This document provides an overview of bradycardia in children, including definitions, types, recognition, ECG characteristics, and management. It describes bradycardia as an abnormally slow heart rate for a child's age that can rapidly lead to cardiopulmonary compromise. The document outlines initial steps to stabilize a child with bradycardia, including checking for hypotension, decreased consciousness, shock, or respiratory distress. It also provides guidelines for determining the heart rate from an ECG and classifying different types of bradycardic rhythms like sinus bradycardia or heart block. Reversible causes of bradycardia are listed as well as an algorithm for treating symptomatic bradycardia with medications.

1. Recognition & Management of
Bradycardia
By Dr. Akshay

2. Objectives
Describe when bradycardia requires immediate intervention.
Describe initial steps to stabilize a child with cardiopulmonary
compromise.
Know when to start CPR in a child with bradycardia.
Manage a child as outlined in s Pediatric Bradycardia with Pulse
& poor perfusion algorithm
Select appropriate medications for treatment of symptomatic
bradycardia

3. definition
Bradycardia is a heart rate that is slow in
comparison with a normal heart rate range for
the child's age & the level of activity.
Bradycardia is an ominous sign!

4. Basic Anatomy and Physiology
The SA node
The AV node
Bundle of His
Right Bundle Branch
Left Bundle Branch

5. Types
Primary Bradycardia
Secondary Bradycardia

6. Recognition of Bradycardia
Bradycardia rapidly turns into cardiopulmonary
compromise.
– Hypotension
– Decreased level of consciousness
– Shock
– Poor-end organ perfusion
– Respiratory distress or failure
– Sudden collapse

7. ECG characteristics
Heart rate Slow compared to the normal heart rate for age
P waves May or may not be visible
QRS complex Narrow or wide (depending on the origin of the
pacemaker &/or location of the injury to the
conduction system)
P wave &
QRS complex
May be unrelated (AV dissociation)

8. What is the paper speed?
Normal paper speed 25
mm/sec
1 small square=0.04s
1 big square= 0.2secs

9. How to calculate the heart rate?
Find 2 adjacent R waves, count the number of big squares between
the R’s
Divide 300 by the number of big squares : this is your heart rate

10. bradyarrhythmias
Bradycardia which is associated with rhythm
disturbance known as bradyarrhythmias.
Common are sinus bradycardia & AV block.

11. Sinus bradycardia

12. First degree heart block

22. Reversible causes
Hypoxia
Hydrogen ion
(acidosis)
Hyperkalemia
Hypothermia
Heart Block
Toxins / poisonings /
drugs
Trauma