Related Experiment Video

Updated: Aug 9, 2025

Testing Acetylcholine Followed by Adenosine for Invasive Diagnosis of Coronary Vasomotor Disorders
05:58

Testing Acetylcholine Followed by Adenosine for Invasive Diagnosis of Coronary Vasomotor Disorders

Published on: February 3, 2021

3.7K

Bedside Carotid Sinus Massage for Syncope Evaluation With Bifascicular Block and First-Degree Atrioventricular Block

Mashood B Badshah1, Muhammad Hamza Saad Shaukat2, Azar Birlas3

  • 1Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, USA.

Cureus
|February 23, 2023
PubMed

Insights

Symptomatic bifascicular block with reversible high-grade atrioventricular block can cause syncope. Carotid sinus massage is a valuable diagnostic tool for assessing pacemaker implantation needs.

Area of Science:

  • Cardiology
  • Electrophysiology

Background:

  • Symptomatic bifascicular block (BFB) with reversible high-grade atrioventricular block (AVB) is an underrecognized cause of syncope.
  • Management strategies for BFB-associated syncope vary, impacting diagnostic and therapeutic decisions.

Observation:

  • A 79-year-old male experienced recurrent syncope.
  • Initial ECG showed left bundle branch block and first-degree AVB.
  • Bedside carotid sinus massage (CSM) exacerbated the AVB, negating the need for further invasive or prolonged monitoring.

Findings:

  • CSM proved a valuable bedside tool for diagnosing reversible high-grade AVB in the context of BFB.
  • This diagnostic approach influenced the decision for permanent pacemaker (PPM) implantation.

Implications:

  • Highlights the utility of CSM in evaluating syncope secondary to BFB and AVB.
  • Informs appropriate PPM implantation decisions, potentially avoiding unnecessary electrophysiologic studies or long-term monitoring.

Keywords:
atrioventricular blockbifascicular blockcardiac syncopecarotid sinus massagepermanent pacemaker

More Related Videos

Continuous Venous-Arterial Doppler Ultrasound During a Preload Challenge09:32

Continuous Venous-Arterial Doppler Ultrasound During a Preload Challenge

Published on: January 20, 2023

3.5K
Analysis of Cerebral Vasospasm in a Murine Model of Subarachnoid Hemorrhage with High Frequency Transcranial Duplex Ultrasound10:41

Analysis of Cerebral Vasospasm in a Murine Model of Subarachnoid Hemorrhage with High Frequency Transcranial Duplex Ultrasound

Published on: June 3, 2021

3.7K

Related Concept Videos

Dysrhythmias IV: Characteristics of Bradyarrhythmias01:18

Dysrhythmias IV: Characteristics of Bradyarrhythmias

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...
15
Cardiopulmonary Resuscitation IV: Pharmacological Management01:25

Cardiopulmonary Resuscitation IV: Pharmacological Management

Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
60
Dysrhythmias VI: Management of Dysrhythmias01:25

Dysrhythmias VI: Management of Dysrhythmias

Dysrhythmia management involves a multifaceted approach, incorporating pharmacological treatments, medical procedures, surgical interventions, lifestyle modifications, and patient education.Pharmacological ManagementAntiarrhythmic Drugs:Class I (Sodium Channel Blockers): This class includes quinidine and procainamide, which reduce the speed of impulse conduction in the heart, stabilize the cardiac membrane, and control arrhythmias. Quinidine and procainamide are Class IA agents that prolong the...
25
Dysrhythmias V: Evaluating Dysrhythmias01:30

Dysrhythmias V: Evaluating Dysrhythmias

Dysrhythmias, also known as arrhythmias, are disturbances in the heart's rhythm that range from benign to life-threatening. A thorough evaluation is crucial for appropriate management and involves a comprehensive medical history, physical examination, and various diagnostic tests.Medical HistorySymptoms: Collect detailed information on palpitations, dizziness, syncope, chest pain, and fatigue. Note their onset, frequency, and triggers.Previous Cardiac Issues: Document any history of heart...
44
Assessment of apical pulse01:17

Assessment of apical pulse

Assessing the Apical Pulse
Assessing the apical pulse is a critical nursing procedure, particularly indicated for:
1.1K
Dysrhythmias VII: Nursing Management of Dysrhythmias01:25

Dysrhythmias VII: Nursing Management of Dysrhythmias

Nursing management of dysrhythmias involves the following:AssessmentSubjective Assessment:The initial step involves gathering patient-reported symptoms such as dizziness, palpitations, and chest discomfort. It is crucial to collect a detailed history, including previous heart conditions, current medication use, and lifestyle factors like caffeine and alcohol consumption.Objective Assessment:This involves observing clinical signs such as jugular venous distention, cool and pale skin, and...
20