BRADYCARDIE SINUSALE:
CLINICAL SIGNS:
* heart rate, regular , frequency less than 50 / min.
* no functional signs, very rarely lipothymia.
ETIOLOGY:
* sinus bradycardia of sport or vagotonic subjects: the pace accelerates with the effort.
* Impregnation, overdose or intoxication with any negative chronotropic drug.
* vagal reflex, coronary artery disease, degeneration of the sinus node.
* hypothyroidism.
ADDITIONAL TESTS:
* ECG : There are as many P waves as QRS.
* scope.
* blood ionogram: look for hypokalemia.
TREATMENT:
* most often, withdrawal of a chronotropic drug or dromotropic negative.
* if symptomatic:
– venous route: G5%, oxygen therapy in the mask.
– Atropine : 0.5 to 1 mg IV, IM or SC.
– if QT long or if hypokalemia : hospitalization, Isuprel: 5 ampoules in G5%.
SINO-AURICULAR BLOCK:
CLINICAL SIGNS:
* none or syncope type Adams-Stokes.
ETIOLOGY:
* Lower IDM.
* taking digitalis, quinidine, betablocker, calcium antagonist.
* Idiopathic especially in the elderly person.
ADDITIONAL TESTS:
* ECG :
– most often intermittent.
– absence of P wave.
– Absence of QRS wave: complete pause then escape rhythm at QRS fine if atrial or junctional response, at QRS wide if ventricular response.
* scope, SpO².
* blood ionogram.
TREATMENT:
* none except stopping negative dromotropic drugs.
* so serious:
– venous route: G5%, oxygen therapy in the mask.
– Atropine : 0.5 to 1 mg IV, IM or SC.
– Isuprel if QT long or if hypokalemia .
– artificial stimulation.
SINUSAL STOP:
CLINICAL SIGNS:
* syncope.
ADDITIONAL TESTS:
* ECG : disappearance of P waves and QRS.
* scope.
TREATMENT:
* if symptomatic:
– venous route: G5%, oxygen therapy in the mask.
– Atropine : 0.5-1 mg IV, IM or SC but often not very effective.
– if failure or if QT long or if hypokalemia : Isuprel, 5 bulbs protected from light in 250 ml G5% while waiting for the pacemaker.
* if iatrogenic bradycardia: remove the drug in question.
