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Bradycardia Algorithm Review

 Major Rhythms found in the Bradycardia Algorithm

Sinus Bradycardia—symptomatic

1^st Degree Heart Block

2^nd Degree Heart Block

Type 1 also known as Mobitz 1 also known as Wenkenbach

Type 2 also known as Mobitz 2

3^rd Degree heart Block also known as Complete Heart Block

See ECG for Everyone Video & Flashcard ECG Rhythms for more detail on how to read Bradycardia ECGs.

Sinus Bradycardia asymptomatic vs. Sinus Bradycardia symptomatic

Asymptomatic bradycardia may be the normal rhythm for athletes who are very fit.  Their resting heart rates may be in the 40-60 beats per minute range but they will have normal blood pressures and normal energy levels.  On the other hand, patients who have slow heart rates due to cardiac issues will have a heart rate less than 60 beats per minutes and frequently less than 50 beats per minute, symptoms such as hypotension, and the symptoms are caused by the bradycardia.

Functional or Relative Bradycardia

Functional or Relative Bradycardia occurs when the heart rate is when the patient’s heart rate is lower than their normal resting heart rate and may be symptomatic.  This may be seen in patients who are in septic shock.

Bradycardia Algorithm

Click on Bradycardia Algorithm Flow Chart to download the chart.  It is important to determine if the patient’s rhythm is adequately perfusing.  If it is observe the patient and monitor.  If it is not as evidenced by vital signs such as BP, level of consciousness, cap refill time, etc. then the healthcare provider should follow the Bradycardia Algorithm.  Administer atropine, prepare to initiate transcutaneous pacing, and give second line drugs such as epinephrine or dopamine.  It is important to determine underlying causes and treat and reverse them if possible.  The H’s and T’s can help with determining and treating underlying causes.

Bradycardia Pharmacology

The Bradycardia algorithm uses three medications:  Atropine, Epinephrine, and Dopamine.  Atropine 1 mg  given IV/IO push every 3-5 minutes up to a maximum dose of 3 mg is the first drug to be given to all symptomatic bradycardic patients.

If atropine is ineffective, then while the team is preparing to initiate transcutaneous pacing epinephrine or dopamine infusions may be given.  The dose for a Dopamine infusion is 2-20 mcg/kg/min.  The dose for an Epinephrine infusion is 2-10 mcg/min.