Sinus Bradycardia Workup

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

Laboratory Studies

Laboratory studies may be helpful if the cause of the bradycardia is thought to be related to electrolytes, drug, or toxins. In cases of sick sinus syndrome, routine laboratory studies are rarely of specific value.

Reasonable screening studies, especially if the patient is symptomatic and this is the initial presentation, include the following:

  • Electrolyte levels
  • Glucose level
  • Calcium level
  • Magnesium level
  • Thyroid function tests
  • Toxicologic screen
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Imaging Studies

Routine imaging studies are rarely of value in the absence of specific indications.

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Other Tests

12-lead ECG may be performed to confirm the diagnosis.

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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].

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

  4. Bharati S, Nordenberg A, Bauernfiend R, Varghese JP, Carvalho AG, Rosen K, et al. The anatomic substrate for the sick sinus syndrome in adolescence. Am J Cardiol. Jul 1980;46(1):163-72. [Medline].

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  13. Mills TA, Kawji MM, Cataldo VD, Pappas ND, O'Meallie LP, Breaux DM, et al. Profound sinus bradycardia due to diltiazem, verapamil, and/or beta-adrenergic blocking drugs. J La State Med Soc. Nov-Dec 2004;156(6):327-31. [Medline].

  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].

  15. Rosenqvist M, Brandt J, Schüller H. Atrial versus ventricular pacing in sinus node disease: a treatment comparison study. Am Heart J. Feb 1986;111(2):292-7. [Medline].

  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].

  17. Touboul P, Atallah G, Gressard A, Kirkorian G. Effects of amiodarone on sinus node in man. Br Heart J. Nov 1979;42(5):573-8. [Medline].

  18. Watt AH. Sick sinus syndrome: an adenosine-mediated disease. Lancet. Apr 6 1985;1(8432):786-8. [Medline].

 
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