Atropine: Your Guide to Bradycardia Treatment

Treat Bradycardia with Atropine. Find out how with an ACLS certification from

What is Bradycardia and How is Atropine Used for Treatment?

Bradycardias include asymptomatic/stable sinus bradycardia, symptomatic/unstable sinus bradycardia, and first-degree AV block. (These are not true bradyarrhythmias.) Bradyarrhythmias are bradycardias with an abnormal rhythm. The bradyarrhythmias include second-degree AV block type I, second-degree AV block type II, and complete (third-degree) AV block.

Atropine has become a go-to medication for various cardiovascular afflictions, primarily due to its efficacy in treating bradycardia. Atropine is known to have a stimulating effect on the heart rate and enhance atrioventricular conduction by blocking the parasympathetic signals.

Bradycardia can be treated with Atropine. Find out how with an ACLS Certification from

What Are the Symptoms of Bradycardia?

Any unstable bradycardia exists when the heart rate is slow, the patient has symptoms, and the symptoms are due to the slow heart rate.

Symptomatic or unstable bradycardia can cause

  • hypotension,
  • pulmonary edema and congestion,
  • chest discomfort,
  • shortness of breath,
  • light-headedness,
  • weakness,
  • altered mental status,
  • and confusion.

Providers should follow the Systematic Approach to Care, as well as the Adult Bradycardia with Pulse Algorithm (you can download one for free at

Patients who have stable or asymptomatic bradycardia should consult a cardiologist specializing in rhythm disorders.

RELATED: A Guide to Bradycardia Pediatric Care

What Causes Bradycardia?

Bradycardia can be attributed to a variety of causes, some of the most frequent ones being outlined below.

  • Eating disorders, such as anorexia nervosa.
  • Lyme disease.
  • Chagas disease.
  • Radiation therapy.
  • Sleep apnea
  • Sick sinus syndrome.
  • Heart block.
  • Hypothermia
  • Hypothyroidism
  • Lupus
  • Electrolyte deficiencies (calcium, magnesium, potassium).
  • Inflammation of the heart (endocarditis, myocarditis or pericarditis).
  • Infections, such as strep throat.
  • Rheumatic fever and rheumatic heart disease.
  • Narcotics and cannabis.
  • Beta-blockers, calcium-channel-blockers, anti-arrhythmia drugs, lithium and depressants.
  • Heart surgery.
  • Injuries/trauma.
  • Heart attack or heart failure.
  • Coronary artery disease.
  • Rheumatoid arthritis.

RELATED: The Latest ACLS Guidelines and How to Implement Them in Your Practice

The Different Types of Atropine Treatments Available for Bradycardia

There are a couple of atropine treatments available, including intravenous, intramuscular and subcutaneous forms. Depending on the severity of the bradycardia, different dosages and administration methods may be recommended.

Severe bradycardia, which can result in dangerously low blood pressure, can be addressed with intravenous or injectable medications such as atropine that can stimulate your heart to beat faster. Treatments such as this usually require specialized hospital care, oftentimes due to the need for ongoing monitoring and additional medical attention of those using these drugs.

An AtroPen (atropine sulfate) auto-injector is an injectable solution that patients experiencing bradycardia may use to calm symptoms. The Atropen can be administered via intramuscular, subcutaneous, or intravenous injections. Healthcare providers may either administer the injection, or teach the patient how to self-administer the medication correctly.

RELATED: How to Calculate the Correct Dose of Epinephrine in ACLS

IV access routes are primarily used in atropine administration.

Atropine Dose and Access Routes for Treating Bradycardia

Bradycardia can cause a variety of symptoms and can be potentially life-threatening if left untreated. Fortunately, atropine is an effective treatment for bradycardia, but it also has some side effects that must be taken into account.


Symptomatic sinus bradycardia

Specific toxins or overdose, such as organophosphates

Dose and Access Route

  • For symptomatic bradycardia:
  • Initial dose: 1 mg bolus
  • Subsequent doses: every 3–5 minutes.
  • Max dose: 3 mg
  • Toxins or Overdose: 2–4 mg or higher IV/IO/ET


  • Use cardiac and blood pressure (BP) monitoring.
  • Use with caution in patients with myocardial ischemia and hypoxia.
  • Do not use in patients with glaucoma or tachyarrhythmias.

If Atropine is ineffective:

  • Transcutaneous pacing
  • AND/OR dopamine infusion: 5–20 mcg/kg/min. Titrate to patient response.
  • AND/OR epinephrine infusion: 2–10 mcg/min. Titrate to patient response.

RELATED: Pediatric (PALS) vs Adult (ACLS) Drug Doses: What You Need to Know

What are the Benefits and Risks of Using Atropine for Bradycardia Treatment?

Where bradycardia is caused by hypothermia, Atropine should be avoided. This is generally true for Mobitz type II (Second-degree block type 2) and complete heart block. Patients with glaucoma should not use atropine. Patients with tachycardia should not use atropine.

Side effects from Atropine include:

  • Enlarged pupils; tearing of the eyes
  • decreased vision, blindness or blurred vision
  • chest pain, discomfort, or tightness
  • cough; increase in mucous from lungs
  • decrease in urine volume and frequency; difficulty in passing urine
  • difficulty swallowing
  • dizziness or fainting, lightheadedness
  • eye pain
  • extremely high fever
  • unusual fatigue or weakness
  • fast, shallow breathing
  • fast, slow, weak, or irregular heartbeat
  • headache
  • hives, itching, skin rash
  • muscle cramps
  • nausea or vomiting; stomach pain
  • pain at the injection site
  • painful urination
  • pale, clammy skin
  • Inflammation of the eyelids or the area around the eyes, face, lips, or tongue can indicate swelling.
  • increased thirst

You can study for your ACLS and take the certification exam online with

RELATED: The 5 Must-Know Questions (and Answers) For Your 2022 ACLS Certification Exam

Where to Get Certified in ACLS and Learn How to Give Atropine for Bradycardia Treatment?

Medical ProCerts is an accredited, AHA-compliant ACLS certification provider.

With the ACLS certification course, you will learn how to:

  • increase the probability of return of spontaneous circulation (ROSC).
  • improve life-threatening conditions.
  • recognize and provide treatment of a patient during abnormal heart rhythms and cardiac episodes.
  • correctly perform BLS.
  • understand ACLS algorithms and protocols.
  • work within effective team dynamics. defibrillate with an AED.
  • know the methods of airway management.
  • understand normal heart anatomy and physiology to quickly identify and treat abnormal deviations.
  • recall drug dosages, access routes and contraindications.
  • provide post-cardiac care.
  • provide acute stroke care.

These certification courses are 100% online and can be completed in as little as 3 hours.

Registering is easy (no proof of prior education or certification is required), and your certification card AND CME credits will be automatically awarded upon completion of the exam and evaluation.

Find out more about certifying with Medical ProCerts today at

RELATED: Certification Requirements for Physicians and Why You Need ACLS Training

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