DESCRIPTION

Just like sinus rhythm, but slower; it is defined as sinus rhythm (every QRS preceded by a proper P wave) with a rate under 60.

HABITAT

Boring lectures, a Kenny G concert, inferior infarcts, sleep apnea, or too much β-blocker.

CALL

“Why is everyone running into in my room and looking at me?”

RESEMBLANCE TO OTHER ARRHYTHMIAS

This looks like sinus rhythm, only slower. When it’s really slow (rates into the 30s) you might think it’s a junctional rhythm, but the presence of P waves with the proper PR interval would indicate it’s definitely a sinus rhythm.

CARE AND FEEDING

Probably here more than anywhere else, it’s a question of “when in doubt, check the patient”! If the heart rate is 30 but the patient is fine, don’t do anything. If the heart rate is slow and the patient is dizzy or hypotensive, then intervene. Here a little atropine might help in the short term. Often withdrawal or reducing the dose of “slower-downers” (such as β-blockers, diltiazem, digoxin, verapamil, or some antiarrhythmics) over time would allow the heart rate to increase. Shouting or showing the patient his or her bill might help also, but if the heart rate stays low and the patient is symptomatic, a pacemaker might be in order.

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