Treatment of Sinus Bradycardia (Nursing)

00:01 Hi, welcome to our video series on electrocardiogram.

00:05 We're going to talk about the treatment for sinus bradycardia.

00:08 Now, remember, sinus bradycardia is like a really slow version of sinus rhythm.

00:14 So the heart rate is less than 60, the rhythm is still regular.

00:18 You have a P wave before every QRS, the PR interval is normal 0.12 to 0.20, and the QRS is less than 0.12.

00:31 So here's a question for you. Take a look at the monitor.

00:34 Note the heart rate, the blood pressure, and then you've got the respiratory sat.

00:39 So what do you think? Does this patient require treatment? Pause the video, write yourself some notes.

00:47 Commit to your answer. Write yourself some quick notes, and we'll come back and walk through the possible answers.

01:00 Alright, let's go back to that monitor.

01:02 You know those numbers can seem kind of scary.

01:05 We know sinus rhythm is at least 60. And look at that heart rate, that is definitely lower than 60.

01:12 Textbook normal blood pressure is 120/80 that blood pressure is lower than normal blood pressure.

01:20 Now, the bottom number is the SAT.

01:22 That we're kind of comfortable with.

01:24 But it's those other two numbers, I really want you to think about.

01:27 How do we know if this patient requires treatment for their sinus bradycardia? Well, here's a caveat.

01:34 I want you to think about, people with sinus bradycardia can be a sign of health.

01:40 So if you have a higher level of cardiovascular fitness, you have a very efficient cardiovascular system.

01:47 Yeah, you're the one in the gym on the stairmaster acting like you're having fun while I'm dying.

01:55 But see, their systems may support their body's needs with a lower heart rate, and a lower blood pressure.

02:02 So, how do we know for sure if treatment is needed or not? Aha, that's up to you. That's what a nurse will do.

02:10 You look at what the normal heart rate and blood pressure is for the patient.

02:14 You ask them if they feel dizzy, or weak, or lightheaded.

02:18 You're assessing for them to be symptomatic with this sinus bradycardia or to see, if they're being perfused adequately.

02:26 I've actually had patients with lower vital signs than this.

02:29 And they were absolutely fine.

02:31 They just had incredible cardiovascular systems.

02:35 So treatment for sinus bradycardia is only needed if the patient is symptomatic.

02:42 You'll see if you can recall what would be the symptoms somebody would be need to be treated for with sinus bradycardia.

02:49 Well, it would be, well below their normal blood pressure.

02:54 They would feel dizzy, or lightheaded, or maybe even nauseated.

02:58 So nurses will assess the patient for signs or symptoms that say this patient is not receiving adequate oxygen to the tissues.

03:07 Oh, whoa, whoa, wait a minute, what number up there would tell us that? Look at the bottom one that tells us the SB O2.

03:14 That's a fairly good indicator that this patient is doing, okay.

03:19 Okay, sometimes in videos and teaching and in class, we go through signs and symptoms pretty quickly.

03:26 But one skill I've picked up in helping me study is that when I'm looking at a list of signs and symptoms, if I can picture someone in my mind that's experiencing all these.

03:38 So meet Bill. Here he is.

03:40 Bill needs some help.

03:43 His bradycardia is not normal for him, his blood pressure is too low, and he's suffering from hypoxemia.

03:50 So instead of being like our marathon runner who's fit and ready to go, Bill is really feeling the effects of bradycardia.

03:58 So, he's feeling like he's going to faint and Bill's a pretty big guy. I'm afraid.

04:02 I'm going to have him faint on me.

04:04 So, I want to get him safely to a place where he won't hurt himself.

04:09 He also said he's feeling dizzy and lightheaded and just has been feeling very tired today.

04:15 Now, as he's talking to me, he could be really short of breath and tell me that his chest is starting to hurt.

04:25 Again, that's an oxygen delivery problem.

04:28 As I'm asking him more questions, he might seem confused and not be able to think clearly.

04:34 And there's no way I could walk Bill from that chair over to the bed, because I can tell he would tire out with even a short walk that small amount of physical activity.

04:47 Now, what are the possible causes that got Bill into trouble? Well, he may have some heart tissue damage related to aging.

04:56 He might have damaged a heart tissue from heart disease or heart attack.

05:00 And Bill may not even be aware that he had a heart attack.

05:03 He might have some heart disorder that was present at birth, he has some type of congenital defect, he has infection of his heart tissue called myocarditis, or a complication of heart surgery.

05:16 So we've got a big long list here.

05:19 I don't know about you, but about option two and a half, I start to take a nap.

05:23 My brain can't remember all those things.

05:27 So here's what I would recommend for you to do when you're studying.

05:30 Let's look at those causes of sinus bradycardia.

05:34 What do they have in common? Ah, easy.

05:39 The heart has been damaged in some way. Right? So damage related to aging, that's unfortunate.

05:45 Damage related to heart disease or heart attack, heart disorder at birth, infection of the tissue, complication of heart surgery.

05:54 So, would I be able to remember, 1, 2, 3, 4, 5 things? Not likely.

05:59 Short term memory is really tough to move to working memory for me to get it into long-term memory.

06:06 So I'm going to look at, ah...

06:09 a possible cause of sinus bradycardia could be damage to the heart.

06:14 Now, we've got some other ones look, the list keeps going on.

06:19 If you have hypothyroidism, that's an under active thyroid gland.

06:25 Those patients will have a very slow heart rate.

06:29 You get an imbalance of chemicals in your blood, such as potassium or calcium.

06:34 You can have a repeated disruption of breathing during your sleep that's called obstructive sleep apnea.

06:41 You also can have an inflammatory disease like rheumatic fever or lupus.

06:46 And finally, keep in mind, medication.

06:50 Some of the drugs for other heart rhythm disorders, and for high blood pressure can cause sinus bradycardia.

06:57 So for example, if we are using a beta-blocker, anything a drug does, well. It can do overwhelm, and that could lead to a sinus bradycardia.

07:08 Also, some of the specific psych medications could cause bradycardia.

07:13 Well, we have it again, right? We have a list.

07:17 I want you to pause the video and look for ways that you can chunk information together, so it will make sense in your brain.

07:25 Don't memorize a list.

07:27 Look for ways that you can chunk information together, so it makes sense to you.

07:33 Okay, so let's talk about our friend the SA or sinoatrial node.

07:37 Remember, the impulse starts in the SA node, which is known as the pacemaker of the heart, and it travels to the AV node.

07:45 Now stop and look at the picture.

07:47 Do you see it starting in the SA node? Do you see it moving through to the AV node? Good deal.

07:54 Sinus bradycardia happens when the electrical signals are slowed down or blocked.

08:00 So that's what sinus brady is. Still starting in the SA node, but the signals are slowed down or blocked.

08:09 and that's why you have the slower heart rate.

08:12 So sinus node problems are a cause of sinus brady.

08:16 I want you to think of three major ways the SA node can be involved in sinus bradycardia or start with a sinus node.

08:25 The first one is, the SA node just discharges electrical impulses slower than normal.

08:31 The second one, the SA node pauses, or it fails to discharge at a regular rate.

08:37 And the third one, the SA node discharges an electrical impulse that is blocked before the atria can contract.

08:45 Okay, so the first two seem kind of similar, right? Either it's coming slower than normal, or it pauses or fails to discharge at a regular rate.

08:55 Those two I think we can safely chunk together.

08:58 And the last one is there some type of block.

09:02 Another cause of bradycardia are heart blocks.

09:05 Here's an animation of a first degree AV block for example.

09:09 As mentioned previously, the role of the AV node is to delay the impulse coming from the SA node.

09:16 In cases, of first degree heart block, this is exacerbated or made worse.

09:21 So the delay is prolonged which causes a long PRI as seen in the animation.

09:27 This causes bradycardia.

09:30 So let's get back to Bill. What are our options for him? Well, we consider medication like atropine.

09:37 That's an anti-muscarinic drug.

09:40 That is gonna speed Bill's heart rate up because remember, Bill is symptomatic.

09:46 He is not feeling it. He's so tired, dizzy and weak.

09:51 We also might consider a pacemaker.

09:53 Now we've got two options for pacemaker.

09:55 If we think that Bill is going to need this for a period of time, we can start with an external pacemaker.

10:01 So you just put pads on the patient's chest and hook them up to a machine that will deliver electrical impulses to keep the heart stimulated at a faster rate.

10:10 And then we can plan for procedure by a cardiologist for an implantable pacemaker.

10:17 Now, you look at that we've shown you a picture of what that is.

10:20 It's a small, really small box that they put underneath the skin of the patient, and it remains there can do some really cool stuff.

10:30 You do all different types of pacing.

10:32 One chamber, two chamber does all kinds of things.

10:35 And there are ways that we can keep a really close eye on the patient's heart through monitoring in that pacemaker.

10:42 So those are our options. Medication like atropine.

10:46 but once it wears off, if he's still having the problem, it's not going to fix it long term.

10:52 We can try an external pacemaker to kind of try to get him over the hump.

10:56 But if this is going to be a chronic and long term problem, the physician will place an implantable pacemaker.

11:05 So let's wrap up this part of the video series.

11:08 Remember, sinus bradycardia meets the same criteria as normal sinus rhythm, except that the heart rate is less than 60.

11:16 Sinus bradycardia may not require treatment, unless the patient is symptomatic or hemodynamically unstable.

11:24 Treatment for acute symptomatic bradycardia may include atropine, which is a medication and an external or temporary pacemaker.

11:33 And finally, treatment for chronic symptomatic bradycardia may include an implanted pacemaker in the patient's chest wall.

11:42 Thank you for watching our video series today.