III. Causes: Secondary

  1. Approach - simplified top secondary causes to consider in Symptomatic Bradycardia (esp. wide complex Bradycardia)
    1. Electrolytes (Hyperkalemia, Hypercalcemia)
    2. Myocardial Ischemia
    3. Hypothermia
    4. Drug Induced Bradycardia (typically with Hypotension)
      1. Calcium Channel Blocker Overdose
      2. Beta Blocker Overdose
      3. Digoxin Overdose
      4. Clonidine Overdose
  2. Electrolyte disturbance
    1. Hypercalcemia
    2. Hyperkalemia
      1. Important cause of Bradycardia that should not be missed
      2. Associated with short P Waves and Tall T Waves
    3. BRASH Syndrome
      1. Bradycardia
      2. Renal Failure
      3. AV Blocker (e.g. Beta Blocker or Calcium Channel Blocker)
      4. Shock (out of proportion to degree of Hyperkalemia, requires fluid Resuscitation and possible pressors)
      5. Hyperkalemia
    4. References
      1. EMCrit (Josh Farkas, MD)
        1. https://emcrit.org/pulmcrit/brash-syndrome-bradycardia-renal-failure-av-blocker-shock-hyperkalemia/
  3. Intracranial cause (Cushing's Reflex or dive reflex)
    1. Neurogenic Shock
    2. Increased Intracranial Pressure (e.g. Head Injury)
  4. Acute ingestions or Poisonings
    1. Opioid Overdose
    2. Gamma Hydroxybutyrate (GHB)
    3. Ciguatera Poisoning
    4. Muscarinic Cholinergic Toxicity
    5. Lead Poisoning
  5. Other conditions
    1. Hypothyroidism
    2. Obstructive Jaundice
    3. Severe Anorexia or starvation
    4. Obstructive Sleep Apnea
  6. Infections
    1. Salmonella typhi
    2. Acute Lassa Fever

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Related Studies

Ontology: Bradyarrhythmia (disorder) (C0079035)

Concepts Disease or Syndrome (T047)
SnomedCT 421869004
Italian Bradiaritmia
English Bradyarrhythmia, Bradyarrhythmia (disorder), bradyarrhythmias, bradyarrhythmia, bradyarrhythmia (diagnosis)
Spanish bradiarritmia (trastorno), bradiarritmia, Bradiarritmia
Japanese 徐脈性不整脈, ジョミャクセイフセイミャク
Czech Bradyarytmie
Hungarian Bradyarrhythmia
French Brady-arythmie
Portuguese Bradiarritmia
Dutch bradyaritmie
German Bradyarrhythmie

Ontology: Bradycardia (C0428977)

Definition (NCI) An abnormally slow heart rate. Thresholds for different age, gender, and patient populations exist.
Definition (CSP) excessive slowness in the action of the heart, usually with a heart rate below 60 beats per minute.
Definition (MSH) Cardiac arrhythmias that are characterized by excessively slow HEART RATE, usually below 50 beats per minute in human adults. They can be classified broadly into SINOATRIAL NODE dysfunction and ATRIOVENTRICULAR BLOCK.
Concepts Pathologic Function (T046)
MSH D001919
ICD10 R00.1
SnomedCT 48867003, 207585002, 207041006
LNC LA17394-0
English Bradycardia, Bradycardias, PULSE RATE DECREASE MARKED, Bradycardia, unspecified, Bradycardia (disorder), Bradycardia (finding), [X]Bradycardia, unspecified, Bradyarrhythmia, Bradyarrhythmias, slow heart rate (symptom), slow heart rate, Bradycardia NOS, Heart rate decreased, Heart rate low, Bradycardia [Disease/Finding], decreasing heart rate, heart rate slow, slow pulse, low heart rate, slow heart beat, Heartbeat (pulse);slow, decreased heart rate, heart rate slowing, low pulse rate, pulse slowing, low pulse rates, pulse slow, bradycardias, pulse rate low, pulse slowed, slow heartbeat, [X]Bradycardia, unspecified (finding), [X]Bradycardia, unspecified (situation), HEART RATE, DECREASED, DECREASED HEART RATE, BRADYCARDIA, Slow heart beat, Decreased heart rate, Heart rate slow, bradycardia, brachycardia, heart beat; slow, heart; frequency low, heart; slow, slow; heart beat, slow; heart, Bradycardia, NOS, [X]Bradycardia, unspecified (context-dependent category)
French BRADYCARDIE, Bradycardie SAI, Fréquence cardiaque basse, Brady-arythmies, Bradyarythmie, Bradyarythmies, RALENTISSEMENT MARQUE DU POULS, Fréquence cardiaque diminuée, Bradycardie
Portuguese BRADICARDIA, Frequência cardíaca baixa, Bradicardia NE, Bradiarritmia, PULSO LENTO, Frequência cardíaca diminuída, Bradicardia
Spanish BRADICARDIA, bradicardia (hallazgo), Bradicardia NEOM, Frecuencia cardiaca baja, [X]bradicardia, no especificada (categoría dependiente del contexto), bradicardia (trastorno), Bradiarritmia, PULSO, FRECUENCIA DISMINUIDA, [X]bradicardia, no especificada, [X]bradicardia, no especificada (hallazgo), bradicardia, frecuencia cardíaca baja, latidos cardíacos lentos, Frecuencia cardiaca disminuida, Bradicardia
German BRADYKARDIE, Bradykardie NNB, Herzfrequenz niedrig, Bradyarrythmie, Bradyarrythmien, Bradykardie, nicht naeher bezeichnet, PULSFREQUENZ STARK ERNIEDRIGT, Herzfrequenz erniedrigt, Bradykardie
Italian Frequenza cardiaca ridotta, Bradicardia NAS, Frequenza cardiaca bassa, Bradiaritmia, Bradicardia
Dutch hartfrequentie laag, bradycardie NAO, hart; frequentie laag, hart; traag, hartslag; traag, traag; hartslag, traag; hart, Bradycardie, niet gespecificeerd, bradycardie, hartfrequentie verlaagd, Bradycardie
Japanese 心拍数減少, 徐脈NOS, シンパクスウゲンショウ, ジョミャク, ジョミャクNOS, 徐拍, 徐脈, 心拍数低値, シンパクスウテイチ
Swedish Bradykardi
Czech bradykardie, Srdeční frekvence snížená, Bradykardie, Bradykardie NOS, Srdeční frekvence nízká, bradyarytmie
Finnish Bradykardia
Korean 상세불명의 느린맥
Polish Bradykardia, Zwolniona czynność serca, Rzadkoskurcz
Hungarian Szívfrekvencia csökkent, Szívfrekvencia alacsony, Bradycardia, Bradycardia k.m.n.
Norwegian Bradykardi, Langsom hjerteaksjon, Bradyarytmi