Drug treatment and dosage of choice for symptomatic bradycardia

Full Answer Section

    Why does this patient probably have bradycardia? There are many possible causes of bradycardia, but the most likely cause in this patient is vagal stimulation. Vagal stimulation is a reflex that occurs when the vagus nerve is stimulated. The vagus nerve is a large nerve that travels from the brain to the heart and other organs. When the vagus nerve is stimulated, it slows down the heart rate. Vagal stimulation can be caused by a number of things, including:

• Bowel movements
• Urination
• Coughing
• Vomiting
• Straining

In this patient, the bradycardia likely occurred as a result of vagal stimulation from the bowel movement. Does this dysrhythmia need treatment? Why or why not? What intervention would you implement first? Whether or not this dysrhythmia needs treatment depends on the patient's symptoms and the underlying cause. If the patient is asymptomatic, or has only mild symptoms, treatment is typically not necessary. However, if the patient is experiencing severe symptoms, such as hypotension, decreased oxygen saturation, lightheadedness, dizziness, or syncope, treatment is necessary. The first intervention that should be implemented is to remove the underlying cause of the bradycardia. In this case, the patient should be assisted with completing the bowel movement as quickly as possible. If the patient's symptoms are severe, or do not improve with removal of the underlying cause, further treatment may be necessary. Drug treatment and dosage of choice for symptomatic bradycardia The drug treatment of choice for symptomatic bradycardia is atropine. Atropine is a medication that blocks the effects of the vagus nerve. This results in an increase in heart rate. The dosage of atropine that is used depends on the patient's weight and the severity of their bradycardia. A typical starting dose is 0.5 mg. If the patient's symptoms do not improve after the initial dose, additional doses of atropine can be given. How does atropine increase heart rate? Atropine blocks the effects of the vagus nerve on the heart. The vagus nerve releases acetylcholine, a neurotransmitter that slows down the heart rate. By blocking the effects of acetylcholine, atropine increases the heart rate. Conclusion Bradycardia is a common dysrhythmia that can be caused by a number of things. The most likely cause of bradycardia in a 60-year-old male patient who becomes short of breath and diaphoretic while having a bowel movement is vagal stimulation. Treatment for bradycardia is typically not necessary unless the patient is experiencing severe symptoms. If treatment is necessary, the drug treatment of choice is atropine. Atropine increases heart rate by blocking the effects of the vagus nerve.  

Sample Solution

   

• Hypotension: Bradycardia can lead to hypotension, or low blood pressure, because the heart is not pumping enough blood to the body.
• Decreased oxygen saturation: Bradycardia can also lead to decreased oxygen saturation, or a low level of oxygen in the blood. This is because the heart is not pumping enough blood to the lungs to be oxygenated.
• Lightheadedness or dizziness: Bradycardia can cause lightheadedness or dizziness because the brain is not receiving enough blood and oxygen.
• Syncope (fainting): In severe cases, bradycardia can cause syncope, or fainting.