Armando Hasudungan
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Bradycardia
Overview
Bradycardia refers to heart rate <60/min in an adult
Bradycardias are classified as regular or irregular, narrow complex or wide complex
Differential diagnosis causing bradycardia
Cardiac disease
Myocardial ischaemia / infarction
Myocarditis
Cardiomyopathies
Hypoxia
Electrolyte disturbance - Hyperkalemia
Medications, poisonings and toxic exposures
Digoxin
Beta blockers
Calcium channel blockers
Amiodarone
Clonidine
Hypothermia
Hypothyroidism
Raised intracranial pressure (Cushing response)
Infections (Lyme disease, diphtheria, typhoid fever)
Autoimmune - Systemic lupus erythematosis
Infiltrative disorders (e.g. sarcoidosis, amyloidosis)
Physiological causes
athletes
vagal response
Remember
Life threatening causes of bradycardia include: hypotension, raised intracranial pressure and MI
History
Past medical history
Cardiac history and risk
Medical conditions - screen for
Hypothyroidism
Autoimmune/ infiltrative disease
Medication - digoxin, beta-blocker, calcium channel blockers or other antiarythmics
Examination
General observation
Vitals
Low body temperature?
Cushings triad
ECG
Hyperkalaemia - Tall tented T-waves
Cardiovascular examination
Respiratory examination
Acute Management
ABCD
Oxygen
IV access
Tredenleberg position if hypotensive
ECG
Drug:
Atropine
Transthoracic pacing
Low dose adrenaline infusion - if transthoracic pacing unavailable
CPR - if deteriorating
Pharmacology
Atropine
Investigations
FBC
EUC
Hyperkalaemia
LFT
CRP
Cardiac biomarkers
Cardiac ultrasound
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