Bradycardia is a very common finding in patients presenting to the emergency department. In 2018, over 18,000 pacemakers were inserted in Canada alone for severe dysrhythmia management.1 However, there are many causes of bradycardia that exist. Knowing and identifying the underlying causes of bradycardias is critical to emergency department management and disposition.
The following mnemonic, BRADIE, is a helpful tool for remembering various causes of bradycardia during the clinical assessment of these patients.
BRADIE (click each heading to expand)
▼ Blocks
1st degree AV block, 2nd degree AV block (Type 1 & 2), 3rd degree AV block, Sick sinus syndrome▼ Reduced Vital Signs
Hypoxemia, hypothermia, hypoglycemia▼ Acute Coronary Syndrome
Unstable angina, NSTEMI, STEMI▼ Drugs
Beta-blockers, calcium channel blockers, digoxin, organophosphates, clonidine▼ Infection & Intra-cranial Pressure (ICP)
– Lyme disease, myocarditis, endocarditis, travel-related diseases– Cushing’s reflex due to increased ICP (bradycardia, hypertension, irregular respirations)
▼ Electrolyte & Endocrine Abnormalities
– Hypokalemia, hyperkalemia, hypermagnesemia, hypocalcemia– Myxedema coma
This post was copyedited by Tim Zhang.
References
- 1.Canadian Institute for Health Information. Implantable Medical Devices in Canada: Insights Into High-Volume Procedures and Associated Costs. Canadian Institute for Health Information. Published 2020. Accessed December 26, 2022. https://secure.cihi.ca/free_products/implantable-medical-devices-report-en.pdf
Reviewing with the Staff
Dr. Warren Cheung
Dr. Cheung is an Emergency Physician at The Ottawa Hospital and Associate Professor in the Department of Emergency Medicine at the University of Ottawa. His program of research focuses on improving the quality of trainee assessments within a competency-based framework, with particular interests in studying workplace-based assessments.
Isaac Kim
Isaac Kim is a 4th year medical student at the University of Ottawa. His academic interests include emergency medicine, medical education, and clinical reasoning in medicine. He also loves to try new restaurants, play squash, and read classic literature!
Latest posts by Isaac Kim (see all)
- Tiny Tips: BRADIE for Differential Causes of Bradycardia - January 17, 2023