BRADICARDIA IN

ADULTS & CHILDREN

Lela Tabidze, MD
2019 year
SINUS BRADYCARDIA

 Sinus bradycardia is a sinus rhythm with a

rate that is lower than normal

 Bradycardia is generally defined to be a rate

of under 60 beats per minute.
SINUS BRADYCARDIA
ECG characteristics:
 Rate: Less than 60 bpm
 Rhythm: Regular
 P waves: Upright, consistent, and normal
 P-R Interval: 0.12-0.20 sec
 QRS Complex: Less than 0.12 sec
ATRIOVENTRICULAR BLOCK
 First-degree AV block - the PR interval is
lengthened beyond 0.20 seconds

 In first-degree AV block, the impulse conducting

from atria to ventricles through AV node is
delayed and travels slower than normal.
 ATRIOVENTRICULAR BLOCK
 Second-degree AV block Type 1 knows as Mobitz
I or Wenckebach periodicity

 characterized by progressive prolongation of the PR interval

followed by a blocked P wave (a 'dropped' QRS complex).

 After the dropped QRS complex, the PR interval resets and

the cycle repeats.
ATRIOVENTRICULAR BLOCK
II degree AV Block type 2 (Mobitz II)
ECG criteria:
 P wave block without PR interval
prolongation
 PR interval is constant
ATRIOVENTRICULAR BLOCK
 The P waves with a regular P-to-P interval represent the
first rhythm.

 The QRS complexes with a regular R-to-R interval represent

the second rhythm.

 The PR interval will be variable, as the hallmark of

complete heart block is lack of any apparent relationship
between P waves and QRS complexes.
ATRIOVENTRICULAR BLOCK
Patients with third-degree AV block typically
experience:

 Severe bradycardia (an abnormally low

measured heart rate),
 Hypotension,
 Hemodynamic instability
SYMPTOMS:
 Chest discomfort or pain
 Shortness of breath
 Decreased level of consciousness
 Weakness
 Fatigue
 Lightheadedness
 Dizziness
 Syncope
 Hypotension
 Orthostatic hypotension
 Heart failure
 Respiratory distress
 Diaphoresis
 Pulmonary congestion
CAUSES
Reversible causes

 Hypoxia
 Acidosis
 Hyperkalemia
 Hypothermia
 Heart block
 Toxins/poisons/drugs
- Cholinesterase inhibitors
- Calcium channel blockers
- Beta-adrenergic blockers
- Digoxin
- Clonidine
- Opioids
- Succinylcholine
MANAGEMENT
 The ABC approach

 The patient is symptomatic or asymptomatic

 So, the algorythm begins with the decision

that the patient's heart rate is < 60 bpm and
that is the reason for the patient’s
symptoms.
MANAGEMENT
 Are the signs or symptoms serious?
such as:
- hypotension,
- pulmonary congestion,
- dizziness,
- shock,
- ongoing chest pain,
- shortness of breath,
- congestive heart failure,
- weakness or fatigue, or acute altered mental status?

 Are the signs and symptoms related to the slow

heart rate?
MANAGEMENT
 Maintain patent airway
 Assist breathing as needed
 Administer oxygen if oxygen saturation is less
than 94% or the patient is short of breath
 Monitor blood pressure and heart rate
 Obtain a 12-lead ECG
 Review patient's rhythm
 Establish IV access
 Search and treat possible contributing
factors
MANAGEMENT - ADULTS
 Consider administering atropine 0.5 mg in every 3-
5 minutes 6 times (max dose 3 mg) IV if IV access
is available.

 If atropine is ineffective, begin pacing

 Consider epinephrine or dopamine while waiting

for the pacer or if pacing is ineffective:
- Epinephrine 2 to 10 mg/min
- Dopamine 2-20 mg/kg/min

 Prepare transcutaneous pacing. Do not delay

pacing. If no IV is present pacing can be first
TRANSCUTANEOUS PACING
THE TRANSCUTANEOUS PACING

 The transcutaneous pacer is set for 70 PPM at 50 mA.

Pacing spikes are visible with what appear to be
large, corresponding QRS complexes.
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