Bradycardia with a Pulse Algorithm Explained
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Article at a Glance
- The provider must determine whether the patient’s symptoms are related to their slow heart rate, or whether their slow heart rate is caused by another condition.
- Clinicians must decide whether the patient is stable or unstable based on clinical parameters, physical exam, and 12-lead electrocardiogram (ECG).
- Patients with bradycardia who are deemed stable may require ongoing monitoring.
Bradycardia With a Pulse Algorithm
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This bradyarrhythmia segment highlights patients presenting with acute symptomatic bradyarrhythmias. The interpretation of ECG findings must be within the context of the patient’s clinical condition. That is assessed by performing a full physical examination and obtaining a patient history. Information must be acquired, including the patient’s ventilation and oxygenation status, heart rate, blood pressure, level of consciousness, and assessment for signs of shock. A 12-lead ECG is necessary; however, if treatment of the patient is based on ECG findings alone, there is potential for errors in the management of the patient. This algorithm simplifies overall patient status and designates as stable or unstable. Stable patients have normal vital signs and present with no serious clinical signs and symptoms.1 However, these patients will still have an abnormal ECG in terms of heart rate. Stable patients present with clinical signs and symptoms that are directly related to the bradyarrhythmia. Common symptoms include: (1) palpitations, (2) light-headedness, and (3) dyspnea. Although symptomatic, these patients are not in imminent danger of cardiac arrest and there is time to decide whether treatment is necessary. Unstable patients will present with the same signs and symptoms but will also display symptoms of instability, such as altered sensorium or other clinical presentations of severely compromised perfusion, oxygenation, and ventilation. Cardiac arrest may occur if no immediate intervention is pursued.Assessing Arrhythmia in the Context of Patient Condition
Common symptoms of bradyarrhythmia include palpitations, lightheadedness, and dyspnea.
The clinician must decide if the patient’s signs and symptoms are brought about by the arrhythmia or by another underlying condition.2
For example, patients with thyroid storms will present with unstable supraventricular tachycardia. Performing synchronized cardioversion is futile unless the clinician addresses the effects of hyperthyroidism on this patient. Hence, in this case, giving beta-antagonists and antithyroid medications precede synchronized cardioversion (unless the patient is very unstable and cardiac arrest is likely).
As another example, treating bradycardia with atropine is futile if the patient’s condition is brought about by severe hypoxemia. In this case, optimizing ventilation and providing oxygen supplementation would supersede administration of atropine or cardiac pacing interventions.
Related Video – ACLS Algorithm – Adult Bradycardia with a Pulse
Due to significant loss of cardiac output in bradycardia, patients will show signs and symptoms of hypoxemia. To compensate, they will have an increase in respiratory effort (tachypnea, intercostal retractions, and paradoxical breathing). Patients’ vital signs must be monitored with attention to oxygenation and ventilation. A pulse oximeter is recommended to monitor arterial oxygen saturation.
When a patient shows signs of hypoxemia (low oxygen saturation < 94%), clinicians should provide oxygen supplementation.3 Close monitoring with a cardiac monitor and 12-lead ECG is essential.
Obtaining intravenous access is likewise recommended when emergency medications are required. With all of this information, the clinician can establish a possible diagnosis for the patient’s medical condition. Refer to Box 2 of the Adult Bradycardia With a Pulse Algorithm.
A pulse oximeter is a device that measures the oxygen levels of the blood.
The next questions are:
- Are the patient’s signs and symptoms of bradycardia cardiac in origin?
- Are there any other clinical conditions that could have brought about bradycardia in this patient?
By answering these questions, the clinician can select appropriate interventions and treatments.
If, after improving oxygenation, the patient’s symptoms diminish, then the clinician may opt to monitor the patient and decide whether to admit the patient for further assessment. These patients are of course stable.
This article summarizes the Adult Bradycardia With a Pulse Algorithm. It is important for the clinician to use the algorithm to determine whether the patient’s symptoms are related to their slow heart rate, or whether their slow heart rate is caused by another condition.
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Editorial Sources
ACLS Certification Association (ACA) uses only high-quality medical resources and peer-reviewed studies to support the facts within our articles. Explore our editorial process to learn how our content reflects clinical accuracy and the latest best practices in medicine. As an ACA Authorized Training Center, all content is reviewed for medical accuracy by the ACA Medical Review Board.
1. Amit Sapra; Ahmad Malik; Priyanka Bhandari. Vital Sign Assessment. National Library of Medicine. 2022.
2. Mayo Clinic. Heart Arrhythmia. 2022.
3. Brant B. Hafen; Sandeep Sharma. Oxygen Saturation. National Library of Medicine. 2021.
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