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==Causes==
==Causes==
Pathologic bradycardias are caused by disorders of impulse generation (impaired automaticity at [[SA node]]), impulse conduction ([[heart block]]) or [[escape pacemaker]]s and rhythms. Bradycardia can be underlain by several causes, which are best divided into cardiac and non-cardiac causes. Non-cardiac causes are usually secondary, and can involve recreational drug use, [[endocrine]] disorders ([[hypothyroid]]); [[electrolyte]] imbalance ([[hyperkalemia]]); autonomic reflexes; situational factors (prolonged [[bed rest]]); infections [[lyme disease]], medications, and [[autoimmune|autoimmunity]] disorders. Cardiac causes include acute or chronic [[ischemic heart disease]], vascular [[heart disease]], [[valvular heart disease]], or degenerative primary electrical disease (fibrosis and calcification of the [[sinus node]] and [[conduction system]]).
Pathologic bradycardias are caused by disorders of impulse generation (impaired automaticity at [[SA node]]), impulse conduction ([[heart block]]) or [[escape pacemaker]]s and rhythms. Bradycardia can be underlain by several causes, which are best divided into cardiac and non-cardiac causes. Non-cardiac causes are usually secondary, and can involve recreational drug use, [[endocrine]] disorders ([[hypothyroid]]); [[electrolyte]] imbalance ([[hyperkalemia]]); autonomic reflexes; situational factors (prolonged [[bed rest]]); infections [[lyme disease]], medications, and [[autoimmune|autoimmunity]] disorders. Cardiac causes include acute or chronic [[ischemic heart disease]], vascular [[heart disease]], [[valvular heart disease]], or degenerative primary electrical disease (fibrosis and calcification of the [[sinus node]] and [[conduction system]]).
===Causes of Bradycardia By Organ System===
{|style="width:70%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |
[[Atrioventricular Block]],
[[Cardiac arrhythmia]],
[[Cardiac Dysrhythmias]],
[[Cardiomegaly]],
[[Right Bundle Branch Block]],
[[Second Degree AV Block]],
[[ST Elevation Myocardial Infarction Complications]],
[[Sinoatrial Block]],
[[Pulseless ventricular tachycardia]],
[[Sick sinus syndrome]],
[[Cardiomyopathy]],
[[Distichiasis - heart and vasculature anomalies - sinus bradycardia]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[Carbamate]],
[[Opioid poisoning]],
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"|
[[Aceclidine]],
[[Acepromazine]],
[[Acetylcholinesterase inhibitor]],
[[Adenosine]],
[[Amiodarone]],
[[Amodiaquine]],
[[Atenolol]],
[[Barbiturates]],
[[Beta-blockers]],
[[Bupivacaine]],
[[Calcium channel blocker]],
[[Clomipramine]],
[[Clonidine]],
[[Detomidine]],
[[Digitalis]],
[[Diltiazem]],
[[Diphenhydramine]],
[[Donepezil]],
[[Doxepin]],
[[Glyceryl trinitrate ]],
[[Hydrocodone]],
[[Ibuprofen]],
[[Isosorbide dinitrate]],
[[Ivabradine]],
[[Levobetaxolol]],
[[Levobupivacaine]],
[[Lidocaine]],
[[Lithium]],
[[Medetomidine]],
[[Mefloquine]],
[[Mepivacaine]],
[[Methacholine]],
[[Methoxamine]],
[[Methyldopa]],
[[Morphine]],
[[Moxonidine]],
[[Nadolol]],
[[Nalbuphine]],
[[Nalmefene]],
[[Opioid]],
[[Oxymorphone]],
[[Phenobarbital]],
[[Phenylephrine]],
[[Phenytoin]],
[[Pilocarpine]],
[[Propafenone]],
[[Propranolol]],
[[Quinidine]],
[[Reserpine]],
[[Ropivacaine]],
[[Sulpiride]],
[[Suxamethonium chloride]],
[[Tacrine]],
[[Timolol]],
[[Trazodone]],
[[Uncaria tomentosa]],
[[Xylazine]],
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Hypothyroidism]],
[[Hashimoto's Thyroiditis]],
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"|
[[Grayanotoxin]],
[[Hellebore]],
[[Hypothermia]],
[[Heat exhaustion]]
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Obstructive jaundice]], [[Necrotizing enterocolitis ]], [[Typhoid fever ]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"|
[[Congenital Long QT Syndrome]],
[[Catecholaminergic polymorphic ventricular tachycardia]], [[Emery-Dreifuss muscular dystrophy]], [[Congenital Central Hypoventilation Syndrome]],
[[Distichiasis - heart and vasculature anomalies - sinus bradycardia]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"|
[[Enema]],
[[Gastric lavage]],
[[PCI Complications: Radiocontrast toxicity]],
[[Rapid sequence induction]], [[Cardiac catheterization]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"|
[[Chagas' disease]],
[[Hantavirus pulmonary syndrome]],
[[Legionella pneumonia and Mycoplasma pneumonia]],
[[Tularaemia]],
[[Colorado tick fever]],
[[Brucellosis]],
[[Trypanosoma cruzi]],
[[Typhoid fever]],
[[Septic shock]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"|
[[Holt-Oram syndrome]],
[[Vertebral subluxation]],
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"|
[[Vasovagal syncope]],
[[Vagal episode]],
[[Neurogenic shock]],
[[Subarachanoid hemorrhage]],
[[Raised Intracranial pressure]],
[[Autonomic neuropathy]],
[[Cerebral hemorrhage]],
[[Cerebral venous sinus thrombosis]],
[[Cushing triad]],
[[Cushing reaction]],
[[Cushing reflex]],
[[Neurocardiogenic Syncope]],
[[Increased intracranial pressure]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"|
[[Hypercalcemia]],
[[Hyperkalemia]],
[[Hypokalemia]],
[[Anorexia Nervosa]],
[[Malnutrition]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"|
[[Fetal distress]],
[[Neonatal lupus erythematosus]],
[[Vasa previa]],
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| [[Oculocardiac reflex]], [[Distichiasis - heart and vasculature anomalies - sinus bradycardia]]
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"|
[[Gamma-Hydroxybutyric acid]],
[[Hydroxyethyl starch]]
[[Speedball (drug)]],
[[Theobromine poisoning]],
[[Sedatives ]]
[[Cyclic antidepressant poisoning ]]
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| [[Anorexia Nervosa]],
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Apnea of prematurity]], [[Asphyxia neonatorum ]], [[Pneumothorax ]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Skull fracture ]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"|
[[Drowning]],
[[Mammalian diving reflex]],
|-
|}


==References==
==References==

Revision as of 03:58, 27 August 2012

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

Overview

Causes

Pathologic bradycardias are caused by disorders of impulse generation (impaired automaticity at SA node), impulse conduction (heart block) or escape pacemakers and rhythms. Bradycardia can be underlain by several causes, which are best divided into cardiac and non-cardiac causes. Non-cardiac causes are usually secondary, and can involve recreational drug use, endocrine disorders (hypothyroid); electrolyte imbalance (hyperkalemia); autonomic reflexes; situational factors (prolonged bed rest); infections lyme disease, medications, and autoimmunity disorders. Cardiac causes include acute or chronic ischemic heart disease, vascular heart disease, valvular heart disease, or degenerative primary electrical disease (fibrosis and calcification of the sinus node and conduction system).

Causes of Bradycardia By Organ System

Cardiovascular

Atrioventricular Block, Cardiac arrhythmia, Cardiac Dysrhythmias, Cardiomegaly, Right Bundle Branch Block, Second Degree AV Block, ST Elevation Myocardial Infarction Complications, Sinoatrial Block, Pulseless ventricular tachycardia, Sick sinus syndrome, Cardiomyopathy, Distichiasis - heart and vasculature anomalies - sinus bradycardia


Chemical / poisoning Carbamate,

Opioid poisoning,

Dermatologic No underlying causes
Drug Side Effect

Aceclidine, Acepromazine, Acetylcholinesterase inhibitor, Adenosine, Amiodarone, Amodiaquine, Atenolol, Barbiturates, Beta-blockers, Bupivacaine, Calcium channel blocker, Clomipramine, Clonidine, Detomidine, Digitalis, Diltiazem, Diphenhydramine, Donepezil, Doxepin, Glyceryl trinitrate , Hydrocodone, Ibuprofen, Isosorbide dinitrate, Ivabradine, Levobetaxolol, Levobupivacaine, Lidocaine, Lithium, Medetomidine, Mefloquine, Mepivacaine, Methacholine, Methoxamine, Methyldopa, Morphine, Moxonidine, Nadolol, Nalbuphine, Nalmefene, Opioid, Oxymorphone, Phenobarbital, Phenylephrine, Phenytoin, Pilocarpine, Propafenone, Propranolol, Quinidine, Reserpine, Ropivacaine, Sulpiride, Suxamethonium chloride, Tacrine, Timolol, Trazodone, Uncaria tomentosa, Xylazine,

Ear Nose Throat No underlying causes
Endocrine Hypothyroidism,

Hashimoto's Thyroiditis,

Environmental

Grayanotoxin, Hellebore, Hypothermia, Heat exhaustion

Gastroenterologic Obstructive jaundice, Necrotizing enterocolitis , Typhoid fever
Genetic

Congenital Long QT Syndrome, Catecholaminergic polymorphic ventricular tachycardia, Emery-Dreifuss muscular dystrophy, Congenital Central Hypoventilation Syndrome, Distichiasis - heart and vasculature anomalies - sinus bradycardia

Hematologic No underlying causes
Iatrogenic

Enema, Gastric lavage, PCI Complications: Radiocontrast toxicity, Rapid sequence induction, Cardiac catheterization

Infectious Disease

Chagas' disease, Hantavirus pulmonary syndrome, Legionella pneumonia and Mycoplasma pneumonia, Tularaemia, Colorado tick fever, Brucellosis, Trypanosoma cruzi, Typhoid fever, Septic shock



Musculoskeletal / Ortho

Holt-Oram syndrome, Vertebral subluxation,


Neurologic

Vasovagal syncope, Vagal episode, Neurogenic shock, Subarachanoid hemorrhage, Raised Intracranial pressure, Autonomic neuropathy, Cerebral hemorrhage, Cerebral venous sinus thrombosis, Cushing triad, Cushing reaction, Cushing reflex, Neurocardiogenic Syncope, Increased intracranial pressure



Nutritional / Metabolic

Hypercalcemia, Hyperkalemia, Hypokalemia, Anorexia Nervosa, Malnutrition


Obstetric/Gynecologic

Fetal distress, Neonatal lupus erythematosus, Vasa previa,


Oncologic No underlying causes
Opthalmologic Oculocardiac reflex, Distichiasis - heart and vasculature anomalies - sinus bradycardia
Overdose / Toxicity

Gamma-Hydroxybutyric acid, Hydroxyethyl starch Speedball (drug), Theobromine poisoning, Sedatives Cyclic antidepressant poisoning

Psychiatric Anorexia Nervosa,
Pulmonary Apnea of prematurity, Asphyxia neonatorum , Pneumothorax
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy No underlying causes
Sexual No underlying causes
Trauma Skull fracture
Urologic No underlying causes
Miscellaneous

Drowning, Mammalian diving reflex,


References

Template:WH Template:WS

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