General Management Approach

The urgency of management depends on the degree of haemodynamic compromise or shock present. Management will also be determined by the specific cause of, and site of, the conduction disturbance.

However, certain general principles or management steps pertain to all cases and are listed below:

• Treat bradycardia if causing haemodynamic compromise
• Identify and treat hypoxia and hypotension
• Apply transcutaneous pacing pads and defibrillator leads
• Identify specific heart blocks
• Identify and treat cardiac ischaemia
• Use atropine 0.5 mg intravenously as first line drug in most cases
• Establish transcutaneous pacing if atropine ineffective
• Start inotropes if above measures are ineffective or there is ongoing hypotension
• Be aware of indications for transvenous pacing
• Identify and treat any underlying systemic conditions (eg. electrolyte disturbances)

This section describes the various types of bradycardia and their specific treatment points in more detail.