From the Guidelines
Bradycardia symptoms include fatigue, dizziness, lightheadedness, fainting or near-fainting spells, shortness of breath, chest pain, confusion, difficulty exercising, and weakness, as defined by the 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay 1.
Symptoms of Bradycardia
The symptoms of bradycardia can vary widely from insidious symptoms to episodes of frank syncope, and can be broadly classified into two general categories: sinoatrial node dysfunction (SND) and atrioventricular block 1.
- Fatigue
- Dizziness
- Lightheadedness
- Fainting or near-fainting spells
- Shortness of breath
- Chest pain
- Confusion
- Difficulty exercising
- Weakness These symptoms typically occur when the heart rate drops below 50 beats per minute, resulting in inadequate oxygen delivery to tissues and organs 1.
Clinical Manifestations
The clinical manifestations of bradycardia can be explained by the disparate electrophysiologic manifestations, ventricular rates, transience of these abnormalities, overall medical conditions, and medications 1.
- The electrocardiographic findings in patients with SND are varied and the diagnosis may be considered in patients with sinus bradycardia or atrial depolarization from a subsidiary pacemaker other than the sinus node.
- The clinical manifestations of atrioventricular block will also depend on whether the atrioventricular block is fixed or intermittent and the ventricular rate or duration of ventricular asystole associated with atrioventricular block. Regardless of whether the bradycardia is caused by SND or atrioventricular block, the term “symptomatic bradycardia” is used throughout the guideline and has been defined as a “documented bradyarrhythmia that is directly responsible for development of the clinical manifestations of syncope or presyncope, transient dizziness or lightheadedness, heart failure symptoms, or confusional states resulting from cerebral hypoperfusion attributable to slow heart rate” 1.
Importance of Medical Attention
If you experience these symptoms, especially fainting or severe shortness of breath, seek medical attention promptly as treatment may be needed, ranging from medication adjustments to pacemaker implantation in severe cases 1.
From the Research
Symptoms of Bradycardia
The symptoms of bradycardia, which is a heart rate lower than 60 beats/min, can include:
- Syncope
- Dizziness
- Chest pain
- Dyspnea
- Fatigue 2 These symptoms can occur due to various types of bradycardia, such as sinus, atrial, or junctional bradycardia, or problems with the conduction system, like an atrioventricular block 2.
Clinical Presentation
Bradycardia can be asymptomatic, especially in trained athletes or during sleep 2. However, symptomatic patients may present with decreased end-organ perfusion, requiring prompt recognition and treatment 3. In some cases, bradycardia can lead to more severe complications, such as ventricular standstill, loss of consciousness, and decorticate posturing 4.
Treatment-Related Symptoms
In some instances, treatment of bradycardia with atropine can paradoxically worsen the condition, particularly in patients with atrioventricular blocks at the level of the His-Purkinje fibers 4. Additionally, transcutaneous cardiac pacing (TCP) can be a painful intervention, although it is generally well-tolerated by conscious patients 5.