[myotonic dystrophy]], [[Romano-Ward syndrome]], [[Timothy syndrome]]
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Hematologic'''
| |
| |bgcolor="Beige"| [[Hemochromatosis]]
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Iatrogenic'''
| |
| |bgcolor="Beige"| [[Cardiac catheterization]], [[cardiac transplantation]], [[liquid breathing|cold water immersion apnea]], [[coronary artery bypass grafting]], [[Fontan procedure]], [[heart surgery]], [[regional anesthesia|infraclavicular brachial plexus block]], [[lung transplantation|post lung transplantation]], [[tilt table testing|tilt testing]]
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Infectious Disease'''
| |
| |bgcolor="Beige"| [[Acute rheumatic fever]], [[Chagas disease]], [[diptheria]], [[Lyme disease]], [[myocarditis]], [[pericarditis]], [[septic shock]]
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Musculoskeletal/Orthopedic'''
| |
| |bgcolor="Beige"| [[Muscular dystrophy]], [[myotonic dystrophy]], [[Timothy syndrome]]
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Neurologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Nutritional/Metabolic'''
| |
| |bgcolor="Beige"| [[Hypermagnesemia]], [[metabolic acidosis]]
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Obstetric/Gynecologic'''
| |
| |bgcolor="Beige"| [[Small for gestational age|Very low birth weight infants]]
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Oncologic'''
| |
| |bgcolor="Beige"| [[cardiac tumor#heart in lymphomas|Cardiac lymphoma]], [[cardiac tumor]], [[multiple myeloma]], [[pheochromocytoma]]
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Ophthalmologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Overdose/Toxicity'''
| |
| |bgcolor="Beige"| [[All-trans retinoic acid]], [[amiodarone]], [[barbiturate]], [[digitalis]], [[digoxin]], [[halothane]], [[isoprenaline|isoprenaline infusion]], [[lithium]], [[propanolol]], [[cholinesterase inhibitors]]
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Psychiatric'''
| |
| |bgcolor="Beige"| [[Takotsubo cardiomyopathy]], [[anorexia nervosa|severe anorexia nervosa]]
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Pulmonary'''
| |
| |bgcolor="Beige"| [[Hypoxia]], [[lung transplantation|post lung transplantation]]
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Renal/Electrolyte'''
| |
| |bgcolor="Beige"| [[Acute renal failure]], [[hyperkalemia]]
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Rheumatology/Immunology/Allergy'''
| |
| |bgcolor="Beige"| [[Sjogren's syndrome]], [[scleroderma]]
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Sexual'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Trauma'''
| |
| |bgcolor="Beige"| [[Myocardial rupture]], [[brain damage|severe brain injury]]
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Urologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Miscellaneous'''
| |
| |bgcolor="Beige"| [[Amyloidosis]], [[idiopathic]]
| |
| |-
| |
| |}
| |
|
| |
|
| ===Causes in Alphabetical Order=== | | ==[[Junctional bradycardia causes|Causes]]== |
| {{col-begin|width=80%}}
| |
| {{col-break|width=33%}}
| |
| *[[Acetylcholine]]
| |
| *[[Acute coronary syndrome]]
| |
| *[[Acute renal failure]]
| |
| *[[acute rheumatic fever]]
| |
| *[[All-trans retinoic acid]]<ref name="pmid22778455">{{cite journal| author=McGregor A, Hurst E, Lord S, Jones G| title=Bradycardia following retinoic acid differentiation syndrome in a patient with acute promyelocytic leukaemia. | doi=10.1136/bcr.02.2012.5848 | issue= | journal=BMJ Case Rep | pages= | pmc= | pmid=22778455 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22778455 }} </ref> *[[Amiodarone]]
| |
| *[[Amyloidosis]]
| |
| *[[Andersen cardiodysrhythmic periodic paralysis]]
| |
| *[[Anthracyclines]]
| |
| *[[Antiarrhythmic drugs]]
| |
| *[[Barbiturate]]
| |
| *[[Berberine]]<ref name="pmid23888197">{{cite journal| author=Cannillo M, Frea S, Fornengo C, Toso E, Mercurio G, Battista S et al.| title=Berberine behind the thriller of marked symptomatic bradycardia. | journal=World J Cardiol | year= 2013 | volume= 5 | issue= 7 | pages= 261-4 | pmid=23888197 | doi=10.4330/wjc.v5.i7.261 | pmc=PMC3722425 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23888197 }} </ref>
| |
| *[[Beta-blockers]]
| |
| *[[Brugada syndrome]]
| |
| *[[Bupivacaine]]
| |
| *[[Calcium channel blockers]]
| |
| *[[Carbamazepine]]
| |
| *[[Cardiac catheterization]]
| |
| *[[cardiac tumor#heart in lymphomas|Cardiac lymphoma]]
| |
| *[[Cardiac transplantation]]
| |
| *[[Cardiac tumor]]
| |
| *[[Chagas disease]]
| |
| *[[Cholinesterase inhibitors]]
| |
| *[[Cimetidine]]
| |
| *[[Citalopram]]
| |
| *[[Clonidine]]
| |
| *[[liquid breathing|Cold water immersion apnea]]
| |
| *[[Congenital heart disease]]
| |
| *[[Congestive heart failure]]
| |
| *[[coronary artery bypass grafting]]
| |
| *[[reperfusion injury|Coronary reperfusion therapy]]
| |
| *[[Diabetic ketoacidosis]]
| |
| *[[Digoxin]]
| |
| *[[Dilated cardiomyopathy]]
| |
| *[[Diltiazem]]
| |
| *[[Diphenhydramine]]
| |
| *[[Diptheria]]
| |
| *[[Donepezil]]
| |
| *[[Edrophonium]]
| |
| *[[Emery-Dreifuss muscular dystrophy]]
| |
| *[[Fontan procedure]]
| |
| *[[Granisetron]]
| |
| {{col-break|width=33%}}
| |
| *[[Grayanotoxin]]
| |
| *[[Guanethidine]]
| |
| *[[Halothane]]
| |
| *[[Hashimoto's thyroiditis]]
| |
| *[[Heart surgery]]
| |
| *[[Hemochromatosis]]
| |
| *[[Hyperkalemia]]
| |
| *[[Hypermagnesemia]]
| |
| *[[Hypertensive heart disease]]
| |
| *[[Hypertrophic cardiomyopathy]]
| |
| *[[Hypothermia]]
| |
| *[[Hypoxia]]
| |
| *[[Idarubicin]]
| |
| *[[Idiopathic]]
| |
| *[[regional anesthesia|Infraclavicular brachial plexus block]]
| |
| *[[Ischemic heart disease]]
| |
| *[[Isoprenaline|Isoprenaline infusion]]
| |
| *[[Jervell and Lange-Nielsen syndrome]]
| |
| *[[Limb-girdle muscular dystrophy|Limb-girdle muscular dystrophy type 1B (LGMD1B)]]
| |
| *[[Lithium]]
| |
| *[[Long QT syndrome]]
| |
| *[[Lyme disease]]
| |
| *[[Mepivacaine]]
| |
| *[[Mesalamine]]
| |
| *[[Metabolic acidosis]]
| |
| *[[Methyldopa]]
| |
| *[[Methylprednisolone]]
| |
| *[[Muscular dystrophy]]
| |
| *[[Myocardial infarction]]
| |
| *[[Myocardial rupture]]
| |
| *[[Myocarditis]]
| |
| *[[Myotonic dystrophy]]
| |
| *[[Nelfinavir]]
| |
| *[[Neostigmine]]
| |
| *[[Nicorandil]]
| |
| *[[NSTEMI]]
| |
| *[[organophosphate|Organophosphorus poisoning]]
| |
| *[[parathion|Parathion poisoning]]
| |
| *[[Pericarditis]]
| |
| *[[Phenothiazine]]
| |
|
| |
|
| {{col-break|width=33%}}
| | ==[[Junctional bradycardia differential diagnosis|Differentiating Junctional bradycardia from other Disorders]]== |
| *[[Phenytoin]]
| |
| *[[Pheochromocytoma]]
| |
| *[[spider bite#spider venom|Poisonous spider bites]]
| |
| *[[lung transplantation|Post lung transplantation]]
| |
| *[[Procainamide]]
| |
| *[[hypothyroidism|Profound hypothyroidism]]
| |
| *[[Propafenone]]
| |
| *[[Propanolol]]
| |
| *[[Propofol]]
| |
| *[[pyrethroid|Pyrethroid poisoning]]
| |
| *[[Pyridostigmine]]
| |
| *[[Remifentanil]]
| |
| *[[Reserpine]]
| |
| *[[Romano-Ward syndrome]]
| |
| *[[Ropivacaine]]
| |
| *[[Ropivacaine]]
| |
| *[[Scleroderma]]
| |
| *[[Arizona bark scorpion|Scorpion toxin]]
| |
| *[[septic shock]]
| |
| *[[anorexia nervosa|Severe anorexia nervosa]]
| |
| *[[brain damage|Severe brain injury]]
| |
| *[[Sick sinus syndrome]]
| |
| *[[Sinus arrest]]
| |
| *[[Sinus bradycardia]]
| |
| *[[Sinoatrial arrest|Sinus node fibrosis]]
| |
| *[[Sjogren's syndrome]]
| |
| *[[STEMI]]
| |
| *[[Tachycardia-bradycardia syndrome]]
| |
| *[[Tacrine]]
| |
| *[[Takotsubo cardiomyopathy]]
| |
| *[[Thiamylal]]
| |
| *[[tilt table testing|Tilt testing]]<ref name="pmid22427080">{{cite journal| author=Zyśko D, Gajek J, Agrawal AK, Rudnicki J| title=[The relevance of junctional rhythm during neurocardiogenic reaction provoked by tilt testing]. | journal=Kardiol Pol | year= 2012 | volume= 70 | issue= 2 | pages= 148-55 | pmid=22427080 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22427080 }} </ref>
| |
| *[[Timolol]]
| |
| *[[Timothy syndrome]]
| |
| *[[Timothy syndrome]]
| |
| *[[Tricyclic antidepressants]]
| |
| *[[Urapidil]]
| |
| *[[Valvular heart disease]]
| |
| *[[Verapamil]]
| |
| *[[Small for gestational age|Very low birth weight infants]]
| |
| {{col-end}}
| |
|
| |
|
| ==Epidemiology and Demographics== | | ==[[Junctional bradycardia epidemiology and demographics|Epidemiology and Demographics]]== |
| ===Age===
| |
| Benign junctional rhythms are common during sleep in both children and athletic young adults.
| |
|
| |
|
| ===Gender=== | | ==[[Junctional bradycardia risk factors|Risk Factors]]== |
| Males and females are affected equally.
| |
|
| |
|
| ==Natural History, Complications and Prognosis== | | ==[[Junctional bradycardia natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| The natural history and prognosis of the disease depends upon the underlying cause that triggered the junctional escape rhythm.
| |
| A [[junctional escape rhythm]] during sleep is benign in children and young adults.
| |
|
| |
|
| ==Diagnosis== | | ==Diagnosis== |
| ===Symptoms===
| | [[Junctional bradycardia history and symptoms|History and Symptoms]] | [[Junctional bradycardia_physical_examination|Physical Examination]] | [[Junctional bradycardia laboratory findings|Laboratory Findings]] | [[Junctional bradycardia electrocardiogram|Electrocardiogram]] | [[Junctional bradycardia EKG examples|EKG Examples]] | [[Junctional bradycardia chest x-ray|Chest X Ray]] | [[Junctional bradycardia echocardiography|Echocardiography]] | [[Junctional bradycardia cardiac MRI|Cardiac MRI]] | [[Junctional bradycardia coronary angiography|Coronary Angiography]] |
| Symptoms are more likely if the atrial rate is faster than the junctional rate (if [[AV dissociation]] or [[complete heart block]] is present) as compared with the scenario whereby the junctional rate is faster than the atrial rate. The following symptoms may be present:
| |
| * [[Dyspnea]]
| |
| * [[Fatigue]]
| |
| * [[Lightheadedness]]
| |
| * [[Palpitations]]
| |
| * [[Presyncope]]
| |
| * [[Reduced exercise tolerance]]
| |
| * [[Syncope]]
| |
| | |
| ===Physical Examination===
| |
| ====Vitals====
| |
| =====Pulse=====
| |
| The [[pulse]] is regular at a rate of 40 to 60 beats per minute.
| |
| | |
| ====Neck====
| |
| * [[Cannon a waves]] may be present if there is delayed atrial contraction against a closed [[tricuspid valve]]
| |
| | |
| ===Laboratory Findings===
| |
| Based upon the patient's history and demographics, consideration should be given to checking the following:
| |
| * [[Digoxin]] levels
| |
| * [[Lyme titers]] in patients where the disease is endemic
| |
| | |
| ===Electrocardiography===
| |
| A 12 lead EKG should be obtained to evaluate the rhythm. In so far as it may alter treatment, any co-existing rhythm disturbance that may have precipitated junctional bradycardia should be ascertained such as:
| |
| | |
| * [[AV dissociation]]
| |
| * [[Complete heart block]]
| |
| * [[Digitalis toxicity]]
| |
| * [[Sinus arrest]]
| |
| * [[Sinus bradycardia]]
| |
| * [[ST elevation MI]]
| |
| | |
| * The rate is 40-60 beats per minute.
| |
| * The rate is generally regular.
| |
| * The [[QRS]] complex is narrow.
| |
| * [[Retrograde p waves]] may be present due to retrograde conduction from the AV node. The p waves will be inverted in leads II and III.
| |
| * The [[p wave]] may be buried within the [[QRS]] complex and may not be discernable.
| |
| * A slow [[AV nodal reentry tachycardia]] ([[AVNRT]]) should be excluded.
| |
| | |
| ===EKG Examples===
| |
| Shown below is an EKG with a nodal escape rhythm. Note the lack of P or [[P' wave]]s. Often the P' wave is hidden in the QRS as the nodal escape conducts down to the ventricle and up to the atrium in a fashion such that the QRS and P' wave occur simultaneously.
| |
| | |
| [[File:Nodal escape rhythm1.jpg|center|500px]] | |
| | |
| Copyleft images obtained courtesy of ECGpedia, http://en.ecgpedia.org.
| |
| ----
| |
| | |
| Example of junctional escape rhythm / junctional bradycardia on telemetry:
| |
| | |
| {{#ev:youtube|S2xnOJfZOPI}}
| |
| | |
| ===Holter / Cardiac Event Monitoring===
| |
| A cardiac event monitor may be helpful in patients with transient symptoms or [[palpitations]] to exclude other rhythms such as [[ventricular tachycardia]].
| |
| | |
| ===Electrophysiologic Studies===
| |
| * There is normal conduction in the [[His bundle]], and the His-ventricular interval is normal.
| |
| * Preceding each [[QRS]], there should be a [[His bundle]] depolarization
| |
| * AV conduction is variable
| |
| * VA conduction is variable
| |
|
| |
|
| ==Treatment== | | ==Treatment== |
| ===Acute Management===
| | [[Junctional bradycardia medical therapy|Medical Therapy]] | [[Junctional bradycardia electrical cardioversion|Electrical Cardioversion]] | [[Junctional bradycardia ablation|Ablation]] | [[Junctional bradycardia surgery|Surgery]] | [[Junctional bradycardia primary prevention|Primary Prevention]] | [[Junctional bradycardia secondary prevention|Secondary Prevention]] | [[Junctional bradycardia cost effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Junctional bradycardia future or investigational therapies|Future or Investigational Therapies]] |
| * Avoid drugs that suppress the [[AV node]] as the junctional bradycardia may be the patient's only escape rhythm
| |
| * Treat symptomatic [[digitalis toxicity]] with [[atropine]] and [[digoxin immune Fab]] ([[Digibind]])
| |
| ===Asymptomatic Patients===
| |
| *Among healthy patients with heightened [[vagal tone]], no treatment is necessary
| |
| | |
| ===Symptomatic Patients===
| |
| * Permanent pacemaker placement in indicated in symptomatic patients with:
| |
| :* [[Complete heart block]]
| |
| :* High grade [[AV block]]
| |
| :* [[Sick sinus syndrome]]
| |
|
| |
|
| ==References== | | ==Case Studies== |
| {{Reflist|2}}
| | [[Junctional bradycardia case study one|Case #1]] |
|
| |
|
| ==Related Chapters== | | ==Related Chapters== |
| Line 384: |
Line 39: |
| * [[Junctional tachycardia]] | | * [[Junctional tachycardia]] |
|
| |
|
| | |
| | [[Category:Disease]] |
| | [[Category:Electrophysiology]] |
| [[Category:Cardiology]] | | [[Category:Cardiology]] |
| [[Category:Electrophysiology]]
| |
| [[Category:Arrhythmia]] | | [[Category:Arrhythmia]] |
| | [[Category:Emergency medicine]] |
| | [[Category:Intensive care medicine]] |
| | [[Category:Best pages]] |
| | [[Category:Up-To-Date cardiology]] |
| | [[Category:Up-To-Date]] |
| | |
| | |
| | {{WikiDoc Help Menu}} |
| | {{WikiDoc Sources}} |