Prev 1 of 1 Next What is Bradycardia Absolute bradycardia is defined as a pulse rate less than 60 bpm. During the patient assessment, it should be determined whether bradycardia-induced life-threatening signs and symptoms are present. Signs and Symptoms of Bradycardia Bradycardia can present itself in several different cardiac rhythms, including sinus bradycardia and varying degrees of atrioventricular heart blocks. Regardless of the rhythm, if the heart rate is too slow, and the patient has symptoms from the slow rate, then the bradycardia should be treated to increase the heart rate and improve perfusion.

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Third-degree AV block complete block Bradycardia vs. Symptomatic Bradycardia Bradycardia is defined as any rhythm disorder with a heart rate less than 60 beats per minute. Symptomatic bradycardia exists when the following 3 criteria are present: 1. The heart rate is slow; 2. The patient has symptoms, and 3. The symptoms are due to the slow heart rate. An example would be a patient with a heart rate of 80 bpm when they are experiencing septic shock. They are atropine, dopamine infusion , and epinephrine infusion.

More detailed ACLS pharmacology information is reviewed following this page. Atropine: The first drug of choice for symptomatic bradycardia. Dopamine: Second-line drug for symptomatic bradycardia when atropine is not effective. Epinephrine: Can be used as an equal alternative to dopamine when atropine is not effective. See Bradycardia Medication Page for more information. Bradycardia Algorithm The decision point for ACLS intervention in the bradycardia algorithm is determination of adequate perfusion.

For the patient with adequate perfusion, observe and monitor the patient. Click below to view the bradycardia algorithm diagram. When finished, click again to close the diagram. This will open in another window. If atropine fails to alleviate symptomatic bradycardia, TCP is initiated. Ideally, the patient receives sedation prior to pacing, but if the patient is deteriorating rapidly, it may be necessary to start TCP prior to sedation. For the patient with symptomatic bradycardia with signs of poor perfusion, transcutaneous pacing is the treatment of choice.

Do not delay TCP for the patient with symptomatic bradycardia with signs of poor perfusion. The dose for pacing is set at 2mA milliamperes above the dose that produces observed capture.

TCP is contraindicated in the patient with hypothermia and is not a recommended treatment for asystole. Do not use a carotid pulse check for the assessment of circulation as TCP can create muscular movements that may feel like a carotid pulse. Assess circulation using the femoral pulse. Identification of contributing factors for symptomatic bradycardia should be considered throughout the ACLS protocol since reversing of the cause will likely return the patient to a state of adequate perfusion.

A: There are a couple of things to mention here. First, atropine may be used for any type of block but may negatively affect outcomes if the bradycardia is being caused by myocardial infarction. This negative effect may occur because atropine increases the heart rate and myocardial oxygen demand.

In the case of bradycardia caused by MI, it would be safer to transcutaneous pace TCP at a rate of 60 and move toward some type of cardiac intervention.

If the patient has severe symptoms, you should not delay transcutaneous pacing TCP. You will usually have time to try atropine as you prepare for TCP. It just means that it should not be relied upon because there is a good chance that it will not work. It may not work because atropine blocks the action of the vagus nerve. Atropine works at the SA and AV node through its effect on the vagus nerve, and since conduction abnormalities associated with 2nd-degree block type II and 3rd-degree heart block are below distal the site of action for atropine, the drug will typically have an insignificant effect.

Q: Why is pacing contraindicated in hypothermia? A: Bradycardia may be physiologic in the hypothermic patient. This type of bradycardia is an appropriate response to the decreased metabolic rate that normally occurs with hypothermia. Also the hypothermic ventricle is more prone to fibrillation with any sort of irritation. Once the hypothermic ventricle begins to fibrillate, it is more resistant to defibrillation. Warm the patient and then treat any remaining arrhythmias.

Q: What is TCP? A: TCP means transcutaneous pacing. Q: What is chemical pacing? A: Chemical pacing is when IV medications epinephrine or dopamine are used to increase the heart rate rather than the transcutaneous pacing which uses electricity to increase the heart rate.

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Bradycardia Algorithm

When you have a patient without a pulse, you must recognize either ventricular fibrillation VF or pulseless ventricular tachycardia pVT as shockable rhythms. View Algorithm Cardiac Arrest Circular Algorithm This algorithm is a summary of the recommended steps when a patient is in cardiac arrest. A stroke is an interruption in blood supply to a part of the brain which causes acute neurologic impairment. View Algorithm Post-Cardiac Arrest Care Algorithm This will take you through the implementation of a comprehensive treatment protocol for post-cardiac arrest care. View Algorithm Acute Coronary Syndromes Algorithm The steps of this ACS Algorithm outline the assessment and management guidelines for patients experiencing symptoms suggestive of ischemia or infarction. View Algorithm Bradycardia With A Pulse Algorithm The Bradycardia Algorithm provides the information you need to assess and manage a patient with symptomatic bradycardia or a heart rate under 50 bpm.

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