Bradycardia pathophysiology

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Bradycardia Microchapters



Historical Perspective




Differentiating Bradycardia from other Conditions

Epidemiology and Demographics

Risk Factors


Natural History, Complications and Prognosis


History and Symptoms

Physical Examination

Laboratory Findings


Chest X Ray




Other Imaging Findings

Other Diagnostic Studies


Medical Therapy


Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M.Umer Tariq [2] Ibtisam Ashraf, M.B.B.S.[3]


Bradycardia generally results from sinus node dysfunction and AV node dysfunction. However, other pathophysiologic conditions can also result in bradycardia such as acute Myocardial infarction, obstructive sleep apnea, exaggerated vagal activity, increased intracranial pressure, and infectious diseases such as Lyme disease, rocky mountain spotted fever, chagas disease, psittacosis, Q fever, and typhoid fever.


The underlying mechanism is not clinically relevant to the treatment.

There are generally two types of problems that result in bradycardia:

Disorders of the sinus node

Disorders of the atrioventricular node (AV node)

Sinus bradycardia can also be seen in these pathophysiologic settings:[3][4]

Acute Myocardial infarction

Obstructive sleep apnea

Exaggerated vagal activity

Increased intracranial pressure

Infectious causes

Microscopic Pathology


  1. Alpert MA, Flaker GC (1983). "Arrhythmias associated with sinus node dysfunction. Pathogenesis, recognition, and management". JAMA. 250 (16): 2160–6. PMID 6620520.
  2. Brodsky, Michael; Wu, Delon; Denes, Pablo; Kanakis, Charles; Rosen, Kenneth M. (1977). "Arrhythmias documented by 24 hour continuous electrocardiographic monitoring in 50 male medical students without apparent heart disease". The American Journal of Cardiology. 39 (3): 390–395. doi:10.1016/S0002-9149(77)80094-5. ISSN 0002-9149.
  3. "StatPearls". 2020. PMID 29630253.
  4. Nof, Eyal; Luria, David; Brass, Dovrat; Marek, Dina; Lahat, Hadas; Reznik-Wolf, Haya; Pras, Elon; Dascal, Nathan; Eldar, Michael; Glikson, Michael (2007). "Point Mutation in the HCN4 Cardiac Ion Channel Pore Affecting Synthesis, Trafficking, and Functional Expression Is Associated With Familial Asymptomatic Sinus Bradycardia". Circulation. 116 (5): 463–470. doi:10.1161/CIRCULATIONAHA.107.706887. ISSN 0009-7322.
  5. Davis WT, Montrief T, Koyfman A, Long B (August 2019). "Dysrhythmias and heart failure complicating acute myocardial infarction: An emergency medicine review". Am J Emerg Med. 37 (8): 1554–1561. doi:10.1016/j.ajem.2019.04.047. PMID 31060863.
  6. Caples SM, Rosen CL, Shen WK, Gami AS, Cotts W, Adams M; et al. (2007). "The scoring of cardiac events during sleep". J Clin Sleep Med. 3 (2): 147–54. PMID 17557424.
  7. Gilson GJ, Miller AC, Clevenger FW, Curet LB (1995). "Acute spinal cord injury and neurogenic shock in pregnancy". Obstet Gynecol Surv. 50 (7): 556–60. doi:10.1097/00006254-199507000-00022. PMID 7566833.
  8. Cunha BA (2000). "The diagnostic significance of relative bradycardia in infectious disease". Clin Microbiol Infect. 6 (12): 633–4. doi:10.1046/j.1469-0691.2000.0194f.x. PMID 11284920.
  9. Puljiz I, Beus A, Kuzman I, Seiwerth S (2005). "Electrocardiographic changes and myocarditis in trichinellosis: a retrospective study of 154 patients". Ann Trop Med Parasitol. 99 (4): 403–11. doi:10.1179/136485905X36307. PMID 15949188.
  10. Nof E, Luria D, Brass D, Marek D, Lahat H, Reznik-Wolf H; et al. (2007). "Point mutation in the HCN4 cardiac ion channel pore affecting synthesis, trafficking, and functional expression is associated with familial asymptomatic sinus bradycardia". Circulation. 116 (5): 463–70. doi:10.1161/CIRCULATIONAHA.107.706887. PMID 17646576.
  11. Sanders P, Kistler PM, Morton JB, Spence SJ, Kalman JM (2004). "Remodeling of sinus node function in patients with congestive heart failure: reduction in sinus node reserve". Circulation. 110 (8): 897–903. doi:10.1161/01.CIR.0000139336.69955.AB. PMID 15302799.

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