At the end of this section, the learner will be able to:

• Define bradycardia
• Describe the algorithm for bradycardia with a pulse
• Understand the AV blocks
• Discuss the treatment of bradycardia in ACS
• Describe the use of pacing with bradyarrhythmias.

Here we will go over the recommended treatments for acute and symptomatic arrhythmias. While ECG analysis is vital for evaluating the patient, the provider does this in the context of the clinical presentation and history. When responders make treatment decisions based only on ECG rhythms, this is to the patient’s detriment. 

Important clinical information includes vital signs, level of consciousness, oxygenation and ventilation, as well as circulatory status. Arrhythmias may be asymptomatic, in which patients have no complaints due to the underlying diagnosis. There are two classifications of arrhythmias that have a clinical effect on the patient. 

Symptomatic arrhythmia indicates that the patient has a subjective sense of the effect of the arrhythmia. This includes the experience of palpitations, dizziness, and shortness of breath. The symptoms can range from mild to severe, with increasing severity suggesting a more significant effect and possible progression to becoming unstable. Unstable arrhythmia indicates very severe signs and symptoms that indicate the need for immediate intervention, such as those associated with myocardial infarction or heart failure.