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 or beta-blockers.
• Sleep
• Sinus bradycardia is a normal finding in a healthy, well-conditioned athlete.

Differential Diagnosis of Causes of Sinus Bradycardia

In alphabetical order.

• Ambenonium
• Acetylcholine
• Alfentanil
• Amiodarone
• Amyloidosis
• Atenolol
• Ativan
• Beta blocker
• Bethanechol
• Brucellosis
• Bupivacaine
• Calcium channel blocker
• Carotid sinus hypersensitivity
• Cardiac catheterization
• Cervical spine injury
• Cilobradine
• Clonidine
• Congenital Heart Disease
• Corgard
• Deserpidine
• Digitalis
• Diltiazem
• Dimethyl sulfoxide (DMSO)
• Diptheria
• Distigmine
• Drugs
• Electrocution
• Fentanyl
• Fetal distress
• Hypercalcemia
• Hypercapnia
• Hyperkalemia
• Hypermagnesemia
• Hypoglycemia
• Hypothermia
• Hypothyroidism
• Hypoxia
• Increased intracranial pressure
• Ivabradine
• Kwashiorkor
• Lidocaine
• Lithium
• Lofexidine
• Meningitis
• Miller-Dieker syndrome
• Myocardial Infarction, particularly inferior MI
• Myocarditis
• Nadolol
• Neostigmine
• Organophosphates
• Paclitaxel
• Physical training, elite athlete status
• Physostigmine (Eserine / Antrilirium)
• Procainamide (Procan-SR / Pronestyl)
• Propranolol
• Quinidine
• Reserpine
• Rheumatic fever
• Sepsis
• Sick Sinus Syndrome (SSS)
• Sleep apnea
• Sotalol (Betapace)
• 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
• Vicodin
• 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.

Signs

There may be a wide pulse pressure. If cardiac output is reduced, there may be signs of end organ hypoperfusion.

Laboratory Studies

TFTs should be checked Check electrolytes, Ca, Mg Hypoglycemia should be excluded Consider a toxicologic screen

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.
• Early repolarization is accentuated in the setting of sinus bradycardia

EKG Examples

• 
  Sinus bradycardia
• 
  Sinus bradycardia

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

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