Cardiovascular Critical Care I

Type

ECG Example

Description

Junctional

rhythm

Manifested when sinus node dysfunction

allows the AV node to take over as the

active cardiac pacemaker, resulting in

retrograde conduction through the atria

Management of bradyarrhythmias includes three principal strategies (see also Figure 8). Stabilize the

patient, if symptomatic.

Consider atropine for temporary correction to decrease vagal tone. Note that the recommended

dose of atropine is 1 mg, which can be given every 3–5 minutes for a maximum of 3 mg.

Consider pacing strategies (temporary transvenous pacer, transcutaneous pacer, pacing pulmonary

artery catheter). Interrogate permanent pacemaker for malfunction/optimization.

Consider chronotropic β-agonist infusion.

Dopamine

ii.

Epinephrine

iii.

Isoproterenol

iv.

Dobutamine (if blood pressure normal or elevated)

Disease 2011:xiv; BMJ 2002;324:662-5; BMJ 2002;324:415-8) (continued)