Medical Specialty >> Cardiology

Doctors Lounge - Cardiology Answers

Back to Cardiology Answers List

If you think you may have a medical emergency, call your doctor or 911 immediately. Doctors Lounge (www.doctorslounge.com) does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site. 

DISCLAIMER: The information provided on www.doctorslounge.com is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician. Please read our 'Terms and Conditions of Use' carefully before using this site.

Date of last update: 10/20/2017.

Forum Name: Arrhythmias

Question: bradycardia with stroke like symptoms


 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!!!!
 Dr.M.Aroon kamath - Sun Jun 27, 2010 11:15 pm

User avatar 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!

| Check a doctor's response to similar questions

Are you a Doctor, Pharmacist, PA or a Nurse?

Join the Doctors Lounge online medical community

  • Editorial activities: Publish, peer review, edit online articles.

  • Ask a Doctor Teams: Respond to patient questions and discuss challenging presentations with other members.

Doctors Lounge Membership Application

Tools & Services: Follow DoctorsLounge on Twitter Follow us on Twitter | RSS News | Newsletter | Contact us