Bradycardia is a common finding in the emergency department (ED) and presents along a clinical spectrum, ranging from asymptomatic to hemodynamic compromise and cardiac arrest.

This manuscript evaluates the management of bradycardia through a discussion of several cases.

Bradycardia may result in severe hemodynamic compromise and is defined as a heart rate less than 60 beats per minute (bpm). There are a variety of causes and associations, including physiologic, pathologic, and pharmacologic. Patients may present with a range of signs and symptoms, from no symptoms to hemodynamic collapse. Obtaining an electrocardiogram is essential, which will determine the severity of bradycardia and underlying rhythm, including first-degree atrioventricular (AV) block, second-degree AV block, and third-degree AV block, among others. Management is based on the underlying etiology and patient hemodynamic status, aiming to improve the heart rate and address the underlying cause. Patients who are hemodynamically unstable require resuscitation with chronotropic agents and transcutaneous or transvenous pacing.

Severe bradycardia requires emergent management, and a knowledge of the treatment strategies can optimize patient care.