Bradycardia diagnosis and general management

In this episode of The Good GP, host Dr Kristiana Pederick welcomes Dr Justin Ng, a specialist cardiologist and electrophysiologist specialising in the diagnosis and management of arrhythmias. They discuss common presentations of bradycardia and how to distinguish between physiological and pathological low heart rates.

Dr Justin highlights red flags in the presentation, investigation, and general management of bradyarrhythmia, as well as the uses and limitations of wearable tracking devices, such as smartwatches.

They explore typical presentations of bradycardia, including syncope, near-syncope, reduced exercise tolerance, and cognitive decline in older adults. Dr Justin emphasises the importance of clinical context when distinguishing between physiological and pathological bradycardia, taking into account the patient's age, fitness level, symptoms, and the circumstances in which a low heart rate is identified.

They also discuss management principles, including reserving pacemaker implantation for symptomatic or irreversible cases. The importance of taking a thorough patient history and correlating symptoms with documented bradycardia is emphasised to help determine the urgency of management and guide further investigations.

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