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{{Infobox_Disease
__NOTOC__
| Name          = {{PAGENAME}}
{{Sinus bradycardia}}
| Image          = Sinusbrady.PNG
| Caption        = Sinus bradycardia.
| DiseasesDB    =
| ICD10          =
| ICD9          = {{ICD9|427.81}}
| ICDO          =
| OMIM          =
| MedlinePlus    =
| eMedicineSubj  = emerg
| eMedicineTopic =
| MeshID        = D001146
}}
{{SI}}
{{SI}}
{{CMG}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}


'''Associate Editor-In-Chief:''' {{CZ}}
==[[Sinus bradycardia overview|Overview]]==


{{Editor Join}}
==[[Sinus bradycardia pathophysiology|Pathophysiology]]==


'''Sinus [[bradycardia]]''' is a heart rhythm that originates from the sinus node and has a rate of under 60 beats per minute. Common causes include [[sick sinus syndrome]] and pharmacotherapy such as [[beta-blockers]].  Sinus bradycardia is not unexpected in highly trained athletes.  It only requires treatment if the patient is symptomatic.
==[[Sinus bradycardia causes|Causes]]==


==Pathosphysiology==
==[[Sinus bradycardia differential diagnosis|Differentiating Sinus bradycardia from other Diseases]]==
This rhythm may be caused by one of the following:
* Increased [[vagal]] tone.
* Intrinsic disease of the [[SA node]].
* An effect of [[drugs]], such as the use of [[digitalis]], [[beta-blockers]], or quinidine.
* [[Sleep]]
* It is a normal finding in a healthy, well-conditioned athlete.


== Differential Diagnosis of Causes of Sinus Bradycardia==  
==[[Sinus bradycardia epidemiology and demographics|Epidemiology and Demographics]]==
In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>


* [[Acetylcholine]]
==[[Sinus bradycardia risk factors|Risk Factors]]==
* [[Alfentanil]]
 
* [[Amiodarone]]
==[[Sinus bradycardia natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
* [[Amyloidosis]]
* [[Beta blocker]]
* [[Brucellosis]]
* [[Calcium channel blocker]]
* [[Carotid sinus hypersensitivity]]
* Cardiac catheterization
* [[Clonidine]]
* [[Congenital Heart Disease]]
* [[Digitalis]]
* [[Dimethyl sulfoxide]] ([[DMSO]])
* Drugs
* [[Fentanyl]]
* [[Hypercalcemia]]
* [[Hypercapnia]]
* [[Hyperkalemia]]
* [[Hypothermia]]
* [[Hypothyroidism]]
* [[Hypoxia]]
* [[Increased intracranial pressure]]
* [[Lithium]]
* [[Meningitis]]
* [[STEMI|Myocardial Infarction]]
* [[Myocarditis]]
* [[Paclitaxel]]
* Physical training, elite athlete status
* [[Quinidine]]
* [[Reserpine]]
* [[Sepsis]]
* [[Sick Sinus Syndrome]] ([[SSS]])
* [[Sufentanil]]
* Tight fitting neckwear
* [[Toluene]]
* Tumors of the neck
* [[Tumor lysis syndrome]]
* [[Typhoid Fever]]
* [[Vagal nerve]] stimulation
* [[Vagotonia]]
* [[Vasovagal syncope]]


==Diagnosis==
==Diagnosis==
===Symptoms===
[[Sinus bradycardia history and symptoms| History and Symptoms]] | [[Sinus bradycardia physical examination | Physical Examination]] | [[Sinus bradycardia laboratory findings|Laboratory Findings]] | [[Sinus bradycardia electrocardiogram|Electrocardiogram]]
The decreased heart rate can cause a decreased [[cardiac output]] resulting in symptoms such as [[lightheadedness]], [[dizziness]], [[hypotension]], [[vertigo]], and [[syncope]].
 
Sinus bradycardia may lead to no symptoms in a young athlete.
 
===ECG Characteristics===
*Rate:  Less than 60.
*Rhythm:  Regular.
*[[P wave]]s:  Upright, consistent, and normal in morphology and duration.
*[[PR Interval]]:  Between 0.12-0.20 seconds in duration.
*[[QRS complex]]:  Less than 0.12 seconds in width, and consistent in morphology.


==Treatment==
==Treatment==
Asymptomatic sinus bradycardia requires no treatment.
[[Sinus bradycardia medical therapy|Medical Therapy]] | [[Sinus bradycardia primary prevention|Primary Prevention]]


==Case Studies==
[[Sinus bradycardia case study one|Case#1]]
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


== See also ==
[[Category:Cardiology]]
*[[Sinus tachycardia]]
[[Category:Up-To-Date]]
*[[Long QT syndrome]]
[[Category:Up-To-Date cardiology]]
 
[[Category:Arrhythmia]]
==Additional resources==
* [http://en.ecgpedia.org ECGpedia: Course for interpretation of ECG]
* [http://www.anaesthetist.com/icu/organs/heart/ecg/ The whole ECG - A basic ECG primer]
* [http://www.ecglibrary.com 12-lead ECG library]
* [http://www.ecgsim.org Simulation tool to demonstrate and study the relation between the electric activity of the heart and the ECG]
* [http://heartcenter.seattlechildrens.org/what_to_expect/electrocardiogram.asp ECG information from Children's Hospital Heart Center, Seattle]
* [http://www.regionalpci-stemi.org/id10.html ECG Challenge from the ACC D2B Initiative]
* [http://0-www.nhlbi.nih.gov.innopac.up.ac.za:80/health/dci/Diseases/ekg/ekg_what.html National Heart, Lung, and Blood Institute, Diseases and Conditions Index]
* [http://www.ecglibrary.com/ecghist.html A history of electrocardiography]
* [http://www.health.gov.mt/impaedcard/issue/issue1/ipc00103.htm EKG Interpretations in infants and children]
 
==EKG Examples==
 
<div align="left">
<gallery heights="175" widths="175">
Image:Sinusbrady.PNG|Sinus bradycardia
Image:Ecg_bradycardia 1.png|Sinus bradycardia
</gallery>
</div>
 
[[Category:Electrophysiology]]
[[Category:Electrophysiology]]
[[Category:Cardiology]]
[[Category:Disease]]
[[Category:Emergency medicine]]
 
{{Electrocardiography}}
{{SIB}}
[[pl:Rzadkokurcz]]
[[sv:Sinusbradykardi]]
[[tr:Sinuzal bradikardi]]
 
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Latest revision as of 22:50, 26 August 2013

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Pathophysiology

Causes

Differentiating Sinus bradycardia from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram

Treatment

Medical Therapy | Primary Prevention

Case Studies

Case#1

References


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