Bradycardia Algorithm

Bradycardia is defined as:

• Heart rate < 60 bpm

Clinical relevance depends on:

• Symptoms
• Hemodynamic stability
• Presence of AV block

This page follows the Dysrhythmias Module and mirrors ACLS principles.

Assess:

• Hypotension
• Altered mental status
• Signs of shock
• Ischemic chest discomfort
• Acute heart failure

If NO symptoms:

→ Monitor  
→ Evaluate underlying cause  
→ No emergent therapy required  

If SYMPTOMATIC:

→ Proceed to Step 2

Common causes:

• Sinus Bradycardia
• AV Block
• Medication-induced bradycardia
  • Beta-Blockers
  • Non-DHP Calcium Channel Blockers
  • Digoxin
  • Amiodarone

Atropine

• 1 mg IV push
• Repeat every 3–5 minutes
• Maximum total dose: 3 mg

Mechanism:

• Blocks vagal tone at SA/AV node

Not effective in:

• Infranodal block
• High-grade distal AV block

Escalate immediately:

• Initiate external pacing
• Provide sedation if patient conscious

See:

• Advanced AV Block

Dopamine infusion OR Epinephrine infusion

Used when pacing not immediately available.

• Often does NOT respond to Atropine
• Early pacing is preferred
• Cardiology consultation required

See:

• AV Block

• Consider Glucagon
• High-dose insulin euglycemia therapy
• Vasopressors

See:

• Beta-Blockers

• IV calcium
• Insulin therapy
• Vasopressors

See:

• Non-DHP CCBs

• Digoxin
• Consider Digoxin Immune Fab

Bradycardia → Is patient symptomatic?

NO → Monitor

YES → Give Atropine

If no response → Transcutaneous pacing

If pacing unavailable → Dopamine or Epinephrine infusion

Consider reversible causes.

• Hypoxia
• Electrolyte abnormalities
• Drug effects
• Increased vagal tone
• Ischemia

Always treat underlying cause.

• Treat the patient, not just the number.
• Asymptomatic bradycardia does not require emergent therapy.
• Atropine works at the AV node — not distal conduction tissue.
• Early pacing saves time in high-grade block.
• Always review medication list.

• Dysrhythmias Module
• Atropine
• Adenosine
• AV Block
• Beta-Blockers
• Calcium Channel Blockers
• Cardiovascular Pharmacology