Dr Atit M Ghoda
• By definition, bradycardia is a heart rate of
<60 beats per minute.
• When it produces symptoms in a patient, it
is called symptomatic bradycardia
Remember the mnemonic AEIOUY
• A = Assess(ABCDE)
• E = ECG (Get an ECG)
• I = IV line
• O = Oxygen and Spo2 monitoring
• U = You go and get help
• Y = Why did this happen (cause)
Is it accompanied by adverse
Adverse features include
• Features of Shock
• Myocardial Ischemia
• Heart Failure
Adverse or Symptomatic?
• Remember and understand that it is
important to distinguish between a
bradycardic patient that has adverse
symptoms and a patient who is just
symptomatic but has features like
dizziness, or a funny feeling in the chest.
Patient with Adverse features
• Needs to be treated promptly.
• Atropine is the drug of choice
• Dose= 500mcg iv
• A maximum of 3mg can be given at 3-5min
• So, a maximum of 6 doses can be given
Patient doesnt respond to
Different options available like
Arrange for Transcutaneous pacing
• Call a specialist for arranging Transvenous
• In certain situations, administration of
certain drugs can be tried before pacing.
• Eg. Using digoxin specific antibody
fragments in cases of digoxin toxicity