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Bradyarrhythmias, Emergency Medicine

Benjamin S. Heavrin Reviewed 06/2017



  • Ventricular heart rate <60 beats/min:

    • Sinus bradycardia can be normal variant.

    • All other rhythms are pathologic.

  • May be asymptomatic or have hypotension, altered mental status, fatig...


Signs and Symptoms

  • Often asymptomatic

  • Lightheadedness, confusion, fatigue, decreased level of consciousness

  • Dyspnea, cyanosis, pallor

  • Chest pain/pressure, diaphoresis

  • Hypotension

  • Syncope

  • Hypothermi...



  • Treat the patient, not the heart rate

  • Oxygen:

    • For all patients, especially children

  • If hypothermic, warm the patient and give magnesium:

    • Do NOT pace; move patient gently as rough han...



Admission Criteria

  • ICU:

    • Hemodynamically unstable bradycardia

    • 2nd-degree type II or 3rd-degree block

    • Transcutaneous or transvenous pacer

    • Pressors

    • Acute myocardial infarction or ischemia

  • T...

Pearls and Pitfalls

  • Asymptomatic sinus bradycardia is the ONLY potentially “normal” bradycardia. All others require treatment or follow-up.

  • O2, O2 sat, IV, ECG, cardiac monitor for all patients.

  • Pediatr...

Additional Reading

  • Dovgalyuk  J, Holstege  C, Mattu  A, et al. The electrocardiogram in the patient with syncope. Am J Emerg Med.  2007;25:688–701.

  • Haro  LH, Hess  EP, Decker  WW. Arrhythmias in t...



  • 427.81 Sinoatrial node dysfunction

  • 427.89 Other specified cardiac dysrhythmias


  • I49.5 Sick sinus syndrome

  • I49.8 Other specified cardiac arrhythmias


  • 421869004 bradyarrhythmia (disorder)

  • ...

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