Bradycardia

Aka: Bradycardia, Bradyarrhythmia, Relative Bradycardia, Relative Bradycardia with Hypotension

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II. Causes: Primary

  1. See Drug Induced Bradycardia
  2. Sinus Bradycardia
  3. Sinus Arrhythmia
  4. Sinoatrial Node Block
  5. Sick Sinus Syndrome
  6. Atrioventricular Block
    1. Second Degree Atrioventricular Block (esp. Mobitz 2)
    2. Third Degree Atrioventricular Block

III. Causes: Secondary - Top secondary causes to consider in Symptomatic Bradycardia (esp. wide complex Bradycardia)

  1. Electrolytes (Hyperkalemia, Hypercalcemia)
  2. Myocardial Ischemia
  3. Hypothermia
  4. Drug Induced Bradycardia (typically with Hypotension)
    1. Calcium Channel Blocker Overdose
    2. Beta Blocker Overdose
    3. Digoxin Overdose
    4. Clonidine Overdose

IV. Causes: Secondary - General

  1. Electrolyte disturbance
    1. Hypercalcemia
    2. Hyperkalemia
      1. Important cause of Bradycardia that should not be missed
      2. Associated with short P Waves and Tall T Waves
    3. BRASH Syndrome
      1. Bradycardia
      2. Renal Failure
      3. AV Blocker (e.g. Beta Blocker or Calcium Channel Blocker)
      4. Shock (out of proportion to degree of Hyperkalemia, requires fluid Resuscitation and possible pressors)
      5. Hyperkalemia
    4. References
      1. EMCrit (Josh Farkas, MD)
        1. https://emcrit.org/pulmcrit/brash-syndrome-bradycardia-renal-failure-av-blocker-shock-hyperkalemia/
  2. Intracranial cause (Cushing's Reflex or dive reflex)
    1. Neurogenic Shock
    2. Increased Intracranial Pressure (e.g. Head Injury)
  3. Acute ingestions or Poisonings
    1. Opioid Overdose
    2. Gamma Hydroxybutyrate (GHB)
    3. Ciguatera Poisoning
    4. Muscarinic Cholinergic Toxicity
    5. Lead Poisoning
  4. Other conditions
    1. Hypothyroidism
    2. Obstructive Jaundice
    3. Severe Anorexia or starvation
    4. Obstructive Sleep Apnea
  5. Infections (including Relative Bradycardia)
    1. Acute Lassa Fever
    2. Babesiosis
    3. Dengue
    4. Legionnaire's Disease
    5. Leptospirosis
    6. Q Fever
    7. Salmonella typhi (Typhoid Fever)
    8. Scrun Typhus
    9. Tularemia
    10. Viral Hemorrhagic Fever (e.g. Lassa Fever, Ebola)
    11. Ye (2018) WMJ 117(2):73-8 +PMID: 30048576 [PubMed]

V. Causes: Relative Bradycardia with Hypotension

  1. See Infections as above
  2. BRASH Syndrome (with Renal Failure, Hyperkalemia, AV Block)
  3. Hyperkalemia
  4. Hypothyroidism
  5. Myocardial Ischemia
  6. Drug Induced Bradycardia (typically with Hypotension)
    1. Calcium Channel Blocker Overdose
    2. Beta Blocker Overdose
    3. Digoxin Overdose
    4. Clonidine Overdose
  7. Intracranial cause (Cushing's Reflex or dive reflex)
    1. Neurogenic Shock
    2. Increased Intracranial Pressure (e.g. Head Injury)
  8. Intraabdominal Hemorrhage
    1. Ruptured Ectopic Pregnancy
    2. Ruptured Abdominal Aortic Aneurysm
  9. References
    1. Kharod (2014) Case Rep Emerg Med 2014:969562 +PMID: 24826356 [PubMed]

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