SINUS BRADYCARDIA

Criteria for Sinus Bradycardia:

How can you know if your patient is presenting with sinus bradycardia?
• Make sure the heart rhythm meets the criteria for normal sinus rhythm and it has a rate of less
than 60 bpm.
PQRST:
P wave: 3’s R’s (regularity of rhythm, rate, resemblance)

• P wave: regularity of rhythm is present in the p waves, rate of less than 60, resemblance: only one p
wave in front of each QRS complex, round and upright (uniform throughout)
• QRS complex: 3’s R’s (regularity of rhythm, rate, resemblance)

• QRS complex: regularity of the rhythm is present in the QRS complexes, rate less than 60, QRS
present with each p wave, measures less than 0.12 seconds
• —-For sinus bradycardia, atrial and ventricular rate should be REGULAR and have the SAME RATE.

• T wave: present after each QRS complex

• PR interval: 0.12-0.20 seconds, ST segment: flat, QT interval: normal 0.36-0.44 seconds
 Causes of Sinus Bradycardia
“Slow Rates”
• Sick Sinus Syndrome (the SA node is damaged severely so it can’t work as the pacemaker of the heart) and this condition can lead to
other dysrhythmias sinus arrest or brady-tachy syndrome
• Low thyroid hormone
• Older adult (as some humans age so does the SA node and this causes the heart to beat slower)
• Weak & damaged heart muscle (ischemia “myocardial infraction” damage to the SA node from decreased blood supply,
inflammation/infection “pericarditis“)
• Raised Intracranial pressure: part of Cushing’s Triad (slow heart rate, irregular respirations, and widened pulse pressure)
• Athlete (well-conditioned)
• Toxicity of: beta blockers “olol”, calcium channel blockers “verapamil”, clonidine, digoxin
• Electrolyte imbalances (hyperkalemia.. severe cases)
• Stimulation of vagal response: overactive or vomiting
 Sinus Bradycardia Nursing Interventions & Treatments

Nursing: if patient is symptomatic and becoming unstable activate the emergency response system in
your facility, place on oxygen is having dyspnea, confirm IV access, place on bedside cardiac monitor and
monitor vitals (heart rate, blood pressure, respiratory rate), assess lung and heart sounds (crackles or
extra heart sounds, which could demonstrate congestive heart failure), hold any medications that slow
the heart rate down, protect from injury (risk of falling), have lifesaving medications and equipment close
by
Treatment:
Find and treat the cause: medication: stop it, electrolyte imbalance: fix it etc
Medications:
Atropine (rapid IV push: 1 mg every 3-5 mins…no more than 3 mg per ACLS guidelines)
doesn’t work if patient has a transplanted heart
blocks the effects of the vagus nerve (this nerve connects to the SA Node and causes it to slow down the
rate) so this medication will help increase the heart rate
If not effective a drip of dopamine (increases heart rate and blood pressure), or epinephrine may be used