Symptomatic Bradycardia

Treatment of Symptomatic Bradycardia

Stable bradycardia is addressed by treating the underlying cause of the bradycardia. If it is related to an acute myocardial infarction (AMI), treating the AMI should have a positive effect on the bradycardia. If it’s medication-related, removing or adjusting the medication should help.

Unstable bradycardia should be treated directly. Left untreated, hemodynamically unstable bradycardia can spiral out of control — the lack of perfusion could further impact cardiac blood flow. Decreased perfusion in the brain can lead to strokes, dizziness, or confusion.

There are three ways to treat unstable symptomatic bradycardia: increase the blood pressure (and therefore perfusion) by increasing fluid volume in the cardiovascular system, constricting peripheral blood vessels to push blood toward vital organs, or increased heart rate. The most successful treatment uses a combination of all three.

A bolus of IV fluid infused can help increase blood pressure and improve perfusion. Sympathomimetic drugs, such as dopamine, can help shunt blood away from the periphery and focus the pressure on the core, especially the brain and heart. Sympathomimetic drugs may also help increase heart rate, which is the most direct treatment possible. In most cases, significant increases in heart rate will only come from either administering atropine sulfate or therapeutic pacing.

And now, the debate.

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