Listen in as I share a case of vasovagal syncope with rapid response guru, Sarah Lorenzini from the Rapid Response RN Podcast, in which my patient had a syncopal episode while on telemetry. We discuss what the telemetry strip looked like, why atropine might not have been the best intervention for this patient and some of the treatment options for bradycardia.
Note: There will not be CEs offered for this episode
Four characteristics of syncope
- Transient LOC
- Loss of postural tone
- Short duration
- Spontaneous recovery
Three categories of syncope
- Reflex Syncope
- Overstimulation of the vagus nerve
- By far the most common type of syncope
- Vasovagal: Emotional stress, severe pain (often intraabdominal), prolonged standing
- Situational: Micturition, defecation, coughing, etc.
- Cardiogenic Syncope
- The cause of syncope arises from the heart
- Arrhythmias: bradycardia, SVT, heart blocks
- Mechanical: cardiomyopathies, valvular disease, massive PE
- Orthostatic Syncope
- A preciptous drop of blood pressure when standing
- Can be caused by hypovolemia, medication side effects, or autonomic dysfunction
ACLS Algorithm for Symptomatic Bradycardia
Atropine for Symptomatic Bradycardia
In the ACLS algorithm for symptomatic bradycardia, atropine is the first line medication. Atropine inhibits the parasympathetic nervous system by blocking the vagus nerve causing the SA node to increase its rate of electrical discharge.
Atropine will not be effective for 2nd and 3rd degree heart block because there is a partial or full block between the SA node and the ventricles. Thus, and increase in firing of the SA node will not necessarily change the status of the ventricles.
Further, new onset 2nd and 3rd degree heart blocks are often associated with mycardial ischemia. Atropine is contraindicated for MIs because an increased HR will decrease diastolic filling and decrease coronary perfusion.
Pacing for Symptomatic Bradycardia
Moving along the ACLS algorithm, after medications and before expert consultation you will see transcutaneous and transvenous pacing.
These are temporary measures that are taken if bradycardia is refractory to medications and the underlying cause has not been addressed.