Treatment of asymptomatic bradycardia is -

Ans. is 'a' i.e., No treatment is required o Sinus bradycardia is a rhythm in which fewer than the normal number of impulses arise from the sinoatrial (SA) node.o The normal heart rate has been considered historically to range from 60 to 100 beats per minute, with sinus bradycardia being defined as a sinus rhythm with a rate below 60 beats per minute.Causes of bradycardiaIntrinsicExtrinsicIdiopathic degenerative disorderDrugsIschemic heart diseaseAntiarrhythmic agentsChronic ischemiaClass IA - quinidine, procainamideAcute myocardial infarctionClass IC - propafenone, flecainideHypertensive heart diseaseClass II - b-blockersCadiomyopathyClass IV - diltiazem, verapamilTraumaCardiac glycosidesSurgery for congenital heart diseaseAntihypertensive agentsHeart transplantClonidine, reserpine, methyldopaInflammationAntipsychotic agentsCollagen vascular diseaseLithium, phenothiazines, amitriptylineRheumatic feverAutonomically mediatedPericarditisVasovagal syncope (cardioinhibitory)InfectionCarotid sinus hypersensitivityViral myocarditisHypothyrodismLyme disease (Borrelia burdorfer I)Intracranial hypertensionNeuromuscular disorderHypothermiaFriedreich ataxiaHyperkalemiaX-linked muscular dystrophyHypoxiaFamilial disorder o Treatment is not indicated in asymptomatic patients with sinus bradycardia.o If symptoms are present that are felt to be related to the bradycardia, any potential offending medications should be withdrawn.o Search for a medication that may be depressing sinus node function.# As an example, a beta blocker, nondihydropyridine calcium channel blocker, or sympathetic blocker can be replaced in hypertensive patients with drugs that do not affect SA node function, such as an angiotensin converting enzyme inhibitor.# Long-term pharmacologic therapy is largely ineffective in chronic sinus bradycardia.# Pharmacologic therapy may be important in an acute myocardial infarction when the SA node is depressed by excessive parasympathomimetic activity or possibly ischemia. Treatment is indicated when Sinus bradycardia results in hemodynamic compromise.# In this setting, the SA node rate generally increases after the administration of a vagolytic drug, such as "atropine ".# If symptoms persist, temporary or permanent electrical pacing may be required.