Recognize Bradycardia

Bradycardia is defined as a heart rate that is slower than what is considered normal for a child’s age. Bradycardia in children and infants should be evaluated, but not all bradycardia needs to be medically managed. Intervention is required when bradycardia is symptomatic and compromises cardiovascular function. This commonly means that the heart is beating too slowly to maintain blood pressure, thereby causing shock, poor tissue perfusion, and/or a change in mental status. Symptomatic bradycardia may cause a number of signs and symptoms including low blood pressure, pulmonary edema/congestion, abnormal rhythm, chest discomfort, shortness of breath, lightheadedness, confusion, and/or syncope. Bradycardia most commonly becomes symptomatic when it is of new onset for the person (acute slowing of the heart rate).

Sinus Bradycardia

• Normal rhythm with slow rate

First Degree AV Block

• PR interval is longer than 0.20 seconds

Type I Second Degree AV Block (Mobitz I/Wenckebach)

• PR interval increases in length until QRS complex is dropped

Type II Second Degree AV Block (Mobitz II)

• PR interval is the same length with an intermittently dropped QRS complex

Third Degree AV Block (Complete)

• PR interval and QRS complex are not coordinated with each other

Respond to Bradycardia

Table 15