Junctional bradycardia causes

	Junctional bradycardia Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mugilan Poongkunran M.B.B.S [2]

Overview

Junctional bradycardia occurs when the rate of depolarization of the SA node falls below the rate of the AV node or when the electrical impulses from the SA node fail to reach the AV node because of SA or AV block. SA node fibrosis and inferior wall myocardial infarction causing sinus arrest may cause the AV node to become the dominant pacemaker of the heart.

Causes

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	Acute coronary syndrome, acute rheumatic fever, Andersen cardiodysrhythmic periodic paralysis, Brugada syndrome, cardiac lymphoma, cardiac tumor, cardioinhibitory syncope, congenital heart disease, congestive heart failure, coronary reperfusion therapy, dilated cardiomyopathy, hypertensive heart disease, hypertrophic cardiomyopathy, ischemic heart disease, Jervell and Lange-Nielsen syndrome, long QT syndrome, myocardial infarction, myocardial rupture, myocarditis, NSTEMI, pericarditis, Romano-Ward syndrome, sick sinus syndrome, sinus arrest, sinus bradycardia, sinus node fibrosis, STEMI, tachycardia-bradycardia syndrome, Timothy syndrome, valvular heart disease
Chemical/Poisoning	Berberine, grayanotoxin, organophosphate poisoning, parathion poisoning, poisonous spider bites, pyrethroid poisoning, scorpion toxin
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Acetylcholine, all-trans retinoic acid, amiodarone, anthracyclines, antiarrhythmic drugs, barbiturate, beta-blockers, bupivacaine, calcium channel blockers, carbamazepine, cholinesterase inhibitors, cimetidine, citalopram, clonidine, digitalis, digoxin, diltiazem, diphenhydramine, donepezil, edrophonium, neostigmine, granisetron, guanethidine, halothane, idarubicin, isoprenaline infusion, lithium, mepivacaine, mesalamine, methyldopa, methylprednisolone, nelfinavir, nicorandil, phenothiazine, phenytoin, procainamide, propafenone, propanolol, propofol, pyridostigmine, remifentanil, reserpine, ropivacaine, tacrine, thiamylal, timolol, tricyclic antidepressants, urapidil, verapamil
Ear Nose Throat	No underlying causes
Endocrine	Diabetic ketoacidosis, Hashimoto's thyroiditis, pheochromocytoma, profound hypothyroidism
Environmental	Berberine, hypothermia, poisonous spider bites, scorpion toxin
Gastroenterologic	No underlying causes
Genetic	Andersen cardiodysrhythmic periodic paralysis, Brugada syndrome, congenital heart disease, Emery-Dreifuss muscular dystrophy, Jervell and Lange-Nielsen syndrome, limb-girdle muscular dystrophy type 1B (LGMD1B), muscular dystrophy, myotonic dystrophy, Romano-Ward syndrome, Timothy syndrome
Hematologic	No underlying causes
Iatrogenic	Cardiac catheterization, cardiac transplantation, coronary artery bypass grafting, Fontan procedure, heart surgery, infraclavicular brachial plexus block, post lung transplantation, tilt testing
Infectious Disease	Acute rheumatic fever, Chagas disease, diptheria, Lyme disease, myocarditis, pericarditis, septic shock
Musculoskeletal/Orthopedic	Muscular dystrophy, myotonic dystrophy, Timothy syndrome
Neurologic	No underlying causes
Nutritional/Metabolic	Hypermagnesemia, metabolic acidosis
Obstetric/Gynecologic	Very low birth weight infants
Oncologic	Cardiac lymphoma, cardiac tumor, multiple myeloma, pheochromocytoma
Ophthalmologic	No underlying causes
Overdose/Toxicity	All-trans retinoic acid, amiodarone, barbiturate, digitalis, digoxin, halothane, isoprenaline infusion, lithium, propanolol, cholinesterase inhibitors
Psychiatric	Takotsubo cardiomyopathy, severe anorexia nervosa
Pulmonary	Hypoxia, post lung transplantation
Renal/Electrolyte	Acute renal failure, hyperkalemia
Rheumatology/Immunology/Allergy	Acute rheumatic fever, scleroderma
Sexual	No underlying causes
Trauma	Myocardial rupture, severe brain injury
Urologic	No underlying causes
Miscellaneous	Amyloidosis, idiopathic

Causes in Alphabetical Order

References

↑ McGregor A, Hurst E, Lord S, Jones G. "Bradycardia following retinoic acid differentiation syndrome in a patient with acute promyelocytic leukaemia". BMJ Case Rep. doi:10.1136/bcr.02.2012.5848. PMID 22778455.
↑ Cannillo M, Frea S, Fornengo C, Toso E, Mercurio G, Battista S; et al. (2013). "Berberine behind the thriller of marked symptomatic bradycardia". World J Cardiol. 5 (7): 261–4. doi:10.4330/wjc.v5.i7.261. PMC 3722425. PMID 23888197.
↑ Mehlsen J, Kaijer MN, Mehlsen AB (2008). "Autonomic and electrocardiographic changes in cardioinhibitory syncope". Europace. 10 (1): 91–5. doi:10.1093/europace/eum237. PMID 17971422.
↑ Isbister GK (2002). "Delayed asystolic cardiac arrest after diltiazem overdose; resuscitation with high dose intravenous calcium". Emerg Med J. 19 (4): 355–7. PMC 1725910. PMID 12101159.CS1 maint: PMC format (link)
↑ Brembilla-Perrot B, Muhanna I, Nippert M, Popovic B, Beurrier D, Houriez P; et al. (2005). "Paradoxical effect of isoprenaline infusion". Europace. 7 (6): 621–7. doi:10.1016/j.eupc.2005.06.012. PMID 16216767.
↑ Guillén EL, Ruíz AM, Bugallo JB (1998). "Hypotension, bradycardia, and asystole after high-dose intravenous methylprednisolone in a monitored patient". Am J Kidney Dis. 32 (2): E4. PMID 10074612.
↑ Landovitz RJ, Sax PE (1999). "Symptomatic junctional bradycardia after treatment with nelfinavir". Clin Infect Dis. 29 (2): 449–50. doi:10.1086/520237. PMID 10476763.
↑ Zyśko D, Gajek J, Agrawal AK, Rudnicki J (2012). "[The relevance of junctional rhythm during neurocardiogenic reaction provoked by tilt testing]". Kardiol Pol. 70 (2): 148–55. PMID 22427080.
↑ Cohen AS, Matharu MS, Goadsby PJ (2007). "Electrocardiographic abnormalities in patients with cluster headache on verapamil therapy". Neurology. 69 (7): 668–75. doi:10.1212/01.wnl.0000267319.18123.d3. PMID 17698788.

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[pmid22778455-1] McGregor A, Hurst E, Lord S, Jones G. "Bradycardia following retinoic acid differentiation syndrome in a patient with acute promyelocytic leukaemia". BMJ Case Rep. doi:10.1136/bcr.02.2012.5848. PMID 22778455.

[pmid23888197-2] Cannillo M, Frea S, Fornengo C, Toso E, Mercurio G, Battista S; et al. (2013). "Berberine behind the thriller of marked symptomatic bradycardia". World J Cardiol. 5 (7): 261–4. doi:10.4330/wjc.v5.i7.261. PMC 3722425. PMID 23888197.

[pmid17971422-3] Mehlsen J, Kaijer MN, Mehlsen AB (2008). "Autonomic and electrocardiographic changes in cardioinhibitory syncope". Europace. 10 (1): 91–5. doi:10.1093/europace/eum237. PMID 17971422.

[pmid12101159-4] Isbister GK (2002). "Delayed asystolic cardiac arrest after diltiazem overdose; resuscitation with high dose intravenous calcium". Emerg Med J. 19 (4): 355–7. PMC 1725910. PMID 12101159.CS1 maint: PMC format (link)

[pmid16216767-5] Brembilla-Perrot B, Muhanna I, Nippert M, Popovic B, Beurrier D, Houriez P; et al. (2005). "Paradoxical effect of isoprenaline infusion". Europace. 7 (6): 621–7. doi:10.1016/j.eupc.2005.06.012. PMID 16216767.

[pmid10074612-6] Guillén EL, Ruíz AM, Bugallo JB (1998). "Hypotension, bradycardia, and asystole after high-dose intravenous methylprednisolone in a monitored patient". Am J Kidney Dis. 32 (2): E4. PMID 10074612.

[pmid10476763-7] Landovitz RJ, Sax PE (1999). "Symptomatic junctional bradycardia after treatment with nelfinavir". Clin Infect Dis. 29 (2): 449–50. doi:10.1086/520237. PMID 10476763.

[pmid22427080-8] Zyśko D, Gajek J, Agrawal AK, Rudnicki J (2012). "[The relevance of junctional rhythm during neurocardiogenic reaction provoked by tilt testing]". Kardiol Pol. 70 (2): 148–55. PMID 22427080.

[pmid17698788-9] Cohen AS, Matharu MS, Goadsby PJ (2007). "Electrocardiographic abnormalities in patients with cluster headache on verapamil therapy". Neurology. 69 (7): 668–75. doi:10.1212/01.wnl.0000267319.18123.d3. PMID 17698788.

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