Difference between revisions of "ACLS: Bradycardia"

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##Sinus bradycardia
##Sinus bradycardia
##Sinus arrest
##Sinus arrest
##Tachy-brady syndrome (sick sinus)
##[[Tachy-Brady Syndrome]] ([[Sick Sinus]])
##Chronotropic incompetence
##Chronotropic incompetence
#'''AV node dysfunction'''
#'''AV node dysfunction'''

Revision as of 06:34, 24 August 2014

This page is for bradycardia with a pulse; for bradycardia without a pulse see Adult Pulseless Arrest (i.e. PEA)


  • Only intervene if pt is symptomatic (hypotension, AMS, chest pain, pulm edema)


  1. Sinus node dysfunction
    1. Sinus bradycardia
    2. Sinus arrest
    3. Tachy-Brady Syndrome (Sick Sinus)
    4. Chronotropic incompetence
  2. AV node dysfunction
    1. 1st degree AV block
    2. 2nd degree AV block Mobitz I/Wenckebach
    3. 2nd degree AV block Mobitz II
    4. 3rd degree AV block (complete heart block)


  1. Ischemia/Infarction
    1. Inferior MI (involving RCA)
  2. Neurocardiogenic/reflex-mediated
    1. Increased ICP
    2. Vasovagal reflex
    3. Hypersensitive carotid sinus syndrome
    4. Intra-abdominal hemorrhage (i.e. ruptured ectopic)
  3. Metabolic/endocrine/environmental
    1. Hyperkalemia
    2. Hypothermia (Osborn waves on ECG)
    3. Hypothyrodism
  4. Toxicologic
    1. B-blocker
    2. Ca-channel blocker
    3. Digoxin toxicity
    4. Opioids
    5. Organophosphates
  5. Infectious/Postinfectious
    1. Chagas dz
    2. Lyme dz
    3. Syphilis
  6. Sick Sinus Syndrome


  1. Atropine
    1. Can be used as temporizing measure (while awaiting pacing and/or chronotropes)
    2. Use cautiously in pts w/ ongoing ischemia (tachycardia may worsen ischemia)
    3. 0.5mg q3-5min (max 3 mg or 6 doses)
      1. may not work in 2nd/3rd deg HB, heart transplant
  2. Chronotropes
    1. Dopamine 2-10mcg/kg/min
    2. Epinephrine 2-10mcg/min
  3. Transcutaneous Pacing
  4. Transvenous Pacing

Antidotes for toxicologic causes

See Also


  1. Semelka, M et al. Sick Sinus Syndrome: A Review. Am Fam Physician. 2013 May 15;87(10):691-696.http://www.aafp.org/afp/2013/0515/p691.html#afp20130515p691-t2.