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Dr Swapnil Pawar May 26, 2023 108

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    Dr Swapnil Pawar


written by Dr Ashly Liu

Bradycardia is typically defined by heart rate < 60 bpm but symptomatic bradycardia is usually associated with rates below 40bpm. 

Clinical findings

Red flag symptoms include signs of

  • Shock
  • Syncope
  • Myocardial Ischaemia
  • Heart Failure


  • Physiological bradycardia
  • Sinus node dysfunction
  • Medication related (i.e. beta blockers, calcium channel blockers, digoxin)

Red flags

  • Anterior myocardial infarction
  • Complete heart block 

AV Nodal Blocks

First Degree Heart Block – This is defined by PR interval > 200ms (‘marked’ first degree heart block is > 300ms)

Second Degree Heart Block

  • Mobitz Type I (Wenkebach) – Progressive lengthening of the PR interval with an eventually dropped QRS complex
  • Mobitz Type II (Hay) – Intermittent dropping of the QRS complex


Third Degree Heart Block – Complete dissociation of the atria and ventricles (i.e. dissociation of P waves and QRS waves)


Management – ACLS algorithm (Resuscitation Council UK)

  • Primary Survey (ABCDE approach)
  • Give oxygen if appropriate and obtain IV access
  • Send bloods
  • Monitor ECG, BP, SpO2 and record a 12-lead ECG
  • If hemodynamically stable or has evidence of poor perfusion
  • Give Atropine 500mcg IV bolus (repeat every 3-5min up to maximum of 3mg) 
  • If there is a poor response or the patient has a risk of asystole*
  • Atropine 500mg IV bolus up to a maximum of 3mg OR
  • Isoprenaline 5mcg/min IV OR
  • Adrenaline 2-10mch/min IV OR
  • Tanscutaenous pacing
  • Cardiology Consult and move patient to CCU/ICU for telemetry 
  • Transvenous pacing 



UpToDate – “Advanced cardiac life support (ACLS) in adults”,


Resuscitation Council UK – “Adult advanced life support Guidelines”, 


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