Bradycardia Recap

by John Marshall, MD

– Bradycardia (HR <60) can be caused by SA & AV nodal disease

In patients with symptoms of instability (chest pain, AMS, hypotension)… remember: ABC’s, IV, O2, monitor.

  • 1st.) Atropine 0.5mg q3-5 min, for a maximum of 3mg (can cause paradoxical bradycardia)
  • 2nd.) TransCutaneous pacing, or… Pressors (Epinephrine & Dopamine: Beta 1 activity increases AV node flow and SA conductivity)
  • 3rd.) TransVenous pacing + expert consultation

Mobitz type 2 or greater are dispo’ed to CCU (AV blocks may deteriorate into complete block).

Only people to send home are people without comorbidity and received no urgent intervention



  • – identifying a block, but missing inferior MI
  • not having pacer pads ready while giving atropine
  • – sending someone home that appears better
  • atropine may worsen ischemia in someone with ischemic disease
  • – atropine may not work in infra-nodal blocks

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