Clinical investigations from the RACP

Investigating the patient with bradycardia

David Amos
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Bradycardia may be a normal physiological response or a manifestation of a wide variety of pathological conditions, both cardiac and non-cardiac. It is arbitrarily defined as a heart rate of less than 60 beats per minute, although the resting pulse may normally be considerably less than this, particularly in fit young adults. A careful history and thorough physical examination are necessary to guide rational, appropriate investigations and, if indicated, treatment.

Key Points

  • Healthy adults may have a resting pulse that is less than 60 beats per minute.
  • It is important to correlate symptoms with the episode(s) of bradycardia.
  • Drug-related bradycardia is a very common problem in clinical practice.
  • The 12-lead ECG is the initial investigation for bradycardia.
  • 24-hour Holter monitoring is more helpful when symptoms are frequent.
  • Temporary cardiac pacing may be useful if the bradyarrhythmia has a reversible cause.
  • Permanent cardiac pacing may be necessary for advanced conduction system disease and once reversible causes have been excluded.