Bradycardia medical therapy

Bradycardia Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M.Umer Tariq [2]

Medical Therapy

Urgent Treatment

• Check drug list and remove drugs predisposing to bradycardia like beta blockers, calcium channel blocker, anti-arrhythmic drug.
• Drug treatment for bradycardia is typically not indicated for patients who are asymptomatic.
• In symptomatic patients, underlying electrolyte or acid-base disorders or hypoxia should be corrected first.
• IV atropine may provide temporary improvement in symptomatic patients, although its use should be balanced by an appreciation of the increase in myocardial oxygen demand this agent causes. Atropine 0.5-1 mg IV or ET q3-5min up to 3 mg total (0.04 mg/kg)

Chronic Management

There are two main reasons for treating brandycardia:

1. With bradycardia, the first is to address the associated symptoms, such as fatigue, limitations on how much an individual can physically exert, fainting (syncope), dizziness or lightheadedness, or other vague and non-specific symptoms.
2. The other reason to treat bradycardia is if the person's ultimate outcome (prognosis) will be changed or impacted by the bradycardia.

Treatment in this vein depends on whether any symptoms are present, and what the underlying cause is. Primary or idiopathic bradycardia is treated symptomatically if it is significant, and the underlying cause is treated if the bradycardia is secondary.

Contraindicated medications

Persistently severe bradycardia is considered an absolute contraindication to the use of the following medications:

• Acebutolol

Symptomatic bradycardia (except in patients with a functioning artificial pacemaker) is considered an absolute contraindication to the use of the following medications:

• Adenosine