ACLS: Bradycardia: Difference between revisions
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==Categories== | ==Categories== | ||
*'''Sinus node dysfunction''' | *'''Sinus node dysfunction''' | ||
**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]]''' | ||
**1st degree AV block | **[[1st degree AV block]] | ||
**2nd degree AV block | **[[2nd degree AV block type I (Wenkebach)]] | ||
**2nd degree AV block | **[[2nd degree AV block type II]] | ||
**3rd degree AV block (complete heart block) | **[[3rd degree AV block]] ([[complete heart block]]) | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Latest revision as of 20:55, 10 December 2025
This page is for bradycardia with a pulse; for bradycardia without a pulse (i.e. PEA) see Adult pulseless arrest
Background
- Heart rate < 60
- Intervention indicated if patient is symptomatic or experiencing symptoms of end organ damage (chest pain, altered mental status, shortness of breath, hypotension)
Categories
- Sinus node dysfunction
- Sinus bradycardia
- Sinus arrest
- Tachy-Brady Syndrome (Sick Sinus)
- Chronotropic incompetence
- AV node dysfunction
Differential Diagnosis
Symptomatic bradycardia
- Cardiac
- Inferior MI (involving RCA)
- Sick sinus syndrome
- 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)
- Hypothyroidism
- Hypoglycemia (neonates)
- Toxicologic
- Infectious/Postinfectious
- Other
Management
- Atropine
- Can be used as temporizing measure (while awaiting pacing and/or chronotropes)
- Use cautiously in patients with ongoing ischemia (tachycardia may worsen ischemia)
- Avoid and/or do not rely on in wide complex bradycardia, especially in setting of ischemia[1]
- 1mg q3-5min (max 3mg or 3 doses)
- May not work in 2nd/3rd degree heart block, heart transplant
- Priority is to use external cardiac pacemaking[2]
- Block is below AV node so atropine will accelerate sinus rate, leading to worsening of block and increased fatigue of AV nodal cells
- Chronotropes
- Dopamine 5-20 mcg/kg/min, max 50 mcg/kg/min
- Dobutamine 2-20 mcg/kg/min, max 40 mcg/kg/min
- Epinephrine 2-10 mcg/min (~0.03-0.2 mcg/kg/min, max 1 mcg/kg/min)
- Isoproterenol 2-10 mcg/min
- Transcutaneous Pacing
- Transvenous Pacing
Antidotes for toxicologic causes
- Beta-Blocker Toxicity
- Glucagon 5mg IV Q10min (repeat up to 3 doses)
- Insulin 1U/kg bolus
- Intralipid (ILE)
- Calcium Channel Blocker Toxicity
- Calcium gluconate 3g
- Insulin 1U/kg bolus
- Intralipid (ILE)
- Digoxin Toxicity
- Dig immune Fab 10-20 vials
- Opioid Toxicity
- Naloxone 0.4mg IV
- Organophosphate Toxicity
- Atropine 2mg IV, double dose q5-30m until secretions controlled
- Pralidoxime 1-2g IV over 15-30min
See Also
External Links
References
- ↑ Neumar RW et al. Part 8: Adult Advanced Cardiovascular Life Support. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
- ↑ Burns, E. AV block: 3rd degree (complete heart block). http://lifeinthefastlane.com/ecg-library/basics/complete-heart-block/