Recognition & Management of

Bradycardia

By Dr. Akshay

Objectives

Describe when bradycardia requires immediate intervention.

Describe initial steps to stabilize a child with cardiopulmonary compromise.

Know when to start CPR in a child with bradycardia.

Manage a child as outlined in s Pediatric Bradycardia with Pulse & poor perfusion algorithm

Select appropriate medications for treatment of symptomatic bradycardia

definition

Bradycardia is a heart rate that is slow in

comparison with a normal heart rate range for

the child's age & the level of activity.

Bradycardia is an ominous sign!

Basic Anatomy and Physiology

The SA node

The AV node

Bundle of His

Right Bundle Branch

Left Bundle Branch

Types

Primary Bradycardia

Secondary Bradycardia

Recognition of Bradycardia

Bradycardia rapidly turns into cardiopulmonary

compromise.

– Hypotension

– Decreased level of consciousness

– Shock

– Poor-end organ perfusion

– Respiratory distress or failure

– Sudden collapse

ECG characteristics

Heart rate Slow compared to the normal heart rate for age

P waves May or may not be visible

QRS complex Narrow or wide (depending on the origin of the

pacemaker &/or location of the injury to the

conduction system)

P wave &

QRS complex

May be unrelated (AV dissociation)

What is the paper speed?

Normal paper speed 25

mm/sec

1 small square=0.04s

1 big square= 0.2secs

How to calculate the heart rate?Find 2 adjacent R waves, count the number of big squares between

the R’s

Divide 300 by the number of big squares : this is your heart rate

bradyarrhythmias

Bradycardia which is associated with rhythm

disturbance known as bradyarrhythmias.

Common are sinus bradycardia & AV block.

Sinus bradycardia

First degree heart block

Reversible causes

Hypoxia

Hydrogen ion

(acidosis)

Hyperkalemia

Hypothermia

Heart Block

Toxins / poisonings /

drugs

Trauma