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Pathology
Sinus rhythm at a rate <60bpm.
Aetiology
Normal: athletes or during sleep
Secondary to drug therapy: Beta blockers, digoxin, calcium channel blockers and anti-arrhythmics)
Other: MI, sick sinus syndrome, hypothyroidism and hypothermia
Signs
Slow regular pulse, tachycardia, hypotension, and audible third heart sound.
Symptoms
Asymptomatic in non-pathological conditions
Symptomatic patients note SOB, pre-syncope, syncope, chest pain
Investigations
Bloods: FBC, TFTs, Digoxin levels
ECG: Holter monitor for 24 hour recording if required.
Treatment
IV atropine
Beta blocker overdose: Glucagon
Digoxin toxicity: Digibind
Chronic: Temporary pacing wire or permanent pacemak
Prognosis
Usually good
Key Facts
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