Recognising Bradycardia for Student Nurses
Learn how to recognise a slow heart rate, assess associated symptoms and understand when bradycardia may form part of a wider pattern of cardiovascular or patient deterioration.
What is bradycardia?
Bradycardia describes a heart rate slower than expected. In adults, a resting heart rate below 60 beats per minute is commonly described as bradycardia, although the clinical significance varies considerably between patients.
Common definition
This is a commonly used adult reference threshold rather than a diagnosis by itself.
Know the patient
A resting pulse in the 50s may be normal for some people, particularly if they are fit and asymptomatic.
How is the patient?
Dizziness, collapse, chest discomfort, breathlessness or altered consciousness make bradycardia more concerning.
How to assess a slow pulse
Confirm the heart rate
Check that the measurement is accurate and assess the pulse manually where appropriate.
Assess the rhythm
Consider whether the pulse feels regular or irregular and report unexpected rhythm changes appropriately.
Compare with baseline
Review previous pulse measurements and establish whether the slow rate is new or normal for the patient.
Check blood pressure
Assess whether blood pressure is stable or whether circulatory compromise may also be present.
Ask about symptoms
Consider dizziness, fainting, weakness, chest discomfort, breathlessness and unusual fatigue.
Assess the whole patient
Review respiration, oxygen saturation, consciousness, perfusion and other observations rather than focusing only on the pulse.
Why might a patient's heart rate be slow?
| Possible context | What you might notice | Clinical thinking |
|---|---|---|
| Normal baseline | Patient is well, asymptomatic and has a documented low resting pulse. | Some healthy individuals naturally have a resting heart rate below 60 bpm. |
| Medication | The patient takes medicines that can reduce heart rate. | Medication history is relevant, but a new symptomatic change still requires assessment. |
| Cardiac conduction problem | New slow pulse, abnormal rhythm or associated symptoms. | Bradycardia can reflect a disturbance in cardiac electrical conduction and may require further clinical assessment. |
| Metabolic or physiological disturbance | Other observations or laboratory findings may also be abnormal. | A slow heart rate can occur in several acute clinical situations and should be interpreted in context. |
| Hypothermia | Low body temperature and broader physiological slowing. | Heart rate may reduce in significant hypothermia. |
| Deteriorating patient | Reduced consciousness, hypotension, poor perfusion or severe illness. | Bradycardia alongside other major abnormalities can be a serious finding requiring urgent escalation. |
Same number, different significance
A fit patient with a usual resting pulse of 54 bpm who feels well is very different from a patient whose pulse has fallen from 82 to 48 bpm and who is now dizzy and hypotensive.
When bradycardia becomes more concerning
- The slow pulse is new for the patient.
- The heart rate is continuing to fall.
- The patient reports dizziness, faintness or collapse.
- Blood pressure is falling.
- The patient develops chest discomfort.
- Breathlessness or respiratory deterioration is present.
- There is new confusion, drowsiness or reduced responsiveness.
- Skin becomes cool, pale or clammy.
- The patient appears clinically unstable or rapidly deteriorating.
Compare the pulse with previous readings
Pulse 78 bpm
Patient comfortable and observations close to usual baseline.
Pulse 62 bpm
The pulse has slowed. Review whether this fits the patient's condition and clinical context.
Pulse 48 bpm
The continuing downward trend becomes particularly important if symptoms or other observations are also changing.
Direction of travel matters
A falling heart rate can be clinically significant before the absolute number becomes extreme. Review trends rather than treating every observation as a separate event.
Putting the observations together
Example
Earlier in the shift, a patient's pulse was 76 bpm and blood pressure was stable.
Their pulse is now 48 bpm. They report feeling dizzy and weak, and their blood pressure has fallen.
They also appear pale and less alert than before.
The concern is not simply the pulse rate of 48 bpm. It is the combined pattern of new bradycardia, symptoms and worsening circulation.
As a student nurse, recognise the deterioration, obtain accurate observations and communicate the findings promptly to the appropriate registered practitioner.
Bradycardia assessment errors to avoid
- Assuming every pulse below 60 bpm is dangerous. Establish the patient's baseline and symptoms.
- Assuming a low pulse is normal without checking. A new change may be significant.
- Ignoring symptoms. Dizziness, collapse or chest discomfort increase concern.
- Ignoring blood pressure and perfusion. Bradycardia should be interpreted within the circulation assessment.
- Failing to review medication. Medication can influence heart rate, though this does not replace clinical assessment.
- Waiting for profound bradycardia. A worsening trend may already need attention.
Recognise → assess → communicate → escalate
Notice the slow pulse
Identify a new bradycardia or a significant fall from the patient's previous heart rate.
Look at the whole patient
Review symptoms, blood pressure, perfusion, rhythm, respiration and consciousness.
Describe the change
Report the current rate, previous readings, symptoms and associated physiological changes clearly.
Recognising Fever and Pyrexia for Student Nurses
Learn how to recognise a raised temperature, assess the patient for associated signs of infection and understand when pyrexia may form part of a wider deterioration picture.
Continue to Fever and Pyrexia →