This handout is for brady-tachy syndrome / sick sinus syndrome. Your care team identified this based on: unexplained syncope or near-syncope (acc/aha/hrs 2018 class i evaluation).
Other reasons your team may use this plan: chronic fatigue / exercise intolerance (acc/aha/hrs 2018 snd symptom criteria); palpitations alternating with brady episodes (acc/aha/hrs 2018 tachy-brady definition); documented sinus brady, sinus pauses, or chronotropic incompetence (acc/aha/hrs 2018 kusumoto).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| atropine | 0.5 mg IV q3–5 min, max 3 mg | IV | q3–5 min | ACLS 2020 bradycardia algorithm first-line; less effective in infranodal block (ACC/AHA/HRS 2018 Kusumoto) |
| isoproterenol | 2–10 mcg/min | IV | continuous | β1/β2 agonist increases SA rate; bridge to pacing (ACLS 2020; ACC/AHA/HRS 2018) |
| epinephrine | 2–10 mcg/min | IV | continuous | Bridge to pacing (ACLS 2020 bradycardia algorithm) |
| dopamine | 5–20 mcg/kg/min | IV | continuous | Chronotrope + inotrope (ACLS 2020 bradycardia algorithm) |
Plan: Acute brady management before / pending pacemaker
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
EP q3–6 mo; PPM check; AC review; lifestyle — OSA management, exercise (ACC/AHA/HRS 2018; ESC 2021 pacing follow-up)
Guideline: 2018 ACC/AHA/HRS Bradycardia Guideline (Kusumoto)