Critical Thinking Clinical Case: 68 Year-Old Man

Case

A 68 year-old man presents with extreme shortness of breath and diaphoresis.  HR 40.  BP 145/98.  With is the approach to treat the patients’ symptoms and bradycardia?

Solution

This is an inferior wall infarction induced bradycardia.  When the inferior wall is involved, it’s the right coronary artery (RCA.)  Is the RCA that feed the AV node also. So, the bradycardia is ischemia induced.  So, this is not an atropine thing. That will be a critical mistake.  

This patient needs either thrombolytics or to go to the cardiac cath lab.  Absolutely needs aspirin and anticoagulation (heparin drip.)