What is the initial treatment for symptomatic bradycardia?

• A. Dopamine or epi infusion (with ineffective pacing)
• B. Atropine THEN transcutaneous pacing
• C. Withholding medications causing bradycardia
• D. Intravenous fluids

Answer: (B)

Symptomatic bradycardia is treated first by reversing the vagal influence on the heart to restore rate and AV conduction, then by providing a reliable pacing backup if needed. Atropine works quickly by blocking muscarinic receptors, which reduces parasympathetic (vagal) tone on the SA and AV nodes. This increases heart rate and improves conduction, making it the immediate first step.

If the rhythm does not respond to atropine, or if the patient has a rhythm or block type where atropine is less effective, transcutaneous pacing is used to guarantee a dependable rate and stabilize perfusion. The other options don’t address the initial need to block vagal influence or provide immediate, reliable pacing, and they are usually considered only after atropine or when pacing is required.