18 YO sinus bradicardia anigma

[MSDeltaFlt]

So, the kid comes back with some checks done and after he saw a cardiologist:
all heart enzymes came back normal, CPK, Troponin the works.
the blood test for Q-fever, which is my comending MD main guess of what cause this, hav'nt come back yet.
he was hopitalized for suspected URTI.

the cardiologist said that the kid was a 10 years basketball player and still is an athlete, the extreme bradi is normal because his pulse rises while exercising.



Personaly and with all due respect I really having a hard time accepting HR of 36 as normal. I've know that HR's of athlets is low, I can accept HR's of 50-40 but, 36 is 4 beats too low for not getting me high alert on the Pt.

What cause this will probably remain a mystery for us, I dont belive it's normal baketball-player HR.
maybe Q-fever will be it...who knows

p.s I didnt mange to get the ECG.

Cardiologist, remember he/she is a specialist with a lot more knowledge and trading than we have, wasn't saying it was normal. I'm taking this as that rate might not be all that abnormal for this particular patient. I've seen heart rates that low in extremely healthy pts with pleuritic pain. Those pts were in a benign state and everybody got tunnel vision And panicked. Never say never. Never say always. Assess your patient with an open mind and look at the big picture and you'll be amazed at what you'll find and learn.

 

[usafmedic45]

Personaly and with all due respect I really having a hard time accepting HR of 36 as normal. I've know that HR's of athlets is low, I can accept HR's of 50-40 but, 36 is 4 beats too low for not getting me high alert on the Pt.

Nice to know that I would have gotten a lights and sirens transport from you. I used to have a resting heart rate in the upper 30's when I was training for a marathon. It used to also freak out people that would take my vitals because I also ran a very low BP (80/70 was not unusual). I've met several people with resting heart rates in the low 30s or even upper 20s.

Tal, you are absolutely correct. A heart rate of 36 is not normal. As medics, we are never in a position to make a diagnosis of any brady less than 50, much less 40 bpm as normal under any circumstances. Basic ventricular rate is 20 to 40 and indicates nodal dysfunction. To not refer this patient to a cardiologist violates a basic standard of care.

Unless the patient knows their body and tells you "That's normal for me". With most endurance athletes, this is case, just like how most diabetics can tell you where they normally run in terms of their blood glucose levels. I once had a paramedic student try to give me atropine after I was shown on the monitor at 48 with "chest pain". I told him he would be having that prefill removed from his rectum if he even tried it. It's normal to have chest pain after broken ribs from being kicked in the chest by a horse after all.

So, the cardiologist was fine with this...OK. They ran a battery of tests to rule out pathology. I'm sure that the cardiologist would not have blown this kid off with only a field exam and assessment. Unfortunately, many medics take on a completely inappropriate cavalier attitude that can kill patients. If one believes that this is not an issue, they really need to go in for retraining.

Ever heard of defensive medicine? Chances are the doc didn't suspect there was anything wrong and was simply covering his ***. It doesn't sound like they did a "battery of tests" beyond what anyone walking in with vague potentially cardiac symptoms would have gotten.

 

[Aidey]

Nice to know that I would have gotten a lights and sirens transport from you. I used to have a resting heart rate in the upper 30's when I was training for a marathon. It used to also freak out people that would take my vitals because I also ran a very low BP (80/70 was not unusual). I've met several people with resting heart rates in the low 30s or even upper 20s.

I had all sorts of fun when I was admitted to the hospital last year. My vitals run low normally, and I was stuck in bed on a morphine PCA. I have sinus arrhythmia, and had a rate of 44-64 and a BP in the 80s. Every time someone checked my vitals I had to tell them it was perfectly normal.