Approach to Bradycardia

Question 1

What 2 factors does the management of bradycardia depend on?

Answer 1

1) Identifying the presence of signs indicating haemodynamic compromise - ‘adverse signs’

2) Identifying the potential risk of asystole

Question 2

What are some factors that indicate haemodynamic compromise and hence the need for treatment for bradycardia?

Answer 2

1) shock: hypotension (systolic blood pressure < 90 mmHg), pallor, sweating, cold, clammy extremities, confusion or impaired consciousness

2) syncope

3) myocardial ischaemia

4) heart failure

Question 3

What is the 1st line treatment of bradycardia with adverse signs?

Answer 3

Atropine (500mcg IV)

Question 4

What are the next steps in bradycardia with adverse signs that does not respond to atropine 500mcg IV?

Answer 4

1) Atropine up to max 3mg

2) Transcutaneous pacing

3) Isoprenaline/adrenaline infusion titrated to response

4) Transvenous pacing –> seek expert help

Question 5

What is max dose of atropine that can be given in bradycardia?

Answer 5

3mg

Question 6

2nd line in bradycardia with adverse signs after atropine max 3mg?

Answer 6

Transcutaneous pacing

Question 7

What are the risk factors for asystole in bradycardia? (4)

Answer 7

1) complete heart block with broad complex QRS

2) recent asystole

3) Mobitz type II AV block

4) ventricular pause > 3 seconds