Bradycardia - Differential Diagnosis Framework



BRADI Mnemonic

 • BRASH/Hyperkalemia

 • Reduced oxygen/Glucose/Temp

 • ACS

 • Drugs

 • ICP / Infections



BRASH Syndrome - Hyperkalemia + AV nodal blocking agents = Bradycardia

 • Bradycardia

 • Renal failure

 • AV nodal blocking agent

 • Shock

 • Hyperkalemia



Pulmonary:

 • Hypoxia

 • Sleep apnea

 • Hypercarbia



Environmental:

 • Hypothermia



Endocrine:

 • Hypothyroidism



Electrolytes:

 • hyperkalemia

 • Hypermagnesemia



Neurological:

 • Raised Intracranial Pressure - Cushing response

 • Ictal Bradycardia



Cardiac Disease:

 • Myocardial ischemia/infarction

 • Myocarditis

 • Congenital disorders

 • Cardiomyopathies

	- Infiltrative: Sarcoidosis, Amyloidosis, Hemochromotosis

 • His-Purkinje Fiber degeneration

 • Tachy-Brady syndrome

 • Aortic Valve Endocarditis + Abscess

 • Sick sinus syndrome

 • Post cardiac/Valve surgery

 • Heart block



Medications:

 • Beta blockers

 • Calcium channel blockers

 • Digoxin

 • Amiodorone

 • Clonidine

 • Organophosphates

 • Ciguatera

 • Flecanide toxicity

 • Sotalol

 • Propofol infusion syndrome

 • Quinidine

 • Amitryptyline

 • Lithium

 • Cimetidine



Infections:

 • Lyme disease

 • Diptheria

 • Typhoid fever

 • Chagas disease

 • Acute rheumatic fever

 • Legionella

 • Psittacosis

 • Q fever

 • Yellow fever

 • Babesiosis

 • Leptospirosis

 • RMSF

 • Trichinosis



Autoimmune:

 • SLE

 • Scleroderma

 • Polymyositis

 • HLAB27 Seronegative Spondylarthropathies



Other causes:

 • Athletes

 • Carotid sinus hypersensitivity

 • Oculocardiac reflex

 • Dysautonomia

 • Failure of permanent pacemaker



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