Bradycardia medical therapy
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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
Medical therapy is divided into urgent and chronic management. Drug treatment of sinus bradycardia is usually not indicated for asymptomatic patients. In symptomatic patients, underlying electrolyte or acid-base disorders or hypoxia should be corrected. Intravenous atropine may provide temporary improvement in symptomatic patients.
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)[1][2]
Chronic Management
There are two main reasons for treating bradycardia:
- 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.
- 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.
| Symptoms | |||||||||||||||||||||||||||||||||||||||
| Yes→ Hemodynamically Stable | Uncertain/no→ No immediate treatment Consider additional diagnostic testing: Ambulatory ECG ETT TSH | ||||||||||||||||||||||||||||||||||||||
| No→ IV atropine 0.5mg IV push; Can be repeated every three to five minutes upto 3mg total | Yes→ Signs/Symptoms of acute MI | ||||||||||||||||||||||||||||||||||||||
| Do HR and symptoms improve? | Yes→ Treat Accordingly | No→ Check for other causes (TSH, infection) | |||||||||||||||||||||||||||||||||||||
| No→ Temporary Pacemaker | Yes→ Monitor | ||||||||||||||||||||||||||||||||||||||
Contraindicated medications
Persistently severe bradycardia is considered an absolute contraindication to the use of the following medications:
Symptomatic bradycardia (except in patients with a functioning artificial pacemaker) is considered an absolute contraindication to the use of the following medications:
References
- ↑ Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW, Kudenchuk PJ, Ornato JP, McNally B, Silvers SM, Passman RS, White RD, Hess EP, Tang W, Davis D, Sinz E, Morrison LJ (November 2010). "Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S729–67. doi:10.1161/CIRCULATIONAHA.110.970988. PMID 20956224.
- ↑ Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD (August 2019). "2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society". J. Am. Coll. Cardiol. 74 (7): e51–e156. doi:10.1016/j.jacc.2018.10.044. PMID 30412709.