ACLS: Bradycardia

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

Background

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

Categories

  • Sinus node dysfunction
  • AV node dysfunction
    • 1st degree AV block
    • 2nd degree AV block Mobitz I/Wenckebach
    • 2nd degree AV block Mobitz II
    • 3rd degree AV block (complete heart block)

Differential

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

Treatment

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

Antidotes for toxicologic causes

See Also

References