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Bradycardia Diagnostic and Management Algorithm

CONSIDER ETIOLOGY (not inclusive): 
 - STRUCTURAL: sick sinus, AV block, ischemia,
Bradycardia Diagnostic ... Hypothyroidism - TOX: beta-blockers ... TREATMENT - Drugs (beta-blockers ... Diagnosis #Management #Bradycardia ... #Algorithm #Differential
Beta Blocker Side Effects / Toxicity
Cardiac Side Effects:
 • Sinus bradycardia, AV block, Heart failure exacerbation,
Beta Blocker Side ... Effects: • Sinus bradycardia ... , AV block, Heart ... exacerbation, Beta ... syndrome (e.g.
Faget Sign - Pulse-Temperature Dissociation
Causes of Relative Bradycardia
 • Infectious Causes: Legionella, Psittacosis, Q fever, Typhoid
Causes of Relative Bradycardia ... Non-Infectious Causes: Beta-blockers ... Dissociation #relative #bradycardia ... #differential #
Beta-Blocker Overdose/toxicity:

•	Bradycardia & hypotension (most common).
•	Myocardial depression & cardiogenic shock (severe overdoses). 
•	Ventricular dysrhythmias (Common with
Beta-Blocker Overdose ... toxicity: • Bradycardia ... lipophilic medications (eg ... labetalol) #Beta-Blocker ... toxicity #poisoning # Bradycardia
Approach to ECGs - Tachy/Bradyarrhythmias
Tachyarrhythmias - HR > 100
Wide
  (1) VT - DANGER
  (2)
Approach to ECGs ... - treat with beta-agonist ... 60 (1) Sinus bradycardia ... bradyarrhythmia #ECG ... electrocardiogram #cardiology #differential
Bradycardia - Differential Diagnosis Framework

BRADI Mnemonic
 • BRASH/Hyperkalemia
 • Reduced oxygen/Glucose/Temp
 • ACS
 • Drugs
 •
Bradycardia - Differential ... Medications: • Beta ... blockers • Calcium ... channel blockers ... #differential #
Common sodium channel blockers which cause QRS widening.

Anticonvulsants: 
 - Carbamazepine 
Antidysrhythmics:  
 - Group
sodium channel blockers ... - Amantadine Beta ... Blockers: - ... QRS #widening #ECG ... Toxicology #Diagnosis #Differential
Deep T Wave Inversions - Differential
Normal variants 
  A. Juvenile T wave pattern
Wave Inversions - Differential ... global T wave inversion ... bundle branch blocks ... bundle branch block ... Causes #Cardiology #ECG
Syncope - Differential Diagnosis Framework
Reflex Syncope:
• Vasovagal: Prolonged standing, Stress, Pain
• Situational: Coughing, Sneezing, Micturition, Defecation,
Syncope - Differential ... standing, Stress, Pain ... Medication Effect: a-blockers ... Bradyarrhythmias: Sinus bradycardia ... Sinus pauses, AV block
Shock - Differential Diagnosis by Classification
Reflex Syncope 
 - Vasovagal syncope
   • Prolonged standing
Shock - Differential ... draw • Severe pain ... Bradyarrhythmias • Sinus bradycardia ... pauses • AV block ... #Syncope #Differential