bradycardia
BRADYCARDIA

Bradycardia is having a heart rate of <60 beats/minute that may not affect the hemodynamic status of some patients.
A heart rate that is inadequate for the patient's current condition and may not be able to support life is a clinically significant bradycardia.

Bradycardia can be caused by problems in the sinoatrial node, problems in the conduction pathways of the heart, metabolic problems or heart attack/disease that caused damage to the heart.

The different types of bradycardia are sinus bradycardia, sick sinus syndrome, tachycardia-bradycardia syndrome, hypersensitive carotid sinus syndrome, sinus pause/arrest, sinoatrial node exit block and atrioventricular block.

  1. Kleinman ME, Brennan EE, Goldberger ZD, et al. Part 5: Adult basic life support and cardiopulmonary resuscitation quality: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015 Nov;132(18)(Suppl 2):S414-S435. doi: 10.1161/CIR.0000000000000259. Accessed 06 Jun 2016. PMID: 26472993
  2. Adán V, Crown LA. Diagnosis and treatment of sick sinus syndrome. Am Fam Physician. 2003 Apr;67(8):1725-1732. http://www.aafp.org/. Accessed 10 Mar 2017. PMID: 12725451
  3. American Heart Association. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Part 7.3. Management of symptomatic bradycardia and tachycardia. Circulation. 2005;112:IV-67-IV-77. doi: 10.1161/CIRCULATIONAHA.105.166558.
  4. Brignole M, Auricchio A, Baron-Esquivias G, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J. 2013 Aug;34(29):2281-2329. doi: 10.1093/eurheartj/eht150. PMID: 23801822
  5. Epstein AE, DiMarco JP, Ellenbogen KA, et al; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines; Heart Rhythm Society. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2013 Jan;127(3):e283-e352. doi: 10.1161/CIR.0b013e318276ce9b. PMID: 23255456
  6. Homoud MK. Sick sinus syndrome: clinical manifestations, diagnosis, and evaluation. UpToDate. https://www.uptodate.com/. Feb 2017.
  7. Homoud MK. Sick sinus syndrome: epidemiology, etiology, and natural history. UpToDate. https://www.uptodate.com/. May 2016.
  8. Homoud MK. Sick sinus syndrome: treatment. UpToDate. https://www.uptodate.com/. May 2016.
  9. Homoud MK. Sinus bradycardia. UpToDate. https://www.uptodate.com/. Jan 2017.
  10. Krul S. Bradycardia. Textbook of Cardiology website. http://www.textbookofcardiology.org/. Jan 2014.
  11. Miller JM, Zipes DP. Diagnosis of cardiac arrhythmias. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, Pennsylvania, USA: Saunders, Elsevier; 2015:662-684.
  12. Olgin JE, Zipes DP. Specific arrhythmias: diagnosis and treatment. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, Pennsylvania, USA: Saunders, Elsevier; 2015:748-797.e2.
  13. Olshansky B. Carotid sinus hypersensitivity. UpToDate. ttps://www.uptodate.com/. Feb 2017.
  14. Sauer WH. First degree atrioventricular block. UpToDate. https://www.uptodate.com/. Nov 2016.
  15. Sauer WH. Second degree atrioventricular block: Mobitz type II. UpToDate. https://www.uptodate.com/. Sep 2016.
  16. Sauer WH. Third degree (complete) atrioventricular block. UpToDate. https://www.uptodate.com/. Aug 2015.
  17. Yealy DM, Kosowsky JM. Dysrhythmias. In: Marx JA, Hockberger RS, Walls RM, Biros MH. Rosen’s Emergency Medicine. 8th ed. Philadelphia, Pennsylvania, USA: Saunders, Elsevier; 2014:1034-1063.e1.
  18. Miller JM, Tomaselli GF, Zipes DP. Diagnosis of cardiac arrhythmias. In: Zipes DP, Libby P, Bonow RO, et al. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, Pennsylvania, USA: Saunders, Elsevier; 2019. 648-669. Accessed 16 Jan 2019:648-669.
  19. Neumar RW, Otto CC, Link MS, et al. Part 8: adult advanced cardiovascular life support: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010 Nov;122(18)(Suppl 3):729-767. doi: 10.1161/CIRCULATIONAHA.110.970988. Accessed 13 Jan 2019. PMID: 20956224
  20. Tomaselli GF, Zipes DP. Approach to the patient with cardiac arrhythmias. In: Zipes DP, Libby P, Bonow RO, et al. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, Pennsylvania, USA: Saunders, Elsevier; 2019. 597-603. Accessed 16 Jan 2019:597-603.
  21. Benditt D. Carotid sinus hypersensitivity and carotid sinus syndrome. UpToDate. http://www.uptodate.com. Jan 2019.
  22. Brignole M, Moya A, de Lange FJ, et al. 2018 ESC guidelines for the diagnosis and management of syncope. Eur Heart J. 2018 Jun;39(21):1883-1948. doi: 10.1093/eurheartj/ehy037. PMID: 29562304
  23. ECC Committee, Subcommittees and Task Force of the American Heart Association. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2005 Dec;112(24):IV1-IV203. doi: 10.1161/CIRCULATIONAHA.105.166550. PMID: 16314375
  24. Homoud MK. Sick sinus syndrome: clinical manifestations, diagnosis, and evaluation. UpToDate. http://www.uptodate.com. Jun 2018.
  25. Homoud MK. Sick sinus syndrome: epidemiology, etiology, and natural history. UpToDate. http://www.uptodate.com. Dec 2017.
  26. Homoud MK. Sinus bradycardia. UpToDate. http://www.uptodate.com. Jun 2017.
  27. Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. Nov 25, 2018. J Am Coll Cardiol. 2018 Nov. doi: 10.1016/j.jacc.2018.10.044. PMID: 30412709
  28. Nolan JP, Soar J, Zideman DA, et al. European Resuscitation Council guidelines for resuscitation 2010. Executive summary. Resuscitation. 2010 Oct;81(10):1219-1276. doi: 10.1016/j.resuscitation.2010.08.021. PMID: 20956052
  29. Olgin JE, Zipes DP. Bradyarrythmias and atrioventricular block. In: Zipes DP, Libby P, Bonow RO, et al. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, Pennsylvania, USA: Saunders, Elsevier; 2019. 772-779. :772-779.
  30. Sauer WH. Etiology of atrioventricular block. UpToDate. http://www.uptodate.com. Nov 2018.
  31. Shen WK, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2017 Aug;136(5):e60-e122. doi: 10.1161/CIR.0000000000000499. PMID: 28280231
  32. Swerdlow CD, Wang PJ, Zipes DP. Pacemakers and implantable cardioverter-defibrillators. In: Zipes DP, Libby P, Bonow RO, et al. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, Pennsylvania, USA: Saunders, Elsevier; 2019. 780-786. :780-786.
  33. Yealy DM, Kosowsky JM. Dysrhythmias. In: Walls RM, Hockberger RS, Gausche-Hill M. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, Pennsylvania, USA: Saunders, Elsevier; 2018. 929-958. :929-958.
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