Summary
Definition
History and exam
Key diagnostic factors
- frequência de pulso <50 bpm
- idade >70 anos
- uso de medicamentos causadores conhecidos
- presença de causa subjacente conhecida
- tontura
- síncope
- fadiga
- intolerância ao exercício
- dispneia
- ondas A em canhão em pulso venoso jugular
- estase jugular
Other diagnostic factors
- pressão intracraniana elevada
- bulhas cardíacas anormais
- edema abdominal ou dos membros inferiores
- hipotensão
- alterações do estado mental
- palidez
- extremidades frias ao serem tocadas
- hipotermia
- dor torácica
- erupções cutâneas
- bócio tireoidiano
Risk factors
- uso de medicamentos causadores conhecidos
- idade >70 anos
- infarto do miocárdio recente
- cirurgia
- procedimentos de substituição da valva percutânea
- hipotireoidismo
- distúrbios eletrolíticos
- acidose
- infecções
- exposição a toxinas
- hipotermia
- doenças infiltrantes
- distúrbios respiratórios do sono
- epilepsia
Diagnostic investigations
1st investigations to order
- eletrocardiograma (ECG) de 12 derivações
- monitoramento com Holter
- Monitoramento de evento/telemetria cardíaca móvel
- teste ergométrico
- massagem do seio carotídeo
- ecocardiograma
- testes da função tireoidiana
- perfil metabólico básico
- gasometria arterial
- biomarcadores cardíacos
- nível sérico de digoxina
- creatinina sérica
Investigations to consider
- loop event recorder implantável
- teste da mesa inclinável
- Títulos de Lyme
- teste eletrofisiológico
- oximetria de pulso noturna ou polissonografia noturna
Treatment algorithm
hemodinamicamente instável
hemodinamicamente estável: disfunção do nó sinusal
hemodinamicamente estável: bloqueio atrioventricular adquirido
hemodinamicamente estável: bloqueio atrioventricular congênito
hemodinamicamente estável: bradicardia vagalmente mediada
hemodinamicamente estável: bradicardia associada a distúrbios neurológicos
Contributors
Authors
Brian Olshansky, MD, FAHA, FACC, FHRS, FESC
Professor Emeritus
University of Iowa
Iowa City
Adjunct Professor
Des Moines University
Electrophysiologist
Covenant Hospital
Waterloo
IA
VA Hospital
Iowa City
IA
CGH Medical Center
Sterling
IL
Disclosures
BO declares that he has no competing interests.
Sandeep Saha, MD, MS, FACC, FHRS
Consultant, Cardiology and Cardiac Electrophysiology
Oregon Heart Center
Salem
OR
Disclosures
SS is a consultant for Medtronic and St Jude Medical. He is on the speakers' bureau and serves as an advisory board member for Medtronic. None of these activities are relevant to the content of this topic.
Rakesh Gopinathannair, MD, MA, FAHA, FACC, FHRS
Director, Cardiac Electrophysiology Laboratories
Kansas City Heart Rhythm Institute and Research Foundation
EP Medical Director
Research Medical Center, HCA Midwest Health
Overland Park
KS
Clinical Professor of Medicine
University of Missouri-Columbia
Columbia
MO
Disclosures
RG is a consultant for St. Jude Medical, Biotrionik, and Boston Scientific. He is on the speakers' bureau for Pfizer Inc. and Zoll Medical. He serves as a physician advisor for HealthTrust PG and AltaThera Pharma, and PaceMate. None of these activities are relevant to the content of this topic.
Acknowledgements
Professor Brian Olshansky, Dr. Sandeep Saha, and Professor Rakesh Gopinathannair would also like to acknowledge Dr Giselle Statz, Dr Renee M. Sullivan, Dr Weiwei Li, Dr Alexander Mazur, and Dr Chirag M. Sandesara, previous contributors to this topic.
Disclosures
GS, RMS, WL, AM, and CMS declare that they have no competing interests.
Peer reviewers
Nora Goldschlager, MD
Professor of Clinical Medicine
University of California
Chief
Clinical Cardiology
San Francisco General Hospital
Director
Coronary Care Unit
ECG Laboratory and Pacemaker Clinic
San Francisco
CA
Disclosures
NG declares that she has no competing interests.
Paul Heidenreich, MD
Associate Professor of Medicine
Stanford University
Stanford
CA
Disclosures
PH declares that he has no competing interests.
Juan M. Sztajzel, MD
Cardiology Center and Medical Polyclinics
University Hospital Geneva
Geneva
Switzerland
Disclosures
JMS declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Mangrum JM, DiMarco JP. The evaluation and management of bradycardia. N Engl J Med. 2000 Mar 9;342(10):703-9. Abstract
Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019 Aug 20;74(7):e51-156.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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