Sinus bradycardia causes

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Sinus bradycardia Microchapters


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Differentiating Sinus bradycardia from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis


History and Symptoms

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Laboratory Findings



Medical Therapy

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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: Ayokunle Olubaniyi, M.B,B.S [2]


Sinus bradycardia does not necessarily refer to the presence of an obvious pathology; in fact, it may occur in normal, healthy individuals including well-trained athletes, some elderly people or during sleep. It may also be due to an exaggerated response to normal physiological processes (e.g. vomiting, coughing, defecation) or from pathologies involving the SA node such as sick sinus syndrome, myocardial infarction. The most common medications causing sinus bradycardia are beta blockers, digitalis and calcium channel blockers. However, life-threatening conditions including chemical poisoning (organophosphate, sarin), sepsis, electrolyte imbalance should be promptly recognized and treated.


Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular Carotid sinus hypersensitivity, endocarditis, hypertrophic cardiomyopathy, left ventricular noncompaction, LQT4 mutation, myocardial infarction, myocarditis, pericarditis, sick sinus syndrome, vasovagal syncope
Chemical/Poisoning Carbamate poisoning, lily of the valley poisoning, nerve agent, organophosphates
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Adenosine, alfentanil, ambenonium, amiodarone, atenolol, bethanechol, bupivacaine, calcium channel blocker, celecoxib, cilobradine,[1] citalopram, clonidine, deserpidine, diltiazem, dimethyl sulfoxide, distigmine, dronedarone, febuxostat, fentanyl,fingolimod, flecainide, fosphenytoin, grayanotoxin, Granisetron, guanethidine, H2 receptor antagonist, ivabradine, lanreotide, lidocaine, lofexidine, mefloquine, methyldopa, mexiletine, muscarine, nadolol, nefazodone,neostigmine, octreotide, paclitaxel, palonosetron, physostigmine, procainamide, propranolol, quinidine, rabeprazole, regadenoson, reserpine, sedative, somatostatin, sotalol, sufentanil,suxamethonium, toluene sniffing, topical cocaine, verapamil, veratridine (false hellebore), zaleplon, zatebradine [2]
Ear Nose Throat No underlying causes
Endocrine Cretinism, diabetic neuropathy, hemochromatosis, hypothyroidism, tumor lysis syndrome
Environmental Altitude sickness, decompression sickness, electric shock, hypothermia
Gastroenterologic No underlying causes
Genetic Arnold-Chiari malformation, cretinism, HCN4 mutation, hemochromatosis, LQT4 mutation, myotonic dystrophy , SCN5A mutation
Hematologic Hemochromatosis
Iatrogenic Cardiac catheterization, cardiac transplantation, toluene sniffing, transcatheter aortic valve implantation
Infectious Disease Babesiosis, brucellosis, Chagas disease, dengue fever, diptheria, legionellosis, leptospirosis , Lyme disease, malaria, meningitis , Q fever , rabies, rheumatic fever, rocky mountain spotted fever, sepsis , trichinosis, typhoid fever, typhus, viral hemorrhagic fever, yellow fever
Musculoskeletal/Orthopedic Myotonic dystrophy
Neurologic Cerebral edema, diabetic neuropathy, epilepsy, increased intracranial pressure, meningitis, rabies, subarachnoid hemorrhage, vasovagal syncope
Nutritional/Metabolic Hypoglycemia, kwashiorkor, sepsis
Obstetric/Gynecologic Pregnancy
Oncologic No underlying causes
Ophthalmologic No underlying causes
Overdose/Toxicity Crizotinib toxicity, digitalis toxicity, fluoxetine, fluvoxamine, ibutilide toxicity, lithium toxicity
Psychiatric Anorexia nervosa
Pulmonary Cough syncope, drowning, hypercapnia, obstructive sleep apnea, sarcoidosis
Renal/Electrolyte Hypercalcemia, hyperkalemia, hypermagnesemia, hypokalemia
Rheumatology/Immunology/Allergy Amyloidosis, neonatal lupus erythematosus, rheumatoid arthritis, sarcoidosis, scleroderma, systemic lupus erythematosus
Sexual No underlying causes
Trauma Cervical spine injury
Urologic No underlying causes
Miscellaneous Aging, altitude sickness, decompression sickness, defecation, drowning, micturition syncope, nausea, sleep, starvation, trained athletes, valsalva maneuver, vomiting

Causes in Alphabetical Order


  1. van bogaert, pp.; pittoors, f. (2003). "use-dependent blockade of cardiac pacemaker current (if) by cilobradine and zatebradine". eur j pharmacol. 478 (2–3): 161–71. PMID 14575801. Unknown parameter |month= ignored (help)
  2. 2.0 2.1 2.2 Van Bogaert, PP.; Pittoors, F. (2003). "Use-dependent blockade of cardiac pacemaker current (If) by cilobradine and zatebradine". Eur J Pharmacol. 478 (2–3): 161–71. PMID 14575801. Unknown parameter |month= ignored (help)

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