Bradycardia

Bradycardia is a slow pulse (<90 in infants and <60 in children and adolescents). Causes range from the benign (athletic heart) to the life threatening (sepsis, severe heart block). Assessing the child's ABCs is the first priority.

Differential Diagnosis

• Vasovagal response
  –Defecation, yawning, rectal stimulation, placement of nasogastric tube, sight of blood, etc.
• Drug reaction
  –β-blockers, calcium channel blockers (diltiazem, verapamil), carbamates, clonidine, digoxin, opiates, organophosphates, gamma-hydroxybutyrate (“date rape” drug), and plants (lily of the valley, foxglove, oleander)
• Healthy athlete
  –Sinus bradycardia
• Hypothermia
• GER (in infants, especially premature)
• Low birth weight infants: Sinus bradycardia (great variations in sinus rate, can have junctional escape beats)
• Congenital complete heart block: Associated with maternal SLE
• Congenital heart disease
• Sepsis

• Obstructive sleep apnea
  –Seen in children with obesity, tonsillar or adenoid hypertrophy, craniofacial anomalies, neuromuscular diseases
  –Hypoxia and hypercapnia lead to pulmonary hypertension and arrhythmia

• Electrolyte abnormalities can lead to dysrhythmias
• Anorexia nervosa
  –Prolonged QT syndrome and junctional arrhythmia
  –Associated hypokalemia may also cause ECG changes and life-threatening dysrhythmias
• AV node blocks (second- and third-degree)
• Idioventricular rhythm
• Hypothyroidism (myxedema)
• Allergic reaction/anaphylaxis
• Increased intracranial pressure (IVH, extradural hemorrhage, trauma, etc.)
• Sick sinus syndrome (tachy-brady syndrome)
• Psittacosis, typhoid fever, Lassa fever
• Myocardial infarction

Workup and Diagnosis

• History
  –For acute patients, history of present illness, associated symptoms
  –Birth history, PMH, and review of systems
  –Medications, medications around the house, alternative medicines/herbs

• Physical exam
  –Vital signs, growth parameters, nutritional status, physical fitness
  –Craniofacial and ENT exam
  –Complete cardiac exam: Evaluate cardiovascular stability, BP, pulse, perfusion, mental status, tachypnea, as well as heart sounds, murmurs, distal pulses

• Labs
  –ECG: Look for block, prolonged QTc, abnormal P
• wave, or QRS complex
  –Electrolytes (include potassium, calcium, magnesium)
  –CBC: Look for infection
  –Consider drug screen: Look for toxic ingestion
• Studies
  –Consider upper GI series, pH probe, or pneumogram (if suspect apnea as well) to look for GER
  –Consider 24-hour Holter monitor if episodic bradycardia
  –Consider echocardiogram to rule out congenital heart disease

Treatment

Stabilize the patient with attention to ABCs

• If bradycardia is symptomatic or life threatening, consider using:
  –Epinephrine: 0.01 mg/kg (maximum: 10 mL/dose) every 3–5 minutes IV, IO; or 0.1 mg/kg (0.1 mL; 1:1,000)/kg/dose ET
  –Atropine 0.01–0.03 mg/kg/dose every 5 minutes prn via IV, endotracheal, or interosseous

• Keep the patient in a monitored setting when appropriate (heart monitor to follow the bradycardia)
• Treat the underlying cause when possible: Stop causative medications; treat sepsis, hypothermia, increased intracranial pressure, and electrolyte abnormalities emergently; intensive therapy for eating disorders; synthroid for hypothyroidism
• Cardiac surgery for CHD may not resolve arrhythmias
• Cardiac pacing (transcutaneous or implanted may be needed)

'>>

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Arrhythmia

Read excerpts from these other book chapters related to Arrhythmia:

Medical Books Excerpts

• BRADYCARDIA
• "Algorithmic Diagnosis of Symptoms and Signs" (2003)
• [ read ]

• PALPITATIONS
• "Algorithmic Diagnosis of Symptoms and Signs" (2003)
• [ read ]

• TACHYCARDIA
• "Algorithmic Diagnosis of Symptoms and Signs" (2003)
• [ read ]

• CARDIAC ARRHYTHMIA
• "Algorithmic Diagnosis of Symptoms and Signs" (2003)
• [ read ]

• CARDIAC MURMURS
• "Algorithmic Diagnosis of Symptoms and Signs" (2003)
• [ read ]

• Bradycardia
• "In a Page: Signs and Symptoms" (2004)
• [ read ]

• Palpitations
• "In a Page: Signs and Symptoms" (2004)
• [ read ]

• Tachycardia
• "In a Page: Signs and Symptoms" (2004)
• [ read ]

• Murmurs - Diastolic
• "In a Page: Signs and Symptoms" (2004)
• [ read ]

• Murmurs - Systolic
• "In a Page: Signs and Symptoms" (2004)
• [ read ]

• Bradycardia
• "In A Page: Pediatric Signs and Symptoms" (2007)
• [ read ]

• Tachycardia/Palpitations
• "In A Page: Pediatric Signs and Symptoms" (2007)
• [ read ]

• BRADYCARDIA
• "Differential Diagnosis in Primary Care" (2007)
• [ read ]

• MURMURS
• "Differential Diagnosis in Primary Care" (2007)
• [ read ]

• TACHYCARDIA
• "Differential Diagnosis in Primary Care" (2007)
• [ read ]

• CARDIAC ARRHYTHMIAS
• "Differential Diagnosis in Primary Care" (2007)
• [ read ]

• PALPITATION
• "Differential Diagnosis in Primary Care" (2007)
• [ read ]

• Bradycardia
• "Handbook of Signs & Symptoms (Third Edition)" (2006)
• [ read ]

• Murmurs
• "Handbook of Signs & Symptoms (Third Edition)" (2006)
• [ read ]

• Palpitations
• "Handbook of Signs & Symptoms (Third Edition)" (2006)
• [ read ]

• Pulse rhythm abnormality
• "Handbook of Signs & Symptoms (Third Edition)" (2006)
• [ read ]

• Pulse, absent or weak
• "Handbook of Signs & Symptoms (Third Edition)" (2006)
• [ read ]

• Pulsus bisferiens
• "Handbook of Signs & Symptoms (Third Edition)" (2006)
• [ read ]

• Tachycardia
• "Handbook of Signs & Symptoms (Third Edition)" (2006)
• [ read ]

• Arrhythmias
• "A Pocket Manual of Differential Diagnosis" (1999)
• [ read ]

• Heart Murmurs*
• "A Pocket Manual of Differential Diagnosis" (1999)
• [ read ]

• Palpitation*
• "A Pocket Manual of Differential Diagnosis" (1999)
• [ read ]

• Cardiac arrhythmias
• "Professional Guide to Diseases (Eighth Edition)" (2005)
• [ read ]

• Bradycardia
• "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
• [ read ]

• Murmurs
• "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
• [ read ]

• Palpitations
• "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
• [ read ]

• Pulse rhythm abnormality
• "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
• [ read ]

• Pulse, absent or weak
• "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
• [ read ]

• Pulsus bisferiens
• "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
• [ read ]

• Tachycardia
• "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
• [ read ]

• Bradycardia
• "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
• [ read ]

• Palpitations
• "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
• [ read ]

• Tachycardia
• "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
• [ read ]

• Heart Murmur, Diastolic
• "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
• [ read ]

• Heart Murmur, Systolic
• "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
• [ read ]

• Bradycardia
• "Field Guide to Bedside Diagnosis" (2007)
• [ read ]

• Palpitations/Tachycardia
• "Field Guide to Bedside Diagnosis" (2007)
• [ read ]

• Diastolic Murmur
• "Field Guide to Bedside Diagnosis" (2007)
• [ read ]

• Systolic Murmur
• "Field Guide to Bedside Diagnosis" (2007)
• [ read ]

• Continuous Murmur
• "Field Guide to Bedside Diagnosis" (2007)
• [ read ]

• Cardiac arrhythmias
• "Handbook of Diseases" (2003)
• [ read ]

• Bradycardia
• "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
• [ read ]

• Murmurs
• "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
• [ read ]

• Palpitations
• "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
• [ read ]

• Pulse rhythm abnormality
• "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
• [ read ]

• Tachycardia
• "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
• [ read ]

• Bradycardia
• "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
• [ read ]

• Murmurs
• "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
• [ read ]

• Palpitations
• "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
• [ read ]

• Pulse rhythm abnormality
• "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
• [ read ]

• Pulse, absent or weak
• "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
• [ read ]

• Pulsus bisferiens
• "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
• [ read ]

• Tachycardia
• "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
• [ read ]

• Heart Murmurs (Asymptomatic)
• "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
• [ read ]

• Bradycardia
• "Nursing: Interpreting Signs and Symptoms" (2007)
• [ read ]

• Murmurs
• "Nursing: Interpreting Signs and Symptoms" (2007)
• [ read ]

• Palpitations
• "Nursing: Interpreting Signs and Symptoms" (2007)
• [ read ]

• Pulse rhythm abnormality
• "Nursing: Interpreting Signs and Symptoms" (2007)
• [ read ]

• Pulse, absent or weak
• "Nursing: Interpreting Signs and Symptoms" (2007)
• [ read ]

• Pulsus bisferiens
• "Nursing: Interpreting Signs and Symptoms" (2007)
• [ read ]

• Tachycardia
• "Nursing: Interpreting Signs and Symptoms" (2007)
• [ read ]

• Bradycardia
• "Differential Diagnosis in Primary Care" (2007)
• [ read ]

• MURMURS
• "Differential Diagnosis in Primary Care" (2007)
• [ read ]

• TACHYCARDIA
• "Differential Diagnosis in Primary Care" (2007)
• [ read ]

• CARDIAC ARRHYTHMIAS
• "Differential Diagnosis in Primary Care" (2007)
• [ read ]

 

Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Arrhythmia

• Back to symptom: Arrhythmia: Introduction (review 234 causes)
• Next Book Extract About Arrhythmia: Tachycardia/Palpitations (In A Page: Pediatric Signs and Symptoms)
• All Book Extracts: All Online Book Extracts for Arrhythmia

---

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

 » Next page: Tachycardia/Palpitations (In A Page: Pediatric Signs and Symptoms)

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• Tachycardia/Palpitations (In A Page: Pediatric Signs and Symptoms)
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• CARDIAC ARRHYTHMIAS (Differential Diagnosis in Primary Care)

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