Bradycardia
Heart rate below 60 beats per minute; may be normal in conditioned athletes but pathological if the patient is symptomatic.
Exam items hinge on one decision: is the patient symptomatic? A stem describing a low rate with stable vitals and an alert client is a trap that wants you to withhold medication and keep monitoring, while the “tell” for action is poor perfusion — ischemic chest pain, dyspnea, altered mental status, hypotension, or other signs of shock. The priority answer is never “give atropine” reflexively; assess airway, breathing, and oxygenation first, because hypoxia is a classic correctable cause. Watch the dose on older banks too: they may still list atropine’s first dose as 0.5 mg, but current AHA ACLS uses 1 mg.
Distinguish symptomatic bradycardia from a high-grade conduction block, which often won’t respond to atropine and goes straight to pacing rather than repeated drug doses. Don’t confuse the slow rate with tachycardia, the body’s compensatory response to falling cardiac output, or with hypotension, a perfusion sign rather than a rate. Memory hook: treat the patient, not the number.
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