Heart Rate: Bradycardia/Tachycardia


  • Symptomatic: lightheaded, syncope, chest pain, SOB, palpitations
    1. Hold 1 dose of currently prescribed HR meds (Beta-blocker, Calcium channel blocker)
  • Order EKG for all patients with bradycardia: (look for pauses or heart blocks) [Consult Cardiology!]
    1. If sinus pauses <2.5s and asymptomatic: No intervention needed.
    2. If sinus pauses 2.5-3s and asymptomatic: Consider trial of Atropine.
    3. If sinus pauses >3s and asymptomatic: External pacer.
      1. Atropine 0.5-1mg IV q3-5 minutes.
      2. Dopamine 5-20mcg/kg/min
      3. Dobutamine (+beta 1 and beta 2 receptors): 2.5mcg/kg/min?
  • Ex scenario: Pt just had a carotid endarterectomy, which may lead to vagus nerve injury¬†-> low HR


Tachycardia: If a cardiology group is already following patient, consider contacting them before intervening.

  • Check vital signs.
  • Stat EKG: look for arrhythmia as underlying etiology
  • Place patient on a telemetry monitor if not already on one.
  • Beta-blocker:
    1. Labatolol 20mg IV stat X 1 dose
    2. Metoprolol 5mg IV stat X 1 dose
  • Calcium channel blocker:
    1. Cardiazem 10mg IV stat X 1 dose
  • Correct underlying cause:
    1. Look at fluid status/IV fluids. Check BP: If low, may be underlying etiology: correct that 1st via IV fluid bolus.
    2. Fever/infection. Check temperature. Consider collecting UA, Urine culture, Blood culture, Chest x-ray.
    3. Thyroid (hyperthyroidism as underlying etiology): Check TSH.
      1. Tx: levothyroxine 125 mcg
    4. Consider changing medications that may be exacerbating tachycardia:
      1. Ex: Change DuoNeb (Albuterol) to Xopenx (Levalbuterol) – less tachycardia.


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