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| {{Infobox_Disease
| | __NOTOC__ |
| | Name = {{PAGENAME}}
| | {{Sinus bradycardia}} |
| | Image = Sinusbrady.PNG
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| | Caption = Sinus bradycardia.
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| | DiseasesDB =
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| | ICD10 =
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| | ICD9 = {{ICD9|427.81}}
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| | ICDO =
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| | OMIM =
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| | MedlinePlus =
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| | eMedicineSubj = emerg
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| | eMedicineTopic =
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| | MeshID = D001146
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| }} | |
| {{SI}} | | {{SI}} |
| {{CMG}} | | {{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}} |
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| '''Associate Editor-In-Chief:''' {{CZ}}
| | ==[[Sinus bradycardia overview|Overview]]== |
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| {{Editor Join}}
| | ==[[Sinus bradycardia pathophysiology|Pathophysiology]]== |
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| '''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]]== |
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| ==Pathosphysiology== | | ==[[Sinus bradycardia differential diagnosis|Differentiating Sinus bradycardia from other Diseases]]== |
| This rhythm may be caused by one of the following:
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| * Increased [[vagal]] tone.
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| * Intrinsic disease of the [[SA node]].
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| * An effect of [[drugs]], such as the use of [[digitalis]] or [[beta-blockers]].
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| * [[Sleep]]
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| * Sinus bradycardia is a normal finding in a healthy, well-conditioned athlete.
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| == 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>
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| * [[Ambenonium]]
| | ==[[Sinus bradycardia risk factors|Risk Factors]]== |
| * [[Acetylcholine]]
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| * [[Alfentanil]]
| | ==[[Sinus bradycardia natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| * [[Amiodarone]]
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| * [[Amyloidosis]]
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| * [[Atenolol]]
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| * [[Ativan]]
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| * [[Beta blocker]]
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| * [[Bethanechol]]
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| * [[Brucellosis]]
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| * [[Bupivacaine]]
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| * [[Calcium channel blocker]]
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| * [[Carotid sinus hypersensitivity]]
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| * [[Cardiac catheterization]]
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| * [[Cervical spine injury]]
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| * [[Cilobradine]]
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| * [[Clonidine]]
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| * [[Congenital Heart Disease]]
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| * [[Deserpidine]]
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| * [[Digitalis]]
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| * [[Diltiazem]]
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| * [[Dimethyl sulfoxide]] ([[DMSO]])
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| * [[Diptheria]]
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| * [[Distigmine]]
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| * [[Drugs]]
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| * [[Electrocution]]
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| * [[Fentanyl]]
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| * [[Fetal distress]]
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| * [[Hypercalcemia]]
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| * [[Hypercapnia]]
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| * [[Hyperkalemia]]
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| * [[Hypermagnesemia]]
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| * [[Hypoglycemia]]
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| * [[Hypothermia]]
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| * [[Hypothyroidism]]
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| * [[Hypoxia]]
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| * [[Increased intracranial pressure]]
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| * [[Ivabradine]]
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| * [[Kwashiorkor]]
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| * [[Lidocaine]]
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| * [[Lithium]]
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| * [[Lofexidine]]
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| * [[Meningitis]]
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| * [[Miller-Dieker syndrome]]
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| * [[STEMI|Myocardial Infarction]], particularly inferior MI
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| * [[Myocarditis]]
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| * [[Neostigmine]]
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| * [[Organophosphates]]
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| * [[Paclitaxel]]
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| * Physical training, elite athlete statu
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| * [[Propranolol]]
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| * [[Quinidine]]
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| * [[Reserpine]]
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| * [[Rheumatic fever]]
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| * [[Sepsis]]
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| * [[Sick Sinus Syndrome]] ([[SSS]])
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| * [[Sleep apnea]]
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| * [[Sotalol]]
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| * [[Spinal cord injury]]
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| * [[Sufentanil]]
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| * [[Suxamethonium]]
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| * Tight fitting neckwear
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| * [[Toluene]]
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| * [[Tumor]]s of the neck
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| * [[Tumor lysis syndrome]]
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| * [[Typhoid Fever]]
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| * [[Vagal nerve]] stimulation
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| * [[Vagotonia]]
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| * [[Valsalva maneuver]]
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| * [[Vasovagal syncope]]
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| * [[Verapamil]]
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| * [[Vicodin]]
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| * [[Yellow fever]]
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| * [[Zatebradine]]
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| ==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]].
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| Sinus bradycardia may lead to no symptoms in a young athlete. | |
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| ===Signs===
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| There may be a wide [[pulse pressure]]. If [[cardiac output]] is reduced, there may be signs of end organ hypoperfusion.
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| ===Laboratory Studies===
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| [[TFT]]s should be checked
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| Check electrolytes, Ca, Mg
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| [[Hypoglycemia]] should be excluded
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| Consider a toxicologic screen
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| ===ECG Characteristics===
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| *Rate: Less than 60.
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| *Rhythm: Regular.
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| *[[P wave]]s: Upright, consistent, and normal in morphology and duration.
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| *[[PR Interval]]: Between 0.12-0.20 seconds in duration.
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| *[[QRS complex]]: Less than 0.12 seconds in width, and consistent in morphology.
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| *[[Early repolarization]] is accentuated in the setting of sinus bradycardia
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| ====EKG Examples====
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Sinusbrady.PNG|Sinus bradycardia
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| Image:Ecg_bradycardia 1.png|Sinus bradycardia
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| </gallery>
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| </div>
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| ==Treatment== | | ==Treatment== |
| Asymptomatic sinus bradycardia requires no treatment.
| | [[Sinus bradycardia medical therapy|Medical Therapy]] | [[Sinus bradycardia primary prevention|Primary Prevention]] |
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| | ==Case Studies== |
| | [[Sinus bradycardia case study one|Case#1]] |
| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |
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| == See also ==
| | [[Category:Cardiology]] |
| *[[Sinus tachycardia]]
| | [[Category:Up-To-Date]] |
| *[[Long QT syndrome]]
| | [[Category:Up-To-Date cardiology]] |
| | | [[Category:Arrhythmia]] |
| ==Additional resources==
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| * [http://en.ecgpedia.org ECGpedia: Course for interpretation of ECG]
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| * [http://www.anaesthetist.com/icu/organs/heart/ecg/ The whole ECG - A basic ECG primer]
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| * [http://www.ecglibrary.com 12-lead ECG library]
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| * [http://www.ecgsim.org Simulation tool to demonstrate and study the relation between the electric activity of the heart and the ECG]
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| * [http://heartcenter.seattlechildrens.org/what_to_expect/electrocardiogram.asp ECG information from Children's Hospital Heart Center, Seattle]
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| * [http://www.regionalpci-stemi.org/id10.html ECG Challenge from the ACC D2B Initiative]
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| * [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]
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| * [http://www.ecglibrary.com/ecghist.html A history of electrocardiography]
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| * [http://www.health.gov.mt/impaedcard/issue/issue1/ipc00103.htm EKG Interpretations in infants and children]
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| [[Category:Electrophysiology]] | | [[Category:Electrophysiology]] |
| [[Category:Cardiology]] | | [[Category:Disease]] |
| [[Category:Emergency medicine]]
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| {{Electrocardiography}}
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| {{SIB}}
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| [[pl:Rzadkokurcz]]
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| [[sv:Sinusbradykardi]]
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| [[tr:Sinuzal bradikardi]]
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