Physical Examination Components for Patients with Bradycardia
A comprehensive physical examination for patients with bradycardia should focus on vital signs, cardiovascular assessment, and signs of underlying causes, as these findings directly impact morbidity and mortality outcomes. 1
Vital Signs Assessment
- Measure heart rate (bradycardia defined as <50-60 beats per minute) 1, 2
- Monitor blood pressure (assess for hypotension which may indicate hemodynamic compromise) 1
- Check respiratory rate and oxygen saturation (hypoxemia is a common cause of bradycardia) 1
- Assess body temperature (hypothermia can cause bradycardia) 1
Cardiovascular Examination
- Auscultate for heart sounds and murmurs (may indicate structural heart disease) 1
- Check for jugular venous distention (may indicate heart failure or volume overload) 1
- Assess peripheral pulses (rate, rhythm, and quality) 1
- Look for peripheral edema (may indicate heart failure) 1
- Evaluate capillary refill time (prolonged time may indicate poor perfusion) 1
Neurological Assessment
- Evaluate mental status (altered mental status may indicate cerebral hypoperfusion) 1, 3
- Check for signs of increased intracranial pressure (particularly in patients with head injuries) 3
- Assess for syncope or pre-syncope symptoms (common presentations of bradycardia) 1
Signs of Hemodynamic Compromise
- Look for signs of shock (cool extremities, delayed capillary refill) 1, 4
- Assess for chest pain (may indicate myocardial ischemia) 1, 5
- Check for dyspnea (may indicate heart failure or pulmonary edema) 4
- Monitor for decreased urine output (may indicate poor renal perfusion) 6
Specific Clinical Scenarios to Consider
- In patients with head injuries, assess for Cushing's triad (bradycardia, hypertension, irregular breathing) 3
- In patients on AV nodal blockers with renal dysfunction, check for signs of BRASH syndrome (Bradycardia, Renal failure, AV nodal blockers, Shock, and Hyperkalemia) 6
- In pediatric patients, assess for age-appropriate heart rate norms (bradycardia definition varies by age) 7
Additional Considerations
- Review medication history for drugs that can cause or exacerbate bradycardia (beta-blockers, calcium channel blockers, digoxin) 1
- Assess for signs of electrolyte abnormalities, particularly hyperkalemia 6
- In pregnant patients, remember that bradycardia treatment should not be withheld due to pregnancy concerns 8
Remember that the physical examination findings should be correlated with the 12-lead ECG, which is essential for documenting rhythm, rate, and conduction abnormalities 1. For patients with intermittent symptoms, ambulatory cardiac monitoring may be necessary to establish correlation between heart rate or conduction abnormalities with symptoms 1.