Sinus Bradycardia Clinical Presentation

  • Author: Mark W Livingston, MD; Chief Editor: David FM Brown, MD   more...
 
Updated: Dec 22, 2010
 

History

  • Sinus bradycardia is most often asymptomatic. However, symptoms may include the following:
    • Syncope
    • Dizziness
    • Lightheadedness
    • Chest pain
    • Shortness of breath
    • Exercise intolerance
  • Pertinent elements of the history include the following:
    • Previous cardiac history (eg, myocardial infarction, congestive heart failure, valvular failure)
    • Medications
    • Toxic exposures
    • Prior illnesses
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Physical

  • Cardiac auscultation and palpation of peripheral pulses reveal a slow, regular heart rate.
  • The physical examination is generally nonspecific, although it may reveal the following signs:
    • Decreased level of consciousness
    • Cyanosis
    • Peripheral edema
    • Pulmonary vascular congestion
    • Dyspnea
    • Poor perfusion
    • Syncope
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Causes

  • One of the most common pathologic causes of symptomatic sinus bradycardia is the sick sinus syndrome.
  • The most common medications responsible include therapeutic and supratherapeutic doses of digitalis glycosides, beta-blockers, and calcium channel-blocking agents.
  • Other cardiac drugs less commonly implicated include class I antiarrhythmic agents and amiodarone.
  • A broad variety of other drugs and toxins have been reported to cause bradycardia, including lithium, paclitaxel, toluene, dimethyl sulfoxide (DMSO), topical ophthalmic acetylcholine, fentanyl, alfentanil, sufentanil, reserpine, and clonidine.
  • Sinus bradycardia may be seen in hypothermia, hypoglycemia, and sleep apnea.
  • Less commonly, the sinus node may be affected as a result of diphtheria, rheumatic fever, or viral myocarditis.
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Contributor Information and Disclosures
Author

Mark W Livingston, MD  Consulting Staff, Department of Emergency Medicine, Yakima Valley Memorial Hospital

Disclosure: Nothing to disclose.

Coauthor(s)

David T Overton, MD  Program Director, Department of Emergency Medicine, Michigan State University, Kalamazoo Center for Medical Studies

David T Overton, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Physician Executives, and American College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel J Dire, MD  FACEP, FAAP, FAAEM, Clinical Professor, Department of Emergency Medicine, University of Texas Medical School at Houston; Clinical Professor, Department of Pediatrics, School of Medicine, University of Texas Health Sciences Center San Antonio

Daniel J Dire, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, and Association of Military Surgeons of the US

Disclosure: Talecris Biotherapeutics Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gary Setnik, MD  Chair, Department of Emergency Medicine, Mount Auburn Hospital; Assistant Professor, Division of Emergency Medicine, Harvard Medical School

Gary Setnik, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: SironaHealth Salary Management position; South Middlesex EMS Consortium Salary Management position; ProceduresConsult.com Royalty Other

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

David FM Brown, MD  Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital

David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

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  2. [Guideline] Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, Hemphill R, et al. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. Nov 2 2010;122(18 Suppl 3):S640-56. [Medline].

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  14. Pollock G, Brady WJ Jr, Hargarten S, DeSilvey D, Carner CT. Hypoglycemia manifested by sinus bradycardia: a report of three cases. Acad Emerg Med. Jul 1996;3(7):700-7. [Medline].

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  16. Sasaki Y, Shimotori M, Akahane K, Yonekura H, Hirano K, Endoh R, et al. Long-term follow-up of patients with sick sinus syndrome: a comparison of clinical aspects among unpaced, ventricular inhibited paced, and physiologically paced groups. Pacing Clin Electrophysiol. Nov 1988;11(11 Pt 1):1575-83. [Medline].

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