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Related Concept Videos

Decreased pulse rate01:14

Decreased pulse rate

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Bradycardia is a medical condition in which the heart rate is slower than normal. It occurs when the heart's natural pacemaker, the sinus node, generates slower electrical impulses than the standard rhythm. In adults, bradycardia is diagnosed when the pulse rate falls below 60 beats per minute, indicating a deviation from the normal heart rate range.
There are specific risk factors that can elevate the likelihood of developing bradycardia. Advanced age is a significant factor, with...
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ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias01:25

ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias

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Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...
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Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

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Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
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Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers01:24

Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers

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Adrenergic stimulation generally impacts cardiac rate and rhythm. Specifically, stimulation of the β-adrenoceptors triggers an increase in intracellular calcium ion influx and pacemaker currents, which may cause arrhythmias. Catecholamines like adrenaline also demonstrate β2-adrenoceptor-mediated hypokalemia, impacting cardiac action potential and disrupting the normal cardiac rhythm. Class II antiarrhythmic drugs are β-adrenoceptor antagonists or β-blockers, which...
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Dysrhythmias IV: Characteristics of Bradyarrhythmias01:18

Dysrhythmias IV: Characteristics of Bradyarrhythmias

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Bradyarrhythmias are cardiac rhythm disorders characterized by a slower-than-normal heart rate, typically defined as fewer than 60 beats per minute. Some of which are discussed here:Sinus BradycardiaSinus bradycardia presents a heart rate lower than 60 beats per minute, with a regular rhythm originating from the SA node. The ECG typically shows normal P waves preceding each QRS complex, a normal PR interval (0.12 to 0.20 seconds), and a normal QRS duration (0.06 to 0.10 seconds).First-Degree AV...
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Hazard Ratio01:12

Hazard Ratio

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The hazard ratio (HR) is a widely used measure in clinical trials to compare the risk of events, such as death or disease recurrence, between two groups over time. It reflects the ratio of hazard rates—the instantaneous risk of the event occurring—between a treatment group and a control group. This measure provides valuable insights into the relative effectiveness of a treatment by assessing how the risk of an event differs between the two groups.
For example, in a clinical trial...
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Ticagrelor and bradycardia: a nested case-control study.

Ricky D Turgeon1, Kimberly A Fernandes2, David Juurlink2,3

  • 1Department of Pharmacy, Vancouver General Hospital, Vancouver, BC, Canada.

Pharmacoepidemiology and Drug Safety
|October 9, 2015
PubMed
Summary
This summary is machine-generated.

Ticagrelor use was not linked to increased bradycardia hospitalizations in older acute coronary syndrome patients compared to clopidogrel. This real-world study found no significant association between ticagrelor and bradycardia risk.

Keywords:
acute coronary syndromebradycardiaclopidogrelmyocardial infarctionp2y12 inhibitorpharmacoepidemiologyticagrelor

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Area of Science:

  • Cardiology
  • Pharmacology
  • Real-world evidence studies

Background:

  • Ticagrelor is known to increase adenosine levels, potentially slowing cardiac conduction and causing bradycardia.
  • Clinical trials and case reports suggest a possible link between ticagrelor and bradyarrhythmias, necessitating further investigation.

Purpose of the Study:

  • To investigate the association between ticagrelor use and hospitalization for bradycardia in older adults following an acute coronary syndrome.
  • To compare the risk of bradycardia hospitalization with ticagrelor versus clopidogrel in a real-world setting.

Main Methods:

  • A population-based, nested case-control study was conducted using Ontario healthcare databases.
  • Older patients (≥66 years) hospitalized for bradycardia after an acute coronary syndrome were identified as cases.
  • Each case was matched with four controls who were also prescribed a P2Y12 inhibitor, with ticagrelor exposure assessed within 90 days prior to the index date.

Main Results:

  • The study included 140 cases and 560 controls between April 2012 and March 2014.
  • No statistically significant association was found between ticagrelor use and hospitalization for bradycardia compared to clopidogrel (adjusted odds ratio: 1.06, 95% CI: 0.65-2.21).
  • Adjustments for potential confounders did not alter the finding of no significant association.

Conclusions:

  • In older patients with a first acute coronary syndrome, ticagrelor use was not associated with an increased risk of bradycardia hospitalization compared to clopidogrel.
  • These real-world findings suggest that ticagrelor can be used safely in this patient population regarding bradycardia risk.