Sinus bradycardia

Sinus bradycardia
Sinus bradycardia.
ICD-9	427.81
eMedicine	emerg/
MeSH	D001146

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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.

Pathosphysiology

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

In alphabetical order. Atenolol Bethanechol Bupivacaine Cervical spine injury Cilobradine Deserpidine Diltiazem Distigmine Fentanyl Foetal distress Hypermagnesaemia Ivabradine Kwashiorkor Lofexidine Miller-Dieker syndrome Neostigmine Organophosphates

• Ambenonium
• Acetylcholine
• Alfentanil
• Amiodarone
• Amyloidosis
• Beta blocker
• Brucellosis
• Calcium channel blocker
• Carotid sinus hypersensitivity
• Cardiac catheterization
• Clonidine
• Congenital Heart Disease
• Digitalis
• Dimethyl sulfoxide (DMSO)
• Diptheria
• Drugs
• Electrocution
• Fentanyl
• Hypercalcemia
• Hypercapnia
• Hyperkalemia
• Hyoglycemia
• Hypothermia
• Hypothyroidism
• Hypoxia
• Increased intracranial pressure
• Lithium
• Meningitis
• Myocardial Infarction, particularly inferior MI
• Myocarditis
• Paclitaxel
• Physical training, elite athlete statu
• Propranolol
• Quinidine
• Reserpine
• Rheumatic fever
• Sepsis
• Sick Sinus Syndrome (SSS)
• Sleep apnea
• [[Sotalol]}
• Spinal cord injury
• Sufentanil
• Suxamethonium
• Tight fitting neckwear
• Toluene
• Tumors of the neck
• Tumor lysis syndrome
• Typhoid Fever
• Vagal nerve stimulation
• Vagotonia
• Valsalva maneuver
• Vasovagal syncope
• Verapamil
• Yellow fever
• Zatebradine

Diagnosis

Symptoms

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 waves: 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

Asymptomatic sinus bradycardia requires no treatment.

See also

• Sinus tachycardia
• Long QT syndrome

Additional resources

• ECGpedia: Course for interpretation of ECG
• The whole ECG - A basic ECG primer
• 12-lead ECG library
• Simulation tool to demonstrate and study the relation between the electric activity of the heart and the ECG
• ECG information from Children's Hospital Heart Center, Seattle
• ECG Challenge from the ACC D2B Initiative
• National Heart, Lung, and Blood Institute, Diseases and Conditions Index
• A history of electrocardiography
• EKG Interpretations in infants and children

EKG Examples

• 
  Sinus bradycardia
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  Sinus bradycardia

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