Bradycardia=HR<60bpm)

Common types of bradycardia and syndromes

associated with bradycardia:

• Sinus bradycardia
• Junctional bradycardia
• 1st Degree AV block
• 2nd Degree AV block
• Ventricular escape rhythm and complete heart block
• Tachy-brady syndrome
• Bradycardia-induced Torsades de Pointes
• BRASH Syndrome
Sinus Bradycardia: (HR<60bpm)
Causes of sinoatrial exit block:

• Sick sinus syndrome

• Increased vagal tone (athletes)
• Vagal stimulation (surgery, pain)
• Inferior myocardial infarction
• Myocarditis
• Drugs: digoxin, beta-blockers, calcium channel blockers, amiodarone.
• Third Degree SA Block
= None of the sinus impulses are conducted to the right atrium.
There is a complete absence of P waves.
The onset of 3rd degree SA block may produce long sinus pauses or sinus arrest
(may lead to fatal asystole).
Rhythm may be maintained by a junctional escape rhythm.
Third degree SA exit block is indistinguishable from sinus arrest due to
pacemaker cell failure. It can only be diagnosed with a sinus node electrode
during electrophysiological evaluation.
Junctional Bradycardia:
-Three or more junctional escape beats at a rate less than 60 b.p.m.
-QRS complexes are the same as in sinus rhythm.
-P waves may be absent (sinus arrest), buried in the QRS, occur after the junctional escape, or
occur as a result of retrograde conduction (inverted P wave)
FIRST DEGREE AV BLOCK:
MOBITZ TYPE I - SECOND DEGREE AV
BLOCK:
MOBITZ TYPE II - SECOND DEGREE AV
BLOCK:
MOBITZ TYPE II – 2:1 SECOND DEGREE AV
BLOCK:
MOBITZ TYPE II – HIGH GRADE
SECOND DEGREE AV BLOCK:
THIRD DEGREE AV BLOCK – NARROW
QRS COMPLEX ESCAPE RHYTHM:
THIRD DEGREE AV BLOCK – WIDE QRS
COMPLEX ESCAPE RHYTHM:
THIRD DEGREE AV BLOCK – AFIB:
4-Step Approach to Bradycardia and
Bradydysrhythmias
Cardiac Output = Heart rate x Stroke volume

Occult Bradycardic Shock:

Normal BP, Concious patient but altered LOA, cool
extremities, low urine output etc due to low cardiac
output.
Importance of Location of Block:
• Sinus and AV nodal
dysfunction rarely leads to
life-threatening
complications and are
treated with watchful
waiting, atropine or
sympathetic medications
such as epinephrine and
dopamine.
• Distal His-Purkinje block is
much more serious, and
tend not to respond to
atropine and sympathetic
stimulation. These patients
almost always need pacing
and a definitive pacemaker.