We discussed a case about an older man with smoking history, who presented with acute exertional dizziness + fatigue + diaphoresis + nausea + presyncope, found to have symptomatic bradycardia due to 3rd degree heart block.

SYNCOPE FRAMEWORK

ACLS ADULT BRADYCARDIA ALGORITHM

• In 2020, there was an update that recommended the 1st dose of Atropine given be 1mg (instead of 0.5mg) q3-5 min for a max of 3 mg.

PERMANENT PACEMAKER PLACEMENT INDICATIONS
FIRST, RULE OUT ALL REVERSIBLE CAUSES!

1. Symptomatic bradycardia due to sinus node dysfunction
2. Permanent afib & symptomatic bradycardia
3. Alternating bundle branch blocks
4. Asymptomatic high-degree AV block, 2nd degree Mobitz type 2 block, or 3rd degree block

REFERENCES

• 2018 AHA/ACA guidelines on eval and mgmt. of pts w/ brady & cardiac conduction delay
• 2020 ACLS AHA Pocket Cards