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Doctors Lounge - Cardiology Answers
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| kwestbrook59
- Sun Jun 06, 2010 11:50 pm |
|
I was recently taken to the ER with what appeared to be a stroke. Upon arrival I was given Ativan and the symptoms subsided slowly. I was admitted and had a series of multiple tests ran including, MRI and MRA of brain, Full body CAT scan, several EKG's, EEG, lab work, Carotid doppler, and CT of spine. I was placed on a telemetry and it was discovered that I now have bradycardia with heart rates of 28 to 48 at rest and with activity. I was then transferred to a specialized cardiac unit where they performed a arteriogram with no significant findings other than the bradycardia. This is the 2nd episode in 8 years of this and the symptoms were almost identical each time. The only difference is that this time, I responded quicker to the Ativan. However, this time, I was also 30 minutes closer to the ER.
I am so frustrated about this and cannot get a diagnosis of anything.
Prior to this, I had been having severe back pain, heaviness in my left leg and arm, headaches and extreme fatigue.
I just don't know where else to turn!!!!
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| Dr.M.Aroon kamath
- Sun Jun 27, 2010 11:15 pm |
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 Hi,
The clinical presentation of bradycardias may range from the totally asymptomatic to those with very fleeting & minor symptoms.The more severely symptomatic ones can cause symptoms such as
- dizziness,
- falls,
- fainting episodes,
- confusion,
- palpitations,
- exertional fatigue,and
- chest pain.
Common pathological conditions that cause bradycardia are Sinus node dysfunction(sick sinus syndrome), atrio-ventricular block or a combination of the two.
Sinus node dysfunction (SND): a collective name given to a number of disorders which manifest as significant brady-arrhythmias such as
- chronotropic incompetence,
- sinus arrest/pause,
- sinoatrial exit block, and
- sinus bradycardia.
Fundamentally, SND can be
- intrisic (age related abnormalities in sinus node impulse formation and conduction),or
- extrinsic (due to causes outside the heart).
Intrinsic sick sinus syndrome is an irreversible dysfunction of the S-A node (sino-atrial node),due to a chronic fibrotic degeneration or calcification in/or around it.
Atrioventricular block(A-V block) is due to a failure in the conduction of electrical impulses from the atria to the ventricles usually caused by conduction defects at the AV node, bundle of His and/or bundle branches. Classified as
first- degree,second-degree or third -degree A-V block. Partial A-V blocks can be asymptomatic but, carry a high risk of progression to complete block.
Diagnosis: of sick sinus syndrome and A-V block is based on
- the symptoms,
- electrocardiographic findings [EKG],&
- ambulatory ECG (Holter monitoring).
Prognosis: is difficult to predict and variable because it depends on the presence or absence as well as severity of co-morbid conditions(notably ischaemic heart disease) and main underlying cause of the conduction defect.
Pacemakers may be indicated for use in the treatment of symptomatic bradycardias.This can be
- intermittent pacing or
- continuous pacing
Difficulties in diagnosing/finding a cause:
- intermittent, at times fleeting nature of the episodes( even while on a 24-hour ambulatory Holter monitoring out of hospital, episodes lasting <1 minute and not causing symptoms may not be reported),
- multi-factorial etiology in some cases,
- very rare causes( inherited genetic defects),
- due to adverse effects of drugs(especially in polypharmacy), etc.
Intracardiac electrophysiologic testing (premature atrial stimulation/atrial overdrive pacing) is a controversial option.These are no longer routinely recommended (risks,their poor sensitivity and specificity).
I hope you will find this information useful.
Best wishes!
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