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Sinus Bradycardia Clinical Presentation

  • Author: Mark W Livingston, MD; Chief Editor: Erik D Schraga, MD  more...
 
Updated: Dec 18, 2014
 

History

Sinus bradycardia is most often asymptomatic. However, symptoms may include the following:

  • 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

Causes of sinus bradycardia include the following:

  • 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, MBA Professor and Chairman, Department of Emergency Medicine, Associate Dean for Educational Affairs, Western Michigan University School of Medicine

David T Overton, MD, MBA is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, Michigan College of Emergency Physicians, Association of Academic Chairs of Emergency Medicine, American College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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

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

Disclosure: Medical Director for: SironaHealth.

Chief Editor

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Additional Contributors

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, University of Texas Health Sciences Center San Antonio

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

Disclosure: Nothing to disclose.

References
  1. Semelka M, Gera J, Usman S. Sick sinus syndrome: a review. Am Fam Physician. 2013 May 15. 87(10):691-6. [Medline].

  2. [Guideline] Tracy CM, Epstein AE, Darbar D, DiMarco JP, Dunbar SB, Estes NA 3rd, et al. 2012 ACCF/AHA/HRS focused update of the 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. [corrected]. Circulation. 2012 Oct 2. 126(14):1784-800. [Medline].

  3. [Guideline] Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, 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):2281-329. [Medline].

  4. [Guideline] Nolan JP, Morley PT, Vanden Hoek TL, Hickey RW, Kloeck WG, Billi J, et al. Therapeutic hypothermia after cardiac arrest: an advisory statement by the advanced life support task force of the International Liaison Committee on Resuscitation. Circulation. 2003 Jul 8. 108(1):118-21. [Medline].

  5. [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. 2010 Nov 2. 122(18 Suppl 3):S640-56. [Medline].

  6. Grantham HJ. Emergency management of acute cardiac arrhythmias. Aust Fam Physician. 2007 Jul. 36(7):492-7. [Medline]. [Full Text].

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