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20.16 Sinus Bradycardia and Sinus Arrest

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This rhythm does not require treatment, unless they are causing symptoms, i.e. syncope, dizziness, tiredness and poor effort tolerance.

Sinus bradycardia < 50/minute or sinus arrest with slow escape rhythm, accompanied by hypotension, strongly suggests a treatable underlying cause:

  • Acute inferior myocardial infarct
  • Hyperkalaemia, especially if wide QRS and/or peaked T waves
  • Drugs, especially combination of verapamil and ß –blocker or digoxin
  • Hypothermia
  • Hypoxia

Treat the cause. Consider atropine if inferior infarct.

 Sinus arrest

  • Refer all to a cardiologist specialist.

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