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What are the management strategies in bradycardias?
Most symptomatic bradycardias (e.g., sinus bradycardia and asystole) should be treated with atropine, transcutaneous pacing (TCP), and dopamine or epinephrine infusions. Patients with third-degree heart block and Mobitz type II second-degree heart block should not receive atropine because it may cause a paradoxical slowing of ventricular escape rates. Isoproterenol should not be used for the treat-ment of bradycardias because it increases myocardial oxygen consumption and may cause hypotension.
In the setting of an acute myocardial infarction, the ACLS protocol recommends that third-degree heart block and Mobitz type II heart block require transvenous pacing. TCP or epinephrine should be used in symptomatic patients until a transvenous pacemaker is inserted.
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