Treatment Of Sinus Bradycardia: General Aspects Of Management
Benign causes of sinus bradycardia do not require treatment. In all other situations it is necessary to find the underlying cause and direct treatments towards it. The most common causes are sinus node dysfunction, side effects of medications or acute myocardial ischemia/infarction. When the bradycardia causes hemodynamic symptoms it should be treated. Note that sinus bradycardia due to ischemia located to the inferior wall of the left ventricle is typically temporary and resolves within 12 weeks .
Benign causes of bradycardia need not be treated. When in doubt whether the bradycardia is physiological, it is useful to perform a Holter ECG . If drug side effects are believed to be the cause, it is fundamental to judge the risk of terminating drug therapy as compared with implementing an artificial pacemaker in order to be able to continue drug therapy. It is very common that patients with bradycardia have a strong indication for drugs that aggravate or even cause the bradycardia in such scenarios, it is generally considered to be evidence based to implement an artificial pacemaker that will allow for drug therapy to continue.
Sick sinus syndrome , which is a common cause of bradycardia, is also discussed separately.
Does Bradycardia Require Treatment
If your heart rate is slow, but you dont have symptoms, theres no reason to worry. However, its a good idea to know the signs of trouble because bradycardia in some cases does require treatment.
For example, if your heart rate drops into the 30s, you might not get enough oxygen to your brain, making fainting, lightheadedness, and shortness of breath possible. Blood can also pool in your heart chambers, causing congestive heart failure.
Next Steps And Considerations
Most often, patients with a first-degree AV block do not experience hemodynamic instability and do not require treatment. This rhythm is largely considered benign. If medications contribute to the development of this rhythm, they can be modified or removed from the patients medication regimen under expert care and monitoring. As patients with a first-degree AV block advance in age, the likelihood of developing atrial fibrillation or more progressive AV blocks increases. Continued and regular monitoring under the care of an expert can help patients with a first-degree AV block identify potential worsening cardiac changes or complications throughout their lifespan.
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Sinus Bradycardia Ecg Review
Sinus bradycardia occurs on an ECG when there is a normal upright P wave in lead II sinus P wave preceding every QRS complex with a ventricular rate of less than 60 beats per minute.
The causes of sinus bradycardia include the following:
- AV blocking medications
- Heightened vagal tone
- Sick sinus syndrome
What Are The Symptoms Of A Low Heart Rate
It is very possible to have a slow heart rate and experience no symptoms. However, if you have symptoms but ignore them, it can sometimes cause more serious problems.
Consult your doctor if you are experiencing some of these symptoms and you have an associated slow heart rate:
- Lack of energy.
- Heart palpitations or flutters.
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Risk Factors For Bradycardia
A key risk factor for bradycardia is age. Heart problems, which are often associated with bradycardia, are more common in older adults.
Risk factors related to heart disease
Bradycardia is often associated with damage to heart tissue from some type of heart disease.
Therefore, factors that increase your risk of heart disease can also increase the risk of bradycardia. Lifestyle changes or medical treatment might decrease the risk of heart disease associated with the following factors:
- High blood pressure
- Psychological stress or anxiety
What Is Sinus Bradycardia
Sinus bradycardia is a heart rhythm thats slower than expected but is otherwise normal. Its sometimes a symptom of certain heart conditions or problems, but it can also be a sign that a person is in very good shape because of regular exercise.
Most people dont have symptoms, but when symptoms do happen, its usually because your heart is pumping too slowly to supply your body with enough blood.
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When Should I See My Healthcare Provider Or When Should I Seek Care
If you have sinus bradycardia without symptoms, you should still see a healthcare provider for an annual physical. These yearly visits are a key way to detect new problems before they become severe enough to cause symptoms.
If you have sinus bradycardia with symptoms, you should see your healthcare provider if your symptoms change noticeably or if your symptoms start to affect your daily life and routine.
When should I go to the hospital emergency room?
Because sinus bradycardia shares the following symptoms with other more serious heart conditions, you should go to the hospital if you experience:
- Chest pain .
- Dizziness, feeling lightheaded or fainting .
A note from Cleveland Clinic
Sinus bradycardia is a condition you may not even know you have, and for most people, it doesnt cause any symptoms. When it does cause symptoms, your healthcare provider can help you find out why its happening and if its a cause for concern. Fortunately, for people who do need treatment, this condition is often very treatable, and it shouldnt have a big impact on your daily life overall.
Can Sinus Arrhythmia Cause Chest Pain
No. Respiratory sinus arrhythmia doesnt cause chest pain.
A note from Cleveland Clinic
You might be concerned when your healthcare provider notices an abnormal heart rhythm in your routine EKG. But respiratory sinus arrhythmia is not a cause for worry. The time between heartbeats can be different depending on whether youre breathing in or out. So this abnormal rhythm is actually a sign of a heart thats working right.
Last reviewed by a Cleveland Clinic medical professional on 03/21/2022.
References
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Normal Causes Of Sinus Bradycardia
Sinus bradycardia is considered a normal finding in the following circumstances:
- During sleep.
- Well-trained individuals display SB at rest due to high vagal tone. These individuals have developed a highly efficient left ventricle, capable of generating sufficient cardiac output at low heart rates.
- During vasovagal syncope
- During vagal maneuvers .
- Its not uncommon to discover SB in healthy young individuals who are not well-trained. This is also a normal finding.
Sinus Bradycardia: When Is Low Heart Rate A Problem
- Sinus bradycardia is when the heart rate is slower than 60 beats a minute.
- It is usually a normal finding, especially in young athletes.
- It can also be caused by medications such as beta-blockers or calcium channel blockers.
- Sinus bradycardia is when the heart rate is slower than 60 beats a minute.
- It is usually a normal finding, especially in young athletes.
- It can also be caused by medications such as beta-blockers or calcium channel blockers.
User Profile
When your smartwatch tells you that you have a low heart rate reading, what does it mean? Your heart rate is then below 60 beats a minute, indicating bradycardia.
Here is everything you should know about sinus bradycardia.
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Enhancing Healthcare Team Outcomes
Because there are many causes of sinus bradycardia, an interprofessional team approach is necessary for making an early diagnosis. Nurses on the floor and in the emergency department should understand bradycardia and its treatment. The pharmacist should ensure that the cause is not potentially related to any patient medications if there is a risk, the clinical team should be contacted. The primary care provider should refer all symptomatic patients to the cardiologist for further workup. If a pacemaker is inserted, then the patient should be closely followed by a pacemaker nurse.
Educating patients at risk for this rhythm and making a closed-loop communication between them and their providers can help further improve the management of these rhythms.
Sinus Bradycardia With Nonspecific T Wave Abnormality
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What Causes A Low Heart Rate
Many things can bring on a slow heart rate.
A heart malfunction
The most common cause for bradycardia is a malfunction in the hearts natural pacemaker, the sinus node. It controls how quickly the top and bottom heart chambers pump blood through the body.
AV Block
Another cause of bradycardia is atrioventricular block , in which the top and bottom chambers dont communicate well and your heart rate drops as a result.
Its like having virtual electrical cables and wires inside the heart, Dr. Baez-Escudero says. These deteriorate as we age. Common medications used in older populations can also often make bradycardia more significant.
Age
Age is the most common risk factor for developing bradycardia. The condition is most common among men and women over age 65.
Having certain illnesses or conditions
Illness or other conditions may also cause bradycardia. These include:
- Heart attacks due to coronary artery disease.
- A bacterial infection in the blood that attacks your heart.
- Inflammation of your heart muscle.
- Low thyroid function.
- Too much potassium in your blood.
- Certain medications, including beta blockers and antiarrhythmics.
Congenital heart defects, diabetes or long-standing high blood pressure all may make bradycardia more likely, says Dr. Baez-Escudero.
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What Is The Definition Of Sinus Bradycardia
Sinus bradycardia can be defined as a sinus rhythm with a resting heart rate of 60 beats per minute or less. However, few patients actually become symptomatic until their heart rate drops to less than 50 beats per minute. The action potential responsible for this rhythm arises from the sinus node and causes a P wave on the surface ECG that is normal in terms of both amplitude and vector. The presence of sinus bradycardia in itself does not cause a change in the QRS complex and T wave.
The frequency of sinus bradycardia is unknown, given that most cases represent normal variants. Although the frequency of sick sinus syndrome is unknown in the general population, in cardiac patients it has been estimated to be 3 in 5000.
What Are The Symptoms Of Sinus Bradycardia
For most people, sinus bradycardia doesnt cause any symptoms. This is especially true for people whore very physically active and have sinus bradycardia because their hearts are more efficient.
For others, symptoms of sinus bradycardia may include:
- Irritability, agitation or other personality changes.
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Who Does It Affect
Sinus bradycardia tends to happen in adults, especially those over age 65, as your heartbeat tends to naturally slow down as you age. Sinus bradycardia is less likely to occur in children unless it happens because of a condition that a child has when theyre born .
Sinus bradycardia also happens normally to people who exercise regularly and are in very good physical condition. Regular exercise and training have a positive effect on your vagus nerve. This nerve, which has a direct connection to your brain, is part of your autonomic nervous system. The better your vagus nerve works, the lower your resting heart rate.
When To Contact A Doctor
If a baby has a low pulse, a parent or caregiver should take them to the emergency room.
Adults and children who have a low pulse and experience symptoms such as chest pain, fainting, or exercise intolerance should also go to the hospital.
A person should contact a doctor about bradycardia when they:
- experience an unexplained change in heart rate that lasts for several days
- have bradycardia and other heart health risk factors, such as diabetes or smoking
- have heart disease and bradycardia
- experience bradycardia and other symptoms, such as fainting spells
- experience episodes of bradycardia and tachycardia, which is a rapid heartbeat
If a person is concerned about their slow heart rate, they should also consult a doctor.
A doctor may not always need to treat a slow heart rate. However, when a slow heart rate causes serious health problems, it is essential that a person receives treatment.
The treatment an individual receives for their bradycardia
a pacemaker. This is a device that is implanted under a persons skin and connected to their heart. The pacemaker then sends impulses to the heart that cause it to beat regularly.
Depending on the cause, a doctor might also recommend:
- changing heart medications
- taking medication to treat thyroid or other metabolic disorders
- making lifestyle changes, such as eating a low fat diet, getting more exercise, or quitting smoking
- monitoring heart rate or blood pressure frequently
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Algorithm For Acute Management Of Bradycardia
- Terminate or adjust any medications that cause or aggravate the bradycardia.
- In case of acute bradycardia with circulatory compromise:
- 12 ml of atropine 0.5 mg/ml is the first line therapy. It can be repeated if necessary.
- If atropine is insufficient or require too frequent dosing, infusion isoproterenol should be given. An ampoule with 5 ml isoproterenol is mixed with 245 ml glucose with starting dose 0,01 g/kg/min. This is titrated up until adequate effect is achieved.
- If atropine and isoproterenol fails, it might be necessary to perform transcutaneous pacing . Most modern defibrillators are equipped with ability to perform transcutaneous pacing. Transcutaneous pacing is only indicated until a permanent pacemaker can be implemented.
- An alternative to transcutaneous pacing is temporary transvenous pacing, which is also indicated until a permanent pacemaker can be implemented.
Patients with bradycardia due to myocardial ischemia/infarction only demand treatment if cardiac output is compromised or if the bradycardia predisposes to more malign arrhythmias . Note, however, that bradycardias due to inferior wall ischemia/infarction is transient in most cases and rarely necessitate permanent pacemaker. Anterior wall infarctions, on the other hand, generally leave permanent bradycardia and thus demand permanent pacemaker. Learn more about conduction defects caused by ischemia and infarction.
How Is Sinus Bradycardia Diagnosed
Your healthcare provider will take a medical history and give you a physical exam. You will need a test called an electrocardiogram . This gives a snapshot of your heart rhythm. This test alone is often enough to make the diagnosis. Continuous electrocardiogram, such as Holter or event monitoring, may be used to check the heart for a longer period.
Other tests to diagnose the condition may include:
- Blood tests to rule out hypothyroidism or other abnormalities
- Tests to diagnose sleep apnea
- Exercise stress testing, to check the heart rates response to exercise
- Electrophysiological testing, to check the heart rhythm in more detail
- Tests to study the autonomic nervous system
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What Is A Normal Sinus Rhythm
Normal sinus rhythm is defined as the rhythm of a healthy heart. It means the electrical pulse from your sinus node is being properly transmitted throughout the heart muscle.
In adults, normal sinus rhythm usually accompanies a heart rate of 60 to 100 bpm. However, its possible for sinus rhythm to be faster or slower than this and still be considered normal.
What Is Sinus Rhythm
Sinus rhythm refers to the rhythm of your heartbeat, determined by the sinus node of your heart. The sinus node creates an electrical pulse that travels through your heart muscle, causing it to contract, or beat. You can think of the sinus node as a natural pacemaker.
While similar, sinus rhythm is a little different from heart rate. Your heart rate is the number of times your heart beats in a minute.
For most people, a resting heart rate of 60 to 100 beats per minute is considered normal. However, your heart rate can be either faster or slower than this, depending on the demands placed on your heart as well as other underlying health conditions.
Sinus rhythm, on the other hand, refers to the pattern of your heartbeat. It corresponds to the rate at which electrical pulses are sent out from the sinus node. When these pulses are sent out at a normal rate, its referred to as normal sinus rhythm.
As you can probably see, sinus rhythm and heart rate are linked. Electrical pulses must first be generated by the sinus node . As these pulses travel through the heart muscle, they cause it to beat . Because of this, sinus rhythm often aligns with your heart rate.
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How Does This Condition Affect My Body
Most people with sinus bradycardia dont have symptoms, making this a benign condition. Many people may not even know their heart rate is under 60 beats per minute unless they have a reason to check their pulse.
For people who have symptoms, sinus bradycardia is a sign that their body isnt pumping enough blood. That means their brain and body arent getting enough oxygen, and that lack is the usual driving force behind symptoms.