Data-Fusion-Based Quality Enhancement for HR Measurements Collected by Wearable Sensors.

The advancements of Internet of Things (IoT) technologies have enabled the implementation of smart and wearable sensors, which can be employed to provide older adults with affordable and accessible continuous biophysiological status monitoring. The quality of such monitoring data, however, is unsatisfactory due to excessive noise induced by various disturbances, such as motion artifacts. Existing methods take advantage of summary statistics, such as mean or median values, for denoising, without taking into account the biophysiological patterns embedded in data. In this research, a functional data analysis modeling method was proposed to enhance the data quality by learning individual subjects' diurnal heart rate (HR) patterns from historical data, which were further improved by fusing newly collected data. This proposed data-fusion approach was developed based on a Bayesian inference framework. Its effectiveness was demonstrated in an HR analysis from a prospective study involving older adults residing in assisted living or home settings. The results indicate that it is imperative to conduct personalized healthcare by estimating individualized HR patterns. Furthermore, the proposed calibration method provides a more accurate (smaller mean errors) and more precise (smaller error standard deviations) HR estimation than raw HR and conventional methods, such as the mean.

Virtual reality-based simulation learning on geriatric oral health care for nursing students: a pilot study.

BACKGROUND: There is a great need for training and education in the nursing curriculum to improve nurses' knowledge and skills to provide oral health care. METHODS: A pilot study was conducted to evaluate the use of a virtual reality (VR)-based Oral Health Care Learning System to train geriatric oral health care among nursing students. Fifty undergraduate nursing students were randomly assigned to experimental (n = 25) and control (n = 25) groups. The experimental group received the VR-based simulation training on geriatric oral health care and the training was implemented twice at two weeks apart from March to November 2021. The control group did not receive the training intervention. Knowledge, attitude, and self-efficacy of geriatric oral health care as well as the intention to assist oral health care for older adults were assessed at the beginning, second, and fourth weeks. Generalized estimating equations were used to analyze the effectiveness of the VR-based simulation training. RESULTS: After the first round of training, students in the experimental group had significantly greater improvements in knowledge and self-efficacy of geriatric oral health care than in the control group. After the second round of training, students in the experimental group had significantly greater improvements in knowledge, attitude, and self-efficacy of geriatric oral health care as well as the intention to assist oral health care for older adult than in the control group. CONCLUSIONS: The VR-based simulation training was effective to improve undergraduate nursing students' knowledge, attitudes and self-efficacy of geriatric oral health as well as the intention to assist oral health care for older adults. The VR-based simulation learning system is an effective tool to provide practice experiences to build confidence and skills and to bridge the gap of understudied geriatric oral health content in entry-level nursing curricula. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05248542; registration date 21/02/2022).

Decrease in Mobility during the COVID-19 Pandemic and Its Association with Increase in Depression among Older Adults: A Longitudinal Remote Mobility Monitoring Using a Wearable Sensor.

BACKGROUND: Social isolation during COVID-19 may negatively impact older adults' wellbeing. To assess its impact, we measured changes in physical activity and sleep among community-dwelling older adults, from pre-to post-pandemic declaration. METHOD: Physical activity and sleep in older adults (n = 10, age = 77.3 ± 1.9 years, female = 40%) were remotely assessed within 3-month pre-to 6-month post-pandemic declaration using a pendant-wearable system. Depression was assessed pre-and post-pandemic declaration using the Center for Epidemiologic Studies Depression scale and was compared with 48 h continuous physical activity monitoring data before and during pandemic. RESULTS: Compared to pre-pandemic, post-pandemic time spent in standing declined by 32.7% (Cohen's d = 0.78, p < 0.01), walking by 52.2% (d = 1.1, p < 0.01), step-counts by 55.1% (d = 1.0, p = 0.016), and postural transitions by 44.6% (d = 0.82, p = 0.017) with increase in sitting duration by 20.5% (d = 0.5, p = 0.049). Depression symptoms increased by 150% (d = 0.8, p = 0.046). Interestingly, increase in depression was significantly correlated with unbroken-prolong sitting bout (ρ = 0.677, p = 0.032), cadence (ρ = -0.70, p = 0.024), and sleep duration (ρ = -0.72, p = 0.019). CONCLUSION: This is one of the early longitudinal studies highlighting adverse effect of the pandemic on objectively assessed physical activity and sleep in older adults. Our observations showed need for timely intervention to mitigate hard to reverse consequences of decreased physical activity such as depression.

Critical care nurses' clinical reasoning about physiologic monitor alarm customisation: An interpretive descriptive study.

AIMS AND OBJECTIVES: To explore clinical reasoning about alarm customisation among nurses in intensive care units. BACKGROUND: Critical care nurses are responsible for detecting and rapidly acting upon changes in patients' clinical condition. Nurses use medical devices including bedside physiologic monitors to assist them in their practice. Customising alarm settings on these devices can help nurses better monitor their patients and reduce the number of clinically irrelevant alarms. As a result, customisation may also help address the problem of alarm fatigue. However, little is known about nurses' clinical reasoning with respect to customising physiologic monitor alarm settings. DESIGN: This article is an in-depth report of the qualitative arm of a mixed methods study conducted using an interpretive descriptive methodological approach. METHODS: Twenty-seven nurses were purposively sampled from three intensive care units in an academic medical centre. Semi-structured interviews were conducted by telephone and were analysed using thematic analysis. Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guidelines were used. RESULTS: Four themes were identified from the interview data: unit alarm culture and context, nurse attributes, motivation to customise and customisation "know-how." A conceptual model demonstrating the relationship of these themes was developed to portray the factors that affect nurses' customisation of alarms. CONCLUSIONS: In addition to drawing on clinical data, nurses customised physiologic monitor alarms based on their level of clinical expertise and comfort. Nurses were influenced by the alarm culture on their clinical unit and colleagues' and patients' responses to alarms, as well as their own technical understanding of the physiologic monitors. RELEVANCE TO CLINICAL PRACTICE: The results of this study can be used to design strategies to support the application of clinical reasoning to alarm management, which may contribute to more appropriate alarm customisation practices and improvements in safety.

A transformer-based diffusion probabilistic model for heart rate and blood pressure forecasting in Intensive Care Unit.

BACKGROUND AND OBJECTIVE: Vital sign monitoring in the Intensive Care Unit (ICU) is crucial for enabling prompt interventions for patients. This underscores the need for an accurate predictive system. Therefore, this study proposes a novel deep learning approach for forecasting Heart Rate (HR), Systolic Blood Pressure (SBP), and Diastolic Blood Pressure (DBP) in the ICU. METHODS: We extracted 24,886 ICU stays from the MIMIC-III database which contains data from over 46 thousand patients, to train and test the model. The model proposed in this study, Transformer-based Diffusion Probabilistic Model for Sparse Time Series Forecasting (TDSTF), merges Transformer and diffusion models to forecast vital signs. The TDSTF model showed state-of-the-art performance in predicting vital signs in the ICU, outperforming other models' ability to predict distributions of vital signs and being more computationally efficient. The code is available at https://github.com/PingChang818/TDSTF. RESULTS: The results of the study showed that TDSTF achieved a Standardized Average Continuous Ranked Probability Score (SACRPS) of 0.4438 and a Mean Squared Error (MSE) of 0.4168, an improvement of 18.9% and 34.3% over the best baseline model, respectively. The inference speed of TDSTF is more than 17 times faster than the best baseline model. CONCLUSION: TDSTF is an effective and efficient solution for forecasting vital signs in the ICU, and it shows a significant improvement compared to other models in the field.

Cardiovascular genomics.

PURPOSE: This article provides an update on cardiovascular genomics using three clinically relevant exemplars, including myocardial infarction (MI) and coronary artery disease (CAD), stroke, and sudden cardiac death (SCD). ORGANIZATIONAL CONSTRUCT: Recent advances in cardiovascular genomic research, testing, and clinical implications are presented. METHODS: Genomic nurse experts reviewed and summarized recent salient literature to provide updates on three selected cardiovascular genomic conditions. FINDINGS: Research is ongoing to discover comprehensive genetic markers contributing to many common forms of cardiovascular disease (CVD), including MI and stroke. However, genomic technologies are increasingly being used clinically, particularly in patients with long QT syndrome (LQTS) or hypertrophic cardiomyopathy (HCM) who are at risk for SCD. CONCLUSIONS: Currently, there are no clinically recommended genetic tests for many common forms of CVD even though direct-to-consumer genetic tests are being marketed to healthcare providers and the general public. On the other hand, genetic testing for patients with certain single gene conditions, including channelopathies (e.g., LQTS) and cardiomyopathies (e.g., HCM), is recommended clinically. CLINICAL RELEVANCE: Nurses play a pivotal role in cardiogenetics and are actively engaged in direct clinical care of patients and families with a wide variety of heritable conditions. It is important for nurses to understand current development of cardiovascular genomics and be prepared to translate the new genomic knowledge into practice.

Shared genomics of type 2 and gestational diabetes mellitus.

Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy and the prevalence of GDM is increasing worldwide. Short- and long-term complications of GDM on mothers and fetuses are well-recognized. These include more than seven-fold higher risk for type 2 diabetes mellitus (T2DM) later in life in women with GDM than those without. Evidence supports that GDM shares several risk factors with T2DM, including genetic risks. This chapter reviewed studies on candidate genes shared by T2DM and GDM published from 1990 to 2011. At least 20 susceptible genes of T2DM have been studied in women with GDM in various races. Results from current association studies on T2DM susceptible genes in GDM have shown significant heterogeneity There may be primary evidence that polymorphisms of susceptible genes of T2DM such as transcription factor 7-like 2 (TCF7L2) gene, potassium channel voltage-gate KQT-like subfamily member 1 (KCNQ1) gene, and cyclin-dependent kinase 5 regulatory subunit-associated protein 1-like 1 (CDKAL1) gene, may increase risk of GDM. Associations between GDM and many genetic variants have led to different findings across populations. Many genetic polymorphisms related to GDM were investigated in a single study or a single population. Replication studies to verify contributions of both common and rare genetic variants for GDM and T2DM in specific racial/ethnic groups are needed.

Precision health: A nursing perspective.

Precision health refers to personalized healthcare based on a person's unique genetic, genomic, or omic composition within the context of lifestyle, social, economic, cultural and environmental influences to help individuals achieve well-being and optimal health. Precision health utilizes big data sets that combine omics (i.e. genomic sequence, protein, metabolite, and microbiome information) with clinical information and health outcomes to optimize disease diagnosis, treatment and prevention specific to each patient. Successful implementation of precision health requires interprofessional collaboration, community outreach efforts, and coordination of care, a mission that nurses are well-positioned to lead. Despite the surge of interest and attention to precision health, most nurses are not well-versed in precision health or its implications for the nursing profession. Based on a critical analysis of literature and expert opinions, this paper provides an overview of precision health and the importance of engaging the nursing profession for its implementation. Other topics reviewed in this paper include big data and omics, information science, integration of family health history in precision health, and nursing omics research in symptom science. The paper concludes with recommendations for nurse leaders in research, education, clinical practice, nursing administration and policy settings for which to develop strategic plans to implement precision health.

Comparison of anterior chamber depth of normal and keratoconus eyes using Scheimpflug photography.

OBJECTIVES: To compare the corneal anterior chamber depth (ACD) adjusted by age and sex in normal and keratoconus eyes. METHODS: Scheimpflug photography with the Oculus Pentacam was used to measure the ACD of 162 normal and 41 keratoconus patients. RESULTS: Univariate analysis showed that the mean ACD of 162 normal subjects (3.18 +/- 0.32 mm) was borderline significantly less than in 41 keratoconus patients (3.28 +/- 0.40 mm; P=0.079). However, we found that sex (P=0.001) and age (P<0.001) are significantly related to ACD in all patients. Women with normal eyes had a significantly lower mean ACD (3.13 +/- 0.34 mm) than men (3.27 +/- 0.28 mm, P=0.008). Women with keratoconus eyes also had a lower mean ACD (3.16 +/- 0.39 mm) than men with keratoconus (3.42 +/- 0.36 mm, P=0.032). Bivariate regression showed that with each additional year of aging, the ACD was decreased by an average of 0.012 mm in a normal eye (P<0.001) and by 0.014 mm in a keratoconus eye (P<0.001). Regression analysis showed that sex (P=0.003), age (P<0.001), and keratoconus (P=0.003) are all significant variables for determining ACD. After adjusting for age and sex, keratoconus eyes had a significantly higher mean ACD (3.34 +/- 0.34 mm) than normal eyes (3.18 +/- 0.28 mm) (P=0.003). CONCLUSIONS: Sex, age, and keratoconus are all significant variables for ACD. After adjusting for age, keratoconus eyes of both genders had a significantly higher ACD than normal eyes of both genders. Women showed lower mean ACD than men in both normal and keratoconus eyes.

Candidate genes of the 5-lipoxygenase pathway in acute coronary syndrome: a pilot study.

PURPOSE: The purpose of this pilot study was to examine arachidonate 5-lipoxygenase (ALOX5) and ALOX5-activating protein (ALOX5AP) gene variations in patients with and without acute coronary syndrome (ACS). METHODOLOGY: Four and six single nucleotide polymorphisms spanning the ALOX5 and ALOX5AP genes, respectively, were genotyped in 19 non-Hispanic Caucasian patients with ACS and 27 controls. RESULTS: Presence of the common allele of rs9508835 (ALOX5AP) and the minor allele of rs2029253 (ALOX5) were associated with ACS. After adjustment for age, being a carrier of the rs9508835 common allele was associated with an increased risk of ACS (odds ratio = 2.86). RELEVANCE FOR NURSING PRACTICE: Through the inhibition of the ALOX5AP gene by downregulation of the leukotriene pathway, the risk of ACS may be decreased in individuals that carry susceptibility allele(s). Knowledge of the genetic basis of treatments that downregulate the leukotriene pathway may prove essential to the care of individuals with ACS.

Improving activities of daily living for nursing home elder persons in Taiwan.

BACKGROUND: Excess disability among nursing home elder persons can be prevented or remediated. Because of self-selected disuse and caregiver support of dependency, nursing home residents are likely to develop excess disability. No study was found to test a theory-based program aimed at improving elder persons' self-care abilities for Taiwanese nursing home elder persons who are at risk for developing excess disability. OBJECTIVES: The purpose of this study was to test the effectiveness of a theory-based intervention program on self-care, specifically on activities of daily living (ADLs) performance among nursing home elder persons in Taiwan. A secondary aim was to determine the correlation between ADLs performance and three bliss concepts: life satisfaction, self-esteem, and motivation in health behavior. METHODS: This study used a quasi-experimental, two-group, pretest-posttest design. Forty-two qualified participants were recruited from two nursing homes located in southern Taiwan and assigned to either the experimental group (n = 21) or the comparison group (n = 21). Participants in the experimental group received the Self-Care Self-Efficacy Enhancement Program (SCSEEP), and those in the comparison group received biweekly social visits for 6 weeks. Levels of ADLs performance were measured by Tappen's Refined ADL Assessment Scale. Life satisfaction was measured by Adams' Life Satisfaction Index A. Self-esteem was measured by Rosenberg's Self-Esteem Scale. Motivation in health behavior was measured by Cox's Health Self-Determinism Index. RESULTS: Elder persons receiving the SCSEEP had significant improvement in feeding, dressing, grooming, and washing activities. Self-esteem (p = .011) and life satisfaction (p = .033) but not motivation in health behavior (p = .282) were positively correlated with levels of ADLs performance. DISCUSSION: The SCSEEP provides a theory-based intervention model for Taiwanese nursing home elder persons aimed at improving ADLs performance. Further research with a larger sample size is needed to determine the long-term maintenance and effectiveness of this theory-driven SCSEEP in specific culture groups.

Electrocardiographic evaluation of cardiovascular status.

The electrocardiogram (ECG) is indispensable for the diagnosis and management of patients with a wide variety of cardiac and noncardiac diseases. The purpose of this paper is focused on recent research that used ECG, specifically the long-QT interval and microvolt T wave alternans, for the evaluation of life-threatening ventricular arrhythmias. Although remaining to be validated, QT prolongation along with other emerging electrocardiographic indices such as T wave morphology, T peak-to-T end time, or beat-to-beat QT variability may be sensitive indicators of malignant polymorphic ventricular tachyarrhythmia, torsade de pointes. Microvolt T wave alternans may provide important information in identifying a low-risk group with left ventricular dysfunction who is unlikely to benefit from unnecessary prophylactic implantable cardioverter defibrillator therapy. These ECG markers have the potential to aid in the safe administration of individualized medications, avoidance of sudden cardiac death, and provision of a noninvasive strategy to identify patients who are most and least likely to benefit from expensive prophylactic implantable cardioverter defibrillator placement.

Critical Care Nurses' Cognitive Ergonomics Related to Medical Device Alarms.

This study uniquely gained insight into the intricacy of intensive care nurses' decision-making process when responding to and managing device alarms. Difficulty in responding to alarms included low staffing, multiple job responsibilities, and competing priority tasks. Novice nurses are more tolerant of alarms sounding owing to a lower threshold of comfort with resetting or silencing alarms; more experienced nurses are more comfortable resetting alarm limits to the patient's baseline. Understanding the decision-making process used by nurses can guide the development of policies and learning experiences that are crucial clinical support for alarm management.

Sensory Overload and Technology in Critical Care.

In this focus group study, we identified issues associated with sensory overload from medical technology alarms/alerts for intensive care unit nurses. Participants indicated that alarms from cardiopulmonary monitors, ventilators, and intravenous pumps contributed the most to sensory overload and, yet, these alarms were also deemed the most helpful. Alerts/alarms from electronic health records and medication dispensing systems were rated low in contributing to sensory overload, as well as being the least helpful. Specific device/technology barriers, related to device alerts/alarms, are detailed. Future user-centered and integrated improvements in alarm systems associated with medical devices in the intensive care unit are needed.

Geographic diversity in genotype frequencies and meta-analysis of the association between rs1801282 polymorphisms and gestational diabetes mellitus.

AIMS: To derive a better understanding of the association between peroxisome proliferator-activated receptor gamma (PPAR-γ) rs1801282 polymorphisms and gestational diabetes mellitus (GDM) in general and in racial and ethnic subgroups and to illustrate geographic distribution of the protective of G allele of rs1801282 in women with and without GDM. METHODS: ProQuest, PubMed, Medline, Web of Science, and Wanfang Data were systematically searched. Case-control studies on association between rs1801282 polymorphisms and GDM were selected. Comprehensive Meta-Analysis 2.0 statistical software was used to determine the relationship between GDM and rs1801282 polymorphism. Race/ethnicity-based and country-based stratified analysis was conducted. RESULTS: Sixteen studies involving 3129 cases and 7168 controls were included. Significant associations were observed between rs1801282 polymorphisms and GDM under the dominant, heterozygote, and allele models. The G allele of rs1801282 polymorphism was associated with a reduced risk of GDM in Asian, especially Chinese, populations. Data revealed significant geographic diversity in frequency of the protective G allele in women with and without GDM. CONCLUSIONS: The rs1801282 polymorphism may not be associated with genetic susceptibility to GDM in whites. The G allele of rs1801282 polymorphism was associated with reduced risk of GDM in Asians, especially Chinese, but not South Koreans.

Challenges of customizing electrocardiography alarms in intensive care units: A mixed methods study.

BACKGROUND: Customizing monitor alarm settings to individual patients can reduce alarm fatigue in intensive care units (ICUs), but has not been widely studied. OBJECTIVES: To understand ICU nurses' approaches to customization of electrocardiographic (ECG) monitor alarms. METHODS: A convergent mixed methods study was conducted in 3 ICUs in 1 hospital. Data on the type and frequency of ECG alarm customization were collected from patient monitors (n=298). Nurses' customization clinical reasoning was explored through semi-structured interviews (n=27). RESULTS: Of the 298 patients, 58.7% had ≥1 alarm(s) customized. Heart rate limits, irregular heart rate, and atrial fibrillation were the most commonly customized alarms. Interviews revealed that customization practices varied widely and were influenced by factors including clinical expertise, lack of customization education, and negative experiences. CONCLUSION: Alarm customization is nuanced and requires adequate support to develop safe and effective practices. The challenges identified can inform development of strategies to improve alarm customization.

Discriminating between right coronary artery and circumflex artery occlusion by using a noninvasive 18-lead electrocardiogram.

BACKGROUND: Differentiating occlusion of the circumflex branch of the left coronary artery (also called the circumflex artery) from occlusion of the right coronary artery is often difficult because either may be associated with a pattern of acute inferior myocardial infarction on the electrocardiogram. OBJECTIVES: To determine if an inexpensive 18-lead electrocardiogram can provide useful information in differentiating sites of coronary occlusion. METHODS: Continuous 18-lead electrocardiograms, including standard 12-lead, right ventricular, and posterior leads, were recorded in 38 and 50 subjects undergoing percutaneous coronary interventions in the right coronary artery and the circumflex artery, respectively. RESULTS: ST-segment elevation in the posterior leads was twice as frequent during occlusion of the circumflex artery as during right coronary occlusion (P < .001). ST-segment elevation in the right ventricular leads and inferior leads occurred more often during occlusion of the right coronary artery than during occlusion of the circumflex artery. ST-segment depression in lead aVL is highly suggestive of right coronary occlusion, whereas ST-segment elevation in posterior leads without depression of the ST segment in lead aVL is highly sensitive and specific for occlusion of the circumflex artery. CONCLUSIONS: ST-segment changes in the 18-lead electrocardiogram can be used to differentiate between occlusions of the circumflex artery and occlusions of the right coronary artery. Knowing which vessel is occluded before percutaneous coronary intervention can help in planning the procedure and recognizing when patients are at high risk for disturbances in conduction at the atrioventricular node.

The lipoprotein lipase gene in combined hyperlipidemia: evidence of a protective allele depletion.

BACKGROUND: Lipoprotein Lipase (LPL), a key enzyme in lipid metabolism, catalyzes the hydrolysis of triglycerides (TG) from TG-rich lipoproteins, and serves a bridging function that enhances the cellular uptake of lipoproteins. Abnormalities in LPL function are associated with pathophysiological conditions, including familial combined hyperlipidemia (FCH). Whereas two LPL susceptibility alleles were found to co-segregate in a few FCH kindred, a role for common, protective alleles remains unexplored. The LPL Ser447Stop (S447X) allele is associated with anti-atherogenic lipid profiles and a modest reduction in risk for coronary disease. We hypothesize that significant depletion of the 447X allele exists in combined hyperlipidemia cases versus controls. A case-control design was employed. The polymorphism was assessed by restriction assay in 212 cases and 161 controls. Genotypic, allelic, and phenotypic associations were examined. RESULTS: We found evidence of significant allelic (447Xcontrol: 0.130 vs. 447Xcase: 0.031, chi2 = 29.085; 1df; p < 0.001) and genotypic association (SS: 0.745 vs. 0.939, and SX+XX: 0.255 vs. 0.061) in controls and cases, respectively (chi2 = 26.09; 1df; p < 0.001). In cases, depletion of the 447X allele is associated with a significant elevation in very-low-density lipoprotein cholesterol (VLDL-C, p = 0.045). Consonant with previous studies of this polymorphism, regression models predict that carriers of the 447X allele displayed significantly lower TG, low-density lipoprotein cholesterol (LDL-C) and TG/high-density lipoprotein cholesterol (HDL-C) ratio. CONCLUSION: These findings suggest a role for the S447X polymorphism in combined hyperlipidemia and demonstrate the importance of evaluating both susceptibility and protective genetic risk factors.

A quantitative evaluation of ST-segment changes on the 18-lead electrocardiogram during acute coronary occlusions.

UNLABELLED: This study determined quantitative ST segment changes on the 18-lead electrocardiogram (ECG) during occlusions in each of the coronary arteries. METHODS: Continuous 18-lead ECGs, including standard 12 leads, posterior (V7-9), and right ventricular (RV) leads (V3-5R) were recorded for 155 subjects undergoing percutaneous coronary occlusions, the maximum intervention. RESULTS: During 58 left anterior descending (LAD) coronary occlusions, the maximum ST elevation and depression were in V3 (4.2 mm) and III (-0.9 mm), respectively. During 44 right coronary artery (RCA) occlusions, the maximum ST elevation and depression were in III (2.2 mm) and aVL (-1.4 mm), respectively. During 53 left circumflex (LCX) occlusions, the maximum ST elevation and depression were in V7 (0.8 mm) and V2 (-1.6 mm), respectively. CONCLUSIONS: ST elevation often occurred in the anteroapical (V1-V6), lateral (I, aVL), and RV lead V(3R) during LAD occlusions; in the inferior, RV, and posterior leads during RCA occlusions; and in the posterior, inferior, and apical leads (V5-V6) during LCX occlusions.

Bradyarrhythmias: Clinical Presentation, Diagnosis, and Management.

Bradyarrhythmias are common clinical findings consisting of physiologic and pathologic conditions (sinus node dysfunction and atrioventricular [AV] conduction disturbances). Bradyarrhythmias can be benign, requiring no treatment; however, acute unstable bradycardia can lead to cardiac arrest. In patients with confirmed or suspected bradycardia, a thorough history and physical examination should include possible causes of sinoatrial node dysfunction or AV block. Management of bradycardia is based on the severity of symptoms, the underlying causes, presence of potentially reversible causes, presence of adverse signs, and risk of progression to asystole. Pharmacologic therapy and/or pacing are used to manage unstable or symptomatic bradyarrhythmias.