This document provides guidance on managing symptomatic bradycardia. It defines bradycardia and distinguishes between symptomatic and adverse bradycardia. For initial management, it recommends assessing ABCDE, obtaining an ECG, starting an IV, providing oxygen monitoring, calling for help, and identifying the cause. Patients with adverse features like shock, ischemia, syncope or heart failure require prompt treatment with atropine up to 3mg in doses of 500mcg every 3-5 minutes. If atropine is not effective, options include isoprenaline, adrenaline, or transcutaneous pacing, and transvenous pacing may be arranged. In some cases of digoxin toxicity, antibody fragments can be tried before

1. Management of
Symptomatic Bradycardia
Dr Atit M Ghoda

2. Definition
• By definition, bradycardia is a heart rate of
<60 beats per minute.
• When it produces symptoms in a patient, it
is called symptomatic bradycardia

3. Initial Management
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)

4. Is it accompanied by adverse
features?
Adverse features include
• Features of Shock
• Myocardial Ischemia
• Syncope
• Heart Failure

5. 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.

6. 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
intervals
• So, a maximum of 6 doses can be given

7. Patient doesnt respond to
Atropine
Different options available like
Drugs: Isoprenaline
Adrenaline
OR
Arrange for Transcutaneous pacing

8. • Call a specialist for arranging Transvenous
Pacing

9. • In certain situations, administration of
certain drugs can be tried before pacing.
• Eg. Using digoxin specific antibody
fragments in cases of digoxin toxicity

10. •THANK YOU